Fat accumulates in legs or arms if low vitamin D - Jan 2024

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Poor vitamin D status was associated with increased appendicular fat deposition in US Adults: Data from 2011–2018 National Health and Nutrition Examination Survey

Nutrition Research Vol 121, Jan 2024, pg 108-118 https://doi.org/10.1016/j.nutres.2023.11.001 PDF behind a $31 paywall
Qian Ren a, Danfeng Xu b, Jinrong Liang c, Yun Cao a, Lili Zhang d, Sheng Ge a, Peizhan Chen e

The aim of the study was to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and regional body fat deposition in 2011–2018 National Health and Nutrition Examination Survey participants aged 18 to 59 years. We hypothesized that serum 25(OH)D concentrations were negatively associated with total, appendicular, and truncal fat deposition. Serum 25(OH)D concentration was categorized into sufficient (≥75.0 nM), insufficient (50.0–74.9 nM), and deficient (<50.0 nM) groups. Fat mass (FM) was measured by dual-energy X-ray absorptiometry, and FM index (FMI) was calculated by dividing FM (kg) with height2 (m2). Multivariant linear regression and Granger causal analysis were performed to assess the causal relationship between vitamin D status and regional FMIs. Overall serum 25(OH)D concentrations were negatively associated with total (β = –0.029, standard error [SE] = 0.002), trunk (β = –0.015, SE = 0.001), arms (β = –0.004, SE = 3.09 × 10−4), and legs (β = –0.010, SE = 0.001) FMIs in all participants (P < .001, respectively); however, after stratified by vitamin D status and BMI, the negative associations were only observed in individuals with vitamin D deficiency and obesity. The causal analysis indicated that serum 25(OH)D concentrations may causally reduce the arms (F = 4.917, probability [P] = 0.007), legs (F = 5.783, P = 0.003), and total (F = 3.202, P = 0.041) FMIs except for trunk FMI but not vice versa. In conclusion, poor vitamin D status was associated with increased total and appendicular body fat deposition in US adults, particularly in participants with obesity.

The aim of the study was to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and body fat deposition in adults. The results showed that poor vitamin D status was associated with increased total and appendicular body fat deposition in US adults, particularly in participants with obesity.Download

Introduction
Obesity has affected around 1.5 billion adults globally, and it may increase the risks of many chronic diseases, including type 2 diabetes mellitus, cardiovascular diseases, chronic kidney diseases, and nonalcoholic fatty liver diseases [1,2]. The overall cost of health care related to obesity is expected to double every 10 years [3], with medical costs for people with obesity forecast to be 30% more than those people with normal weight [4].
Vitamin D deficiency is a global epidemic affecting more than 1 billion children and adults around the world [5]. Vitamin D deficiency was commonly noticed in individuals with obesity [6]. Inadequate intake of vitamin D, poor dietary habits, and low sunlight exposure are important risk factors for vitamin D deficiency [5]. It has been reported that body fat acts as a storage site for lipid-soluble vitamin D, and higher body fat deposition increases its sequestration in adipose tissues [7]. Meanwhile, adiposity-initiated insulin resistance and hepatic steatosis can reduce the 25-hydroxyvitamin D [25(OH)D] synthesis in liver, which resulted in low bioavailability of this precursor hormone [7]. On the other hand, low vitamin D may be implicated in adipose tissue differentiation and growth, which leads to obesity by regulating expression of genes involved in parathyroid hormone, calcium, leptin, and tumor necrosis factor-α signaling pathways [6,8].

Multiple studies evaluated the associations between vitamin D and obesity; however, the results remain controversial [6,9,10]. In addition, most studies focus on obesity assessed by body mass index (BMI) rather than fat deposition in different body areas [11]. A bidirectional Mendelian randomization study (up to 42,024 participants) found each 1-kg/m2 increment of BMI was associated with a 1.15% lower 25(OH)D; however, genetically lower 25(OH)D was not causally associated with BMI [11]. Another randomized double-blind clinical study included participants with suboptimal vitamin D concentrations [25(OH)D <75 nM], who were provided with either vitamin D (4000 IU/d) or placebo for 4 months, and the study reported that only adults with obesity and metabolically unhealthy phenotype may benefit from vitamin D treatment [12]. Further, vitamin D supplementation improved adipose tissue inflammation and hepatic steatosis but did not reduce weight gain or obesity in mice received high-fat and high-glucose diets [13]. However, in another study, vitamin D supplementation decreased body weight gain and abdominal fat deposition and ameliorated the plasma lipid profiles in Western diet-fed obese rats [8]. Thus, the relationship between vitamin D and obesity is still inconclusive and further investigations are needed.

