Clinical nutrition

Decreased lung function is associated with vitamin D deficiency in apparently health, middle aged Koreans: the Kangbuk Samsung Health Study

Abstract

Background/Objectives

There has been inconsistent relationships between serum vitamin D levels and lung function in previous studies. However, previous studies included patients with medical diseases, affecting both vitamin D levels and lung function. Considering this view of potential confounders, we investigated if vitamin D deficiency (VDD) is linked to lung function in health screening examinee without overt medical conditions.

Subjects/Methods

We conducted a cohort study on 68,457 healthy Koreans (36,759 males, mean age: 37.7 years) with a health examination in 2015. Measured forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were categorized in quartiles. To examine the relationships between VDD and lung function, adjusted odds ratios (aORs) for VDD were estimated by logistic regression.

Results

Median vitamin D level was 14.9 ng/mL. The prevalence of VDD (defined as <20 ng/ml) was 74.5%. Compared with the highest quartile (Q4, reference), the aORs for VDD across decreasing quartiles (from Q3 to Q1) were 1.05, 1.06, 1.10 for FVC, and 1.07, 1.10, 1.10 for FEV1 (P for trend < 0.01 for both), in all subjects. Similarly, the aOR of having VDD for men also increased with decreasing quartiles of FVC and FEV1 in a dose-response manner (p for trend < 0.01 for both). However, neither FVC nor FEV1 was associated with VDD in women.

Conclusions

VDD was associated with decreased lung function in middle aged Korean men without overt medical conditions. VDD could be a modifiable risk factor for impaired lung function, in men but not in women.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Flow chart of study participants.
Fig. 2: Multivariable-adjusted odds ratio for having vitamin D deficiency according to quartile of lung function.

References

  1. 1.

    Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas. 2010;65:225–36.

    CAS  PubMed  Google Scholar 

  2. 2.

    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.

    CAS  PubMed  Google Scholar 

  3. 3.

    Herr C, Greulich T, Koczulla RA, Meyer S, Zakharkina T, Branscheidt M, et al. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer. Respir Res. 2011;12:31.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Engstrom G, Hedblad B, Nilsson P, Wollmer P, Berglund G, Janzon L. Lung function, insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study. J Intern Med. 2003;253:574–81.

    CAS  PubMed  Google Scholar 

  5. 5.

    Janssens W, Bouillon R, Claes B, Carremans C, Lehouck A, Buysschaert I, et al. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax. 2010;65:215–20.

    PubMed  Google Scholar 

  6. 6.

    Persson LJ, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TM. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS ONE. 2012;7:e38934.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Berry DJ, Hesketh K, Power C, Hypponen E. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr. 2011;106:1433–40.

    CAS  PubMed  Google Scholar 

  8. 8.

    Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. Chest. 2005;128:3792–8.

    CAS  PubMed  Google Scholar 

  9. 9.

    Thuesen BH, Skaaby T, Husemoen LL, Fenger M, Jorgensen T, Linneberg A. The association of serum 25-OH vitamin D with atopy, asthma, and lung function in a prospective study of Danish adults. Clin Exp Allergy. 2015;45:265–72.

    CAS  PubMed  Google Scholar 

  10. 10.

    Larose TL, Brumpton BM, Langhammer A, Camargo CA Jr., Chen Y, Romundstad P, et al. Serum 25-hydroxyvitamin D level, smoking and lung function in adults: the HUNT Study. Eur Respir J. 2015;46:355–63.

    CAS  PubMed  Google Scholar 

  11. 11.

    Choi CJ, Seo M, Choi WS, Kim KS, Youn SA, Lindsey T, et al. Relationship between serum 25-hydroxyvitamin D and lung function among Korean adults in Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2010. J Clin Endocrinol Metab. 2013;98:1703–10.

    CAS  PubMed  Google Scholar 

  12. 12.

    Kim MS, Choi CJ, Kwon KM, Kim KS, Choi WS, Oh YJ. Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults. Korean J Fam Med 2019;40:93–9.

    PubMed  Google Scholar 

  13. 13.

