Association between Vitamin D Concentration and Visceral Fat Area in Healthy Korean Adults

Jeong Ki Paek; Ji Hye Won; Hye Rin Shin; Dea Youn Kim; Kyunam Kim; Seon Yeong Lee

doi:10.15384/kjhp.2017.17.3.129

Korean J Health Promot > Volume 17(3); 2017 > Article

Association between Vitamin D Concentration and Visceral Fat Area in Healthy Korean Adults

Original Article

Korean Journal of Health Promotion 2017;17(3):129-136.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.3.129

Association between Vitamin D Concentration and Visceral Fat Area in Healthy Korean Adults

Jeong Ki Paek, Ji Hye Won, Hye Rin Shin, Dea Youn Kim, Kyunam Kim, Seon Yeong Lee

Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea

Corresponding author : Seon Yeong Lee, MD, PhD Department of Family Medicine, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea
Tel: +82-2-950-1150, Fax: +82-2-952-4093 E-mail: sylee@paik.ac.kr

Received July 10, 2017 Accepted August 21, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

요약

Background:

Studies on the relationship between vitamin D and visceral fat area (VFA; intra-abdominal fat area) have been actively conducted. But, there is a few Korean population-based studies about the association between serum vitamin D level and VFA. The aim of our study was to explore the correlation between serum 25-hydroxyvitamin D (25[OH]D) levels and VFA measured using bioelectrical impedance analysis (BIA; electric impedance) in healthy Korean adults.

Methods:

This cross-sectional study involved 1,945 adults aged 20-70 years who visited a health promotion center. All subjects underwent the BIA to estimate the VFA. Serum 25(OH)D level was measured using chemiluminescent immunoassay. Multiple regression analysis was performed to identify independent correlation of VFA and serum 25(OH)D level.

Results:

The prevalence of vitamin D deficiency (25[OH]D: 20-29 ng/mL) and insufficiency (25[OH]D <20 ng/mL) were 54.4% and 38.1%, respectively. After having adjusted age and season, VFA were negatively associated with serum 25(OH)D levels in both men (P<0.001) and women (P<0.001). The obese group with VFA ≥ 100 cm² had significant lower serum 25(OH)D level in men (P<0.001) and women (P=0.0034).

Conclusions:

VFA measured using BIA could be negatively associated with serum 25(OH)D levels in healthy Korean adult.

Keywords: Vitamin D, Intra-abdominal fat, Electric impedance, Obesity

Figure 1.

Differential serum 25-hydroxyvitamin D (25[OH]D) concentrations in subjects with or without obesity. (A, B) Comparison of serum 25-hydroxyvitamin D (25[OH]D) levels according to body mass index (BMI) in men and women. Subjects with a BMI ≥25 kg/m² were classified as obese. (C, D) Comparison of serum 25(OH)D levels according to percentage body fat (PBF) in men and women. Men with a PBF ≥25 % and women with a PBF ≥30 % were classified as obese. (E, F) Comparison of serum 25[OH]D levels according to visceral fat area (VFA) in men and women. Subjects with a VFA ≥100 cm² were classified as obese. Data are presented as mean±standard deviation. ^∗P value from an independent-sample t-test.

Figure 2.

Correlation between 25(OH)D and fatness indices in men and women (A-C); in women aged ≥50 and <50 years (D). Smoothing curve with 95% confidence interval (shaded areas) are fitted by a Loess curve.

Table 1.

