Higher Serum 25-Hydroxyvitamin D Is Associated with Lower All-Cause and Cardiovascular Mortality among US Adults with Nonalcoholic Fatty Liver Disease
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Participants
2.2. Definition of NAFLD
2.3. Serum 25(OH)D Measurement
2.4. Ascertainment of Mortality
2.5. Study Covariates
3. Statistical Analysis
4. Results
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Serum 25(OH)D Levels (nmol/L) | ||||||
---|---|---|---|---|---|---|
Characteristics | Total (N = 4512) | <25.0 (N = 143) | 25.0–49.9 (N = 1362) | 50.0–74.9 (N = 1874) | ≥75.0 (N = 1133) | p Value |
Age (years) | 54.12 ± 0.29 | 47.52 ± 1.70 | 50.22 ± 0.60 | 53.23 ± 0.47 | 59.37 ± 0.57 | <0.001 |
Sex, n (%) | <0.001 | |||||
Male | 2452 (56.77) | 55 (35.06) | 652 (48.99) | 1112 (62.42) | 633 (57.09) | |
Female | 2060 (43.23) | 88 (64.94) | 710 (51.01) | 762 (37.58) | 500 (42.91) | |
Race/ethnicity, n (%) | <0.001 | |||||
Non-Hispanic White | 2189 (72.03) | 23 (27.87) | 435 (55.68) | 972 (75.19) | 759 (85.32) | |
Non-Hispanic Black | 508 (6.55) | 65 (38.56) | 254 (13.62) | 127 (3.49) | 62 (2.27) | |
Mexican American | 1042 (10.21) | 34 (20.91) | 418 (15.67) | 470 (10.91) | 120 (3.54) | |
Others | 773 (11.20) | 21 (12.66) | 255 (15.04) | 305 (10.41) | 192 (8.87) | |
Smoking status, n (%) | <0.001 | |||||
Never | 2495 (55.06) | 87 (59.26) | 792 (59.22) | 1025 (55.18) | 591 (51.03) | |
Former | 1428 (31.40) | 26 (18.89) | 359 (23.44) | 625 (32.77) | 418 (37.46) | |
Current | 585 (13.47) | 30 (21.85) | 210 (17.34) | 222 (12.05) | 123 (11.51) | |
Education level, n (%) | 0.02 | |||||
Less than high school | 1466 (21.53) | 46 (30.19) | 497 (23.70) | 630 (21.65) | 293 (18.79) | |
High school or equivalent | 1023 (24.19) | 31 (20.31) | 298 (26.30) | 410 (22.93) | 284 (24.53) | |
College or above | 2019 (54.23) | 66 (49.50) | 565 (50.00) | 833 (55.42) | 555 (56.68) | |
Family poverty income ratio, n (%) | <0.001 | |||||
<1.0 | 865 (12.62) | 35 (23.72) | 295 (16.67) | 363 (12.06) | 172 (9.00) | |
≥1.0 and <3.0 | 1825 (35.72) | 67 (47.21) | 583 (39.17) | 735 (34.65) | 440 (33.34) | |
≥3.0 | 1453 (44.97) | 29 (20.93) | 364 (36.83) | 628 (47.05) | 432 (51.01) | |
Unknown | 369 (6.68) | 12 (8.14) | 120 (7.33) | 148 (6.24) | 89 (6.65) | |
Physical activity, n (%) | <0.001 | |||||
Sedentary | 1479 (28.28) | 59 (43.41) | 523 (35.33) | 546 (25.08) | 351 (25.55) | |
