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Serum 25-hydroxyvitamin D mediates the association of Triglyceride–glucose index with hypertension in US adults from NHANES 2001–2018: a national cross-sectional study

Published online by Cambridge University Press:  24 March 2025

Jing Lu
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
Mengying Cao
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
Xiaoxue Zhang
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
Wenhao Zhong
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
Jie Yuan*
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
Yunzeng Zou*
Affiliation:
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, People’s Republic of China
*
Corresponding authors: Jie Yuan; Email: [email protected], Yunzeng Zou; Email: [email protected]
Corresponding authors: Jie Yuan; Email: [email protected], Yunzeng Zou; Email: [email protected]

Abstract

This study was designed to explore the mediating role of serum 25-hydroxyvitamin D (25(OH) D) in Triglyceride–glucose (TyG) index and hypertension (HTN). Study participants were selected from the 2001 to 2018 National Health and Nutrition Examination Survey. Firstly, we estimated the association between TyG index and serum 25(OH)D with HTN using a weighted multivariable logistic regression model and restricted cubic spline. Secondly, we used a generalised additive model to investigate the correlation between TyG index and serum 25(OH)D. Lastly, serum 25(OH)D was investigated as a mediator in the association between TyG index and HTN. There were 14 099 subjects in total. TyG index was positively and linearly associated with HTN risk, while serum 25(OH)D had a U-shaped relationship with the prevalence of HTN. When the serum 25(OH)D levels were lower than 57·464 mmol/l, the prevalence of HTN decreased with the increase of serum 25(OH)D levels. When serum 25(OH)D levels rise above 57·464 mmol/l, the risk of HTN increases rapidly. Based on the U-shaped curve, serum 25(OH)D concentrations were divided into two groups: < 57·464 and ≥57·464 mmol/l. According to the mediation analysis, when serum 25(OH)D levels reached < 57·464 mmol/l, the positive association between the TyG index and incident HTN was increased by 25(OH)D. When serum 25(OH)D levels reached ≥ 57·464 mmol/l, the negative association between the TyG index and incident HTN was increased by 25(OH)D. There was a mediation effect between the TyG index and HTN, which was mediated by 25(OH)D. Therefore, we found that the association between serum 25(OH)D levels and TyG index may influence the prevalence of HTN.

Type
Research Article
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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Footnotes

