{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T06:35:02Z","timestamp":1771655702021,"version":"3.50.1"},"reference-count":54,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Body mass index (BMI) as well as sugar-sweetened beverages (SSB) has been suggested to independently decrease 25-hydroxyvitamin D (25(OH)D). However, the relationship between SSB, BMI, and 25(OH)D is uncertain. This study aimed to investigate the potential mediating role of BMI in the association between SSB intake and 25(OH)D. A total of 4505 representative U.S. adults aged above 20 years and without liver conditions were selected from the 2013\u20132014 NHANES. All analyses were performed under survey modules with appropriate sampling weights. The prevalence of 25(OH)D insufficiency and deficiency was 37.8% and 24.1% in U.S. adults, respectively. Compared with non-SSB consumers, an increased risk of vitamin D deficiency was found in either heavy SSB consumers or soda consumers, respectively (aOR = 2.10, 95% CI = 1.25\u20133.54 in heavy SSB consumers; aOR = 1.61, 95% CI = 1.06\u20132.44 in soda consumers). Around 21.3% of the total effect of sugar intake from SSB on decreased 25(OH)D was explained by BMI. In conclusion, high total sugar intake from SSB and BMI independently contribute to lower 25(OH)D, and BMI mediates the inverse association between total sugar intake from SSB intake and 25(OH)D. Furthermore, an increased risk of having vitamin D deficiency was found in the population who consumed higher levels of sugar from SSB or soda drinks.<\/jats:p>","DOI":"10.3390\/nu15153291","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T01:03:25Z","timestamp":1690333405000},"page":"3291","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mediation of BMI on 25-Hydroxyvitamin D Levels in U.S. Adults with Sugar-Sweetened Beverages Consumption"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-2754","authenticated-orcid":false,"given":"Wei-Ting","family":"Lin","sequence":"first","affiliation":[{"name":"Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle V.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Behavioral and Community Health Sciences Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Hsiang","family":"Kao","sequence":"additional","affiliation":[{"name":"Behavioral and Community Health Sciences Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3307-5549","authenticated-orcid":false,"given":"Hui-Yi","family":"Lin","sequence":"additional","affiliation":[{"name":"Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirandy S.","family":"Li","sequence":"additional","affiliation":[{"name":"Behavioral and Community Health Sciences Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Seal","sequence":"additional","affiliation":[{"name":"Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-264X","authenticated-orcid":false,"given":"Chien-Hung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"},{"name":"Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-yang","family":"Hu","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-6350","authenticated-orcid":false,"given":"Lei-Shih","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-9891","authenticated-orcid":false,"given":"Tung-Sung","family":"Tseng","sequence":"additional","affiliation":[{"name":"Behavioral and Community Health Sciences Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","unstructured":"National Institutes of Health (2023, January 16). Vitamin D: Fact Sheet for Health Professionals, Available online: https:\/\/ods.od.nih.gov\/factsheets\/VitaminD-HealthProfessional\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S0140-6736(13)61647-5","article-title":"Effects of vitamin D supplements on bone mineral density: A systematic review and meta-analysis","volume":"383","author":"Reid","year":"2014","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16041","DOI":"10.1038\/boneres.2016.41","article-title":"Vitamin D, calcium homeostasis and aging","volume":"4","author":"Veldurthy","year":"2016","journal-title":"Bone Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1530\/EJE-19-0156","article-title":"Effects of 6-month vitamin D supplementation on insulin sensitivity and secretion: A randomised, placebo-controlled trial","volume":"181","author":"Lemieux","year":"2019","journal-title":"Eur. J. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1038\/nrcardio.2016.73","article-title":"Vitamin D and cardiovascular disease prevention","volume":"13","author":"Pilz","year":"2016","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"491","DOI":"10.21873\/anticanres.13977","article-title":"Review of Recent Advances in Understanding the Role of Vitamin D in Reducing Cancer Risk: Breast, Colorectal, Prostate, and Overall Cancer","volume":"40","author":"Grant","year":"2020","journal-title":"Anticancer. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"74","DOI":"10.4103\/jpgm.JPGM_571_17","article-title":"Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials","volume":"65","author":"Vellekkatt","year":"2019","journal-title":"J. Postgrad. