Association between serum vitamin D deficiency and visceral fat indices in adolescents: The Ewha Birth and growth cohort study

Hyelim Lee; Hyunjin Park; Seunghee Jun; Hyeseung Jang; Young Sun Hong; Kyunghee Jung-Choi; Hye Ah Lee; Hyesook Park

doi:10.1371/journal.pone.0335507

Abstract

Purpose

Vitamin D plays a crucial role in cardiometabolic health, but its association with visceral fat in adolescents remains unclear. This study aimed to evaluate the relationship between vitamin D levels visceral fat indices—Hypertriglyceridemic Waist Phenotype (HWP), Visceral Adiposity Index (VAI), and Lipid Accumulation Product (LAP)—which serve as practical markers for visceral fat.

Methods

This study analyzed 238 adolescents (aged 13–15) data from the Ewha Birth and Growth Study, a longitudinal Korean cohort. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured and categorized as deficiency (<20 ng/mL) or non-deficiency (≥20 ng/mL). Visceral fat was assessed using HWP, VAI, and LAP as surrogate markers for visceral adiposity. Logistic and linear regression analyses were performed to evaluate associations, adjusting for key covariates. Sensitivity analyses used alternative HWP definitions and vitamin D categorizations.

Results

Among 238 adolescents, 76.0% had vitamin D deficiency, and 7.1% had HWP. Logistic regression indicated a lower HWP risk in the non-deficiency group with a borderline level of significance (p = 0.060). Sensitivity analyses confirmed a significantly lower HWP risk in the non-deficiency group under the lowered TG criterion and also showed that, in the three-category classification of vitamin D status, the non-deficiency group had a significantly lower HWP risk than the severe deficiency group, with a decreasing trend as vitamin D levels increased. Multiple linear regression showed inverse associations between vitamin D levels and log VAI (β = –0.020, p = 0.008) and log LAP (β = –0.018, p = 0.060).

Conclusions

The inverse relationship observed between vitamin D levels and visceral fat indices suggests a potential role in adiposity regulation and cardiometabolic health. Enhancing vitamin D status may help prevent obesity and reduce cardiometabolic risks in adolescents.

Citation: Lee H, Park H, Jun S, Jang H, Hong YS, Jung-Choi K, et al. (2025) Association between serum vitamin D deficiency and visceral fat indices in adolescents: The Ewha Birth and growth cohort study. PLoS One 20(10): e0335507. https://doi.org/10.1371/journal.pone.0335507

Editor: Marwan Salih Al-Nimer, University of Diyala College of Medicine, IRAQ

Received: May 19, 2025; Accepted: October 13, 2025; Published: October 31, 2025

Copyright: © 2025 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The Institutional Review Board on Human Subjects at Ewha Womans University approved the study protocol (SEUMC- 2019-04-035). Our dataset cannot be shared publicly due to the Institutional Review Board (IRB) of Ewha Womans University Seoul Hospital restrictions on data obtained from participants without consent for sharing publicly. Researchers who wish to collaborate in analysis of the Ewha Birth and Growth cohort data will need to collaborate with the researcher of Department of Preventive Medicine, College of Medicine, Ewha Womans University and obtain IRB approval. Those who are requesting access to the Ewha Birth and Growth cohort data should contact the Ethical Committee (irbseoul@eumc.ac.kr).

Funding: This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2023-00253552). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Vitamin D is an essential nutrient and hormone regulating calcium-phosphorus metabolism for bone health and plays a key role in immunity, cell growth, differentiation, and other physiological processes [1]. Growing evidence suggests that vitamin D deficiency is associated with a wide range of adverse health conditions, including cardiometabolic diseases, as well as musculoskeletal and mental illnesses. Given its widespread prevalence and health implications, vitamin D deficiency is now recognized as a critical global public health issue [2–4].

A comprehensive 2025 meta-analysis of 586 studies across 102 countries reported that about 75% of the population had vitamin D insufficiency or deficiency (<30 ng/mL), with mean levels slightly lower in children than in adults [5]. In Korea, data from 332 medical institutions revealed that 79.8% of boys and 83.8% of girls aged 0–18 years were vitamin D insufficient or deficient, with rates peaking at about 96% during adolescence [6]. Consistently, the Korea National Health and Nutrition Examination Survey (KNHANES) confirmed that adolescents aged 10–19 years exhibited the highest prevalence of vitamin D insufficiency and deficiency among all age groups [7]. Despite typically being a period of greater outdoor activity and sun exposure, adolescents show high rates of vitamin D deficiency. This suggests that shifts in lifestyle, dietary habits, and limited sun exposure may be contributing factors.

Beyond vitamin D deficiency, the prevalence of obesity, abdominal obesity, and prediabetes among Korean adolescents has nearly doubled over the past decade, while metabolic syndrome and hypertension have continued to rise, suggesting an increasing burden of cardiometabolic diseases [8–10]. As these risks often persist into adulthood, early intervention during adolescence is crucial for reducing long-term health complications.

Cardiometabolic health is a major public health concern, with abdominal obesity playing a critical role in its pathogenesis. Visceral fat contributes to cardiometabolic dysfunction through the secretion of inflammatory mediators and adipokines [11]. Vitamin D may help counteract these effects by enhancing energy expenditure, reducing visceral fat accumulation, and exerting anti-inflammatory and lipid-modulating properties. In addition, it may influence adiposity regulation through pathways such as PPAR-γ signaling. Through these mechanisms, it may support cardiometabolic health and reduce the risk of cardiometabolic diseases [12,13]. Conversely, obesity itself may also contribute to vitamin D deficiency through reduced physical activity and sequestration of vitamin D in adipose tissue, suggesting a potential bidirectional relationship between vitamin D and visceral fat [13].

Visceral fat can be measured with MRI and CT as the gold standard, but cost and radiation exposure limit their use in epidemiologic studies. In addition, body composition analysis (BIA), which can estimate visceral adipose tissue (VAT) area, is difficult to perform in unequipped settings, so surrogate markers such as Hypertriglyceridemic Waist Phenotype (HWP), Visceral Adiposity Index (VAI), and Lipid Accumulation Product (LAP) using blood tests and basic anthropometry are utilized.

HWP, defined by waist circumference and triglyceride levels, is a predictor of the atherogenic metabolic triad, characterized by hyperinsulinemia, elevated apolipoprotein B, and small Low-Density Lipoprotein (LDL) particles [14–16]. VAI incorporates waist circumference (WC), triglycerides (TG), HDL cholesterol, and BMI, through sex-specific equations to assess visceral fat accumulation [17]. Similarly, LAP is derived from WC and TG and is calculated through sex-specific equations, serving as an indicator of lipid accumulation [18]. These indices are used as surrogate markers for visceral fat in epidemiological studies and used for early cardiometabolic risk assessment [16–18]. Adolescence is a critical period when cardiometabolic risk factors begin to emerge, emphasizing the need for early assessment for long-term disease prevention [19]. In epidemiological research, visceral fat indices are valuable tools for assessing cardiometabolic risk in adolescents. Studies have shown that HWP effectively predicts cardiovascular risk factor clustering (area under the curve [AUC]=0.78), VAI identifies metabolically unhealthy phenotypes (AUC = 0.76–0.83), and LAP is a strong predictor of metabolic syndrome (AUC = 0.94) [20–22].

Most studies examining the association between vitamin D and visceral fat indices have focused on adults. In these populations, vitamin D deficiency has been linked to a 3.9-fold increased risk of HWP compared to vitamin D sufficiency [23]. However, findings regarding VAI and LAP remain inconsistent. While one study suggested a positive association between vitamin D levels and LAP, another study conducted in individuals with obesity or diabetes reported an inverse relationship [24,25].

