Endocrinol Metab.  2013 Jun;28(2):96-102. 10.3803/EnM.2013.28.2.96.

Adiposity in the Relationship between Serum Vitamin D Level and Insulin Resistance in Middle-Aged and Elderly Korean Adults: The Korea National Health and Nutrition Examination Survey 2008

• Kang JH
• Kim SS
• Moon SS
• Kim WJ
• Bae MJ
• Choi BG
• Jeon YK
• Kim BH
• Kim YK
• Kim IJ

• KMID: 1973807
• DOI: http://doi.org/10.3803/EnM.2013.28.2.96

Abstract

BACKGROUND
The role of adiposity in the relationship between serum vitamin D levels and insulin resistance has not yet been fully studied. This aim of this study is to clarify the role of adiposity in the relationship between serum vitamin D level and insulin resistance among middle-aged and elderly Korean adults.
METHODS
We used data from 2,710 individuals aged > or =50 years based on national data from a representative sample of the fourth Korea National Health and Nutrition Examination Survey IV-2 in 2008.
RESULTS
After adjustment for potential confounders, body mass index (BMI) was significantly associated with 25(OH) vitamin D (P=0.008). However, waist circumference was not significantly associated with 25(OH) vitamin D. In the stratified analyses, 25(OH) vitamin D was found to be negatively associated with fasting insulin and homeostasis model assessment estimate of insulin resistance (HOMA-IR) in participants with BMIs > or =25 kg/m2 (P=0.003 for both insulin and HOMR-IR) but was not found to be associated in those with BMIs <23 kg/m2. However, we observed a significant inverse in the association of 25(OH) vitamin D with fasting insulin and HOMA-IR in both the normal (P=0.001 and P<0.001 and the abdominally obese group (P=0.010 and P=0.009) in the stratified analyses according to abdominal obesity.
CONCLUSION
Our results support that the idea that endogenously-produced vitamin D might be stored in subcutaneous fat deposits. In addition, the association of vitamin D with insulin resistance in middle-aged and elderly Korean adults was stronger when it was stratified by BMI than when abdominal obesity status.

Keyword

Korea National Health and Nutrition Examination Survey; Vitamin D; Obesity; Insulin resistance

MeSH Terms

Adiposity
Adult
Aged
Body Mass Index
Fasting
Homeostasis
Humans
Insulin
Insulin Resistance
Korea
Nutrition Surveys
Obesity
Obesity, Abdominal
Subcutaneous Fat
Vitamin D
Vitamins
Waist Circumference
Insulin
Vitamin D
Vitamins

Reference

1. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010. 21:1151–1154.

2. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, Kim KJ, Rhee Y, Lim SK. Vitamin D insufficiency in Korea: a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011. 96:643–651.

3. Haussler MR, Haussler CA, Bartik L, Whitfield GK, Hsieh JC, Slater S, Jurutka PW. Vitamin D receptor: molecular signaling and actions of nutritional ligands in disease prevention. Nutr Rev. 2008. 66:10 Suppl 2. S98–S112.

4. Scragg R, Sowers M, Bell C. Third National Health and Nutrition Examination Survey. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care. 2004. 27:2813–2818.

5. Boucher BJ, Mannan N, Noonan K, Hales CN, Evans SJ. Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in east London Asians. Diabetologia. 1995. 38:1239–1245.

6. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004. 79:820–825.

7. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care. 2005. 28:1228–1230.

8. Hypponen E, Power C. Vitamin D status and glucose homeostasis in the 1958 British birth cohort: the role of obesity. Diabetes Care. 2006. 29:2244–2246.

9. Kabadi SM, Lee BK, Liu L. Joint effects of obesity and vitamin D insufficiency on insulin resistance and type 2 diabetes: results from the NHANES 2001-2006. Diabetes Care. 2012. 35:2048–2054.

10. Yoon YS, Oh SW, Baik HW, Park HS, Kim WY. Alcohol consumption and the metabolic syndrome in Korean adults: the 1998 Korean National Health and Nutrition Examination Survey. Am J Clin Nutr. 2004. 80:217–224.

11. Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare. Korean National Health and Nutrition Examination Surveys: the 4th surveys, 2007 [Internet]. 2012. updated 2012 Aug 30; cited 2012 Dec 30. Cheongwon: Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare;Available from: http://knhanes.cdc.go.kr.

12. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007. 75:72–80.

13. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985. 28:412–419.

14. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005. 366:1059–1062.

15. Park HY, Lim YH, Kim JH, Bae S, Oh SY, Hong YC. Association of serum 25-hydroxyvitamin D levels with markers for metabolic syndrome in the elderly: a repeated measure analysis. J Korean Med Sci. 2012. 27:653–660.

16. Kim TN, Park MS, Lim KI, Choi HY, Yang SJ, Yoo HJ, Kang HJ, Song W, Choi H, Baik SH, Choi DS, Choi KM. Relationships between sarcopenic obesity and insulin resistance, inflammation, and vitamin D status: the Korean Sarcopenic Obesity Study. Clin Endocrinol (Oxf). 2013. 78:525–532.

17. McGill AT, Stewart JM, Lithander FE, Strik CM, Poppitt SD. Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J. 2008. 7:4.

18. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips P. 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. 90:4119–4123.

19. Looker AC. Body fat and vitamin D status in black versus white women. J Clin Endocrinol Metab. 2005. 90:635–640.

20. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, Yanovski JA. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004. 89:1196–1199.

21. Grethen E, McClintock R, Gupta CE, Jones R, Cacucci BM, Diaz D, Fulford AD, Perkins SM, Considine RV, Peacock M. Vitamin D and hyperparathyroidism in obesity. J Clin Endocrinol Metab. 2011. 96:1320–1326.

22. Ou HY, Karnchanasorn R, Lee LZ, Chiu KC. Interaction of BMI with vitamin D and insulin sensitivity. Eur J Clin Invest. 2011. 41:1195–1201.

23. Sung CC, Liao MT, Lu KC, Wu CC. Role of vitamin D in insulin resistance. J Biomed Biotechnol. 2012. 2012:634195.

24. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000. 72:690–693.

25. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr. 2006. 148:188–194.

26. Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr. 2002. 75:683–688.