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2502","DOI":"10.3390\/nu5072502","article-title":"Vitamin D and immune function","volume":"5","author":"Prietl","year":"2013","journal-title":"Nutrients"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1212\/01.WNL.0000101723.79681.38","article-title":"Vitamin D intake and incidence of multiple sclerosis","volume":"62","author":"Munger","year":"2004","journal-title":"Neurology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20200033","DOI":"10.1515\/hmbci-2020-0033","article-title":"Association between vitamin D deficiency and prevalence of metabolic syndrome in female population: A systematic review","volume":"41","author":"Maroufi","year":"2020","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/ajcn\/84.1.18","article-title":"Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes","volume":"84","author":"Giovannucci","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1017\/S0007114518000491","article-title":"Vitamin D deficiency and insufficiency among US adults: Prevalence, predictors and clinical implications","volume":"119","author":"Liu","year":"2018","journal-title":"Br. J. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1080S","DOI":"10.1093\/ajcn\/87.4.1080S","article-title":"Vitamin D deficiency: A worldwide problem with health consequences","volume":"87","author":"Holick","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.nutres.2010.12.001","article-title":"Prevalence and correlates of vitamin D deficiency in US adults","volume":"31","author":"Forrest","year":"2011","journal-title":"Nutr. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s00394-012-0354-0","article-title":"Vitamin D status is associated with sociodemographic factors, lifestyle and metabolic health","volume":"52","author":"Jaaskelainen","year":"2013","journal-title":"Eur. J. Nutr."},{"key":"ref_17","unstructured":"WHO (2023, March 05). W.H.O. Fact Sheet Obesity and Overweight 2013. Available online: http:\/\/www.who.int\/mediacentre\/factsheets\/fs311\/en\/#."},{"key":"ref_18","unstructured":"Hales, C.M., Carroll, M.D., Fryar, C.D., and Ogden, C.L. (2020). Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017\u20132018, National Center for Health Statistics. NCHS Data Brief, no 360."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vimaleswaran, K.S., Berry, D.J., Lu, C., Tikkanen, E., Pilz, S., Hiraki, L.T., Cooper, J.D., Dastani, Z., Li, R., and Houston, D.K. (2013). Causal relationship between obesity and vitamin D status: Bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001383"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","article-title":"Decreased bioavailability of vitamin D in obesity","volume":"72","author":"Wortsman","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E35","DOI":"10.5888\/pcd18.200434","article-title":"Prevalence of Self-Reported Intake of Sugar-Sweetened Beverages Among US Adults in 50 States and the District of Columbia, 2010 and 2015","volume":"18","author":"Chevinsky","year":"2021","journal-title":"Prev. Chronic. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1161\/CIRCULATIONAHA.109.876185","article-title":"Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk","volume":"121","author":"Malik","year":"2010","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00038-020-01330-5","article-title":"The association between sugar-sweetened beverages intake, body mass index, and inflammation in US adults","volume":"65","author":"Lin","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1016\/j.jacc.2015.08.025","article-title":"Fructose and Cardiometabolic Health: What the Evidence From Sugar-Sweetened Beverages Tells Us","volume":"66","author":"Malik","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2987","DOI":"10.3390\/nu6082987","article-title":"Association between intake of sugar-sweetened beverages and circulating 25-hydroxyvitamin D concentration among premenopausal women","volume":"6","author":"Duchaine","year":"2014","journal-title":"Nutrients"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1210\/jc.2011-1507","article-title":"Vitamin D deficiency in obese children and its relationship to glucose homeostasis","volume":"97","author":"Olson","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1188612","DOI":"10.3389\/fnut.2023.1188612","article-title":"Associations between vitamin D levels and dietary patterns in patients with Hashimoto\u2019s thyroiditis","volume":"10","author":"Kalicanin","year":"2023","journal-title":"Front. Nutr."},{"key":"ref_28","unstructured":"Centers for Disease Control and Prevention (CDC), and National Center for Health Statistics (NCHS) (2023, March 05). NHANES Survey. Methods and Analytic Guidelines, Available online: https:\/\/www.cdc.gov\/nchs\/nhanes\/index.htm."},{"key":"ref_29","unstructured":"The World Health Organization (WHO) (2023, March 05). Global Strategy on Diet, Physical Activity and Health. Available online: https:\/\/www.who.int\/dietphysicalactivity\/factsheet_adults\/en\/."},{"key":"ref_30","unstructured":"Institute of Medicine, Food and Nutrition Board, and Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011). Dietary Reference Intakes for Calcium and Vitamin D, The National Academies Press."