Association of serum total 25(OH)D with cardiometabolic factors among adult women
Abstract
Background: Vitamin D deficiency remains common among adult women in tropical settings, but its association with cardiometabolic factors is not fully characterized.
Objective: To examine the association between serum total 25-hydroxyvitamin D [25(OH)D] and cardiometabolic factors among adult women.
Methods: This secondary cross-sectional analysis used baseline screening data collected in Bogor City, Indonesia, from 29 August to 20 September 2025 before a vitamin D3 clinical trial. Using purposive sampling, 85 nonpregnant, nonlactating, premenopausal women aged 19 to 49 years with complete data were included. Serum total 25(OH)D was measured by VIDAS 25 OH Vitamin D Total using enzyme-linked fluorescent assay. Fasting capillary lipid profiles included total cholesterol, triglycerides, HDL-C, and LDL-C. Spearman correlation was the primary bivariate analysis. Multiple linear regression with HC3 robust standard errors modeled natural log-transformed serum total 25(OH)D, with total cholesterol as the exposure and age and waist-to-hip ratio as covariates.
Results: Serum total 25(OH)D was <20 ng/mL in 92.9% of participants and <10 ng/mL in 60.0%; the median was 8.95 ng/mL. Total cholesterol was inversely associated with serum total 25(OH)D (ρ = −0.293, p = 0.006) and remained associated in the adjusted model (B = −0.0027, robust SE = 0.0009, p = 0.005).
Conclusion: A large proportion of this purposively sampled group had low vitamin D status. Total cholesterol showed a weak inverse association with serum total 25(OH)D, but the cross-sectional design does not establish causality.
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References
1. Carlberg C. Genomic signaling of vitamin D. Steroids. 2023;198:109271. doi:https://doi.org/10.1016/j.steroids.2023.109271
2. Fleet JC. Vitamin D receptors and the regulation of gene expression. Annu Rev Nutr. 2022;42:19–41. doi:10.1146/annurev-nutr-032420-120029
3. Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11). doi:10.1038/s41430-020-0558-y
4. Cui Y, Zhang ZL, Zhu GQ, Zhang Y. Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022. Front Nutr. 2023;10. doi:10.3389/fnut.2023.1070808
5. Demay M, Pittas A, Bikle D, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. Published online 2024. doi:10.1210/clinem/dgae290
6. Giustina A, Bilezikian J, Adler R, et al. Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows. Endocr Rev. 2024;45:625–654. doi:10.1210/endrev/bnae009
7. Green TJ, Skeaff CM, Rockell JEP, et al. Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr. 2008;62(3). doi:10.1038/sj.ejcn.1602696
8. Risanti SP, Desmawati, Karmia HR. Differences in serum 25(OH)D levels, intake of vitamin D, magnesium, and zinc in obese and normal nutritional status. Amerta Nutr. 2024;8(2):305–311. doi:10.20473/amnt.v8i2.2024.305-311
9. Bahadorpour S, Hajhashemy Z, Saneei P. Serum 25-hydroxyvitamin D levels and dyslipidemia: a systematic review and dose-response meta-analysis of epidemiologic studies. Nutr Rev. 2023;81(1). doi:10.1093/nutrit/nuac038
10. Lhilali I, Zouine N, Godderis L, Midaoui A El, Jaafari E, Filali-Zegzouti Y. Relationship between Vitamin D Insufficiency, Lipid Profile and Atherogenic Indices in Healthy Women Aged 18–50 Years. Eur J Investig Heal Psychol Educ. 2024;14:2337–2357. doi:10.3390/ejihpe14080155
11. Mba CM, Koulman A, Forouhi NG, et al. Association between circulating 25-hydroxyvitamin D and cardiometabolic risk factors in adults in rural and urban settings. Nutr Diabetes. 2022;12:34. doi:10.1038/s41387-022-00215-1
12. Nejabat A, Emamat H, Afrashteh S, et al. Association of serum 25-hydroxy vitamin D status with cardiometabolic risk factors and total and regional obesity in southern Iran: evidence from the PoCOsteo study. Sci Rep. 2024;14. doi:10.1038/s41598-024-68773-1
13. Jaruratanasirikul S, Boonrusmee S, Kasemsripitak S, Saengkaew T, Chimrung K, Sriplung H. Vitamin D status in non-pregnant women of reproductive age: a study in Southern Thailand. Sci Rep. 2023;13. doi:10.1038/s41598-023-42557-5
14. Gröber U, Kisters K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 2012;4(2):158–166. doi:10.4161/derm.20731
15. Santana K, Oliver SL, Mendes MM. Association between vitamin D status and lifestyle factors in Brazilian women: implications of sun exposure levels, diet, and health. EClinicalMedicine. 2022;47:101400. doi:10.1016/j.eclinm.2022.101400
