Hostname: page-component-5447f9dfdb-g96hj Total loading time: 0 Render date: 2025-07-30T15:54:03.711Z Has data issue: false hasContentIssue false
  • English
  • Français

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 Open the ORCID record for Jing Lu [Opens in a new window] ,
Mengying Cao ,
Xiaoxue Zhang ,
Wenhao Zhong ,
Jie Yuan  and
Yunzeng Zou
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: yuan.jie@zs-hospital.sh.cn, Yunzeng Zou; Email: zou.yunzeng@zs-hospital.sh.cn
Corresponding authors: Jie Yuan; Email: yuan.jie@zs-hospital.sh.cn, Yunzeng Zou; Email: zou.yunzeng@zs-hospital.sh.cn
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

HypertensionTyG indexMediation analysisSerum 25-hydroxyvitamin D

Information

Type
Research Article
Information
British Journal of Nutrition , Volume 133 , Issue 8 , 28 April 2025 , pp. 1021 - 1031
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

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, 2488–2496.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
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, 957–980.CrossRefGoogle Scholar
Mills, KT, Stefanescu, A & He, J (2020) The global epidemiology of hypertension. Nat Rev Nephrol 16, 223–237.CrossRefGoogle ScholarPubMed
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, 1223–1249.CrossRefGoogle 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, 1192–1201.CrossRefGoogle 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, 3347–3351.CrossRefGoogle ScholarPubMed
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, 299–304.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Hill, MA, Yang, Y, Zhang, L, et al. (2021) Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 119, 154766.CrossRefGoogle ScholarPubMed
Han, YY, Forno, E & Celedón, JC (2017) Vitamin D insufficiency and asthma in a US nationwide study. J Allergy Clin Immunol Pract 5, 790–796.e1.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Lee, SB, Ahn, CW, Lee, BK, et al. (2018) Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol 17, 41.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Holick, MF (2007) Vitamin D deficiency. N Engl J Med 357, 266–281.CrossRefGoogle ScholarPubMed
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, 877–890.CrossRefGoogle ScholarPubMed
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, 1340–1349.CrossRefGoogle ScholarPubMed
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, 1629–1637.CrossRefGoogle ScholarPubMed
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, 350–357.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 941–961.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 516–526.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 1–16.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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Vanderweele, TJ & Vansteelandt, S (2010) Odds ratios for mediation analysis for a dichotomous outcome. Am J Epidemiol 172, 1339–1348.CrossRefGoogle ScholarPubMed
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), 277–282.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 1293–1316.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Horita, S, Seki, G, Yamada, H, et al. (2011) Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens 2011, 391762.CrossRefGoogle ScholarPubMed
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, 169–175.CrossRefGoogle ScholarPubMed
Shimosawa, T, Ogihara, T, Matsui, H, et al. (2003) Deficiency of adrenomedullin induces insulin resistance by increasing oxidative stress. Hypertension 41, 1080–1085.CrossRefGoogle ScholarPubMed
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, 637–652.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 387–392.CrossRefGoogle Scholar
Simeoni, M, Perna, AF & Fuiano, G (2020) Secondary hyperparathyroidism and hypertension: an intriguing couple. J Clin Med 9, 629.CrossRefGoogle ScholarPubMed
Mustafa, A & Shekhar, C (2022) Association between serum 25-hydroxyvitamin-D and Triglycerides-Glucose index among Indian adolescents. BMC Nutr 8, 69.CrossRefGoogle ScholarPubMed
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, 2651–2660.CrossRefGoogle ScholarPubMed
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, 511–525.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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, 95–101.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lu et al. supplementary material 1

Lu et al. supplementary material
Download Lu et al. supplementary material 1(File)
File 540.8 KB
Supplementary material: File

Lu et al. supplementary material 2

Lu et al. supplementary material
Download Lu et al. supplementary material 2(File)
File 544 KB
Supplementary material: File

Lu et al. supplementary material 3

Lu et al. supplementary material
Download Lu et al. supplementary material 3(File)
File 466.6 KB
Supplementary material: File

Lu et al. supplementary material 4

Lu et al. supplementary material
Download Lu et al. supplementary material 4(File)
File 471.2 KB
Supplementary material: File

Lu et al. supplementary material 5

Lu et al. supplementary material
Download Lu et al. supplementary material 5(File)
File 439 KB
Supplementary material: File

Lu et al. supplementary material 6

Lu et al. supplementary material
Download Lu et al. supplementary material 6(File)
File 408 KB
Supplementary material: File

Lu et al. supplementary material 7

Lu et al. supplementary material
Download Lu et al. supplementary material 7(File)
File 33.4 KB
Supplementary material: File

Lu et al. supplementary material 8

Lu et al. supplementary material
Download Lu et al. supplementary material 8(File)
File 20.6 KB
Supplementary material: File

Lu et al. supplementary material 9

Lu et al. supplementary material
Download Lu et al. supplementary material 9(File)
File 20.5 KB
Supplementary material: File

Lu et al. supplementary material 10

Lu et al. supplementary material
Download Lu et al. supplementary material 10(File)
File 18.5 KB
Supplementary material: File

Lu et al. supplementary material 11

Lu et al. supplementary material
Download Lu et al. supplementary material 11(File)
File 18.2 KB