To the best of our knowledge, no studies have specifically examined the relationship between vitamin D status and visceral fat indices in adolescents. Understanding this relationship is particularly important because adolescence represents a critical period for metabolic and hormonal changes, which influence long-term metabolic health [26]. If vitamin D plays a role in regulating visceral fat accumulation during this formative stage, its effects may persist beyond adolescence, influencing the risk of cardiometabolic diseases later in life. Investigating this relationship is essential for developing early intervention strategies to reduce future cardiometabolic risks. Thus, this study aims to evaluate the association between vitamin D levels and three visceral fat indices (HWP, VAI, and LAP) in adolescents.

Materials and methods

Study participants

This study utilized data from the Ewha Birth and Growth Study, a longitudinal cohort established with pregnant women who visited Ewha Womans University Mokdong Hospital for prenatal care between 24–28 weeks of gestation from September 2001 to June 2006. A total of 940 children born to participating mothers were enrolled and followed from age 3, with follow-up assessments at ages 5, 7, and annually thereafter. Follow-up is ongoing, and data collection at age 19 is currently in progress. These assessments included anthropometric measurements, dietary surveys, questionnaires, and biological sample collection. Detailed cohort information is available in a previous publication [27].

In this study, we analyzed data from 248 participants who were followed up at ages 13–15. Data were collected between April 2015 and August 2020—from April to May during 2015–2019, and from July to August in 2020. Among them, 10 participants were excluded because of missing data on serum vitamin D levels and key variables required to calculate visceral fat indices (HWP, VAI, LAP), including TG, WC, BMI. Consequently, 238 participants were included in the final analysis.

During follow-up, all participants and their guardians were provided with a comprehensive explanation of the study, and written informed consent was obtained. This study was approved by the Institutional Review Board of Ewha Womans University Seoul Hospital (IRB No. SEUMC 2019-04-035). The dataset used in this analysis was accessed and analyzed in June 2024, and all data were completely anonymous before author access and analysis.

Anthropometric and blood biomarkers

All anthropometric measurements were obtained by trained examiners. Height and weight were measured to the nearest 0.1 cm and 0.1 kg, respectively, with participants wearing light clothing and barefoot. BMI was calculated as weight (kg) divided by height squared (m²). WC (cm) was measured at the narrowest circumference between the iliac crest and the lowest rib using a non-elastic tape. Blood samples were collected following a minimum of 8 hours of fasting. Venous blood was drawn into a 15 mL vacuum-sealed tube, centrifuged, and immediately analyzed for TG and HDL-C using an automated biochemical analyzer (Olympus AU2700; Beckman Coulter Inc., Fullerton, CA, USA).

Measurement of vitamin D

Serum 25-hydroxyvitamin D [25(OH)D], a key indicator of vitamin D status, was analyzed using stored previously frozen serum samples. Measurements were performed using a chemiluminescent immunoassay (CLIA) on a DxI 800 analyzer (Beckman Coulter, Brea, CA, USA) (intra-assay coefficient of variation ranged from 6.2% to 9.1%). According to the Endocrine Society guidelines, vitamin D levels are classified as deficiency (≤20 ng/mL), insufficiency (20–30 ng/mL), and sufficiency (≥30 ng/mL). However, given that only three participants met the sufficiency criteria, our study categorized participants into two groups based on vitamin D levels: deficiency (<20 ng/mL) and non-deficiency (≥20 ng/mL) [28–30].

Definition of visceral fat indices

This study assessed visceral fat using three indices: HWP, VAI, and LAP. TG and HDL-C levels were originally measured in mg/dL and converted to mmol/L using standardized conversion formulas:

HWP was defined as the simultaneous presence of abdominal obesity and hypertriglyceridemia. Abdominal obesity was determined based on WC at or above the 75^th percentile for age and sex, according to the 2007 Korean Children and Adolescents Growth Standards by the Korea Disease Control and Prevention Agency (KDCA) [31]. Hypertriglyceridemia was defined as TG levels ≥130 mg/dL, based on the Korean Pediatric Society guidelines [32]. In this study, individuals satisfying both criteria were classified as having HWP [33]. Individuals with HWP are considered to have a higher risk of developing cardiometabolic diseases.

VAI was calculated using WC, TG, HDL-C, and BMI according to the following sex-specific formulas:

LAP was calculated based on WC and TG levels using the following sex-specific formulas:

Higher values of both VAI and LAP indicate greater visceral fat accumulation, which is associated with an increased risk of cardiometabolic diseases. Although VAI and LAP were originally developed for adults, emerging evidence suggests their applicability in assessing metabolic syndrome and cardiovascular risk in children and adolescents [21,22].

Covariates

Sex, household income, frequency of moderate-intensity physical activity, total energy intake, follow-up month, and use of growth-related dietary supplements were included as covariates using data collected at ages 13–15. These variables were selected based on previous literature [23]. Household income was categorized into three groups: < 3 million South Korean won (KRW), 3–5 million KRW, and ≥5 million KRW. The frequency of moderate-intensity physical activity was classified into three groups: none, 1–2 days per week, and ≥3 days per week. The follow-up month was categorized into April, May, and July–August (July was combined with August due to the small number of participants in July). The use of growth-related dietary supplements was categorized as ‘yes’ or ‘no’.

Statistical analysis

All statistical analyses were conducted using SAS software (version 9.4; SAS Institute, Cary, NC, USA), with p < 0.05 considered statistically significant. Descriptive statistics were presented as mean ± standard deviation for normally distributed variables, median (interquartile range) for non-normally distributed variables, and frequencies (percentages) for categorical variables. TG, VAI, and LAP, which showed non-normal distributions, were log-transformed before analysis. The association between HWP and vitamin D status was assessed using the chi-square test, with Fisher’s exact test applied when expected frequencies were < 5. Logistic regression was performed with vitamin D deficiency (<20 ng/mL) as the reference group, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). In cases of rare events, Firth’s logistic regression was utilized to adjust for the small sample bias. For VAI, values exceeding 1.5 times Interquartile Range (IQR) were considered outliers, leading to the exclusion of one participant. Since the LAP values included negative numbers (minimum = –5.4), a constant of 6 was added to all values to ensure positivity before log-transformation. Group differences in visceral fat indices according to vitamin D status were evaluated using the independent t-test for normally distributed variables and the Mann–Whitney U test for non-normally distributed variables. The linear associations between VAI, LAP, and serum 25(OH)D concentration were assessed using linear regression, with results reported beta coefficients (β), standard errors (SEs), and p-values. Multivariate analyses adjusted for sex, household income, physical activity, total energy intake, and growth-related dietary supplement use.

Sensitivity analysis

Sensitivity analyses were conducted to assess the robustness of the findings using alternative definitions of vitamin D status and HWP classification. To evaluate whether different categorizations of vitamin D levels influence the observed associations, participants were additionally classified into three groups: non-deficiency (≥20 ng/mL), deficiency (12–19 ng/mL), and severe deficiency (<12 ng/mL).

To further assess the robustness of the association between vitamin D status and HWP, different criteria were used to define HWP:

1) Borderline definition: HWP was defined as WC at or above the 75th percentile and TG ≥ 90 mg/dL [32–33].
2) Conservative definition: HWP was defined as WC at or above the 90th percentile and TG ≥ 130 mg/dL [34].

Based on these criteria, the prevalence of HWP was compared across vitamin D groups, and the association between HWP and vitamin D status was evaluated using logistic regression. Logistic regression was performed using the severe deficiency group as the reference, and the trend test was applied to assess trends across categories.

