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Nutr."],"abstract":"<jats:p>Obesity and vitamin D deficiency are both considered risk factors for mortality, but the potential additive effects of vitamin D status and obesity on mortality has not been well-studied. We aimed to examine the possible additive effects of obesity and vitamin D status on all-cause and cause-specific mortality. The data from the NHANES III (1988\u20131994) and NHANES 2001\u20132014 surveys were used, and multivariate Cox regression models were performed to assess the additive effects of vitamin D status and overweight\/obesity\/abdominal obesity on the all-cause, cardiovascular and cancer mortality, by stratifying Cox Hazard Ratios (HRs) across different categories of vitamin D status and body mass index (BMI) and waist circumference (WC) categories. The models were adjusted for age, race\/ethnicity, gender, educational level, family income to poverty ratio, leisure-time physical activity, smoking, and drinking. Across all BMI\/WC categories, there was an additive effect of the vitamin D both insufficiency and deficiency on all mortality rates, with deficiency having much stronger effect than insufficiency. Interestingly, the effect of vitamin D deficiency overcame the effect of obesity on all mortality rates. The highest HRs for overall and cardiovascular mortality were observed among vitamin D deficient obese\/abdominally obese subjects, while for cancer mortality among vitamin D deficient normal weight\/non-abdominally obese subjects. In stratified analyses, regarding all-cause mortality, there was an additive effect of the vitamin D both insufficiency and deficiency in all BMI\/WC categories. Regarding cardiovascular mortality, there was an additive effect of vitamin D deficiency in all BMI\/WC categories, but the additive effect of vitamin D insufficiency reached significance only in normal weight subjects. Regarding cancer mortality, the effect did not reach significance among obese subjects for vitamin D deficiency, while for insufficiency, significance was reached only among non-abdominally obese subjects. Interestingly, vitamin D surplus was associated with increased risk for cancer mortality in obese subjects, but there was an inadequate number of subjects in this category to make proper judgment. In conclusion, vitamin D insufficiency and deficiency gradually increase risk for mortality across all BMI\/WC categories. In our analyses, vitamin D deficiency overcame the effect of obesity on mortality rates.<\/jats:p>","DOI":"10.3389\/fnut.2022.999489","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T08:20:16Z","timestamp":1666340416000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Additive effects of obesity and vitamin D insufficiency on all-cause and cause-specific 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