The relation between serum Vitamin D levels and body antioxidant status in ischemic stroke patients: A case–control study


1 Department of Nutrition, Arvand International Division, Faculty of Paramedicine, Health Research Institute, Diabetes Research Center, Ahvaz, Iran

2 Department of Nutrition, Faculty of Paramedicine, Health Research Institute, Diabetes Research Center, Ahvaz, Iran

3 Department of Aneshtesiology, ICU, Golestan Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Department of Statistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

5 Department of Biochemistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


Background: Stroke is the second cause of death among elderly people. Oxidative stress plays an important role in brain damage after stroke. Currently, Vitamin D has been shown as an antioxidant. The aim of this study was to evaluate the status of Vitamin D, antioxidant enzymes, and the relation between them in ischemic stroke patients.
Materials and Methods: This case–control study was carried out on 36 patients with ischemic stroke patients and 36 matched subjects as controls. Intake of fruits and vegetables, exposure of sunlight, serum lipid profile, concentrations of serum 25-dihydroxy Vitamin D (25(OH) D), activities of serum superoxide dismutase, and glutathione peroxidase enzymes were determined.
Results: Severe Vitamin D deficiency was seen in 30% of the patients versus 11% of the controls (P < 0.05). Consumption of fruits and vegetables was lower in patients than that of controls (P < 0.05). Activities of antioxidant enzymes and intake of fruits were positively correlated in stroke patients (P = 0.02). The most potent predictors of stroke risk were hypertension, high levels of low-density lipoprotein cholesterol (LDL-C) and history of cardiovascular disease (CVD) (odds ratios: 3.33, 3.15, and 3.14, respectively, P < 0.05 for all). There was no association between 25(OH) D levels with activities of serum antioxidant enzymes and lipid profile in the two groups.
Conclusion: Ischemic stroke patients have higher prevalence of severe Vitamin D deficiency and lower intakes of fruits and vegetables. Intake of fruits was positive correlated to higher antioxidant enzymes levels. High levels of blood pressure, history of CVD, and high LDL-C levels are the strongest predictors of ischemic stroke.