*

Jing Lu and Mengying Cao contributed equally to this work

References

Liu, J, Bu, X, Wei, L, et al. (2021) Global burden of cardiovascular diseases attributable to hypertension in young adults from 1990 to 2019. J Hypertens 39, 24882496.Google Scholar
Hou, XZ, Lv, YF, Li, YS, et al. (2024) Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study. Cardiovasc Diabetol 23, 86.Google Scholar
Zhou, B, Carrillo-Larco, RM, Danaei, G, et al. (2021) Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 398, 957980.Google Scholar
Mills, KT, Stefanescu, A & He, J (2020) The global epidemiology of hypertension. Nat Rev Nephrol 16, 223237.Google Scholar
Murray, CJL, Aravkin, AY, Zheng, P, et al. (2020) Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 12231249.Google Scholar
Whelton, PK, Carey, RM, Mancia, G, et al. (2022) Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines: comparisons, reflections, and recommendations. J Am Coll Cardiol 80, 11921201.Google Scholar
Guerrero-Romero, F, Simental-Mendía, LE, González-Ortiz, M, et al. (2010) The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 95, 33473351.Google Scholar
Simental-Mendía, LE, Rodríguez-Morán, M & Guerrero-Romero, F (2008) The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 6, 299304.Google Scholar
Khan, SH, Sobia, F, Niazi, NK, et al. (2018) Metabolic clustering of risk factors: evaluation of Triglyceride-glucose index (TyG index) for evaluation of insulin resistance. Diabetol Metab Syndr 10, 74.Google Scholar
Hill, MA, Yang, Y, Zhang, L, et al. (2021) Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 119, 154766.Google Scholar
Han, YY, Forno, E & Celedón, JC (2017) Vitamin D insufficiency and asthma in a US nationwide study. J Allergy Clin Immunol Pract 5, 790796.e1.Google Scholar
Zhou, D, Liu, XC, Kenneth, L, et al. (2021) A non-linear association of triglyceride glycemic index with cardiovascular and all-cause mortality among patients with hypertension. Front Cardiovasc Med 8, 778038.Google Scholar
Yang, S, Shi, X, Liu, W, et al. (2023) Association between triglyceride glucose-body mass index and heart failure in subjects with diabetes mellitus or prediabetes mellitus: a cross-sectional study. Front Endocrinol 14, 1294909.Google Scholar
Lee, SB, Ahn, CW, Lee, BK, et al. (2018) Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol 17, 41.Google Scholar
Thai, PV, Tien, HA, Van Minh, H, et al. (2020) Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes. Cardiovasc Diabetol 19, 137.Google Scholar
Holick, MF (2007) Vitamin D deficiency. N Engl J Med 357, 266281.Google Scholar
Li, A, Yi, B, Han, H, et al. (2022) Vitamin D-VDR (vitamin D receptor) regulates defective autophagy in renal tubular epithelial cell in streptozotocin-induced diabetic mice via the AMPK pathway. Autophagy 18, 877890.Google Scholar
Dobnig, H, Pilz, S, Scharnagl, H, et al. (2008) Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med 168, 13401349.Google Scholar
Melamed, ML, Michos, ED, Post, W, et al. (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168, 16291637.Google Scholar
Wan, Z, Guo, J, Pan, A, et al. (2021) Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes. Diabetes Care 44, 350357.Google Scholar
Wang, B, Yang, Y & Li, X (2022) Interaction of hypertension and insulin resistance exacerbates the occurrence of diabetes mellitus in healthy individuals. J Diabetes Res 2022, 9289812.Google Scholar
Papakonstantinou, E, Zacharodimos, N, Georgiopoulos, G, et al. (2024) Two-month consumption of orange juice enriched with vitamin D3 and probiotics decreases body weight, insulin resistance, blood lipids, and arterial blood pressure in high-cardiometabolic-risk patients on a westernized type diet: results from a randomized clinical trial. Nutrients 16, 1331.Google Scholar
Xiao, S, Wang, Z, Zuo, R, et al. (2023) Association of systemic immune inflammation index with all-cause, cardiovascular disease, and cancer-related mortality in patients with cardiovascular disease: a cross-sectional study. J Inflammation Res 16, 941961.Google Scholar
Xiao, S, Wang, X, Zhang, G, et al. (2023) Association of systemic immune inflammation index with estimated pulse wave velocity, atherogenic index of plasma, triglyceride-glucose index, and cardiovascular disease: a large cross-sectional study. Mediators Inflamm 2023, 1966680.Google Scholar
Ye, H, Li, Y, Liu, S, et al. (2024) Association between serum 25-hydroxyvitamin D and vitamin D dietary supplementation and risk of all-cause and cardiovascular mortality among adults with hypertension. Nutr J 23, 33.Google Scholar
Ni, S, Zhong, Z, Wei, J, et al. (2022) Association between dietary intake of polyunsaturated fatty acid and prevalence of hypertension in U.S. adults: a cross-sectional study using data from NHANES 2009–2016. Hypertens Res 45, 516526.Google Scholar
Tan, L, Liu, Y, Liu, J, et al. (2023) Association between insulin resistance and uncontrolled hypertension and arterial stiffness among US adults: a population-based study. Cardiovasc Diabetol 22, 311.Google Scholar
Zhang, Y, Wang, F, Tang, J, et al. (2024) Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999–2018. Cardiovasc Diabetol 23, 262.Google Scholar