Insufficient | 913 (21.07) | 19 (12.06) | 272 (21.01) | 426 (23.46) | 196 (18.35) | |
Moderate | 527 (12.68) | 13 (9.34) | 134 (10.82) | 240 (13.78) | 140 (12.96) | |
High | 1593 (37.97) | 52 (35.19) | 433 (32.83) | 662 (37.68) | 446 (43.15) | |
BMI (kg/m2), n (%) | <0.001 | |||||
<25.0 | 291 (5.06) | 6 (6.66) | 73 (3.44) | 114 (4.69) | 98 (6.99) | |
25.0–29.9 | 1346 (28.18) | 20 (14.38) | 325 (20.92) | 603 (29.04) | 398 (34.94) | |
≥30.0 | 2839 (66.22) | 117 (78.97) | 954 (75.64) | 1141 (66.27) | 627 (58.07) | |
Diabetes, n (%) | 1526 (28.31) | 50 (30.60) | 506 (32.22) | 594 (26.11) | 376 (27.91) | 0.05 |
Hypertension, n (%) | 2745 (58.58) | 85 (56.77) | 782 (54.51) | 1084 (55.49) | 794 (66.81) | <0.001 |
Hyperlipidemia, n (%) | 3970 (88.12) | 121 (81.51) | 1169 (87.00) | 1664 (88.73) | 1016 (88.72) | 0.21 |
CVD, n (%) | 815 (16.18) | 28 (19.79) | 233 (15.32) | 305 (14.63) | 249 (18.92) | 0.03 |
Steroid use, n (%) | 84 (1.57) | 3 (2.31) | 24 (1.51) | 32 (1.52) | 25 (1.63) | 0.93 |
eGFR (mL/min/1.73 m2) | 88.32 ± 0.42 | 97.75 ± 2.92 | 94.83 ± 0.81 | 89.44 ± 0.61 | 80.20 ± 0.62 | <0.001 |
Waist circumference (cm) | 112.12 ± 0.32 | 115.67 ± 1.97 | 114.70 ± 0.50 | 111.85 ± 0.52 | 109.97 ± 0.55 | <0.001 |
Total cholesterol (mg/dL) | 195.48 ± 0.89 | 187.47 ± 3.45 | 196.97 ± 1.74 | 195.59 ± 1.22 | 194.63 ± 1.56 | 0.12 |
Low-density lipoprotein cholesterol (mg/dL) | 115.43 ± 0.74 | 113.31 ± 2.96 | 117.26 ± 1.55 | 115.82 ± 1.08 | 113.45 ± 1.19 | 0.18 |
High-density lipoprotein cholesterol (mg/dL) | 46.52 ± 0.21 | 46.94 ± 0.92 | 45.47 ± 0.42 | 45.53 ± 0.29 | 48.84 ± 0.49 | <0.001 |
Fasting triglyceride (mg/dL) | 173.24 ± 2.91 | 137.76 ± 8.70 | 177.16 ± 6.82 | 177.85 ± 3.73 | 165.88 ± 4.43 | <0.001 |
Fasting glucose (mg/dL) | 118.74 ± 0.77 | 126.71 ± 5.93 | 123.00 ± 1.79 | 117.48 ± 1.01 | 116.19 ± 1.08 | 0.01 |
Fasting insulin (pmol/L) | 20.87 ± 0.35 | 24.83 ± 1.25 | 23.00 ± 0.56 | 20.88 ± 0.63 | 18.65 ± 0.50 | <0.001 |
Glycosylated hemoglobin, Type A1C (%) | 5.99 ± 0.02 | 6.22 ± 0.14 | 6.13 ± 0.05 | 5.93 ± 0.03 | 5.95 ± 0.04 | 0.001 |
Gamma-glutamyltransferase (U/L) | 36.98 ± 0.61 | 41.16 ± 5.47 | 36.37 ± 1.10 | 36.02 ± 0.83 | 38.59 ± 1.39 | 0.31 |
Serum 25(OH)D Levels (nmol/L) | ||||||
---|---|---|---|---|---|---|
Subgroup | No. Deaths/Total | <25.0 | 25.0–49.9 | 50.0–74.9 | ≥75.0 | p for Interaction |
Age, years | 0.014 | |||||
<60 | 126/2266 | 1.00 | 0.87 (0.43, 1.78) | 0.42 (0.18, 0.99) | 0.34 (0.13, 0.90) | |