Results

General characteristics of study participants

A total of 238 participants were included, comprising 116 boys (48.7%) and 122 girls (51.3%). Vitamin D deficiency (<20 ng/mL) was observed in 76.0% of participants, with a significantly higher prevalence in girls than in boys (p = 0.005). HWP was present in 7.1% of participants, with no significant sex difference (p = 0.886). Its components, abdominal obesity (27.3%) and high triglyceride levels (9.7%), also showed no significant sex differences. Both LAP and VAI showed significantly higher median values in girls than boys (p = 0.001 and p < 0.001, respectively), indicating sex differences (Table 1). Covariate distributions across vitamin D status groups are shown in S1 Table. In the deficiency group, the proportion of participants reporting almost never engaging in moderate physical activity was higher (p = 0.023; S1 Table), and the remaining covariates did not show significant differences.

Download:

Table 1. Characteristics of Study Participants.

https://doi.org/10.1371/journal.pone.0335507.t001

HWP Prevalence by vitamin D status

HWP was observed in 17 participants, all within the vitamin D deficiency group, while no cases were found in the non-deficiency group (p = 0.015). Among its components, vitamin D deficiency was significantly more prevalent in participants with abdominal obesity than in those with low WC, whereas no significant difference was observed between high and low TG groups (Fig 1). Sensitivity analyses were performed using alternative HWP criteria. The association between vitamin D status and HWP remained significant even when the WC threshold was increased to the 90th percentile or the TG cutoff was lowered to 90 mg/dL. Similarly, when vitamin D levels were categorized into three groups (non-deficiency, deficiency, and severe deficiency), a significant association and trend with HWP remained (p for trend < 0.05) (S1 and S2 Fig).

Download:

Fig 1. Distribution of Hypertriglyceridemic Waist Phenotype, abdominal obesity, and high triglyceride by serum vitamin D Status.

Vitamin D status was defined as Deficiency (<20 ng/mL) and Non-deficiency (≥20 ng/mL) based on serum 25(OH)D concentration. HWP was defined as Abdominal obesity (WC ≥ 75th percentile) and High TG (TG ≥ 130 mg/dL). Based on these criteria, WC was categorized into two groups: Abdominal obesity (WC ≥ 75th percentile) and Low WC (WC < 75th percentile), and TG was categorized into two groups: High TG (TG ≥ 130 mg/dL) and Low TG (TG < 130 mg/dL). ^**p < 0.05, calculated using the chi-square test.

https://doi.org/10.1371/journal.pone.0335507.g001

Logistic regression analysis of vitamin D status and HWP

Participants were categorized into deficiency and non-deficiency groups, with deficiency group as the reference. The non-deficiency group had a 12-fold (1/0.082) lower risk of HWP than the deficiency group, though not statistically significant. After adjustment, the risk further decreased to 11-fold (1/0.088) lower, with borderline significance (p = 0.060). Among HWP components, the risk of abdominal obesity was lower in the non-deficiency group, with borderline significance (p = 0.065) (Table 2). In sensitivity analyses, lowering the TG threshold to 90 mg/dL made the association between vitamin D status and HWP risk statistically significant (p = 0.030) (S2 Table). Additionally, when vitamin D status was classified into three groups (severe deficiency, deficiency, and non-deficiency), the non-deficiency group had a significantly lower HWP risk than the severe deficiency group, with a significant trend indicating decreasing risk as vitamin D levels increased (p for trend = 0.015) (S3 Table).

Download:

Table 2. Association Between Vitamin D Status and Hypertriglyceridemic Waist Phenotype (HWP).

https://doi.org/10.1371/journal.pone.0335507.t002

Comparison of Visceral Fat Indices by Vitamin D Status

Differences in the distribution of visceral fat indicators were observed according to vitamin D status. The deficiency group showed significantly higher median values of VAI (0.85 vs. 0.67, p = 0.002), LAP (12.50 vs. 9.76, p = 0.041), and TG (68.0 vs. 59.0, p = 0.034) compared to the non-deficiency group (Fig 2).

Download:

Fig 2. Comparison of Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Related Variables by Vitamin D Status (A) VAI, (B) LAP, (C) TG, (D) WC, (E) BMI, (F) HDL-C.

VAI, Visceral Adiposity Index; LAP, Lipid Accumulation Product; TG, Triglyceride; WC, Waist circumference; BMI, Body mass index; HDL-C, High-density lipoprotein cholesterol. Boxplots show the distribution of each variable by vitamin D status (Deficiency vs. Non-deficiency). The bold line inside each box represents the median, and the whiskers extend to the minimum and maximum values within 1.5 × IQR. p values were obtained using the Mann–Whitney U test for non-normally distributed variables (VAI, LAP, TG) and the independent t-test for normally distributed variables (WC, BMI, HDL-C).

https://doi.org/10.1371/journal.pone.0335507.g002

Linear regression analysis of vitamin D levels and VAI/LAP

Linear regression analysis identified significant inverse associations of vitamin D concentration with log-transformed VAI, LAP, and TG (log VAI: p < 0.001; log LAP: p = 0.019; log TG: p = 0.008). After adjustment, the associations remained significant for log VAI (p = 0.008) and log TG (p = 0.015), while the association with log LAP showed borderline significance (p = 0.060). In contrast, no significant associations were observed for WC, BMI, or HDL-C (Table 3).

Download:

Table 3. Linear association Between Vitamin D Concentration and Visceral Adiposity Index (VAI) and Lipid Accumulation Product (LAP).

https://doi.org/10.1371/journal.pone.0335507.t003

Discussion

This study identified significant associations between vitamin D levels and visceral fat indices (HWP, VAI, and LAP) in adolescents. Approximately 3 out of 4 participants (76.0%) were categorized as vitamin D deficiency (<20 ng/mL), with 19.3% showing severe deficiency (<12 ng/mL). Additionally, HWP was present in 7.1% of the participants. The findings indicated that adolescents in the non-deficiency group had a lower risk of HWP compared to those in the deficiency group. Additionally, higher vitamin D levels were inversely associated with VAI and LAP, suggesting a potential role of vitamin D in visceral fat regulation. These associations remained consistent even after excluding the three participants classified as vitamin D sufficient (≥30 ng/mL) (data not shown).

Previous studies have also reported associations between vitamin D and HWP. A study in Brazilian children aged 6–11 years found that vitamin D deficiency was associated with a 121% higher risk of HWP compared to sufficiency [33]. Similarly, a study in Iranian adults reported a 4-fold higher risk of HWP among vitamin D-deficiency individuals [23], and a study in Chinese patients with type 2 diabetes showed a nearly 6-fold higher HWP risk in the vitamin D-deficiency group [35]. Studies on the association of vitamin D with VAI and LAP have reported conflicting results. A study in Iranian adults found no significant association between vitamin D and VAI, but higher vitamin D levels were associated with a 2.07-fold higher risk of having a high LAP, showing a trend opposite to our findings [24]. In contrast, a study in Italian adults with type 2 diabetes and obesity found that higher vitamin D levels were associated with lower LAP in both groups [25]. Furthermore, a study in Iranian adults with metabolic syndrome reported that vitamin D insufficiency was linked to significantly higher levels of AIP and LAP, although no significant association was found with VAI [36]. Similarly, a study in healthy Korean adults found that higher vitamin D levels were significantly associated with lower visceral fat area (VFA), which aligns with our findings and supports a potential role of vitamin D in visceral fat reduction [37]. Additionally, a study in Brazil investigated the effects of vitamin D supplementation on visceral fat. Obese patients who underwent Roux-en-Y gastric bypass received either 800 IU/day or 1800 IU/day of vitamin D3 for 12 months, with the higher-dose group showing a significantly greater reduction in VAI (p = 0.001), indicating that vitamin D supplementation may contribute to visceral fat reduction [38].