In the current study, we investigated the relationship and exploratory causality between serum 25(OH)D and total, appendicular and truncal body fat mass (FM) in US adults who participated in the 2011–2018 National Health and Nutrition Examination Survey (NHANES). The results may provide evidence supporting relationships between serum 25(OH)D and appendicular body fat deposition in US adults.

Section snippets
Study design and participants recruitments
The NHANES is a large cross-sectional study designed to assess the nutritional status and health outcomes across the United States [14]. The survey began in the 1960s and consisted mainly of interviews and physical examinations. Since 1999, the survey has been performed with a 2-year cycle, and approximately 5000 participants are recruited each year. A total of 39,156 participants recruited between 2011 and 2018 were included in current study, and those younger than age 18 years (n = 15,331), . . . .

Characteristics, body measurements, and DXA parameters of participants grouped by serum vitamin D status
The main characteristics, body measurements and DXA parameters of the study participants grouped by serum 25(OH)D concentrations are shown in Table 1. A total of 11,307 adults (5613 males and 5694 females) with a mean age of 37.75 years (standard deviation = 12.39) were recruited, and the blood vitamin D concentrations were determined in winter/spring (n = 5530, 48.91%) or summer/fall (n = 5,777, 51.09%). Overall, the prevalence of vitamin D insufficiency was 37.50% and vitamin D deficiency . . . .

Discussion
In this study, we found that serum 25(OH)D concentrations were negatively associated with total and appendicular but not truncal body fat deposition in US adults, especially in subjects with vitamin D deficiency and obesity. Several epidemiological studies have investigated the relationship between vitamin D concentrations and body fat mass. Consistent with our results, Looker et al. examined the relationship between serum 25(OH)D and body fat percent by race in 6042 women aged >12 years in . . . .

Conclusion
Serum 25(OH)D concentrations were negatively associated with total and regional (arms, legs, and trunk) fat deposition, particularly in individuals with vitamin D deficiency and obesity. Moreover, poor vitamin D status may causally increase appendicular fat deposition. Therefore, our results indicated that maintaining vitamin D in a sufficient status may reduce the risk of total and appendicular fat deposition in populations with hypovitaminosis D and obesity. However, more prospective cohort . . . .

Some of the 45 References

• SA Polyzos et al. Obesity: seize the day, fight the fat Metabolism. (2019)
• SS Lim et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet. (2012)
• MM Cordeiro et al. Vitamin D supplementation decreases visceral adiposity and normalizes leptinemia and circulating TNF-α levels in western diet-fed obese rats Life Sci. (2021)
• H Li et al. Central body fat deposits are associated with poor vitamin D status in Chinese children and adolescents Nutrition. (2022)
• N Ahluwalia et al. Update on NHANES dietary data: focus on collection, release, analytical considerations, and uses to inform public policy Adv Nutr. (2016)
• CE Moore et al. Elevated systolic blood pressure of children in the United States is associated with low serum 25-hydroxyvitamin D concentrations related to body mass index: National Health and Examination Survey 2007-2010 Nutr Res. (2017)
• ME Cogswell et al. Modeled changes in US sodium intake from reducing sodium concentrations of commercially processed and prepared foods to meet voluntary standards established in North America: NHANES Am J Clin Nutr. (2017)
• AK Seth A MATLAB toolbox for Granger causal connectivity analysis J Neurosci Methods. (2010)
• SM Yakout et al. Vitamin D level and its relation to muscle and fat mass in adult male Arabs Saudi J Biol Sci. (2020)
• MS Treuth et al. Estimating intraabdominal adipose tissue in women by dual-energy X-ray absorptiometry Am J Clin Nutr. (1995)
• Y Wang et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic Obesity (Silver Spring). (2008)
• D Withrow et al. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity Obes Rev. (2011)
• MF Holick The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention Rev Endocr Metab Disord. (2017)
• I Karampela et al. Vitamin D and obesity: current evidence and controversies Curr Obes Rep. (2021)
• L Wamberg et al. Expression of vitamin D-metabolizing enzymes in human adipose tissue – the effect of obesity and diet-induced weight loss Int J Obes (Lond). (2013)
• S Savastano et al. Low vitamin D status and obesity: role of nutritionist Rev Endocr Metab Disord. (2017)
• KS Vimaleswaran et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts PLoS Med. (2013)
• M Bagheri et al. Effectiveness of vitamin D therapy in improving metabolomic biomarkers in obesity phenotypes: two randomized clinical trials Int J Obes (Lond). (2018)
• A Marziou et al. Vitamin D supplementation improves adipose tissue inflammation and reduces hepatic steatosis in obese C57BL/6J mice Nutrients. (2020)
• IJ Neeland et al. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management Circulation. (2018)
• A Coin et al. Trunk and lower limb fat mass evaluated by dual-energy X-ray absorptiometry in a 20- to 80-year-old healthy Italian population Ann Nutr Metab. (2012)
• H Kahleova et al. Effect of a low-fat vegan diet on body weight, insulin sensitivity, postprandial metabolism, and intramyocellular and hepatocellular lipid levels in overweight adults: a randomized clinical trial JAMA Netw Open. (2020)

