Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Differential Association of Vitamin D Deficiency With Albuminuria by Sex in the Korean General Population: A Cross-sectional Study of the Korea National Health and Nutrition Examination Survey 2011-2012

  • Jeon, Yongwoo (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Shin, Jaeyong (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Jhee, Jong Hyun (Department of Nephrology, Yonsei University College of Medicine) ;
  • Cho, Youngdae (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Park, Eun-Cheol (Department of Preventive Medicine, Yonsei University College of Medicine)
  • Received : 2017.01.05
  • Accepted : 2018.01.23
  • Published : 2018.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: Albuminuria has emerged as a biomarker for several medical conditions, and vitamin D has received attention due to its associations with various disorders. We evaluated the association between low serum vitamin D levels and prevalent albuminuria by sex in the Korean general population. Methods: We analyzed 9823 participants (4401 males, 5422 females) from the Korea National Health and Nutrition Examination Survey 2011-2012 (KNHANES V-2), and categorized them as having a normal range of vitamin D levels, vitamin D insufficiency, or vitamin D deficiency. A multivariable logistic regression model was used to compare the risk of albuminuria across these groups. Stratified analyses were conducted by smoking status, obesity, and renal function. Results: Albuminuria was found in 325 of the 4401 male participants (7.4%) and in 455 of the 5422 female participants (8.4%). Among the males, vitamin D deficiency was associated with an odds ratio (OR) for albuminuria of 1.78 (95% confidence interval [CI], 1.07 to 2.97, p<0.05). However, such an association was not found in females. The association was stronger in male current smokers (OR, 3.54; 95% CI, 1.47 to 8.50; p=0.005). Conclusions: The findings of this study suggest that sex differences exist in the association between serum vitamin D deficiency and albuminuria. Additionally, we observed that the association was stronger in current smokers than in the overall male population, but was not seen in non-smokers. Therefore, different approaches by sex and smoking status might be needed when considering using vitamin D as a biomarker for renal function.