Globally, vitamin D deficiency is recognized as a critical public health issue, with adolescents exhibiting the highest prevalence among all age groups. Despite the expectation of greater sun exposure during this life stage, vitamin D deficiency remains highly prevalent in children and adolescents worldwide, including Korea, where nearly 80% are affected [5,6]. Given the role of vitamin D in cardiometabolic health, its deficiency is a concern, with studies linking it to cardiovascular risk in children [39] and to metabolic syndrome in youth populations [40]. In particular, a study of adolescents and young adults at elevated risk of metabolic syndrome reported that low vitamin D levels were significantly associated with metabolic syndrome [40]. In parallel with widespread vitamin D deficiency, the prevalence of obesity, abdominal obesity, hypertension, and metabolic syndrome is rising among children and adolescents. These conditions increase the risk of insulin resistance, dyslipidemia, and cardiovascular diseases, often persisting into adulthood [8–10]. In this context, identifying modifiable factors to mitigate these risks is crucial, with vitamin D emerging as a potential candidate.

Vitamin D plays a role in multiple metabolic pathways that regulate visceral fat accumulation and obesity, which are major contributors to metabolic syndrome and cardiovascular disease. Visceral fat promotes chronic inflammation by increasing pro-inflammatory cytokines while decreasing anti-inflammatory cytokines, contributing to atherosclerosis and metabolic dysfunction. It also exacerbates insulin resistance and elevates triglyceride levels, thereby increasing cardiometabolic risk. Vitamin D may counteract these effects through multiple mechanisms, including promoting energy expenditure, reducing fat storage, and modulating inflammation and oxidative stress. Additionally, it influences lipid metabolism by lowering triglycerides and LDL-C while increasing HDL-C, potentially reducing the risk of cardiometabolic diseases. However, obesity itself may also contribute to vitamin D deficiency due to reduced physical activity and the sequestration of vitamin D in excess fat tissue. The precise mechanisms linking vitamin D, visceral fat, and obesity-related health risks remain unclear, warranting further investigation [12–13].

Vitamin D has a protective effect cardiometabolic health [41,42], and this study further supports this association. A significant relationship was observed between vitamin D levels and visceral fat indices, suggesting its potential role in cardiometabolic regulation. Despite data collection between April and August—outside the winter season when vitamin D levels are typically lower—76% of adolescents were vitamin D deficiency, and 98.7% had insufficient or deficiency levels (<30 ng/mL). This underscores the persistence of vitamin D deficiency even during adolescence, a life stage characterized by relatively high physical activity and sun exposure, emphasizing the necessity of targeted interventions. Consistently, a KNHANES-based study reported that nearly 80% of Korean adolescents had vitamin D deficiency (<20 ng/mL), with lifestyle factors such as limited outdoor activity highlighted as major contributors [43]. With the rising prevalence of young-onset obesity and visceral fat accumulation, cardiometabolic health concerns are escalating. Given vitamin D’s potential role in mitigating these risks, strategies such as promoting outdoor activity, improving dietary intake, and considering supplementation may be essential for supporting adolescent cardiometabolic health and mitigating the long-term burden of cardiometabolic diseases. Nutrition and broader dietary patterns have been shown to play a role in supporting cardiometabolic health [44–45]. However, research specifically focusing on vitamin D within these patterns remains insufficient, and further studies considering multiple influencing factors are needed.

This study has several limitations. As it is based on a birth cohort from a single hospital, the findings may not be generalizable to all adolescents. Potential information bias from measurement and survey responses could also affect the results. Additionally, the absence of body composition analysis prevented direct assessment of visceral adipose tissue (VAT), relying instead on indirect indices. As a cross-sectional study, it cannot establish causality and does not fully account for seasonal variations and other external factors. Finally, because the number of HWP events was small (7.1%), the post-hoc power for the logistic regression was limited (61.4%), indicating that larger-scale studies are needed to more reliably estimate odds ratios for this outcome.

Despite these limitations, this study is the first to investigate the relationship between vitamin D and visceral fat indices in adolescents. By integrating HWP, VAI, and LAP, this study provides a useful assessment of cardiometabolic health, with sensitivity analyses further strengthening the reliability of the findings. These results contribute to understanding adolescent cardiometabolic health and may inform preventive strategies to reduce long-term disease risk.

In conclusion, we found a significant association between vitamin D levels and visceral fat indices (HWP, VAI, and LAP) in adolescents, suggesting a potential role of vitamin D in cardiometabolic health. Given the high prevalence of vitamin D deficiency and the rising concern of young-onset obesity, assessing vitamin D levels in adolescents may be warranted to prevent cardiometabolic risk

Supporting information

S1 Fig. Distribution of HWP by Criteria and Vitamin D Status (Two Groups).

HWP, Hypertriglyceridemic Waist Phenotype; The criteria for HWP are as follows – HWP 1: Waist circumference (WC) ≥75th percentile and triglycerides (TG) ≥130 mg/dL. HWP 2: WC ≥ 75th percentile and TG ≥ 90 mg/dL. HWP 3: WC ≥ 90th percentile and TG ≥ 130 mg/dL. Vitamin D status was categorized as Deficiency (<20 ng/mL) and Non-Deficiency (≥20 ng/mL). ^*p-values are calculated using chi-square test.

https://doi.org/10.1371/journal.pone.0335507.s001

(TIF)

S2 Fig. Distribution of HWP by Criteria and Vitamin D Status (Three Groups).

HWP, Hypertriglyceridemic Waist Phenotype; The criteria for HWP are as follows – HWP 1: Waist circumference (WC) ≥75th percentile and triglycerides (TG) ≥130 mg/dL. HWP 2: WC ≥ 75th percentile and TG ≥ 90 mg/dL. HWP 3: WC ≥ 90th percentile and TG ≥ 130 mg/dL. Vitamin D status was categorized as Severe Deficiency (<12 ng/mL), Deficiency (12–19 ng/mL), and Non-Deficiency (≥20 ng/mL). ^*p-values are calculated using chi-square test ^†p for trend values are calculated using the Cochran-Armitage trend test to assess the trend across vitamin D categories.

https://doi.org/10.1371/journal.pone.0335507.s002

(TIF)

S1 Table. Distribution of covariates across vitamin D deficiency and non-deficiency groups.

Serum 25-hydroxyvitamin D [25(OH)D] was categorized as Non-deficiency (≥20 ng/mL) and Deficiency (<20 ng/mL). a Continuous variables were analyzed using the t-test. Categorical variables were analyzed using the chi-square test.

https://doi.org/10.1371/journal.pone.0335507.s003

(DOCX)

S2 Table. Logistic Regression Analysis of the Association Between HWP and Vitamin D Status (Two Groups).

HWP, Hypertriglyceridemic Waist Phenotype; OR, Odds Ratio; 95% CI, 95% Confidence Interval. ^aThe criteria for HWP are as follows – HWP 1: Waist circumference (WC) ≥75th percentile and triglycerides (TG) ≥130 mg/dL (n = 17). HWP 2: WC ≥ 75th percentile and TG ≥ 90 mg/dL (n = 30). HWP 3: WC ≥ 90th percentile and TG ≥ 130 mg/dL (n = 8). ^bVitamin D status was categorized as Deficiency (<20 ng/mL) and Non-Deficiency (≥20 ng/mL). ^cAdjusted for sex, monthly household income, moderate physical activity, total energy intake, and supplement use at the age of 13–15 years.

https://doi.org/10.1371/journal.pone.0335507.s004

(DOCX)

S3 Table. Logistic Regression Analysis of the Association Between HWP and Vitamin D Status (Three Groups).