Hankey GJ. Secondary stroke prevention. Lancet Neurol 2014;13:178-94.  Back to cited text no. 1
Tikhonoff V, Zhang H, Richart T, Staessen JA. Blood pressure as a prognostic factor after acute stroke. Lancet Neurol 2009;8:938-48.  Back to cited text no. 2
Karami M, Soori H, Monfared AB. Estimating the contribution of selected risk factors in attributable burden to stroke in Iran. Iran J Public Health 2012;41:91-6.  Back to cited text no. 3
Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, et al. Excessive incidence of stroke in Iran: Evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke 2010;41:e3-10.  Back to cited text no. 4
Chen H, Yoshioka H, Kim GS, Jung JE, Okami N, Sakata H, et al. Oxidative stress in ischemic brain damage: Mechanisms of cell death and potential molecular targets for neuroprotection. Antioxid Redox Signal 2011;14:1505-17.  Back to cited text no. 5
Chan CP, Jiang HL, Leung LY, Wan WM, Cheng NM, Ip WS, et al. Multiple atherosclerosis-related biomarkers associated with short-and long-term mortality after stroke. Clin Biochem 2012;45:1308-15.  Back to cited text no. 6
Javanbakht M, Keshavarz S, Mirshafiey A, Djalali M, Siassi F, Eshraghian M, et al. The effects of vitamins E and D supplementation on erythrocyte superoxide dismutase and catalase in atopic dermatitis. Iran J Public Health 2010;39:57-63.  Back to cited text no. 7
Saidinia A, Larijani B, Jalalinia SH, Farzadfar F, Keshtkar AA, Rezai E. Prevalence of vitamin D deficiency in Iran population 1999-2010. Iran J Diabetes Metab 2012;12:574-84.  Back to cited text no. 8
Mahe G, Ronziere T, Laviolle B, Golfier V, Cochery T, De Bray JM, et al. An unfavorable dietary pattern is associated with symptomatic ischemic stroke and carotid atherosclerosis. J Vasc Surg 2010;52:62-8.  Back to cited text no. 9
Kim YJ, Ahn YH, Lim Y, Kim JY, Kim J, Kwon O. Daily nutritional dose supplementation with antioxidant nutrients and phytochemicals improves DNA and LDL stability: A double-blind, randomized, and placebo-controlled trial. Nutrients 2013;5:5218-32.  Back to cited text no. 10
Khosravi-Boroujeni H, Saadatnia M, Shakeri F, Keshteli AH, Esmaillzadeh A. A case-control study on potato consumption and risk of stroke in central Iran. Arch Iran Med 2013;16:172-6.  Back to cited text no. 11
Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 2010;13:654-62.  Back to cited text no. 12
Prohan M, Amani R, Nematpour S, Jomehzadeh N, Haghighizadeh MH. Total antioxidant capacity of diet and serum, dietary antioxidant vitamins intake, and serum hs-CRP levels in relation to depression scales in university male students. Redox Rep 2014;19:133-9.  Back to cited text no. 13
Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 2004;4:38.  Back to cited text no. 14
Cherubini A, Polidori MC, Bregnocchi M, Pezzuto S, Cecchetti R, Ingegni T, et al. Antioxidant profile and early outcome in stroke patients. Stroke 2000;31:2295-300.  Back to cited text no. 15
Rahnavard Z, Eybpoosh S, Homami MR, Meybodi HA, Azemati B, Heshmat R, et al. Vitamin D deficiency in healthy male population: Results of the Iranian multi-center osteoporosis study. Iran J Public Health 2010;39:45-52.  Back to cited text no. 16
Poole KE, Loveridge N, Barker PJ, Halsall DJ, Rose C, Reeve J, et al. Reduced vitamin D in acute stroke. Stroke 2006;37:243-5.  Back to cited text no. 17
Sun Q, Pan A, Hu FB, Manson JE, Rexrode KM. 25-Hydroxyvitamin D levels and the risk of stroke: A prospective study and meta-analysis. Stroke 2012;43:1470-7.  Back to cited text no. 18
Kojima G, Bell C, Abbott RD, Launer L, Chen R, Motonaga H, et al. Low dietary vitamin D predicts 34-year incident stroke: The Honolulu Heart Program. Stroke 2012;43:2163-7.  Back to cited text no. 19
Daubail B, Jacquin A, Guilland JC, Khoumri C, Aboa-Eboulé C, Giroud M, et al. Association between serum concentration of vitamin D and 1-year mortality in stroke patients. Cerebrovasc Dis 2014;37:364-7.  Back to cited text no. 20
Chaudhuri JR, Mridula KR, Alladi S, Anamika A, Umamahesh M, Balaraju B, et al. Serum 25-hydroxyvitamin d deficiency in ischemic stroke and subtypes in Indian patients. J Stroke 2014;16:44-50.  Back to cited text no. 21
Iranmanesh F, Gadari F. Vitamin D and ischemic stroke. J Hormozgan Med Sci 2011;15:178-83.  Back to cited text no. 22
Gupta A, Prabhakar S, Modi M, Bhadada SK, Lal V, Khurana D. Vitamin D status and risk of ischemic stroke in North Indian patients. Indian J Endocrinol Metab 2014;18:721-5.  Back to cited text no. 23
Boshtam M, Rafiei M, Sarrafzadegan N, Mostafavi S, Naderi G. The relationship between serum vitamin D level, coronary artery disease and the associated risk factors in female carpet weavers. J Qazvin Univ Med Sci 2005;35:44-52  Back to cited text no. 24
Bonakdaran S, Varasteh A, Khajeh Dalouie M. Serum 25 hydroxy vitamin D3 and laboratory risk markers of cardiovascular diseases in type 2 diabetic patients. Iran J Endocrinol Metab 2010;11:504-9.  Back to cited text no. 25
Hirschler V, Maccallini G, Molinari C, Inés U, Castano LA, San Antonio de los Cobres Study Group, et al. Association between vitamin D and Apo B concentrations in Argentinean Indian children. Clin Chim Acta 2014;429:147-51.  Back to cited text no. 26
Fang KM, Cheng FC, Huang YL, Chung SY, Jian ZY, Lin MC. Trace element, antioxidant activity, and lipid peroxidation levels in brain cortex of gerbils after cerebral ischemic injury. Biol Trace Elem Res 2013;152:66-74.  Back to cited text no. 27
Chen X, Touyz RM, Park JB, Schiffrin EL. Antioxidant effects of vitamins C and E are associated with altered activation of vascular NADPH oxidase and superoxide dismutase in stroke-prone SHR. Hypertension 2001;38:606-11.  Back to cited text no. 28
Taheri E, Jalali M, Saedi A, Jazayeri A, Rahimi A. Association between 25(OH) D and antioxidant marker in type 2 diabetes mellitus with healthy subjects. Iran J Diabetes Metab 2010;10:502-13.  Back to cited text no. 29
Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: A meta-analysis of cohort studies. J Nutr 2006;136:2588-93.  Back to cited text no. 30
Liu RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr 2003;78:517S-20.  Back to cited text no. 31
Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: A meta-analysis of prospective cohort studies. Stroke 2014;45:1613-9.  Back to cited text no. 32
Fahimfar N, Khalili D, Mohebi R, Azizi F, Hadaegh F. Risk factors for ischemic stroke; results from 9 years of follow-up in a population based cohort of Iran. BMC Neurol 2012;12:117.  Back to cited text no. 33
Ghandehari K, Izadi-Mood Z. Khorasan stroke registry: Analysis of 1392 stroke patients. Arch Iran Med 2007;10:327-34.  Back to cited text no. 34
Delbari A, Salman Roghani R, Tabatabaei SS, Lökk J. A stroke study of an urban area of Iran: Risk factors, length of stay, case fatality, and discharge destination. J Stroke Cerebrovasc Dis 2010;19:104-9.  Back to cited text no. 35