Characteristics of study subjects

	Total (n=1,945)	Men (n=1,395)	Women (n=550)	P^a
Age (y)	46±9.5	46.3±9.1	47±10.4	0.204
BMI (kg/m²)	24.6±3.2	25±3	23.3±3.2	<0.001
Normal (18.5-22.9)	639 (32.9)	346 (24.8)	293 (53.3)	<0.001
Overweight (23-24.9) Obese (≥25)	517 (26.6) 789 (40.6)	401 (28.7) 648 (46.5)	116 (21.1) 141 (25.6)	0.001 <0.001
Percentage body fat (%)	27±8	24.4±5.4	33.1±5.8	<0.001
Non-obese (<25 in males, <30 in females)	939 (48.3)	786 (56.3)	153 (27.8)	<0.001
Obese (≥25 in males, ≥30 in females)	1,006 (51.7)	619 (43.7)	397 (72.2)	<0.001
VFA (cm²)	82.5±31.7	78±29	94.1±10.4	<0.001
Normal (<100) High-VFA (≥100)	1,501 (77.2) 444 (22.8)	1,161 (83.2) 234 (16.8)	340 (61.8) 210 (38.2)	<0.001 <0.001
Blood pressure (mmHg)
Systolic	118.5±13.9	120.4±13.2	113.4±14.4	<0.001
Diastolic	78.4±11.3	80.1±11.1	74.3±10.9	<0.001
25(OH)D (ng/mL)	19.5±7.4	20.3±7	17.3±8	<0.001
Normal (≥30)	144 (7.4)	103 (7.4)	41 (7.5)	0.957
Insufficiency (20-29.9) Deficiency (<20)	742 (38.1) 1,059 (54.4)	596 (42.7) 696 (49.9)	146 (26.5) 363 (66)	<0.001 <0.001
Total cholesterol (mg/dL)	193.4±34.8	193.4±35	193.6±34.4	0.916
Triglyceride (mg/dL)	138.9±91	153.1±98.3	102.8±54	<0.001
HDL cholesterol (mg/dL)	50.7±11.8	48.2±10.3	57.1±13.1	<0.001
LDL cholesterol (mg/dL)	119.2±25.6	120.4±25.7	116.2±25.3	0.001
Fasting glucose (mg/dL)	87.2±10.4	88.1±10.6	84.8±9.8	<0.001

Abbreviations: BMI, body mass index; VFA, visceral fat area; 25(OH)D; 25-hydroxyvitamin D; HDL, high density lipoprotein; LDL, low density lipoprotein. Variables are presented as mean±standard deviation or number (%).

^a P-value from an independent-sample t-test for continuous variables and χ

² test for categorical variables.

Table 2.

Correlation between serum 25(OH)D and variables

	Men		Women
	r^a	P^b	r	P
Age	0.142	<0.001	0.305	<0.001
Body mass index	-0.127	<0.001	-0.134	0.002
Percentage body fat	-0.195	<0.001	-0.096	0.025
Visceral fat area	-0.185	<0.001	-0.153	<0.001
Systolic blood pressure	-0.079	0.003	-0.038	0.379
Diastolic blood pressure Total cholesterol	-0.115 -0.087	<0.001 0.001	-0.064 0.060	0.133 0.160
Triglyceride	-0.312	<0.001	-0.163	<0.001
High density lipoprotein cholesterol	0.058	0.031	0.006	0.892
Low density lipoprotein cholesterol	-0.029	0.284	0.105	0.014
Fasting glucose	-0.062	0.020	-0.029	0.493

Abbreviation: 25(OH)D, 25-hydroxyvitamin D.

^a Correlation coefficients.

^b P-value are calculated by Pearson correlation analysis.

Table 3.

Regression analysis of relationship between vitamin D and obesity indices

	Men		Women
	β±SE	P^a	β±SE	P
Model 1^b
Body mass index	-0.004±0.064	0.950	-0.342±0.111	0.002
Percentage body fat	-0.142±0.035	<0.001	-0.158±0.059	0.008
Visceral fat area	-0.018±0.007	0.008	-0.034±0.010	-0.149
Model 2^c
Body mass index Percentage body fat	-0.188±0.060 -0.211±0.033	0.002 <0.001	-0.492±0.100 -0.225±0.056	<0.001 <0.001
Visceral fat area	-0.032±0.006	<0.001	-0.046±0.009	<0.001

Abbreviation: SE, standard error.

^a P-value are calculated by multiple regression analysis.

^b Model 1 was adjusted for age, SBP, DBP, total cholesterol, TG, HDL-C, LDL-C, glucose and season.

^c Model 2 was adjusted for age and season. Model 2 was final model.

REFERENCES

1.. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22(4):477-501.

2.. Ahn J, Albanes D, Berndt SI, Peters U, Chatterjee N, Freedman ND, et al. Vitamin D-related genes, serum vitamin D concentrations and prostate cancer risk. Carcinogenesis 2009;30(5):769-76.

3.. Cardoso AT, Nanji L, Costa J, Vaz-Carneiro A. Analysis of the cochrane review: vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev. 2014, 6: CD007469. Acta Med Port 2014;27(4):411-3.

4.. Strange RC, Shipman KE, Ramachandran S. Metabolic syndrome: a review of the role of vitamin D in mediating susceptibility and outcome. World J Diabetes 2015;6(7):896-911.

