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Vitamin D and Obesity: Current Evidence and Controversies

  • Metabolism (M Dalamaga, Section Editor)
  • Published:
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Abstract

Purpose of Review

Evidence from observational studies suggests that obesity is associated with low vitamin D. As both obesity and hypovitaminosis D present an alarmingly increased prevalence worldwide, there is an intense research interest to clarify all aspects of this association. This review summarizes current evidence from meta-analyses investigating vitamin D status in obesity, including the effects of weight loss and bariatric surgery on vitamin D status and the outcomes of vitamin D supplementation on body weight. We also discuss potential pathophysiologic mechanisms and important controversies.

Recent Findings

Data from meta-analyses consistently support an inverse association of vitamin D levels with body weight. However, the impact of weight loss on improving vitamin D status is small, while studies on the supplementation with vitamin D after bariatric surgery have shown conflicting results regarding vitamin D status. Moreover, interventional studies do not support a beneficial effect of vitamin D supplementation on body weight. These findings warrant a cautious interpretation due to important methodological limitations and confounding factors, such as high heterogeneity of studies, variable methods of determination of vitamin D and definition of deficiency/insufficiency, use of various adiposity measures and definitions of obesity, and inadequate adjustment for confounding variables influencing vitamin D levels. The underlying pathogenetic mechanisms associating low vitamin D in obesity include volumetric dilution, sequestration into adipose tissue, limited sunlight exposure, and decreased vitamin D synthesis in the adipose tissue and liver. Experimental studies have demonstrated that low vitamin D may be implicated in adipose tissue differentiation and growth leading to obesity either by regulation of gene expression or through modulation of parathyroid hormone, calcium, and leptin.

Summary

Obesity is associated with low vitamin D status but weight loss has little effect on improving this; vitamin D supplementation is also not associated with weight loss. Evidence regarding vitamin D status after bariatric surgery is contradicting. The link between vitamin D and obesity remains controversial due to important limitations and confounding of studies. More research is needed to clarify the complex interplay between vitamin D and adiposity.

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Abbreviations

BIA:

bioelectrical impedance analysis

BMI:

body mass index

CLIA:

chemiluminescence immunoassay

CPBA:

competitive protein-binding assays

CVD:

cardiovascular disease

DBP:

vitamin D binding protein

DEXA:

dual-energy X-ray absorptiometry

DM2:

type 2 diabetes mellitus

ELISA:

enzyme-linked immunosorbent assay

FM:

fat mass

HPLC:

high-performance liquid chromatography

LC-MS/MS:

liquid chromatography tandem mass spectrometry

MR:

Mendelian randomization

mRNA:

messenger RNA

NHANES:

National Health and Nutrition Examination Survey

OR:

odds ratio

PFM:

percentage of fat mass

PCOS:

polycystic ovary syndrome

PTH:

parathyroid hormone

RCT:

randomized controlled trial

RIA:

radioimmunoassay

RR:

relative risk

SNPs:

single nucleotide polymorphisms

UVB:

type B ultraviolet

VAT:

visceral adipose tissue

VDR:

vitamin D receptor

WC:

waist circumference

WHI:

Women’s Health Initiative

WHR:

waist-hip ratio

1,25(OH)2D:

1,25-dihydroxyvitamin D

25(OH)D:

25-hydroxyvitamin D

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  1. Second Department of Critical Care, Medical School, Attikon General University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462, Athens, Greece

    Irene Karampela & Alexandra Sakelliou

  2. Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece

    Irene Karampela, Gerasimos-Socrates Christodoulatos & Maria Dalamaga

  3. First Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ypsilantou St, 10676, Athens, Greece

    Natalia Vallianou

  4. Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark

    Faidon Magkos

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Karampela, I., Sakelliou, A., Vallianou, N. et al. Vitamin D and Obesity: Current Evidence and Controversies. Curr Obes Rep 10, 162–180 (2021). https://doi.org/10.1007/s13679-021-00433-1

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