The analysis included laboratory results and questionnaire responses from 264 randomly selected adults aged 19 to 60 years, with a mean age of 41.19 years. The sample comprised 109 men and 155 women. By body mass index, 72 participants had normal weight, 65 were overweight and 127 had obesity. People with conditions that could affect comparability, including heart failure, kidney disease, liver cirrhosis, thyroid disorders and certain other chronic illnesses, were excluded.

Participants were grouped by serum 25(OH)D status as sufficient at 50 nmol/L or higher, insufficient at 25–49.9 nmol/L, or deficient below 25 nmol/L. Investigators measured height, weight, waist circumference and blood pressure. Body composition was assessed by bioelectrical impedance analysis and dual-energy X-ray absorptiometry. A single morning blood sample collected after a 12-hour overnight fast was used to measure 25(OH)D, glucose, insulin, triglycerides, total cholesterol, HDL-C, LDL-C and high-sensitivity C-reactive protein. HOMA-IR, an index of insulin resistance, was calculated from fasting glucose and fasting insulin rather than measured directly as a blood marker.

Vitamin D status was significantly associated with BMI category (p < 0.001). Mean serum 25(OH)D concentrations declined across BMI categories, from 48.80 nmol/L among normal-weight participants to 22.20 nmol/L among those with class III obesity. Vitamin D deficiency was present in 54.0% of participants with class II–III obesity, compared with 18.1% of those with normal weight. In the class II–III obesity group, 10.0% had sufficient 25(OH)D and no participants had the optimal status reported in the study.

Greater vitamin D deficiency was associated with higher BMI, waist-to-height ratio, percentage body fat and visceral fat mass in both men and women. Across the full sample, the strongest inverse correlations between 25(OH)D and body-composition measures involved fat mass in kilograms and percentage, fat mass index and waist-to-height ratio. Their Spearman coefficients were −0.339, −0.339, −0.343 and −0.307, respectively. Body weight, waist circumference and BMI also had significant inverse correlations with serum 25(OH)D.

Serum 25(OH)D was inversely associated with several cardiometabolic markers. Across the full group, significant correlations were observed for triglycerides, HOMA-IR, high-sensitivity C-reactive protein, fasting insulin and the ratio of total cholesterol to HDL-C. Among participants with class II or class III obesity, 25(OH)D was also associated with triglycerides, the LDL-C-to-HDL-C ratio, HOMA-IR, high-sensitivity C-reactive protein and glucose measured 120 minutes after an oral glucose tolerance test. The study reported no significant correlations between 25(OH)D and the assessed biochemical parameters in the overweight or class I obesity groups.

Multiple linear regression treated the measured serum 25(OH)D concentration as the outcome. In the full sample, the TC-to-HDL-C and LDL-C-to-HDL-C ratios and percentage body fat were among the strongest statistical predictors. Subgroup models identified fasting glucose and BMI in men; percentage body fat, body water content and waist circumference in women; fasting insulin and waist-to-height ratio among normal-weight participants; and BMI and fasting insulin among participants with excess BMI. These models describe associations within the study sample and do not establish predictive performance in other populations.

Questionnaire data showed differences in reported diseases across vitamin D groups. Cardiovascular disease was reported by 15.9% of participants with deficiency, compared with 6.6% of those with insufficiency and 7.1% of those with sufficient status (p < 0.01). Diabetes was reported by 8.0%, 3.8% and 4.3%, respectively, while overweight or obesity was reported by 70.5%, 60.4% and 48.6% (p < 0.001 for each comparison). Elevated blood pressure was reported by 36.4% of deficient participants and 30.0% of those with sufficient concentrations. Depression was also more frequently reported among deficient participants, 25.0% versus 10.0% (p < 0.001).

The findings are limited by the cross-sectional design, the sample of 264 adults and the use of self-reported questionnaires for disease prevalence. Associations among vitamin D status, body composition and cardiometabolic measures cannot be interpreted as causal effects. The study did not test vitamin D supplementation or any cardiovascular treatment. Its results instead document measured relationships in this population, including lower 25(OH)D concentrations at higher BMI and differences in reported cardiovascular and metabolic conditions across vitamin D status groups.

Subject of Research: Associations of vitamin D status and body mass index with cardiometabolic risk markers and reported cardiovascular disease in adults

Article Title: Association of vitamin D status and body mass index with cardiometabolic risk and cardiovascular disease in adults

Article References: Nikolova, M., Alakidi, A., Tafradjiiska-Hadjiolova, R., Petkova, V., & Agovska, A. (2026). Association of vitamin D status and body mass index with cardiometabolic risk and cardiovascular disease in adults. Pharmacia, 73, Article e198293. https://doi.org/10.3897/pharmacia.73.e198293

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e198293

Keywords: vitamin D status, 25-hydroxyvitamin D, body mass index, adiposity, cardiometabolic risk, cardiovascular disease, insulin resistance, inflammation, cross-sectional study, Association, vitamin, status