    Park CY, Kwak SY, Jo G, Shin MJ. Genetic association between serum 25-hydroxyvitamin D levels and lung function in Korean men and women: data from KNHANES 2011–2012. Nutrients. 2018;10:1362.

    PubMed Central  Google Scholar 

  14. 14.

    Shim SY, Chae WJ, Kim HC, Park EC, Jang SI. Association between serum 25-hydroxyvitamin D levels and pulmonary function, among Korean adults, during 2010-2014, by sex, age, and body mass index. Respir Med 2018;140:32–8.

    PubMed  Google Scholar 

  15. 15.

    Afzal S, Lange P, Bojesen SE, Freiberg JJ, Nordestgaard BG. Plasma 25-hydroxyvitamin D, lung function and risk of chronic obstructive pulmonary disease. Thorax. 2014;69:24–31.

    PubMed  Google Scholar 

  16. 16.

    Lange NE, Sparrow D, Vokonas P, Litonjua AA. Vitamin D deficiency, smoking, and lung function in the normative aging study. Am J Respir Crit Care Med 2012;186:616–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Kunisaki KM, Niewoehner DE, Singh RJ, Connett JE. Vitamin D status and longitudinal lung function decline in the Lung Health Study. Eur Respir J. 2011;37:238–43.

    CAS  PubMed  Google Scholar 

  18. 18.

    Niruban SJ, Alagiakrishnan K, Beach J, Senthilselvan A. Association between vitamin D and respiratory outcomes in Canadian adolescents and adults. J Asthma. 2015;52:653–61.

    PubMed  Google Scholar 

  19. 19.

    Rafiq R, Thijs W, Prein R, de Jongh RT, Taube C, Hiemstra PS, et al. Associations of serum 25(OH)D concentrations with lung function, airway inflammation and common cold in the general population. Nutrients. 2018;10:35.

    PubMed Central  Google Scholar 

  20. 20.

    Hansen JG, Gao W, Dupuis J, O’Connor GT, Tang W, Kowgier M, et al. Association of 25-Hydroxyvitamin D status and genetic variation in the vitamin D metabolic pathway with FEV1 in the Framingham Heart Study. Respir Res. 2015;16:81.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Shaheen SO, Jameson KA, Robinson SM, Boucher BJ, Syddall HE, Sayer AA, et al. Relationship of vitamin D status to adult lung function and COPD. Thorax. 2011;66:692–8.

    PubMed  Google Scholar 

  22. 22.

    Khan S, Mai XM, Chen Y. Plasma 25-hydroxyvitamin D associated with pulmonary function in Canadian adults with excess adiposity. Am J Clin Nutr. 2013;98:174–9.

    CAS  PubMed  Google Scholar 

  23. 23.

    Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009;12:497–506.

    PubMed  Google Scholar 

  24. 24.

    Sung KC, Wild SH, Byrne CD. Development of new fatty liver, or resolution of existing fatty liver, over five years of follow-up, and risk of incident hypertension. J Hepatol. 2014;60:1040–5.

    PubMed  Google Scholar 

  25. 25.

    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    CAS  Google Scholar 

  26. 26.

    American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med. 1995;152:1107–36.

    Google Scholar 

  27. 27.

    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;96:643–51.

    CAS  PubMed  Google Scholar 

  28. 28.

    Cirillo DJ, Agrawal Y, Cassano PA. Lipids and pulmonary function in the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2002;155:842–8.

    PubMed  Google Scholar 

  29. 29.

    Vitezova A, Voortman T, Zillikens MC, Jansen PW, Hofman A, Uitterlinden AG, et al. Bidirectional associations between circulating vitamin D and cholesterol levels: the Rotterdam Study. Maturitas. 2015;82:411–7.

    CAS  PubMed  Google Scholar 

  30. 30.

    Hurskainen AR, Virtanen JK, Tuomainen TP, Nurmi T, Voutilainen S. Association of serum 25-hydroxyvitamin D with type 2 diabetes and markers of insulin resistance in a general older population in Finland. Diabetes Metab Res Rev. 2012;28:418–23.

    CAS  PubMed  Google Scholar 

  31. 31.

