血清褪黑素与维生素D的交互及联合作用影响超重与肥胖的风险

The interaction and joint effect of serum melatonin and vitamin D on the risk of overweight and obesity

  • 摘要: 目的: 探究血清褪黑素(MT)与维生素D(Vit D)的交互作用及联合效应对超重与肥胖风险的影响,以及代谢指标的中介作用。方法: 采用横断面研究设计,纳入3 739例健康体检者,根据体质量指数分成非超重/肥胖组(n=2 029)和超重/肥胖组(n=1 710),根据血清MT水平的中位数及Vit D的临床标准(充足、不足/缺乏)对参与者进行分层。采用多元线性回归和logistic回归模型分析MT与Vit D对体质量指数和超重/肥胖风险的独立与联合效应,进行亚组分析探究人群异质性,并通过中介分析探讨代谢指标的中介作用。结果: 多因素校正模型显示,血清MT与Vit D对体质量指数的影响存在显著的相乘交互作用(交互项,β=-0.47,P交互=0.001)。联合作用分析表明,与“低MT+Vit D不足/缺乏”组相比,“高MT+Vit D充足”组显著降低体质量指数(β=-0.64,95%CI:-0.97~-0.31,P<0.001)及超重/肥胖风险(OR=0.76,95%CI:0.61~0.93,P=0.010),且联合作用呈现显著的剂量反应关系。亚组分析显示,该联合保护作用在老年人、2型糖尿病患者、高血压患者中尤为显著。中介分析进一步揭示,总胆固醇、甘油三酯、低密度脂蛋白胆固醇、空腹血糖和甘油三酯—葡萄糖(TyG)指数是该联合作用与体质量指数关联的重要中介变量,中介比例分别为10.2%、33.4%、5.6%、18.3%和57.0%。结论: 血清MT与Vit D在影响超重与肥胖风险方面存在联合保护作用,维持较高的MT与充足的Vit D水平可能是预防超重与肥胖的策略,该联合保护作用可通过改善胰岛素抵抗和脂质代谢来实现。

     

    Abstract: Objective: To investigate the interaction and joint effect of serum melatonin (MT) and vitamin D (Vit D) on the risk of overweight and obesity, and to explore the mediating role of metabolic indicators. Methods: This cross-sectional study enrolled 3, 739 health examinees, who were categorized by body mass index (BMI) into non-overweight/obesity (n=2,029) and overweight/obesity (n=1,710) groups, and subsequently stratified by median serum MT levels and clinical Vit D status (sufficient, insufficient/deficient). Multiple linear regression and logistic regression models were employed to analyze the independent and joint effect of MT and Vit D on BMI and the risk of overweight/obesity. Subgroup analyses were conducted to examine potential effect heterogeneity across different populations, and mediation analysis was performed to assess the mediating effect of metabolic parameters. Results: Multivariate-adjusted models revealed a significant multiplicative interaction between serum MT and Vit D on BMI (interaction term, β=-0.47, P=0.001). Analysis of their joint effect demonstrated that compared to the“low MT + insufficiency/deficiency Vit D”group, the“high MT + Sufficient Vit D”group was significantly associated with a lower BMI (β=-0.64, 95% CI: -0.97 to -0.31, P<0.001) and a reduced risk of overweight/obesity (OR=0.76, 95% CI: 0.61 to 0.93, P=0.010). Furthermore, a significant dose-response relationship was observed for this joint effect. Subgroup analyses indicated that this joint protective association was particularly pronounced among older adults, individuals with type 2 diabetes mellitus, and those with hypertension. Mediation analysis further identified total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting blood glucose, and the triglyceride-glucose (TyG) index as significant mediators of the joint effect on BMI, accounting for 10.2%, 33.4%, 5.6%, 18.3%, and 57.0% of the total effect, respectively. Conclusion: Serum MT and Vit D exhibit a joint protective effect against the risk of overweight and obesity. Maintaining relatively higher MT and sufficient Vit D levels may represent a potential strategy for preventing overweight and obesity. This protective joint effect is likely mediated through the improvement of insulin resistance and lipid metabolism.

     

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