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. 2024 Dec 18:11:1492647.
doi: 10.3389/fnut.2024.1492647. eCollection 2024.

The mediating role of vitamin D in the relationship between triglyceride glucose index and mortality in patients with diabetes mellitus: a causal mediation analysis

Fan Zhang  1   2   3 , Wenjian Li  1   4
Affiliations

The mediating role of vitamin D in the relationship between triglyceride glucose index and mortality in patients with diabetes mellitus: a causal mediation analysis

Fan Zhang et al. Front Nutr. .

Abstract

Objective: This study investigated the effects of triglyceride glucose index (TyG) and vitamin D levels on all-cause and cardiovascular mortality in diabetic patients and assessed the potential mediating role of vitamin D in the relationship between TyG and mortality.

Methods: The study was based on data from the National Health and Nutrition Examination Survey (NHANES) database from 2001 to 2018, which included 6,318 patients with diabetes. Multivariable Cox proportional risk regression models were employed to assess the association between TyG and vitamin D levels and the risk of death in diabetic patients. The interaction between TyG and vitamin D and its effect on mortality was explored through restricted cubic spline analysis and causal mediation analysis.

Results: The results demonstrated that the TyG index was positively associated with all-cause and cardiovascular mortality in diabetic patients, whereas vitamin D levels were negatively associated with mortality, exhibiting an overall U-shaped association. The results indicated that vitamin D partially mediated the association between TyG and all-cause mortality. Further analysis revealed a significant mediation between vitamin D and TyG, whereby alterations in vitamin D levels influenced the impact of TyG on mortality. Subgroup analyses demonstrated that the correlation between TyG and mortality was more pronounced in diabetic patients with vitamin D insufficiency.

Conclusion: The study demonstrates the mediating influence of vitamin D on the relationship between TyG and mortality in diabetic patients. This finding underscores the necessity of evaluating the influence of vitamin D on survival outcomes in individuals with disparate levels of the TyG index.

Keywords: diabetes mellitus; mediation analysis; mortality; triglyceride glucose index; vitamin D.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Participant screening flowchart.
Figure 2
Figure 2
Restricted cubic spline fitting for the association between mortality and the TyG and vitamin D. (A,B) All-cause mortality according to the TyG and vitamin D; (C,D) cardiovascular mortality according to the TyG and vitamin D. Solid lines indicate HR, and shaded areas indicate 95% CI. These analyses were adjusted according to Model 3.
Figure 3
Figure 3
Interaction restricted cubic spline fitting of vitamin D for the association between mortality and the TyG. (A) All-cause mortality according to the TyG; (B) cardiovascular mortality according to the TyG. Solid lines indicate HR, and areas between the two dotted lines indicate 95% CI. These analyses were adjusted according to Model 3.
Figure 4
Figure 4
Subgroup analysis of vitamin D for the association between TyG and all-cause mortality. These analyses were adjusted according to Model 3.
Figure 5
Figure 5
Subgroup analysis of vitamin D for the association between TyG and cardiovascular mortality. These analyses were adjusted according to Model 3.
See this image and copyright information in PMC

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