HWP, Hypertriglyceridemic Waist Phenotype; OR, Odds Ratio; 95% CI, 95% Confidence Interval. ^aThe criteria for HWP are as follows – HWP 1: Waist circumference (WC) ≥75th percentile and triglycerides (TG) ≥130 mg/dL (n = 17). HWP 2: WC ≥ 75th percentile and TG ≥ 90 mg/dL (n = 30). HWP 3: WC ≥ 90th percentile and TG ≥ 130 mg/dL (n = 8). ^bVitamin D status was categorized as Severe Deficiency (<12 ng/mL), Deficiency (12–19 ng/mL), and Non-Deficiency (≥20 ng/mL). ^c Adjusted for sex, monthly household income, moderate physical activity, average energy intake, and supplement use at the age of 13–15 years.

https://doi.org/10.1371/journal.pone.0335507.s005

(DOCX)

References

1. Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 2016;96(1):365–408. pmid:26681795
- View Article
- PubMed/NCBI
- Google Scholar
2. Anglin RES, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013;202:100–7. pmid:23377209
- View Article
- PubMed/NCBI
- Google Scholar
3. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S-6S. pmid:18400738
- View Article
- PubMed/NCBI
- Google Scholar
4. Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11):1498–513. pmid:31959942
- View Article
- PubMed/NCBI
- Google Scholar
5. Dunlop E, Pham NM, Van Hoang D, Mazahery H, Neo B, Shrapnel J, et al. A systematic review and meta-analysis of circulating 25-hydroxyvitamin D concentration and vitamin D status worldwide. J Public Health (Oxf). 2025;:fdaf080. pmid:40652566
- View Article
- PubMed/NCBI
- Google Scholar
6. Lee A, Kim SH, Nam CM, Kim Y-J, Joo S-H, Lee K-R. Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors. Lab Med Online. 2016;6(2):70.
- View Article
- Google Scholar
7. Park J-H, Hong IY, Chung JW, Choi HS. Vitamin D status in South Korean population: Seven-year trend from the KNHANES. Medicine (Baltimore). 2018;97(26):e11032. pmid:29952942
- View Article
- PubMed/NCBI
- Google Scholar
8. Jeong S-M, Jung J-H, Yang YS, Kim W, Cho IY, Lee Y-B, et al. 2023 Obesity Fact Sheet: Prevalence of Obesity and Abdominal Obesity in Adults, Adolescents, and Children in Korea from 2012 to 2021. J Obes Metab Syndr. 2024;33(1):27–35. pmid:38531533
- View Article
- PubMed/NCBI
- Google Scholar
9. Lee J, Kang S-C, Kwon O, Hwang S-S, Moon JS, Chae HW, et al. Temporal Trends of the Prevalence of Abdominal Obesity and Metabolic Syndrome in Korean Children and Adolescents between 2007 and 2020. J Obes Metab Syndr. 2023;32(2):170–8. pmid:37073728
- View Article
- PubMed/NCBI
- Google Scholar
10. Park PG, Park E, Kang HG. Increasing trend in hypertension prevalence among Korean adolescents from 2007 to 2020. BMC Public Health. 2024;24(1):617. pmid:38409007
- View Article
- PubMed/NCBI
- Google Scholar
11. Ouchi N. Adipocytokines in cardiovascular and metabolic diseases. J Atheroscler Thromb. 2016;23(6):645–54. pmid:27087513
- View Article
- PubMed/NCBI
- Google Scholar
12. Surdu AM, Pînzariu O, Ciobanu D-M, Negru A-G, Căinap S-S, Lazea C, et al. Vitamin D and its role in the lipid metabolism and the development of atherosclerosis. Biomedicines. 2021;9(2):172. pmid:33572397
- View Article
- PubMed/NCBI
- Google Scholar
13. Mutt SJ, Hyppönen E, Saarnio J, Järvelin M-R, Herzig K-H. Vitamin D and adipose tissue-more than storage. Front Physiol. 2014;5:228. pmid:25009502
- View Article
- PubMed/NCBI
- Google Scholar
14. Lemieux I, Poirier P, Bergeron J, Alméras N, Lamarche B, Cantin B, et al. Hypertriglyceridemic waist: a useful screening phenotype in preventive cardiology? Can J Cardiol. 2007;23 Suppl B(Suppl B):23B-31B. pmid:17932584
- View Article
- PubMed/NCBI
- Google Scholar
15. Buchan DS, Boddy LM, Despres J-P, Grace FM, Sculthorpe N, Mahoney C, et al. Utility of the hypertriglyceridemic waist phenotype in the cardiometabolic risk assessment of youth stratified by body mass index. Pediatr Obes. 2016;11(4):292–8. pmid:26251875
- View Article
- PubMed/NCBI
- Google Scholar
16. Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Alméras N, et al. Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?. Circulation. 2000;102(2):179–84. pmid:10889128
- View Article
- PubMed/NCBI
- Google Scholar
17. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–2. pmid:20067971
- View Article
- PubMed/NCBI
- Google Scholar
18. Nascimento-Ferreira MV, Rendo-Urteaga T, Vilanova-Campelo RC, Carvalho HB, da Paz Oliveira G, Paes Landim MB, et al. The lipid accumulation product is a powerful tool to predict metabolic syndrome in undiagnosed Brazilian adults. Clin Nutr. 2017;36(6):1693–700. pmid:28081980
- View Article
- PubMed/NCBI
- Google Scholar
19. Mattsson N, Rönnemaa T, Juonala M, Viikari JSA, Raitakari OT. Childhood predictors of the metabolic syndrome in adulthood. The Cardiovascular Risk in Young Finns Study. Ann Med. 2008;40(7):542–52. pmid:18728920
- View Article
- PubMed/NCBI
- Google Scholar
20. Cai R, Zhou J, Bai L, Dong Y, Ding W. Hypertriglyceridemic-waist phenotype is strongly associated with cardiovascular risk factor clustering in Chinese adolescents. Sci Rep. 2022;12(1):15464. pmid:36104430
- View Article
- PubMed/NCBI
- Google Scholar
21. Dong Y, Bai L, Cai R, Zhou J, Ding W. Visceral adiposity index performed better than traditional adiposity indicators in predicting unhealthy metabolic phenotype among Chinese children and adolescents. Sci Rep. 2021;11(1):23850. pmid:34903825
- View Article
- PubMed/NCBI
- Google Scholar
22. Chen Z-Y, Liu L, Zhuang X-X, Zhang Y-C, Ma Y-N, Liu Y, et al. Lipid accumulation product is a better predictor of metabolic syndrome in Chinese adolescents: a cross-sectional study. Front Endocrinol (Lausanne). 2023;14:1179990. pmid:37424867
- View Article
- PubMed/NCBI
- Google Scholar
23. Rashidbeygi E, Rahimi MH, Mollahosseini M, Yekaninejad MS, Imani H, Maghbooli Z, et al. Associations of vitamin D status and metabolic dyslipidemia and hypertriglyceridemic waist phenotype in apparently healthy adults. Diabetes Metab Syndr. 2018;12(6):985–90. pmid:29983347
- View Article
- PubMed/NCBI
- Google Scholar
24. Bazshahi E, Pourreza S, Ghanbari M, Khademi Z, Amini MR, Djafarian K, et al. Association of Vitamin D status with Visceral Adiposity Index and Lipid Accumulation Product Index among a Group of Iranian People. Clin Nutr Res. 2021;10(2):150–60. pmid:33987141
- View Article
- PubMed/NCBI
- Google Scholar
25. Bardini G, Giannini S, Romano D, Rotella CM, Mannucci E. Lipid accumulation product and 25-OH-vitamin D deficiency in type 2 diabetes. Rev Diabet Stud. 2013;10(4):243–51. pmid:24841878
- View Article
- PubMed/NCBI
- Google Scholar
26. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. pmid:30169257
- View Article
- PubMed/NCBI
- Google Scholar
27. Lee HA, Park B, Min J, Choi EJ, Kim UJ, Park HJ, et al. Cohort profile: the Ewha Birth and Growth Study. Epidemiol Health. 2021;43:e2021016. pmid:33677859
- View Article
- PubMed/NCBI
- Google Scholar
28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30. pmid:21646368
- View Article
- PubMed/NCBI
- Google Scholar
29. Arnanz A, De Munck N, El Khatib I, Bayram A, Abdala A, Melado L, et al. Vitamin D in follicular fluid correlates with the euploid status of blastocysts in a Vitamin D deficient population. Front Endocrinol (Lausanne). 2021;11:609524. pmid:33584542
- View Article
- PubMed/NCBI
- Google Scholar
30. Im Y-G, Han M-Y, Baek H-S. Association of Serum Vitamin D Level with Temporomandibular Disorder Incidence: A Retrospective, Multi-Center Cohort Study Using Six Hospital Databases. Nutrients. 2023;15(13):2860. pmid:37447187
- View Article
- PubMed/NCBI
- Google Scholar
31. Korea Centers for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents. Korean Children and Adolescents Growth Standard: Commentary for the Development of 2007 Growth Chart. Seoul: Korea Centers for Disease Control and Prevention. 2007. https://www.kdca.go.kr
32. Lim JS, Kim EY, Kim JH, Yoo JH, Yi KH, Chae HW, et al. Committee of Dyslipidemia of Korean Children and Adolescents of the Korean Society of Pediatric Endocrinology. 2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents. Clin Exp Pediatr. 2020;63(12):454–62.
- View Article
- Google Scholar
33. Milagres LC, Filgueiras MDS, Rocha NP, Juvanhol LL, Franceschini S do CC, Farias de Novaes J. Vitamin D is associated with the hypertriglyceridemic waist phenotype in Brazilian children. J Public Health (Oxf). 2021;43(4):e570–7. pmid:32323726
- View Article
- PubMed/NCBI
- Google Scholar
34. Dikaiakou E, Athanasouli F, Fotiadou A, Kafetzi M, Fakiolas S, Michalacos S, et al. Hypertriglyceridemic waist phenotype and its association with metabolic syndrome components, among greek children with excess body weight. Metabolites. 2023;13(2):230. pmid:36837848
- View Article
- PubMed/NCBI
- Google Scholar
35. Ma C-M, Yin F-Z. The relationship between hypertriglyceridemic-waist phenotype and vitamin D status in type 2 diabetes. Diabetes Metab Syndr Obes. 2019;12:537–43. pmid:31118717
- View Article
- PubMed/NCBI
- Google Scholar
36. Amirkhizi F, Khademi Z, Hamedi Shahraki S, Rahimlou M. Vitamin D insufficiency and its association with adipokines and atherogenic indices in patients with metabolic syndrome: a case-control study. Front Endocrinol (Lausanne). 2023;14:1080138. pmid:36742396
- View Article
- PubMed/NCBI
- Google Scholar
37. Paek JK, Won JH, Shin HR, Kim DY, Kim K, Lee SY. Association between Vitamin D Concentration and Visceral Fat Area in Healthy Korean Adults. Korean J Health Promot. 2017;17(3):129.
- View Article
- Google Scholar
38. Cordeiro A, Pereira SE, Saboya CJ, Ramalho A. Vitamin D Supplementation and Its Relationship with Loss of Visceral Adiposity. Obes Surg. 2022;32(10):3419–25. pmid:35953634
- View Article
- PubMed/NCBI
- Google Scholar
39. Murni IK, Sulistyoningrum DC, Oktaria V. Association of vitamin D deficiency with cardiovascular disease risk in children: implications for the Asia Pacific Region. Asia Pac J Clin Nutr. 2016;25(Suppl 1):S8–19. pmid:28027627
- View Article
- PubMed/NCBI
- Google Scholar
40. Fu J, Han L, Zhao Y, Li G, Zhu Y, Li Y, et al. Vitamin D levels are associated with metabolic syndrome in adolescents and young adults: The BCAMS study. Clin Nutr. 2019;38(5):2161–7. pmid:30236482
- View Article
- PubMed/NCBI
- Google Scholar
41. Wang C. Role of vitamin d in cardiometabolic diseases. J Diabetes Res. 2013;2013:243934. pmid:23671861
- View Article
- PubMed/NCBI
- Google Scholar
42. Judd SE, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci. 2009;338(1):40–4. pmid:19593102
- View Article
- PubMed/NCBI
- Google Scholar
43. Song K, Kwon A, Chae HW, Suh J, Choi HS, Choi Y, et al. Vitamin D status is associated with bone mineral density in adolescents: Findings from the Korea National Health and Nutrition Examination Survey. Nutr Res. 2021;87:13–21. pmid:33596507
- View Article
- PubMed/NCBI
- Google Scholar
44. Amirkhizi F, Hamedi-Shahraki S, Rahimlou M. Dietary total antioxidant capacity is associated with lower disease severity and inflammatory and oxidative stress biomarkers in patients with knee osteoarthritis. J Health Popul Nutr. 2023;42(1):104. pmid:37770996
- View Article
- PubMed/NCBI
- Google Scholar
45. Hashemi R, Mehdizadeh Khalifani A, Rahimlou M, Manafi M. Comparison of the effect of Dietary Approaches to Stop Hypertension diet and american diabetes association nutrition guidelines on lipid profiles in patients with type 2 diabetes: A comparative clinical trial. Nutr Diet. 2020;77(2):204–11. pmid:31162810
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 2016;96(1):365–408. pmid:26681795
View Article
PubMed/NCBI
Google Scholar