16. Cohen J. Statistical power analysis for the behavioral sciences. 2 ed. Lawrence Erlbaum Associates; 1988.
17. Babyak MA. What You See May Not Be What You Get: A Brief, Nontechnical Introduction to Overfitting in Regression-Type Models. Psychosom Med. 2004;66(3):411–421. doi:10.1097/01.PSY.0000127692.23278.A9
18. Nishida C, Barba C, Cavalli-Sforza T, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403). doi:10.1016/S0140-6736(03)15268-3
19. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869–871. doi:10.1001/archderm.1988.01670060015008
20. Prihartini S, Julianti ED, Permanasari Y. Buku Foto Makanan: Survei Konsumsi Makanan Individu (SKMI 2014). Badan Penelitian dan Pengembangan Kesehatan; 2014.
21. Indonesia KKR. Tabel Komposisi Pangan Indonesia 2017. Direktorat Gizi Masyarakat, Direktorat Jenderal Kesehatan Masyarakat, Kementerian Kesehatan Republik Indonesia; 2017.
22. Organization WH. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. World Health Organization; 2011.
23. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–163. doi:10.1016/S0140-6736(03)15268-3
24. Sinocare. PalmLab SLX-120 Blood Lipid Analyzer and LL-12 Lipid Test Strip: user manual. Sinocare Inc; 2022.
25. Moreau E, Bächer S, Mery S. Performance characteristics of the VIDAS® 25-OH Vitamin D Total assay: Comparison with four immunoassays and two liquid chromatography-tandem mass spectrometry methods in a multicentric study. Clin Chem Lab Med. 2016;54(1):45–53. doi:10.1515/cclm-2014-1249
26. Hajhashemy Z, Shahdadian F, Ziaei R, Saneei P. Serum vitamin D levels in relation to abdominal obesity: A systematic review and dose–response meta‐analysis of epidemiologic studies. Obes Rev. 2020;22. doi:10.1111/obr.13134
27. Patriota P, Rezzi S, Guessous I, Marques-Vidal P. Association between anthropometric markers of adiposity, adipokines and vitamin D levels. Sci Rep. 2022;12. doi:10.1038/s41598-022-19409-9
28. JS L, LH E. Using heteroscedasticity consistent standard errors in the linear regression model. Am Stat. 2000;54(3):217–224. doi:10.1080/00031305.2000.10474549
29. AF H, Cai L. Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation. Behav Res Methods. 2007;39(4):709–722. doi:10.3758/BF03192961
30. Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol. 2013;5(1):34–37. doi:10.4161/derm.24054
31. Jeenduang N, Sangkaew B. The association between serum 25-hydroxyvitamin D concentrations and serum lipids in the Southern Thai population. Arch Med Sci. 2022;18(1). doi:10.5114/aoms.2020.101100
32. Warren T, McAllister R, Morgan A, et al. The interdependency and co-regulation of the vitamin D and cholesterol metabolism. Cells. 2021;10(8). doi:10.3390/cells10082007
33. Liang Z, Wang Z, Liu X, He Y. Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management. Front Nutr. 2024;11:1416344. doi:10.3389/fnut.2024.1416344
34. Ponda MP, Huang X, Odeh MA, Breslow JL, Kaufman HW. Vitamin D may not improve lipid levels: A serial clinical laboratory data study. Circulation. 2012;126(3):270–277. doi:10.1161/CIRCULATIONAHA.111.077875
35. Lu Q, Liang Q, Xi Y. The effects of vitamin D supplementation on serum lipid profiles in people with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Front Nutr. 2024;11. doi:10.3389/fnut.2024.1419747
36. Yu K, Song W, Tu X, Zhou K, Prabahar K. The effect of vitamin D on the lipid profile in individuals with overweight or obesity: a meta-analysis and systematic review of randomized controlled trials. Prostaglandins Other Lipid Mediat. 2025;176:106938. doi:10.1016/j.prostaglandins.2024.106938
37. Li J, Wang W, Qiu L, et al. The causal association between body composition and 25-hydroxyvitamin D levels: A bidirectional Mendelian randomization analysis. Medicine (Baltimore). 2024;103(50):e40618. doi:10.1097/md.0000000000040618
