Background: Vitamin D status has been found to be inversely
associated with metabolic syndrome (MetS) in some studies.Vitamin
Dstatus varies by race and ethnicity, and the association ofMetSwith
vitamin D status in US adults and by race and Hispanic origin has not
been evaluated extensively.
Objectives: We aimed to examine the associations between vitamin
D status and MetS overall, and across race and Hispanic origin
groups, in a nationally representative sample of US adults who
participated in the NHANES from 2007 to 2014.
Methods: The total sample included 8639 adults, ≥20 y of age.
Serum vitamin D was measured using a standardized LC-tandem
MS method and was categorized using data-driven tertiles. MetS
was defined using measured waist circumference, triglycerides,
HDL cholesterol, blood pressure, and fasting glucose. Multivariable
logistic regression models were fitted [accounting for
sociodemographic and lifestyle factors, dietary supplement use, and
BMI (in kg/m2)] to examine the associations of serum vitamin
D with MetS among adults overall, and by race and Hispanic
origin.
Results: Serum vitamin D in the lowest tertile (≤56 nmol/L) was
significantly associated with increased odds of MetS compared with
the highest tertile (>77.9 nmol/L) (fully adjusted model OR: 1.85;
95% CI: 1.51, 2.27). Inverse associations were noted for all race-
Hispanic origin groups: non-Hispanic white (NHW) (OR: 2.24; 95%
CI: 1.67, 3.01), non-Hispanic black (OR: 1.56; 95% CI: 1.06, 2.29),
and Hispanic (OR: 1.48; 95% CI: 1.03, 2.14) adults.
Conclusions: Lower vitamin D status was significantly associated
with MetS among US adults after adjusting for sociodemographic
and lifestyle factors, dietary supplement use, and BMI. This finding
was noted across all race and Hispanic origin groups, although the
strength of the association varied, being strongest for NHW adults.
Am J Clin Nutr 2022;116:1400–1408.
Keywords: vitamin D status, NHANES, metabolic syndrome, raceethnicity,
insulin resistance, serum vitamin D
Introduction
Metabolic syndrome (MetS), a cluster of risk factors including
obesity, dyslipidemia, hypertension, insulin resistance, and
hyperglycemia (1–3), is associated with increased risk of chronic
diseases (4) and death (5). A higher incidence of cardiovascular
disease (CVD), coronary heart disease, and stroke is reported
in persons with MetS (6). The prevalence of MetS in adults
has increased >35% in the United States, from 25.3% in 1988–
1994 to 34.2% in 2007–2012 (7); although the increase was not
significant (P = 0.07) between 2011–2012 and 2015–2016 (8).
Based on NHANES 2015–2016 data, 36.9% of US adults had
MetS (9). Furthermore, MetS varied across race-Hispanic origin
groups; MetS prevalence for non-Hispanic white (NHW), non-
Hispanic black (NHB), non-Hispanic Asian, and Hispanic adults
was 37.6%, 30.0%, 26.2%, and 40.4%, respectively (8).
Vitamin D is acquired through exposure to sunlight, diet,
fortified foods (e.g., milk), and dietary supplements (10, 11).
Vitamin D inadequacy is a public health concern (12). Based on
NHANES 2011–2012, ∼40% of adults have inadequate vitamin
D status using the Institute of Medicine’s cutoff (<50 nmol/L)
(9, 13–15). The prevalence further varies based on season,
geographic location, and race and Hispanic origin (16). The
Author disclosures: The authors report no conflicts of interest.
The authors reported no funding received for this study.
The findings and conclusions in this report are those of the authors and do
not reflect the position of the CDC.
Address correspondence to NA (e-mail: woq0@cdc.gov).
Abbreviations used: CVD, cardiovascular disease; eGFR, estimated
glomerular filtration rate; MEC, Mobile Examination Center; MetS,
metabolic syndrome; NCHS, National Center for Health Statistics; NHB,
non-Hispanic black; NHW, non-Hispanic white; PIR, poverty-to-income
ratio; 25(OH)D2, 25-hydroxyvitamin D2; 25(OH)D3, 25-hydroxyvitamin D3.
Received March 30, 2022. Accepted for publication August 24, 2022.
First published online August 29, 2022; doi: https://doi.org/10.1093/ajcn/
nqac234.
