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ORIGINAL RESEARCH article

Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1527333

Association Between Vitamin D Levels and Preserved Ratio Impaired Spirometry: An Investigation of Mediating Roles of Systemic Inflammation and Metabolic Indicators

Provisionally accepted
Tong Lin Tong Lin Shanshan Huang Shanshan Huang Fen Zhou Fen Zhou Xingkai Shen Xingkai Shen Haiyan Mao Haiyan Mao *
  • Ningbo Medical Centre Lihuili Hospital, Ningbo, China

The final, formatted version of the article will be published soon.

    Preserved Ratio Impaired Spirometry (PRISm) represents an abnormal lung function state distinct from traditional chronic obstructive pulmonary disease, characterized by unique clinical and epidemiological features. PRISm has been associated with various health issues, including an increased risk of metabolic disorders and cardiovascular diseases. Vitamin D, known for its anti-inflammatory, immunomodulatory, and antioxidant properties, may play a role in reducing the risk of PRISm. This study aims to investigate the relationship between vitamin D levels and PRISm, including the mediating effects of systemic inflammation markers and metabolic indicators in a population of U.S. adults. Methods This cross-sectional study analyzed data from 17,333 participants from the U.S. National Health and Nutrition Examination Survey, including 1,577 individuals with PRISm and 15,756 without. Baseline characteristics were assessed, and multivariate logistic regression models were employed to examine the relationship between vitamin D and PRISm. Mediationanalysis was conducted to explore potential mediating roles of systemic immuneinflammation index (SII), triglyceride-glucose (TyG) index, and bilirubin. Nonlinear relationships were assessed using restricted cubic spline (RCS) models.The PRISm group had lower median vitamin D levels and distinct inflammatory and metabolic profiles compared to the non-PRISm group. Multivariate analysis confirmed an inverse association between vitamin D levels and PRISm (adjusted OR: 0.989, 95% CI: 0.984-0.994, P < 0.001). RCS analysis showed a nonlinear protective effect of vitamin D, with risk stabilizing at levels above 50 nmol/ml. Mediation analysis highlighted bilirubin as a positive mediator (ACME = -4.11e-05, P < 0.001), while TyG demonstrated a suppressive mediation effect (ACME = 2.68e-05, P < 0.001). SII did not show significant mediation.Elevated vitamin D levels are linked to a lower risk of PRISm, with bilirubin potentially acting as a mediator in this protective relationship. This underscores the clinical significance of maintaining sufficient vitamin D levels to promote lung health and mitigate the prevalence of PRISm among U.S. adults. Further research is warranted to investigate personalized vitamin D supplementation strategies as a potential preventive approach.

    Keywords: Vitamin D, Preserved Ratio Impaired Spirometry, respiratory disease, Mediation analysis, NHANES

    Received: 13 Nov 2024; Accepted: 16 Jan 2025.

    Copyright: © 2025 Lin, Huang, Zhou, Shen and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Haiyan Mao, Ningbo Medical Centre Lihuili Hospital, Ningbo, China

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