    Cannell JJ, Grant WB, Holick MF. Vitamin D and inflammation. Dermatoendocrinol. 2014;6:e983401.

    PubMed  Google Scholar 

  32. 32.

    Shaaban R, Kony S, Driss F, Leynaert B, Soussan D, Pin I, et al. Change in C-reactive protein levels and FEV1 decline: a longitudinal population-based study. Respir Med. 2006;100:2112–20.

    PubMed  Google Scholar 

  33. 33.

    Brot C, Jorgensen NR, Sorensen OH. The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr. 1999;53:920–6.

    CAS  PubMed  Google Scholar 

  34. 34.

    Thuesen BH, Heede NG, Tang L, Skaaby T, Thyssen JP, Friedrich N, et al. No association between vitamin D and atopy, asthma, lung function or atopic dermatitis: a prospective study in adults. Allergy. 2015;70:1501–4.

    CAS  PubMed  Google Scholar 

  35. 35.

    Xu J, Bartz TM, Chittoor G, Eiriksdottir G, Manichaikul AW, Sun F, et al. Meta-analysis across Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium provides evidence for an association of serum vitamin D with pulmonary function. Br J Nutr. 2018;120:1159–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Sluyter JD, Camargo CA, Waayer D, Lawes CMM, Toop L, Khaw KT, et al. Effect of monthly, high-dose, long-term Vitamin D on lung function: a randomized controlled trial. Nutrients. 2017;9:1353.

    PubMed Central  Google Scholar 

  37. 37.

    Gibson JB, Martin NG, Oakeshott JG, Rowell DM, Clark P. Lung function in an Australian population: contributions of polygenic factors and the Pi locus to individual differences in lung function in a sample of twins. Ann Hum Biol. 1983;10:547–56.

    CAS  PubMed  Google Scholar 

  38. 38.

    Protiva P, Cross HS, Hopkins ME, Kallay E, Bises G, Dreyhaupt E, et al. Chemoprevention of colorectal neoplasia by estrogen: potential role of vitamin D activity. Cancer Prev Res (Philos) 2009;2:43–51.

    CAS  Google Scholar 

  39. 39.

    Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20:1807–20.

    CAS  PubMed  Google Scholar 

  40. 40.

    Berraies A, Hamzaoui K, Hamzaoui A. Link between vitamin D and airway remodeling. J Asthma Allergy. 2014;7:23–30.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    van Eeden SF, Tan WC, Suwa T, Mukae H, Terashima T, Fujii T, et al. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med. 2001;164:826–30.

    PubMed  Google Scholar 

  42. 42.

    American Thoracic Society. Chronic obstructive pulmonary disease: a disorder of the cardiovascular and respiratory systems. Lund, Sweden, April 15-16, 2004. Proceedings. Proc Am Thorac Soc. 2005;2:5–100.

    Google Scholar 

  43. 43.

    Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996;313:711–5. discussion 5–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Scientific Advisory Committee on Nutrition. Update on vitamin D: position statement by the Scientific Advisory Committee on Nutrition. (The Stationery Office, Norwich, 2007).

  45. 45.

    Sonderman JS, Munro HM, Blot WJ, Signorello LB. Reproducibility of serum 25-hydroxyvitamin d and vitamin D-binding protein levels over time in a prospective cohort study of black and white adults. Am J Epidemiol. 2012;176:615–21.

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by a research grant from Jeju National University Hospital development fund in 2019.

Author information

Affiliations

Authors

Contributions

Conception and design: J-U.S Data analysis, interpretation, and manuscript writing: J-US; JL; HKP. Revision of the manuscript and contribution of intellectual content: J-US; JL; HKP; M-JK; S-YH and SYL.

Corresponding author

Correspondence to Jae-Uk Song.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, J., Park, H.K., Kwon, MJ. et al. Decreased lung function is associated with vitamin D deficiency in apparently health, middle aged Koreans: the Kangbuk Samsung Health Study. Eur J Clin Nutr (2020). https://doi.org/10.1038/s41430-020-00748-7

Download citation

Search

Quick links