Schleicher, RL, Sternberg, MR, Lacher, DA, et al. (2016) A method-bridging study for serum 25-hydroxyvitamin D to standardize historical radioimmunoassay data to liquid chromatography-tandem mass spectrometry. Natl Health Statistics Rep 93, 116.Google Scholar
Liu, T, Zuo, R, Wang, J, et al. (2023) Association between serum 25-hydroxyvitamin D and abdominal aortic calcification: a large cross-sectional study. Int J Clin Pract 2023, 1621873.Google Scholar
Liu, K, Lu, X, Wang, A, et al. (2024) Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with gout and hyperuricemia. Nutr J 23, 89.Google Scholar
Lu, L & Ni, R (2023) Association between polycyclic aromatic hydrocarbon exposure and hypertension among the U.S. adults in the NHANES 2003–2016: a cross-sectional study. Environ Res 217, 114907.Google Scholar
Xi, X, Wu, Q, Wang, X, et al. (2023) The association between iron metabolism with the change of blood pressure and risk of hypertension: a large cross-sectional study. J Trace Elements Med Biol: Organ Soc Minerals Trace Elements (GMS) 79, 127193.Google Scholar
Vanderweele, TJ & Vansteelandt, S (2010) Odds ratios for mediation analysis for a dichotomous outcome. Am J Epidemiol 172, 13391348.Google Scholar
Wang, D, Li, W, Zhou, M, et al. (2023) Association of the triglyceride-glucose index variability with blood pressure and hypertension: a cohort study. QJM 117(4), 277282.Google Scholar
Argoty-Pantoja, AD, Velázquez-Cruz, R, Meneses-León, J, et al. (2023) Triglyceride-glucose index is associated with hypertension incidence up to 13 years of follow-up in Mexican adults. Lipids Health Dis 22, 162.Google Scholar
Niu, ZJ, Cui, Y, Wei, T, et al. (2024) The effect of insulin resistance in the association between obesity and hypertension incidence among Chinese middle-aged and older adults: data from China health and retirement longitudinal study (CHARLS). Front Public Health 12, 1320918.Google Scholar
Sabir, U, Irfan, HM & Alamgeer, Ullah, A (2022) Reduction of hepatic steatosis, oxidative stress, inflammation, ballooning and insulin resistance after therapy with Safranal in NAFLD animal model: a new approach. J Inflammation Res 15, 12931316.Google Scholar
Kumar, P, Liu, C, Hsu, JW, et al. (2021) Glycine and N-acetylcysteine (GlyNAC) supplementation in older adults improves glutathione deficiency, oxidative stress, mitochondrial dysfunction, inflammation, insulin resistance, endothelial dysfunction, genotoxicity, muscle strength, and cognition: results of a pilot clinical trial. Clin Translational Med 11, e372.Google Scholar
Horita, S, Seki, G, Yamada, H, et al. (2011) Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens 2011, 391762.Google Scholar
Limberg, JK, Soares, RN & Padilla, J (2022) Role of the autonomic nervous system in the hemodynamic response to hyperinsulinemia-implications for obesity and insulin resistance. Curr Diabetes Rep 22, 169175.Google Scholar
Shimosawa, T, Ogihara, T, Matsui, H, et al. (2003) Deficiency of adrenomedullin induces insulin resistance by increasing oxidative stress. Hypertension 41, 10801085.Google Scholar
Lin, Y, Bai, M, Wang, S, et al. (2022) Lactate is a key mediator that links obesity to insulin resistance via modulating cytokine production from adipose tissue. Diabetes 71, 637652.Google Scholar
Wu, S, Xu, L, Wu, M, et al. (2021) Association between triglyceride-glucose index and risk of arterial stiffness: a cohort study. Cardiovasc Diabetol 20, 146.Google Scholar
Shen, Q, Xu, Q, Li, G, et al. (2021) Joint effect of 25-hydroxyvitamin D and secondhand smoke exposure on hypertension in non-smoking women of childbearing age: NHANES 2007–2014. Environ Health: Global Access Sci Source 20, 117.Google Scholar
Che, J, Tong, J & Kuang, X (2023) Relationship between serum 25-hydroxyvitamin D concentrations and blood pressure among US adults without a previous diagnosis of hypertension: evidence from NHANES 2005–2018. Front Nutr 10, 1265662.Google Scholar
Li, YC, Qiao, G, Uskokovic, M, et al. (2004) Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol 89–90, 387392.Google Scholar
Simeoni, M, Perna, AF & Fuiano, G (2020) Secondary hyperparathyroidism and hypertension: an intriguing couple. J Clin Med 9, 629.Google Scholar
Mustafa, A & Shekhar, C (2022) Association between serum 25-hydroxyvitamin-D and Triglycerides-Glucose index among Indian adolescents. BMC Nutr 8, 69.Google Scholar
Liu, Z, Zhang, W, Zhao, Z, et al. (2023) The triglyceride-glucose index is associated with vitamin D status in metabolic-associated fatty liver disease. Diabetes, Metab Syndrome Obes: Targets Therapy 16, 26512660.Google Scholar
Jia, Y, Song, T, Li, Z, et al. (2022) The relationship between triglyceride glucose index and vitamin D in type 2 diabetes mellitus. Diabetes, Metab Syndrome Obes: Targets Therapy 15, 511525.Google Scholar
Xiang, Q, Xu, H, Zhan, J, et al. (2023) Association between the triglyceride-glucose index and vitamin D status in type 2 diabetes mellitus. Nutrients 15, 639.Google Scholar
Dhas, Y, Banerjee, J, Damle, G, et al. (2019) Association of vitamin D deficiency with insulin resistance in middle-aged type 2 diabetics. Clin Chim Acta 492, 95101.Google Scholar
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