Keywords

References

  1. Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106(14):1777-1782. https://doi.org/10.1161/01.CIR.0000031732.78052.81
  2. Jang M, Oh S, Noh HM, Chun S, Oh HY, Park KH, et al. Differences in factors associated with albuminuria according to gender and comorbidities of hypertension and diabetes. Korean J Fam Med 2015;36(6):316-322. https://doi.org/10.4082/kjfm.2015.36.6.316
  3. Won JC, Lee YJ, Kim JM, Han SY, Noh JH, Ko KS, et al. Prevalence of and factors associated with albuminuria in the Korean adult population: the 2011 Korea National Health and Nutrition Examination Survey. PLoS One 2013;8(12):e83273. https://doi.org/10.1371/journal.pone.0083273
  4. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008;168(11):1174-1180. https://doi.org/10.1001/archinte.168.11.1174
  5. Nam GE, Kim DH, Cho KH, Park YG, Han KD, Kim SM, et al. 25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr 2014;17(1):186-194. https://doi.org/10.1017/S1368980012004855
  6. Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med 2009;169(4):384-390. https://doi.org/10.1001/archinternmed.2008.560
  7. McCullough ML, Weinstein SJ, Freedman DM, Helzlsouer K, Flanders WD, Koenig K, et al. Correlates of circulating 25-hydroxyvitamin D: cohort consortium vitamin D pooling project of rarer cancers. Am J Epidemiol 2010;172(1):21-35. https://doi.org/10.1093/aje/kwq113
  8. Kang JW, Choi HS, Kim K, Choi JY. Dietary vitamin intake correlates with hearing thresholds in the older population: the Korean National Health and Nutrition Examination Survey. Am J Clin Nutr 2014;99(6):1407-1413. https://doi.org/10.3945/ajcn.113.072793
  9. Yoo EH, Cho HJ. Prevalence of 25-hydroxyvitamin D deficiency in Korean patients with anemia. J Clin Lab Anal 2015;29(2):129-134. https://doi.org/10.1002/jcla.21740
  10. Isakova T, Gutierrez OM, Patel NM, Andress DL, Wolf M, Levin A. Vitamin D deficiency, inflammation, and albuminuria in chronic kidney disease: complex interactions. J Ren Nutr 2011;21(4): 295-302. https://doi.org/10.1053/j.jrn.2010.07.002
  11. Mattila C, Knekt P, Mannisto S, Rissanen H, Laaksonen MA, Montonen J, et al. Serum 25-hydroxyvitamin D concentration and subsequent risk of type 2 diabetes. Diabetes Care 2007;30(10): 2569-2570. https://doi.org/10.2337/dc07-0292
  12. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 2011;96(3): 643-651. https://doi.org/10.1210/jc.2010-2133
  13. Choi EY. 25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults. Asia Pac J Clin Nutr 2012;21(4):526-535.
  14. Sonneveld R, Hoenderop JG, Stavenuiter AW, Ferrantelli E, Baltissen MP, Dijkman HB, et al. 1,25-Vitamin D3 deficiency induces albuminuria. Am J Pathol 2016;186(4):794-804. https://doi.org/10.1016/j.ajpath.2015.11.015
  15. de Boer IH, Ioannou GN, Kestenbaum B, Brunzell JD, Weiss NS. 25-Hydroxyvitamin D levels and albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2007;50(1):69-77. https://doi.org/10.1053/j.ajkd.2007.04.015
  16. Kim SM, Choi HJ, Lee JP, Kim DK, Oh YK, Kim YS, et al. Prevalence of vitamin D deficiency and effects of supplementation with cholecalciferol in patients with chronic kidney disease. J Ren Nutr 2014;24(1):20-25. https://doi.org/10.1053/j.jrn.2013.07.003
  17. Oh YJ, Park RW, Yoon D, Kim M, Han SS, Jang HR, et al. Non-linear association of serum 25-hydroxyvitamin D with urinary albumin excretion rate in normoalbuminuric subjects. BMC Nephrol 2014;15:97. https://doi.org/10.1186/1471-2369-15-97
  18. Tak YJ, Lee JG, Song SH, Kim YJ, Lee S, Jung DW, et al. The relationship between the level of serum 25-hydroxyvitamin D and renal function in patients without chronic kidney disease: a cross-sectional study. J Ren Nutr 2015;25(2):88-96. https://doi.org/10.1053/j.jrn.2014.07.007
  19. Eikelenboom MJ, Killestein J, Kragt JJ, Uitdehaag BM, Polman CH. Gender differences in multiple sclerosis: cytokines and vitamin D. J Neurol Sci 2009;286(1-2):40-42. https://doi.org/10.1016/j.jns.2009.06.025
  20. Kim TH, Lee MJ, Yoo KB, Han E, Choi JW. Association of demographic and socioeconomic factors with risk factors for chronic kidney disease. J Prev Med Public Health 2015;48(3):170-177. https://doi.org/10.3961/jpmph.15.002
  21. Choi HS, Sung KC, Lee KB. The prevalence and risk factors of microalbuminuria in normoglycemic, normotensive adults. Clin Nephrol 2006;65(4):256-261. https://doi.org/10.5414/CNP65256
  22. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005;16(7):713-716. https://doi.org/10.1007/s00198-005-1867-7
  23. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604-612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
  24. Schwarz U, Amann K, Orth SR, Simonaviciene A, Wessels S, Ritz E. Effect of 1,25 (OH)2 vitamin D3 on glomerulosclerosis in subtotally nephrectomized rats. Kidney Int 1998;53(6):1696-1705. https://doi.org/10.1046/j.1523-1755.1998.00951.x
  25. Kim CS, Kim SW. Vitamin D and chronic kidney disease. Korean J Intern Med 2014;29(4):416-427. https://doi.org/10.3904/kjim.2014.29.4.416
  26. Deb DK, Sun T, Wong KE, Zhang Z, Ning G, Zhang Y, et al. Combined vitamin D analog and AT1 receptor antagonist synergistically block the development of kidney disease in a model of type 2 diabetes. Kidney Int 2010;77(11):1000-1009. https://doi.org/10.1038/ki.2010.22
  27. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110(2):229-238. https://doi.org/10.1172/JCI0215219
  28. Zou MS, Yu J, Nie GM, He WS, Luo LM, Xu HT. 1, 25-Dihydroxyvitamin D3 decreases adriamycin-induced podocyte apoptosis and loss. Int J Med Sci 2010;7(5):290-299.
  29. Christensen EI, Birn H. Megalin and cubilin: synergistic endocytic receptors in renal proximal tubule. Am J Physiol Renal Physiol 2001;280(4):F562-F573. https://doi.org/10.1152/ajprenal.2001.280.4.F562
  30. Verhave JC, Hillege HL, Burgerhof JG, Navis G, de Zeeuw D, de Jong PE, et al. Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women. J Am Soc Nephrol 2003;14(5):1330-1335. https://doi.org/10.1097/01.ASN.0000060573.77611.73
  31. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288(3):321-333. https://doi.org/10.1001/jama.288.3.321
  32. Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J Am Soc Nephrol 2000;11(2):319-329.
  33. Quan A, Chakravarty S, Chen JK, Chen JC, Loleh S, Saini N, et al. Androgens augment proximal tubule transport. Am J Physiol Renal Physiol 2004;287(3):F452-F459. https://doi.org/10.1152/ajprenal.00188.2003
  34. Kragt J, van Amerongen B, Killestein J, Dijkstra C, Uitdehaag B, Polman CH, et al. Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women. Mult Scler 2009;15(1):9-15. https://doi.org/10.1177/1352458508095920
  35. Hagenfeldt Y, Linde K, Sjoberg HE, Zumkeller W, Arver S. Testosterone increases serum 1,25-dihydroxyvitamin D and insulin-like growth factor-I in hypogonadal men. Int J Androl 1992; 15(2):93-102. https://doi.org/10.1111/j.1365-2605.1992.tb01118.x
  36. van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, et al. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn Study. Am J Clin Nutr 2007;85(3):755-761. https://doi.org/10.1093/ajcn/85.3.755
  37. Jacobs DR Jr, Murtaugh MA, Steffes M, Yu X, Roseman J, Goetz FC. Gender- and race-specific determination of albumin excretion rate using albumin-to-creatinine ratio in single, untimed urine specimens: the Coronary Artery Risk Development in Young Adults Study. Am J Epidemiol 2002;155(12):1114-1119. https://doi.org/10.1093/aje/155.12.1114

Cited by

  1. Long-term vitamin D deficiency promotes renal fibrosis and functional impairment in middle-aged male mice vol.125, pp.8, 2021, https://doi.org/10.1017/s0007114520003232