38. Kyomuhangi I, Abeku TA, Kirby MJ, Tesfaye G, Giorgi E. Understanding the effects of dichotomization of continuous outcomes on geostatistical inference. Spat Stat. 2021;42:100424. doi:10.1016/j.spasta.2020.100424
39. Carazo Díaz C, Prieto Valiente L. The dramatic loss of statistical power when dichotomising continuous variables. Rev Neurol. 2024;78(1). doi:10.33588/rn.7801.2023163
2. Fleet JC. Vitamin D receptors and the regulation of gene expression. Annu Rev Nutr. 2022;42:19–41. doi:10.1146/annurev-nutr-032420-120029
3. Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11). doi:10.1038/s41430-020-0558-y
4. Cui Y, Zhang ZL, Zhu GQ, Zhang Y. Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022. Front Nutr. 2023;10. doi:10.3389/fnut.2023.1070808
5. Demay M, Pittas A, Bikle D, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. Published online 2024. doi:10.1210/clinem/dgae290
6. Giustina A, Bilezikian J, Adler R, et al. Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows. Endocr Rev. 2024;45:625–654. doi:10.1210/endrev/bnae009
7. Green TJ, Skeaff CM, Rockell JEP, et al. Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr. 2008;62(3). doi:10.1038/sj.ejcn.1602696
8. Risanti SP, Desmawati, Karmia HR. Differences in serum 25(OH)D levels, intake of vitamin D, magnesium, and zinc in obese and normal nutritional status. Amerta Nutr. 2024;8(2):305–311. doi:10.20473/amnt.v8i2.2024.305-311
9. Bahadorpour S, Hajhashemy Z, Saneei P. Serum 25-hydroxyvitamin D levels and dyslipidemia: a systematic review and dose-response meta-analysis of epidemiologic studies. Nutr Rev. 2023;81(1). doi:10.1093/nutrit/nuac038
10. Lhilali I, Zouine N, Godderis L, Midaoui A El, Jaafari E, Filali-Zegzouti Y. Relationship between Vitamin D Insufficiency, Lipid Profile and Atherogenic Indices in Healthy Women Aged 18–50 Years. Eur J Investig Heal Psychol Educ. 2024;14:2337–2357. doi:10.3390/ejihpe14080155
11. Mba CM, Koulman A, Forouhi NG, et al. Association between circulating 25-hydroxyvitamin D and cardiometabolic risk factors in adults in rural and urban settings. Nutr Diabetes. 2022;12:34. doi:10.1038/s41387-022-00215-1
12. Nejabat A, Emamat H, Afrashteh S, et al. Association of serum 25-hydroxy vitamin D status with cardiometabolic risk factors and total and regional obesity in southern Iran: evidence from the PoCOsteo study. Sci Rep. 2024;14. doi:10.1038/s41598-024-68773-1
13. Jaruratanasirikul S, Boonrusmee S, Kasemsripitak S, Saengkaew T, Chimrung K, Sriplung H. Vitamin D status in non-pregnant women of reproductive age: a study in Southern Thailand. Sci Rep. 2023;13. doi:10.1038/s41598-023-42557-5
14. Gröber U, Kisters K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 2012;4(2):158–166. doi:10.4161/derm.20731
15. Santana K, Oliver SL, Mendes MM. Association between vitamin D status and lifestyle factors in Brazilian women: implications of sun exposure levels, diet, and health. EClinicalMedicine. 2022;47:101400. doi:10.1016/j.eclinm.2022.101400
16. Cohen J. Statistical power analysis for the behavioral sciences. 2 ed. Lawrence Erlbaum Associates; 1988.
17. Babyak MA. What You See May Not Be What You Get: A Brief, Nontechnical Introduction to Overfitting in Regression-Type Models. Psychosom Med. 2004;66(3):411–421. doi:10.1097/01.PSY.0000127692.23278.A9
18. Nishida C, Barba C, Cavalli-Sforza T, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403). doi:10.1016/S0140-6736(03)15268-3
19. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869–871. doi:10.1001/archderm.1988.01670060015008
20. Prihartini S, Julianti ED, Permanasari Y. Buku Foto Makanan: Survei Konsumsi Makanan Individu (SKMI 2014). Badan Penelitian dan Pengembangan Kesehatan; 2014.
