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Background <p>Cardiometabolic dysfunction is highly prevalent in older adults, but the relationship between vitamin D status and their cardiometabolic health was not fully elucidated. The cardiometabolic index (CMI) is a simple and accurate quantitative indicator for assessing cardiovascular health. This study aimed to investigate the association between vitamin D and CMI in older adults from different national populations.</p> Methods <p>We analyzed data from two nationally representative cohorts (NHANES, <i>n</i> = 5491; ELSA, <i>n</i> = 5647) and one Chinese hospital-based cohort (<i>n</i> = 1255), all comprising adults aged ≥ 50&#xa0;years. CMI was calculated as waist-to-height ratio × (triglycerides/HDL-cholesterol). Associations were examined using weighted multivariable linear regression, restricted cubic splines (RCS), permutation‑based variable importance analysis, and ordinal logistic regression. External validation of Western models was assessed using calibration plots in the Chinese cohort.</p> Results <p>In fully adjusted models, vitamin D sufficiency was associated with significantly lower CMI compared with deficiency in the ELSA cohort (<i>β</i> = − 0.265, 95% CI − 0.311 to − 0.219), in the CZYY cohort (<i>β</i> = − 0.074, 95% CI − 0.104 to − 0.045), and in the NHANES cohort (<i>β</i> = − 0.152, 95% CI − 0.254 to − 0.049). Vitamin D insufficiency showed a graded inverse association in ELSA and CZYY but was not significant in NHANES. A near‑linear inverse relationship was observed in ELSA, whereas a threshold effect above approximately 65.8&#xa0;nmol/L emerged in NHANES, and an attenuated association was seen in the CZYY cohort. External calibration showed that the ELSA‑derived model had acceptable performance in the Chinese cohort (slope = 0.819, intercept = 0.119), whereas the NHANES‑derived model calibrated less well (slope = 0.626, intercept = 0.257), confirming the inverse association while revealing population‑specific heterogeneity. External validation using a Chinese hospital‑based cohort confirmed the inverse association between vitamin D and CMI, while revealing that the pattern of this relationship varied across populations.</p> Conclusion <p>Vitamin D status is inversely associated with CMI in older adults, but the relationship exhibits population-specific patterns. These findings highlight the importance of maintaining adequate vitamin D levels while considering population context in geriatric metabolic care.</p>

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Serum 25-hydroxyvitamin D and cardiometabolic index in older adults: a multi-cohort study reveals generalizable inverse association and heterogeneous patterns

  • 期刊论文

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  • 发表日期：

    2026年6月14日

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  • Liangping Wang,
  • Jie Wu,
  • Li Zhang,
  • Yishuang Liu,
  • Xiaofei Mo

摘要

Background

Cardiometabolic dysfunction is highly prevalent in older adults, but the relationship between vitamin D status and their cardiometabolic health was not fully elucidated. The cardiometabolic index (CMI) is a simple and accurate quantitative indicator for assessing cardiovascular health. This study aimed to investigate the association between vitamin D and CMI in older adults from different national populations.

Methods

We analyzed data from two nationally representative cohorts (NHANES, n = 5491; ELSA, n = 5647) and one Chinese hospital-based cohort (n = 1255), all comprising adults aged ≥ 50 years. CMI was calculated as waist-to-height ratio × (triglycerides/HDL-cholesterol). Associations were examined using weighted multivariable linear regression, restricted cubic splines (RCS), permutation‑based variable importance analysis, and ordinal logistic regression. External validation of Western models was assessed using calibration plots in the Chinese cohort.

Results

In fully adjusted models, vitamin D sufficiency was associated with significantly lower CMI compared with deficiency in the ELSA cohort (β = − 0.265, 95% CI − 0.311 to − 0.219), in the CZYY cohort (β = − 0.074, 95% CI − 0.104 to − 0.045), and in the NHANES cohort (β = − 0.152, 95% CI − 0.254 to − 0.049). Vitamin D insufficiency showed a graded inverse association in ELSA and CZYY but was not significant in NHANES. A near‑linear inverse relationship was observed in ELSA, whereas a threshold effect above approximately 65.8 nmol/L emerged in NHANES, and an attenuated association was seen in the CZYY cohort. External calibration showed that the ELSA‑derived model had acceptable performance in the Chinese cohort (slope = 0.819, intercept = 0.119), whereas the NHANES‑derived model calibrated less well (slope = 0.626, intercept = 0.257), confirming the inverse association while revealing population‑specific heterogeneity. External validation using a Chinese hospital‑based cohort confirmed the inverse association between vitamin D and CMI, while revealing that the pattern of this relationship varied across populations.

Conclusion

Vitamin D status is inversely associated with CMI in older adults, but the relationship exhibits population-specific patterns. These findings highlight the importance of maintaining adequate vitamin D levels while considering population context in geriatric metabolic care.