[2] View Article

[3] PubMed/NCBI

[4] Google Scholar

[ref2] 2. Anglin RES, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013;202:100–7. pmid:23377209
View Article
PubMed/NCBI
Google Scholar

[6] View Article

[7] PubMed/NCBI

[8] Google Scholar

[ref3] 3. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S-6S. pmid:18400738
View Article
PubMed/NCBI
Google Scholar

[10] View Article

[11] PubMed/NCBI

[12] Google Scholar

[ref4] 4. Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11):1498–513. pmid:31959942
View Article
PubMed/NCBI
Google Scholar

[14] View Article

[15] PubMed/NCBI

[16] Google Scholar

[ref5] 5. Dunlop E, Pham NM, Van Hoang D, Mazahery H, Neo B, Shrapnel J, et al. A systematic review and meta-analysis of circulating 25-hydroxyvitamin D concentration and vitamin D status worldwide. J Public Health (Oxf). 2025;:fdaf080. pmid:40652566
View Article
PubMed/NCBI
Google Scholar

[18] View Article

[19] PubMed/NCBI

[20] Google Scholar

[ref6] 6. Lee A, Kim SH, Nam CM, Kim Y-J, Joo S-H, Lee K-R. Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors. Lab Med Online. 2016;6(2):70.
View Article
Google Scholar

[22] View Article

[23] Google Scholar

[ref7] 7. Park J-H, Hong IY, Chung JW, Choi HS. Vitamin D status in South Korean population: Seven-year trend from the KNHANES. Medicine (Baltimore). 2018;97(26):e11032. pmid:29952942
View Article
PubMed/NCBI
Google Scholar