21. Indonesia KKR. Tabel Komposisi Pangan Indonesia 2017. Direktorat Gizi Masyarakat, Direktorat Jenderal Kesehatan Masyarakat, Kementerian Kesehatan Republik Indonesia; 2017.
22. Organization WH. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. World Health Organization; 2011.
23. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–163. doi:10.1016/S0140-6736(03)15268-3
24. Sinocare. PalmLab SLX-120 Blood Lipid Analyzer and LL-12 Lipid Test Strip: user manual. Sinocare Inc; 2022.
25. Moreau E, Bächer S, Mery S. Performance characteristics of the VIDAS® 25-OH Vitamin D Total assay: Comparison with four immunoassays and two liquid chromatography-tandem mass spectrometry methods in a multicentric study. Clin Chem Lab Med. 2016;54(1):45–53. doi:10.1515/cclm-2014-1249
26. Hajhashemy Z, Shahdadian F, Ziaei R, Saneei P. Serum vitamin D levels in relation to abdominal obesity: A systematic review and dose–response meta‐analysis of epidemiologic studies. Obes Rev. 2020;22. doi:10.1111/obr.13134
27. Patriota P, Rezzi S, Guessous I, Marques-Vidal P. Association between anthropometric markers of adiposity, adipokines and vitamin D levels. Sci Rep. 2022;12. doi:10.1038/s41598-022-19409-9
28. JS L, LH E. Using heteroscedasticity consistent standard errors in the linear regression model. Am Stat. 2000;54(3):217–224. doi:10.1080/00031305.2000.10474549
29. AF H, Cai L. Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation. Behav Res Methods. 2007;39(4):709–722. doi:10.3758/BF03192961
30. Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol. 2013;5(1):34–37. doi:10.4161/derm.24054
31. Jeenduang N, Sangkaew B. The association between serum 25-hydroxyvitamin D concentrations and serum lipids in the Southern Thai population. Arch Med Sci. 2022;18(1). doi:10.5114/aoms.2020.101100
32. Warren T, McAllister R, Morgan A, et al. The interdependency and co-regulation of the vitamin D and cholesterol metabolism. Cells. 2021;10(8). doi:10.3390/cells10082007
33. Liang Z, Wang Z, Liu X, He Y. Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management. Front Nutr. 2024;11:1416344. doi:10.3389/fnut.2024.1416344
34. Ponda MP, Huang X, Odeh MA, Breslow JL, Kaufman HW. Vitamin D may not improve lipid levels: A serial clinical laboratory data study. Circulation. 2012;126(3):270–277. doi:10.1161/CIRCULATIONAHA.111.077875
35. Lu Q, Liang Q, Xi Y. The effects of vitamin D supplementation on serum lipid profiles in people with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Front Nutr. 2024;11. doi:10.3389/fnut.2024.1419747
36. Yu K, Song W, Tu X, Zhou K, Prabahar K. The effect of vitamin D on the lipid profile in individuals with overweight or obesity: a meta-analysis and systematic review of randomized controlled trials. Prostaglandins Other Lipid Mediat. 2025;176:106938. doi:10.1016/j.prostaglandins.2024.106938
37. Li J, Wang W, Qiu L, et al. The causal association between body composition and 25-hydroxyvitamin D levels: A bidirectional Mendelian randomization analysis. Medicine (Baltimore). 2024;103(50):e40618. doi:10.1097/md.0000000000040618
38. Kyomuhangi I, Abeku TA, Kirby MJ, Tesfaye G, Giorgi E. Understanding the effects of dichotomization of continuous outcomes on geostatistical inference. Spat Stat. 2021;42:100424. doi:10.1016/j.spasta.2020.100424
39. Carazo Díaz C, Prieto Valiente L. The dramatic loss of statistical power when dichotomising continuous variables. Rev Neurol. 2024;78(1). doi:10.33588/rn.7801.2023163
Authors
Pertiwi, F. D., Damayanthi, E., Rimbawan, R., & Utomo, A. R. H. (2026). Association of serum total 25(OH)D with cardiometabolic factors among adult women. JURNAL RISET KESEHATAN POLTEKKES DEPKES BANDUNG, 18(2), 474–487. https://doi.org/10.34011/juriskesbdg.v18i2.3358
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