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Independent association of hypovitaminosis d with non-alcoholic fatty liver disease in people with chronic spinal cord injury: a cross-sectional study

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Abstract

Purpose

Non-alcoholic fatty liver disease (NAFLD) and hypovitaminosis D are highly prevalent in people with spinal cord injury (SCI) and could exert an unfavorable influence on cardiovascular profile and rehabilitation outcomes. We aimed to assess the independent association between low 25-hydroxy vitamin D (25(OH)D) levels and NAFLD in people with chronic (> 1 year) SCI.

Methods

One hundred seventy-three consecutive patients with chronic SCI (132 men and 41 women) admitted to a rehabilitation program underwent clinical/biochemical evaluations and liver ultrasonography.

Results

NAFLD was found in 105 patients (60.7% of the study population). They were significantly older and exhibited a poorer leisure time physical activity (LTPA) and functional independence in activities of daily living, a greater number of comorbidities and a higher prevalence of metabolic syndrome (MetS) and its correlates, including lower HDL and higher values of body mass index (BMI), systolic blood pressure, HOMA-index of insulin resistance and triglycerides. 25(OH)D levels were significantly lower in NAFLD (median: 10.6 ng/ml, range: 2.0–31.0) than in non-NAFLD group (22.5 ng/ml, 4.2–51.6). When all these variables were included in a multiple logistic regression analysis, a significant independent association with NAFLD only persisted for lower 25(OH)D levels, a greater number of comorbidities and a poorer LTPA. The ROC analysis revealed that 25(OH)D levels < 18.25 ng/ml discriminated patients with NAFLD with a sensitivity of 89.0% and a specificity of 73.0% (AUC: 85.7%; 95%CI: 79.6–91.7%). NAFLD was exhibited by 83.9% of patients with 25(OH)D levels < 18.25 ng/ml and by 18% of those with 25(OH)D levels ≥ 18.25 ng/ml (p < 0.0001).

Conclusion

In people with chronic SCI, 25(OH)D levels < 18.25 ng/ml may represent a marker of NAFLD independent of MetS-related features. Further studies are warranted to define the cause-effect relationships of this association.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    F. Di Giulio, C. Castellini, D. Tienforti, M. G. Baroni & A. Barbonetti

  2. Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy

    G. Felzani

  3. Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy

    M. G. Baroni

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Contributions

FDG and CC performed literature search, data analysis and interpretation, and drafted the manuscript; CC and DT substantially contributed to literature search and prepared tables and figures; GF and MGB revised the manuscript critically for important intellectual content; AB conceived the study and supervised the manuscript writing, and critically reviewed and revised the manuscript for intellectual content, by relevantly improving the scientific content and the formal style. All authors read and approved the final manuscript.

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Di Giulio, F., Castellini, C., Tienforti, D. et al. Independent association of hypovitaminosis d with non-alcoholic fatty liver disease in people with chronic spinal cord injury: a cross-sectional study. J Endocrinol Invest 47, 79–89 (2024). https://doi.org/10.1007/s40618-023-02124-1

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