This study disagrees with the consensus

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VitaminDWiki – Overview Obesity and Vitamin D contains:

• FACT: People who are obese have less vitamin D in their blood
• FACT: Obese need a higher dose of vitamin D to get to the same level of vit D
• FACT: When obese people lose weight the vitamin D level in their blood increases
• FACT: Adding Calcium, perhaps in the form of fortified milk, often reduces weight
• FACT: 168 trials for vitamin D intervention of obesity as of Dec 2021
• FACT: Less weight gain by senior women with > 30 ng of vitamin D
• FACT: Dieters lost additional 5 lbs if vitamin D supplementation got them above 32 ng - RCT
• FACT: Obese lost 3X more weight by adding $10 of Vitamin D
• FACT: Those with darker skins were more likely to be obese Sept 2014
• OBSERVATION: Low Vitamin D while pregnancy ==> more obese child and adult
• OBSERVATION: Many mammals had evolved to add fat and vitamin D in the autumn
  • and lose both in the Spring - unfortunately humans have forgotten to lose the fat in the Spring
• SPECULATION: Low vitamin D might be one of the causes of obesity – several studies
• SUGGESTION: Probably need more than 4,000 IU to lose weight if very low on vitamin D due to
    risk factors such as overweight, age, dark skin, live far from equator,shut-in, etc.
• Obesity category has 441 items

See also: Weight loss and Vitamin D - many studies   Child Obesity and Vitamin D - many studies   Obesity, Virus, and Vitamin D - many studies
Obese need more Vitamin D

• Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study

• Normal weight     Obese     (50 ng = 125 nanomole)

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VitaminDWiki – Obesity is associated with low Vitamin D (and treated by D as well) – Aug 2019 contains:

Fast weight loss by Obese Adults: Summary of the data as of Sept 2019
1) 50,000 IU Vitamin D weekly for at least 6 months
   If gut problems, should use a gut-friendly form of vitamin D
2) Add calorie restriction diet and light exercise after ~2 months*
   * Vitamin D levels must be above 30ng/ml to help with weight loss
   * Start losing weight 2 months sooner if take a 50,000 IU daily for a week
3) More weight loss if also add Magnesium or cofactors
   30% Improved Vitamin D response with Magnesium - a Vitamin D Cofactor
   Note: Magnesium reduces weight loss by itself as well
   20% improved vitamin D response if also add Omega-3 a Vitamin D Cofactor
  Note: Omega-3 reduces weight loss by itself as well
4) More weight loss if also improve activation of Vitamin D Receptor
   Vitamin D Receptor activator: 0-30% improved Vitamin D response
   Obesity 1.5 X more likely if poor Vitamin D Receptor – meta-analysis Nov 2019
Update Dec 2019 - Dr. Greger plant-based eating (not diet) for both weight loss and health.
  His book does not mention Vitamin D nor Adenovirus