[25] View Article

[26] PubMed/NCBI

[27] Google Scholar

[ref8] 8. Jeong S-M, Jung J-H, Yang YS, Kim W, Cho IY, Lee Y-B, et al. 2023 Obesity Fact Sheet: Prevalence of Obesity and Abdominal Obesity in Adults, Adolescents, and Children in Korea from 2012 to 2021. J Obes Metab Syndr. 2024;33(1):27–35. pmid:38531533
View Article
PubMed/NCBI
Google Scholar

[29] View Article

[30] PubMed/NCBI

[31] Google Scholar

[ref9] 9. Lee J, Kang S-C, Kwon O, Hwang S-S, Moon JS, Chae HW, et al. Temporal Trends of the Prevalence of Abdominal Obesity and Metabolic Syndrome in Korean Children and Adolescents between 2007 and 2020. J Obes Metab Syndr. 2023;32(2):170–8. pmid:37073728
View Article
PubMed/NCBI
Google Scholar

[33] View Article

[34] PubMed/NCBI

[35] Google Scholar

[ref10] 10. Park PG, Park E, Kang HG. Increasing trend in hypertension prevalence among Korean adolescents from 2007 to 2020. BMC Public Health. 2024;24(1):617. pmid:38409007
View Article
PubMed/NCBI
Google Scholar

[37] View Article

[38] PubMed/NCBI

[39] Google Scholar

[ref11] 11. Ouchi N. Adipocytokines in cardiovascular and metabolic diseases. J Atheroscler Thromb. 2016;23(6):645–54. pmid:27087513
View Article
PubMed/NCBI
Google Scholar

[41] View Article

[42] PubMed/NCBI

[43] Google Scholar

[ref12] 12. Surdu AM, Pînzariu O, Ciobanu D-M, Negru A-G, Căinap S-S, Lazea C, et al. Vitamin D and its role in the lipid metabolism and the development of atherosclerosis. Biomedicines. 2021;9(2):172. pmid:33572397
View Article
PubMed/NCBI
Google Scholar

[45] View Article

[46] PubMed/NCBI

[47] Google Scholar

[ref13] 13. Mutt SJ, Hyppönen E, Saarnio J, Järvelin M-R, Herzig K-H. Vitamin D and adipose tissue-more than storage. Front Physiol. 2014;5:228. pmid:25009502
View Article
PubMed/NCBI
Google Scholar

[49] View Article

[50] PubMed/NCBI

[51] Google Scholar

[ref14] 14. Lemieux I, Poirier P, Bergeron J, Alméras N, Lamarche B, Cantin B, et al. Hypertriglyceridemic waist: a useful screening phenotype in preventive cardiology? Can J Cardiol. 2007;23 Suppl B(Suppl B):23B-31B. pmid:17932584
View Article
PubMed/NCBI
Google Scholar

[53] View Article

[54] PubMed/NCBI

[55] Google Scholar

[ref15] 15. Buchan DS, Boddy LM, Despres J-P, Grace FM, Sculthorpe N, Mahoney C, et al. Utility of the hypertriglyceridemic waist phenotype in the cardiometabolic risk assessment of youth stratified by body mass index. Pediatr Obes. 2016;11(4):292–8. pmid:26251875
View Article
PubMed/NCBI
Google Scholar

[57] View Article

[58] PubMed/NCBI

[59] Google Scholar

[ref16] 16. Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Alméras N, et al. Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?. Circulation. 2000;102(2):179–84. pmid:10889128
View Article
PubMed/NCBI
Google Scholar

[61] View Article

[62] PubMed/NCBI

[63] Google Scholar

[ref17] 17. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–2. pmid:20067971
View Article
PubMed/NCBI
Google Scholar

[65] View Article

[66] PubMed/NCBI

[67] Google Scholar

[ref18] 18. Nascimento-Ferreira MV, Rendo-Urteaga T, Vilanova-Campelo RC, Carvalho HB, da Paz Oliveira G, Paes Landim MB, et al. The lipid accumulation product is a powerful tool to predict metabolic syndrome in undiagnosed Brazilian adults. Clin Nutr. 2017;36(6):1693–700. pmid:28081980
View Article
PubMed/NCBI
Google Scholar

[69] View Article

[70] PubMed/NCBI

[71] Google Scholar

[ref19] 19. Mattsson N, Rönnemaa T, Juonala M, Viikari JSA, Raitakari OT. Childhood predictors of the metabolic syndrome in adulthood. The Cardiovascular Risk in Young Finns Study. Ann Med. 2008;40(7):542–52. pmid:18728920
View Article
PubMed/NCBI
Google Scholar

[73] View Article

[74] PubMed/NCBI

[75] Google Scholar

[ref20] 20. Cai R, Zhou J, Bai L, Dong Y, Ding W. Hypertriglyceridemic-waist phenotype is strongly associated with cardiovascular risk factor clustering in Chinese adolescents. Sci Rep. 2022;12(1):15464. pmid:36104430
View Article
PubMed/NCBI
Google Scholar

[77] View Article

[78] PubMed/NCBI

[79] Google Scholar

[ref21] 21. Dong Y, Bai L, Cai R, Zhou J, Ding W. Visceral adiposity index performed better than traditional adiposity indicators in predicting unhealthy metabolic phenotype among Chinese children and adolescents. Sci Rep. 2021;11(1):23850. pmid:34903825
View Article
PubMed/NCBI
Google Scholar

[81] View Article

[82] PubMed/NCBI

[83] Google Scholar

[ref22] 22. Chen Z-Y, Liu L, Zhuang X-X, Zhang Y-C, Ma Y-N, Liu Y, et al. Lipid accumulation product is a better predictor of metabolic syndrome in Chinese adolescents: a cross-sectional study. Front Endocrinol (Lausanne). 2023;14:1179990. pmid:37424867
View Article
PubMed/NCBI
Google Scholar

[85] View Article

[86] PubMed/NCBI

[87] Google Scholar

[ref23] 23. Rashidbeygi E, Rahimi MH, Mollahosseini M, Yekaninejad MS, Imani H, Maghbooli Z, et al. Associations of vitamin D status and metabolic dyslipidemia and hypertriglyceridemic waist phenotype in apparently healthy adults. Diabetes Metab Syndr. 2018;12(6):985–90. pmid:29983347
View Article
PubMed/NCBI
Google Scholar

[89] View Article

[90] PubMed/NCBI

[91] Google Scholar

[ref24] 24. Bazshahi E, Pourreza S, Ghanbari M, Khademi Z, Amini MR, Djafarian K, et al. Association of Vitamin D status with Visceral Adiposity Index and Lipid Accumulation Product Index among a Group of Iranian People. Clin Nutr Res. 2021;10(2):150–60. pmid:33987141
View Article
PubMed/NCBI
Google Scholar

[93] View Article

[94] PubMed/NCBI

[95] Google Scholar

[ref25] 25. Bardini G, Giannini S, Romano D, Rotella CM, Mannucci E. Lipid accumulation product and 25-OH-vitamin D deficiency in type 2 diabetes. Rev Diabet Stud. 2013;10(4):243–51. pmid:24841878
View Article
PubMed/NCBI
Google Scholar

[97] View Article

[98] PubMed/NCBI

[99] Google Scholar

[ref26] 26. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. pmid:30169257
View Article
PubMed/NCBI
Google Scholar

[101] View Article

[102] PubMed/NCBI

[103] Google Scholar

[ref27] 27. Lee HA, Park B, Min J, Choi EJ, Kim UJ, Park HJ, et al. Cohort profile: the Ewha Birth and Growth Study. Epidemiol Health. 2021;43:e2021016. pmid:33677859
View Article
PubMed/NCBI
Google Scholar

