Association between serum vitamin D levels and cardiorespiratory fitness in the adult population of the USA

Abstract

Aims

The small number of studies that have investigated the relationship between serum vitamin D levels and cardiorespiratory fitness (CRF) have reported conflicting results. We investigated the association between vitamin D levels and CRF in a representative sample of the US population using data from the National Health and Nutrition Survey (2001–2004).

Methods

We included participants between the ages of 20 and 49 years and excluded those with vitamin D levels at the 5% extremes of the distribution. We used survey-weighted linear regression without and with adjustment for age, sex, race, body mass index, hypertension, diabetes, smoking, C-reactive protein, hemoglobin, and glomerular filtration rate to examine the relationship between the maximal oxygen consumption (VO₂ max) (as a surrogate for CRF) and vitamin D levels.

Results

Of the 1995 participants, 45.2% were women, 49.1% were white, 13% had hypertension, and 4% had diabetes. The mean ± SD age was 33 ± 8.6 years, with a mean ± SD vitamin D level of 58 ± 5.3 nmol/L and a mean ± SD VO₂ max of 40 ± 9.7 ml/kg/min. Participants in the highest quartile of vitamin D levels had a significantly higher CRF than participants in the lowest quartile (difference 4.3, 95% confidence interval (CI) 3.0–5.5; P < 0.001). After adjustment for potential confounders, the difference between the highest and lowest vitamin D quartiles remained significant (difference 2.9, 95% CI 1.6–4.1; P < 0.001). In unadjusted and adjusted linear regression, each 10 nmol/L increase in vitamin D level was associated with a significant increase in VO₂ max (β = 0.78 ml/kg/min, 95% CI 0.55–1.01; P < 0.001; β = 0.51 ml/kg/min, 95% CI 0.23–0.79; P = 0.001, respectively).

Conclusions

We found an independent and robust association between serum vitamin D levels and CRF, but our results need to be validated with clinical trials examining the effect of vitamin D supplementation on CRF.

Keywords

Cardiorespiratory fitness vitamin D

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References

Dobnig

Pilz

Scharnagl

et al.

Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168: 1340–1349.

Melamed

Michos

Post

et al.

25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008; 168: 1629–1637.

Bischoff

Borchers

Gudat

et al.

In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 2001; 33: 19–24.

Gouni-Berthold

Krone

Berthold

. Vitamin D and cardiovascular disease. Curr Vasc Pharmacol 2009; 7: 414–422.

Holick

. Vitamin D deficiency. N Engl J Med 2007; 357: 266–281.

Ross

Blair

Arena

et al.

Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation 2016; 134: e653–e699.

Lee

Artero

Sui

et al.

Mortality trends in the general population: The importance of cardiorespiratory fitness. J Psychopharmacol 2010; 24(Suppl): 27–35.

Guazzi

Adams

Conraads

et al.

EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012; 126: 2261–2274.

Carson

Pourshahidi

Hill

et al.

Vitamin D, muscle function, and cardiorespiratory fitness in adolescents from the young hearts study. J Clin Endocrinol Metab 2015; 100: 4621–4628.

10.

Mowry

Costello

Heelan

. Association among cardiorespiratory fitness, body fat, and bone marker measurements in healthy young females. J Am Osteopath Assoc 2009; 109: 534–539.

11.

Ardestani

Parker

Mathur

et al.

Relation of vitamin D level to maximal oxygen uptake in adults. Am J Cardiol 2011; 107: 1246–1249.

12.

Farrell

Cleaver

Willis

. Cardiorespiratory fitness, adiposity, and serum 25-dihydroxyvitamin D levels in men. Med Sci Sports Exerc 2011; 43: 266–271.

13.

Farrell

Willis

. Cardiorespiratory fitness, adiposity, and serum 25-dihydroxyvitamin D levels in women: The Cooper Center Longitudinal Study. J Womens Health (Larchmt) 2012; 21: 80–86.

14.

Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey, www.cdc.gov/nchs/nhanes/index.htm (published 14 December 2010, accessed 11 January 2018).

15.

Bouillon

Verstuyf

. Vitamin D, mitochondria, and muscle. J Clin Endocrinol Metab 2013; 98: 961–963.

16.

Mukherjee

Zerwekh

Nicar

et al.

Effect of chronic vitamin D deficiency on chick heart mitochondrial oxidative phosphorylation. J Mol Cell Cardiol 1981; 13: 171–183.

17.

Stio

Lunghi

Iantomasi

et al.

Effect of vitamin D deficiency and 1,25-dihydroxyvitamin D3 on rat heart metabolism. J Mol Cell Cardiol 1994; 26: 1421–1428.

18.

Sorensen

Lund

Saltin

et al.

Myopathy in bone loss of ageing: Improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Lond) 1979; 56: 157–161.

19.

Inoue

Kawashima

. 1,25-Dihydroxyvitamin D3 stimulates 45Ca²⁺-uptake by cultured vascular smooth muscle cells derived from rat aorta. Biochem Biophys Res Commun 1988; 152: 1388–1394.

20.

Tishkoff

Nibbelink

Holmberg

et al.

Functional vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility. Endocrinology 2008; 149: 558–564.

21.

Weishaar

Kim

Saunders

et al.

Involvement of vitamin D3 with cardiovascular function. Iii. Effects on physical and morphological properties. Am J Physiol 1990; 258: E134–142.

22.

Kokkinos

Myers

. Exercise and physical activity: Clinical outcomes and applications. Circulation 2010; 122: 1637–1648.

23.

Swift

Lavie

Johannsen

et al.

Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77: 281–292.

24.

Kodama

Saito

Tanaka

et al.

Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA 2009; 301: 2024–2035.

25.

Zittermann

Schleithoff

Tenderich

et al.

Low vitamin D status: A contributing factor in the pathogenesis of congestive heart failure?

J Am Coll Cardiol 2003; 41: 105–112.

26.

Lavie

Church

Milani

et al.

Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev 2011; 31: 137–145.

27.

Kawano

Shono

Yoshimura

et al.

Improved cardio-respiratory fitness correlates with changes in the number and size of small dense LDL: Randomized controlled trial with exercise training and dietary instruction. Intern Med 2009; 48: 25–32.

28.

Holick

. The vitamin D deficiency pandemic and consequences for nonskeletal health: Mechanisms of action. Mol Aspects Med 2009; 29: 361–368.

29.

Giovannucci

Liu

Hollis

et al.

25-Hydroxyvitamin D and risk of myocardial infarction in men: A prospective study. Arch Intern Med 2008; 168: 1174–1180.

30.

Wang

Pencina

Booth

et al.

Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117: 503–511.

31.

Fowler

Southgate

Waite

et al.

Excess winter deaths in Europe: A multi-country descriptive analysis. Eur J Public Health 2014; 25: 339–345.

32.

Halonen

Zanobetti

Sparrow

et al.

Relationship between outdoor temperature and blood pressure. Occup Environ Med 2011; 68: 296–301.

33.

Sartini

Barry

Whincup

et al.

Relationship between outdoor temperature and cardiovascular disease risk factors in older people. Eur J Prev Cardiol 2017; 24: 349–356.

34.

Kendrick

Targher

Smits

et al.

25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis 2009; 205: 255–260.

35.

Sara MG, Beth AP, Jeffrey AC, et al. Changes in Vitamin D are Not Associated with Changes in Cardiorespiratory Fitness. Clin Med Res 2013; 2: 68–72.