5.. Yao Y, Zhu L, He L, Duan Y, Liang W, Nie Z, et al. A meta-analysis of the relationship between vitamin D deficiency and obesity. Int J Clin Exp Med 2015;8(9):14977-84.

6.. Zittermann A, Ernst JB, Gummert JF, Börgermann J. Vitamin D supplementation, body weight and human serum 25-hydrox-yvitamin D response: a systematic review. Eur J Nutr 2014;53(2):367-74.

7.. Fox CS, Massaro JM, Hoffmann U, Pou KM, Mauro-vich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007;116(1):39-48.

8.. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357(3):266-81.

9.. Organization WH. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia. 2000.

10.. Sim SJ, Park HS. The cut-off values of body fat to identify cardiovascular risk among Korean adults. J Korean Soc Study Obes 2004;13(1):14-21.

11.. Choi HJ, Yoon K, Han KH, Kim SH. The cut-off values of the visceral fat area to identify metabolic syndrome among Korean adults: using visceral fat area presented by body composition analyzer, inbody 4.0. Korean J Obes 2006;15(4):219-26.

12.. Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med 2006;260(3):245-54.

13.. Arunabh S, Pollack S, Yeh J, Aloia JF. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab 2003;88(1):157-61.

14.. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 2005;90(7):4119-23.

15.. Jorde R, Sneve M, Emaus N, Figenschau Y, Grimnes G. Cross-sectional and longitudinal relation between serum 25-hydroxyvitamin D and body mass index: the Tromsø study. Eur J Nutr 2010;49(7):401-7.

16.. Sun X, Cao ZB, Tanisawa K, Ito T, Oshima S, Ishimi Y, et al. Associations between the serum 25(OH)D concentration and lipid profiles in Japanese men. J Atheroscler Thromb 2015;22(4):355-62.

17.. Shin SR, Han AL, Park SH. Vitamin D status and its relation with abdominal adiposity and cardiovascular risk factors of Korean adults in certain areas. Korean J Obes 2015;24(1):30-5.

18.. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96(1):53-8.

19.. Vanlint S. Vitamin D and obesity. Nutrients 2013;5(3):949-56.

20.. Hjelmesaeth J, Hofsø D, Aasheim ET, Jenssen T, Moan J, Hager H, et al. Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study. Cardiovasc Diabetol 2009;8:7.

21.. Kremer R, Campbell PP, Reinhardt T, Gilsanz V. Vitamin D status and its relationship to body fat, final height, and peak bone mass in young women. J Clin Endocrinol Metab 2009;94(1):67-73.

22.. Mai XM, Chen Y, Camargo CA Jr, Langhammer A. Cross-sectional and prospective cohort study of serum 25-hydroxyvitamin D level and obesity in adults: the HUNT study. Am J Epidemiol 2012;175(10):1029-36.

23.. Pathak K, Soares MJ, Calton EK, Zhao Y, Hallett J. Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2014;15(6):528-37.

24.. Chandler PD, Wang L, Zhang X, Sesso HD, Moorthy MV, Obi O, et al. Effect of vitamin D supplementation alone or with calcium on adiposity measures: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2015;73(9):577-93.

25.. Pannu PK, Zhao Y, Soares MJ. Reductions in body weight and percent fat mass increase the vitamin D status of obese subjects: a systematic review and metaregression analysis. Nutr Res 2016;36(3):201-13.

26.. Kim D, Kim J. Association between serum 25-hydroxyvitamin D levels and adiposity measurements in the general Korean population. Nutr Res Pract 2016;10(2):206-11.

27.. Nagai M, Komiya H, Mori Y, Ohta T, Kasahara Y, Ikeda Y. Estimating visceral fat area by multifrequency bioelectrical impedance. Diabetes Care 2010;33(5):1077-9.

28.. Xu L, Cheng X, Wang J, Cao Q, Sato T, Wang M, et al. Comparisons of body-composition prediction accuracy: a study of 2 bioelectric impedance consumer devices in healthy Chinese persons using DXA and MRI as criteria methods. J Clin Densitom 2011;14(4):458-64.

29.. Ryo M, Maeda K, Onda T, Katashima M, Okumiya A, Nishida M, et al. A new simple method for the measurement of visceral fat accumulation by bioelectrical impedance. Diabetes Care 2005;28(2):451-3.

30.. Zhang M, Li P, Zhu Y, Chang H, Wang X, Liu W, et al. Higher visceral fat area increases the risk of vitamin D insufficiency and deficiency in Chinese adults. Nutr Metab (Lond) 2015;12:50.