[105] View Article

[106] PubMed/NCBI

[107] Google Scholar

[ref28] 28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30. pmid:21646368
View Article
PubMed/NCBI
Google Scholar

[109] View Article

[110] PubMed/NCBI

[111] Google Scholar

[ref29] 29. Arnanz A, De Munck N, El Khatib I, Bayram A, Abdala A, Melado L, et al. Vitamin D in follicular fluid correlates with the euploid status of blastocysts in a Vitamin D deficient population. Front Endocrinol (Lausanne). 2021;11:609524. pmid:33584542
View Article
PubMed/NCBI
Google Scholar

[113] View Article

[114] PubMed/NCBI

[115] Google Scholar

[ref30] 30. Im Y-G, Han M-Y, Baek H-S. Association of Serum Vitamin D Level with Temporomandibular Disorder Incidence: A Retrospective, Multi-Center Cohort Study Using Six Hospital Databases. Nutrients. 2023;15(13):2860. pmid:37447187
View Article
PubMed/NCBI
Google Scholar

[117] View Article

[118] PubMed/NCBI

[119] Google Scholar

[ref31] 31. Korea Centers for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents. Korean Children and Adolescents Growth Standard: Commentary for the Development of 2007 Growth Chart. Seoul: Korea Centers for Disease Control and Prevention. 2007. https://www.kdca.go.kr

[ref32] 32. Lim JS, Kim EY, Kim JH, Yoo JH, Yi KH, Chae HW, et al. Committee of Dyslipidemia of Korean Children and Adolescents of the Korean Society of Pediatric Endocrinology. 2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents. Clin Exp Pediatr. 2020;63(12):454–62.
View Article
Google Scholar

[122] View Article

[123] Google Scholar

[ref33] 33. Milagres LC, Filgueiras MDS, Rocha NP, Juvanhol LL, Franceschini S do CC, Farias de Novaes J. Vitamin D is associated with the hypertriglyceridemic waist phenotype in Brazilian children. J Public Health (Oxf). 2021;43(4):e570–7. pmid:32323726
View Article
PubMed/NCBI
Google Scholar

[125] View Article

[126] PubMed/NCBI

[127] Google Scholar

[ref34] 34. Dikaiakou E, Athanasouli F, Fotiadou A, Kafetzi M, Fakiolas S, Michalacos S, et al. Hypertriglyceridemic waist phenotype and its association with metabolic syndrome components, among greek children with excess body weight. Metabolites. 2023;13(2):230. pmid:36837848
View Article
PubMed/NCBI
Google Scholar

[129] View Article

[130] PubMed/NCBI

[131] Google Scholar

[ref35] 35. Ma C-M, Yin F-Z. The relationship between hypertriglyceridemic-waist phenotype and vitamin D status in type 2 diabetes. Diabetes Metab Syndr Obes. 2019;12:537–43. pmid:31118717
View Article
PubMed/NCBI
Google Scholar

[133] View Article

[134] PubMed/NCBI

[135] Google Scholar

[ref36] 36. Amirkhizi F, Khademi Z, Hamedi Shahraki S, Rahimlou M. Vitamin D insufficiency and its association with adipokines and atherogenic indices in patients with metabolic syndrome: a case-control study. Front Endocrinol (Lausanne). 2023;14:1080138. pmid:36742396
View Article
PubMed/NCBI
Google Scholar

[137] View Article

[138] PubMed/NCBI

[139] Google Scholar

[ref37] 37. Paek JK, Won JH, Shin HR, Kim DY, Kim K, Lee SY. Association between Vitamin D Concentration and Visceral Fat Area in Healthy Korean Adults. Korean J Health Promot. 2017;17(3):129.
View Article
Google Scholar

[141] View Article

[142] Google Scholar

[ref38] 38. Cordeiro A, Pereira SE, Saboya CJ, Ramalho A. Vitamin D Supplementation and Its Relationship with Loss of Visceral Adiposity. Obes Surg. 2022;32(10):3419–25. pmid:35953634
View Article
PubMed/NCBI
Google Scholar

[144] View Article

[145] PubMed/NCBI

[146] Google Scholar

[ref39] 39. Murni IK, Sulistyoningrum DC, Oktaria V. Association of vitamin D deficiency with cardiovascular disease risk in children: implications for the Asia Pacific Region. Asia Pac J Clin Nutr. 2016;25(Suppl 1):S8–19. pmid:28027627
View Article
PubMed/NCBI
Google Scholar

[148] View Article

[149] PubMed/NCBI

[150] Google Scholar

[ref40] 40. Fu J, Han L, Zhao Y, Li G, Zhu Y, Li Y, et al. Vitamin D levels are associated with metabolic syndrome in adolescents and young adults: The BCAMS study. Clin Nutr. 2019;38(5):2161–7. pmid:30236482
View Article
PubMed/NCBI
Google Scholar

[152] View Article

[153] PubMed/NCBI

[154] Google Scholar

[ref41] 41. Wang C. Role of vitamin d in cardiometabolic diseases. J Diabetes Res. 2013;2013:243934. pmid:23671861
View Article
PubMed/NCBI
Google Scholar

[156] View Article

[157] PubMed/NCBI

[158] Google Scholar

[ref42] 42. Judd SE, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci. 2009;338(1):40–4. pmid:19593102
View Article
PubMed/NCBI
Google Scholar

[160] View Article

[161] PubMed/NCBI

[162] Google Scholar

[ref43] 43. Song K, Kwon A, Chae HW, Suh J, Choi HS, Choi Y, et al. Vitamin D status is associated with bone mineral density in adolescents: Findings from the Korea National Health and Nutrition Examination Survey. Nutr Res. 2021;87:13–21. pmid:33596507
View Article
PubMed/NCBI
Google Scholar

[164] View Article

[165] PubMed/NCBI

[166] Google Scholar

[ref44] 44. Amirkhizi F, Hamedi-Shahraki S, Rahimlou M. Dietary total antioxidant capacity is associated with lower disease severity and inflammatory and oxidative stress biomarkers in patients with knee osteoarthritis. J Health Popul Nutr. 2023;42(1):104. pmid:37770996
View Article
PubMed/NCBI
Google Scholar

[168] View Article

[169] PubMed/NCBI

[170] Google Scholar

[ref45] 45. Hashemi R, Mehdizadeh Khalifani A, Rahimlou M, Manafi M. Comparison of the effect of Dietary Approaches to Stop Hypertension diet and american diabetes association nutrition guidelines on lipid profiles in patients with type 2 diabetes: A comparative clinical trial. Nutr Diet. 2020;77(2):204–11. pmid:31162810
View Article
PubMed/NCBI
Google Scholar

[172] View Article

[173] PubMed/NCBI

[174] Google Scholar

Figures

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Materials and methods

Study participants

Anthropometric and blood biomarkers

Measurement of vitamin D

Definition of visceral fat indices

Covariates

Statistical analysis

Sensitivity analysis

Results

General characteristics of study participants

HWP Prevalence by vitamin D status

Logistic regression analysis of vitamin D status and HWP

Comparison of Visceral Fat Indices by Vitamin D Status

Linear regression analysis of vitamin D levels and VAI/LAP

Discussion

Supporting information

S1 Fig. Distribution of HWP by Criteria and Vitamin D Status (Two Groups).

S2 Fig. Distribution of HWP by Criteria and Vitamin D Status (Three Groups).

S1 Table. Distribution of covariates across vitamin D deficiency and non-deficiency groups.

S2 Table. Logistic Regression Analysis of the Association Between HWP and Vitamin D Status (Two Groups).

S3 Table. Logistic Regression Analysis of the Association Between HWP and Vitamin D Status (Three Groups).

References