≥60 | 772/2246 | 1.00 | 0.47 (0.28, 0.79) | 0.39 (0.22, 0.68) | 0.35 (0.20, 0.62) | |
Sex | 0.568 | |||||
Male | 554/2452 | 1.00 | 0.78 (0.31, 1.93) | 0.50 (0.20, 1.23) | 0.50 (0.20, 1.27) | |
Female | 344/2060 | 1.00 | 0.46 (0.25, 0.86) | 0.40 (0.21, 0.75) | 0.31 (0.16, 0.60) | |
Race/ethnicity | 0.186 | |||||
White | 604/2189 | 1.00 | 0.51 (0.27, 0.95) | 0.36 (0.19, 0.69) | 0.31 (0.16, 0.58) | |
Non-White | 294/2323 | 1.00 | 0.59 (0.31, 1.12) | 0.41 (0.22, 0.75) | 0.53 (0.27, 1.04) | |
Smoking status | 0.770 | |||||
Never | 367/2495 | 1.00 | 0.58 (0.34, 1.00) | 0.38 (0.22, 0.64) | 0.35 (0.21, 0.60) | |
Former/Current | 528/2013 | 1.00 | 0.48 (0.21, 1.09) | 0.35 (0.16, 0.78) | 0.32 (0.14, 0.73) | |
BMI, kg/m2 | 0.300 | |||||
<30 | 396/1637 | 1.00 | 2.53 (0.50, 12.68) | 1.76 (0.35, 8.73) | 1.49 (0.29, 7.55) | |
≥30 | 475/2839 | 1.00 | 0.41 (0.24, 0.71) | 0.30 (0.17, 0.52) | 0.28 (0.17, 0.47) | |
Physical activity | 0.723 | |||||
Sedentary/Insufficient | 608/2329 | 1.00 | 0.50 (0.31, 0.81) | 0.37 (0.22, 0.61) | 0.34 (0.20, 0.56) | |
Moderate/High | 290/2120 | 1.00 | 0.58 (0.20, 1.69) | 0.33 (0.11, 0.98) | 0.34 (0.12, 0.98) | |
eGFR, mL/min/1.73 m2 | 0.222 | |||||
≤90 | 742/2358 | 1.00 | 0.41 (0.24, 0.69) | 0.35 (0.20, 0.59) | 0.31 (0.19, 0.51) | |
>90 | 156/2154 | 1.00 | 1.05 (0.37, 2.99) | 0.62 (0.22, 1.77) | 0.71 (0.24, 2.14) |
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Chen, Y.; Feng, S.; Chang, Z.; Zhao, Y.; Liu, Y.; Fu, J.; Liu, Y.; Tang, S.; Han, Y.; Zhang, S.; et al. Higher Serum 25-Hydroxyvitamin D Is Associated with Lower All-Cause and Cardiovascular Mortality among US Adults with Nonalcoholic Fatty Liver Disease. Nutrients 2022, 14, 4013. https://doi.org/10.3390/nu14194013
Chen Y, Feng S, Chang Z, Zhao Y, Liu Y, Fu J, Liu Y, Tang S, Han Y, Zhang S, et al. Higher Serum 25-Hydroxyvitamin D Is Associated with Lower All-Cause and Cardiovascular Mortality among US Adults with Nonalcoholic Fatty Liver Disease. Nutrients. 2022; 14(19):4013. https://doi.org/10.3390/nu14194013
Chicago/Turabian StyleChen, Yuxiong, Siqin Feng, Zhen’ge Chang, Yakun Zhao, Yanbo Liu, Jia Fu, Yijie Liu, Siqi Tang, Yitao Han, Shuyang Zhang, and et al. 2022. "Higher Serum 25-Hydroxyvitamin D Is Associated with Lower All-Cause and Cardiovascular Mortality among US Adults with Nonalcoholic Fatty Liver Disease" Nutrients 14, no. 19: 4013. https://doi.org/10.3390/nu14194013