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Vitamin D Status and Glucose Homeostasis in the 1958 British Birth Cohort

The role of obesity

From the Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, U.K

Address correspondence and reprint requests to Dr. Elina Hyppönen, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guildford St., London, WC1N 1EH, U.K. E-mail: e.hypponen{at}ich.ucl.ac.uk

OBJECTIVE—Obesity is a well-known risk factor for vitamin D deficiency. We evaluated the interrelationship between vitamin D status, body size, and glucose homeostasis, measured by HbA_1c (A1C).

RESEARCH DESIGN AND METHODS—Data are from the survey of the 45-year-old 1958 British birth cohort (2002–2004). Information on A1C, 25-hydroxyvitamin D [25(OH)D; an indicator of vitamin D status], and BMI was collected from 7,198 Caucasian subjects.

RESULTS—25(OH)D was <75 nmol/l in 80% of the obese subjects (BMI 30 kg/m²) versus 68% of the other subjects (P < 0.0001). Serum 25(OH)D decreased and A1C increased by increasing BMI (P < 0.0001 for both comparisons). There was a nonlinear association between 25(OH)D and A1C: a steep linear decrease in A1C by 25(OH)D until 65 nmol/l and only smaller decreases with further increases. There was evidence for effect modification by BMI in the association between 25(OH)D and A1C (P < 0.0001), and differences appeared stronger for participants with higher compared with lower BMIs. After adjustment for sex, season, geographical location, physical activity, and social class, percent change in A1C by 10-nmol/l increase in 25(OH)D was –0.21 (95% CI –0.31 to –0.11) for BMI <25 kg/m², –0.25 (–0.37 to –0.13) for BMI 25–29.9 kg/m², –0.65 (–0.95 to –0.34) for BMI 30–34.9 kg/m², and –1.37 (–2.09 to –0.64) for BMI 35 kg/m².

CONCLUSIONS—Body size was a strong determinant for 25(OH)D, with concentrations being suboptimal in most obese participants. Randomized controlled trials [using dosages sufficient to improve 25(OH)D also for the obese] are required to determine whether clinically relevant improvements in glucose metabolism can be obtained by vitamin D supplementation.

Abbreviations: 25(OH)D, 25-hydroxyvitamin D

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