Association between serum 25-hydroxy vitamin D concentrations and mortality among individuals with metabolic dysfunction-associated fatty liver disease: a prospective cohort study

Ji-Juan Zhang; Han-Cheng Yu; Yue Li; Yan-Bo Zhang; Ting-Ting Geng; Qi Lu; Yun-Fei Liao; Kun-Quan Guo; Liang Du; Hua-Ling Ruan; Kun Yang; Gang Liu; An Pan

doi:10.1093/ajcn/nqac260

Association between serum 25-hydroxy vitamin D concentrations and mortality among individuals with metabolic dysfunction-associated fatty liver disease: a prospective cohort study

Am J Clin Nutr. 2022 Nov;116(5):1409-1417. doi: 10.1093/ajcn/nqac260. Epub 2023 Feb 10.

Authors

Ji-Juan Zhang¹, Han-Cheng Yu¹, Yue Li¹, Yan-Bo Zhang¹, Ting-Ting Geng¹, Qi Lu², Yun-Fei Liao³, Kun-Quan Guo⁴, Liang Du⁴, Hua-Ling Ruan⁴, Kun Yang⁵, Gang Liu⁶, An Pan⁷

Affiliations

¹ Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Endocrinology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China.
⁵ Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China. Electronic address: 1732310370@qq.com.
⁶ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: liugang026@hust.edu.cn.
⁷ Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: panan@hust.edu.cn.

PMID: 36107812
DOI: 10.1093/ajcn/nqac260

Abstract

Background: The association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and mortality among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) or nonalcoholic fatty liver disease (NAFLD) remains unclear.

Objective: The aim was to evaluate the association between serum 25(OH)D concentrations and mortality among individuals with MAFLD/NAFLD.

Methods: The study included 4651 individuals with fatty liver disease (FLD; 3964 had MAFLD and 3968 had NAFLD) from NHANES III. Fatty liver disease was identified by ultrasonographic detection of hepatic steatosis. Mortality was ascertained by linkage to the National Death Index up to 31 December 2019. Cox proportional hazards models were used to estimate the HRs and 95% CIs, with adjustment of potential confounders.

Results: Of 4651 individuals with FLD, 3427 individuals (69.7%) had both MAFLD and NAFLD. During median follow-ups of 25.8 and 26.1 y, we identified 1809 and 1665 deaths among 3964 participants with MAFLD and 3968 participants with NAFLD, respectively. Compared with participants with serum 25(OH)D concentrations ≤30.0 nmol/L, the multivariable-adjusted HRs and 95% CIs of all-cause mortality were 0.62 (0.43, 0.89) for participants with MAFLD having serum 25(OH)D >75.0 nmol/L (P-trend = 0.001) and 0.63 (0.42, 0.95) for participants with NAFLD having serum 25(OH)D >75.0 nmol/L (P-trend = 0.002). A nonlinear inverse association was observed between serum 25(OH)D concentrations and all-cause mortality among participants with MAFLD (P_overall < 0.001; P_nonlinear = 0.003) or NAFLD (P_overall < 0.001; P_nonlinear = 0.009), with a threshold effect at ∼50.0 nmol/L. The inverse association was stronger among participants with MAFLD aged <60 y (P-interaction = 0.001).

Conclusions: This study suggested a nonlinear inverse association between serum 25(OH)D concentrations and all-cause mortality among patients with MAFLD/NAFLD, with a threshold effect at ∼50.0 nmol/L of serum 25(OH)D.

Keywords: MAFLD; NAFLD; cohort study; mortality; vitamin D.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Calcifediol
Humans
Non-alcoholic Fatty Liver Disease* / complications
Nutrition Surveys
Prospective Studies
Vitamin D
Vitamin D Deficiency*

Substances

25-hydroxyvitamin D
Vitamin D
Calcifediol