Adiposity, Cardiometabolic Risk, and Vitamin D Status: the Framingham Heart Study

  1. Susan Cheng, MD1,2,3,4,
  2. Joseph M. Massaro, PhD1,5,
  3. Caroline S. Fox, MD, MPH1,6,7,
  4. Martin G. Larson, ScD1,5,
  5. Michelle J. Keyes, PhD1,5,
  6. Elizabeth L. McCabe, MS1,2,
  7. Sander J. Robins, MD1,10,
  8. Christopher J. O'Donnell, MD1,2,6,
  9. Udo Hoffmann, MD8,
  10. Paul F. Jacques, DSc9,
  11. Sarah L. Booth, PhD9,
  12. Ramachandran S. Vasan, MD1,10,11,
  13. Myles Wolf, MD, MMsc12 and
  14. Thomas J. Wang, MD (tjwang{at}partners.org)1,2
  1. From the (1) Framingham Heart Study, Framingham, MA
  2. (2) Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
  3. (3) Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  4. (4) Clinical Investigator Training Program, Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, MA
  5. (5) Department of Mathematics and Statistics, Boston University, Boston, MA
  6. (6) Center for Population Studies, National Heart, Lung, & Blood Institute, Bethesda, MD
  7. (7) Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  8. (8) Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA
  9. (9) Nutritional Epidemiology Program, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA
  10. (10) Department of Medicine, Boston University School of Medicine, Boston, MA
  11. (11) Epidemiology Department, Boston University School of Public Health, Boston, MA
  12. (12) Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.

    Abstract

    Objective: Because vitamin D deficiency is associated with a variety of chronic diseases, understanding the characteristics that promote vitamin D deficiency in otherwise healthy adults could have important clinical implications. Few studies relating vitamin D deficiency to obesity have included direct measures of adiposity. Furthermore, the degree to which vitamin D is associated with metabolic traits after adjusting for adiposity measures is unclear.

    Research Design and Methods: We investigated the relations of serum 25-hydroxyvitamin D (25[OH]D) concentrations with indices of cardiometabolic risk in 3,890 non-diabetic individuals; 1,882 had subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes measured by multi-detector computed tomography (CT).

    Results: In multivariable-adjusted regression models, 25(OH)D was inversely associated with winter season, waist circumference, and serum insulin ( P<0.005 for all). In models further adjusted for CT measures, 25(OH)D was inversely related to SAT (−1.1 ng/mL per standard deviation [SD] increment in SAT, P=0.016) and VAT (−2.3 ng/mL per SD, P<0.0001). The association of 25(OH)D with insulin resistance measures became non-significant after adjustment for VAT. Higher adiposity volumes were correlated with lower 25(OH)D across different categories of body mass index (BMI), including in lean individuals (BMI <25 kg/m2). The prevalence of vitamin D deficiency (25(OH)D <20 ng/mL ) was 3-fold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P<0.0001).

    Conclusion: Vitamin D status is strongly associated with variation in subcutaneous and especially visceral adiposity. The mechanisms by which adiposity promotes vitamin D deficiency warrant further study.

    Footnotes

      • Received July 10, 2009.
      • Accepted September 22, 2009.

    This Article

    1. Published online before print October 15, 2009, doi: 10.2337/db09-1011
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