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1001\/jama.292.8.978","article-title":"Sugar-sweetened soft drinks, obesity, and type 2 diabetes","volume":"292","author":"Apovian","year":"2004","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.nut.2014.04.003","article-title":"Fructose content in popular beverages made with and without high-fructose corn syrup","volume":"30","author":"Walker","year":"2014","journal-title":"Nutrition"},{"key":"ref_33","unstructured":"Agricultural Research Service US & Department of Agriculture Beltsville Human Nutrition Research Center (2023, March 05). Food and Nutrient Database for Dietary Studies (FNDDS), Available online: https:\/\/www.ars.usda.gov\/northeast-area\/beltsville-md-bhnrc\/beltsvillehuman-nutrition-research-center\/food-surveys-research-group\/docs\/fndds-download-databases\/."},{"key":"ref_34","unstructured":"Centers for Disease Control and Prevention (CDC) (2023, March 10). Defining Adult Overweight and Obesity, Available online: https:\/\/www.cdc.gov\/obesity\/adult\/defining.html."},{"key":"ref_35","unstructured":"Centers for Disease Control and Prevention (CDC) (2023, February 08). The National Health and Nutrition Examination Survey Laboratory Procedure Manual Serum 25-Hydroxyvitamin D Diasorin (Formerly Incstar) 25-OH-D Assay, Available online: https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/2013-2014\/VID_H.htm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12291-013-0408-y","article-title":"Alkaline phosphatase: An overview","volume":"29","author":"Sharma","year":"2014","journal-title":"Indian J. Clin. Biochem."},{"key":"ref_39","unstructured":"National Institutes of Health (NIH) (2023, March 22). Office of Dietary Supplements. Phosphorus. Fact Sheet for Health Professionals, Available online: https:\/\/ods.od.nih.gov\/factsheets\/Phosphorus-HealthProfessional\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1309\/LMGLMZ8CIYMFNOGX","article-title":"Calcium, Magnesium, and Phosphate","volume":"45","author":"Bazydlo","year":"2014","journal-title":"Lab. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/S0188-4409(00)00090-4","article-title":"Cola beverage consumption induces bone mineralization reduction in ovariectomized rats","volume":"31","author":"Paniagua","year":"2000","journal-title":"Arch. Med. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1681\/ASN.2009080795","article-title":"Dietary fructose inhibits intestinal calcium absorption and induces vitamin D insufficiency in CKD","volume":"21","author":"Douard","year":"2010","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.cbi.2008.10.011","article-title":"Fructose and carbonyl metabolites as endogenous toxins","volume":"178","author":"Lee","year":"2009","journal-title":"Chem. Biol. Interact."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1172\/JCI112304","article-title":"Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans","volume":"77","author":"Portale","year":"1986","journal-title":"J. Clin. Invest."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1093\/ajcn\/84.4.936","article-title":"Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study","volume":"84","author":"Tucker","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"242","DOI":"10.2337\/db09-1011","article-title":"Adiposity, cardiometabolic risk, and vitamin D status: The Framingham Heart Study","volume":"59","author":"Cheng","year":"2010","journal-title":"Diabetes"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1445-5994.2009.01900.x","article-title":"Body mass index determines sunbathing habits: Implications on vitamin D levels","volume":"39","author":"Kull","year":"2009","journal-title":"Intern. Med. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/07315724.2009.10719779","article-title":"Vitamin D3 distribution and status in the body","volume":"28","author":"Heaney","year":"2009","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jsbmb.2012.12.003","article-title":"The effect of vitamin D supplementation on serum 25(OH)D in thin and obese women","volume":"136","author":"Gallagher","year":"2013","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1017\/S1368980014000457","article-title":"Vitamin D deficiency in minority populations","volume":"18","author":"Taksler","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1093\/aje\/kwn163","article-title":"Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: Results from the Third National Health and Nutrition Examination Survey","volume":"168","author":"Scragg","year":"2008","journal-title":"Am. J. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Tonnesen, R., Hovind, P.H., Jensen, L.T., and Schwarz, P. (2016). Determinants of vitamin D status in young adults: Influence of lifestyle, sociodemographic and anthropometric factors. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3042-9"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/07315724.2015.1039866","article-title":"Sunlight and Vitamin D: Necessary for Public Health","volume":"34","author":"Baggerly","year":"2015","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.3945\/ajcn.111.031070","article-title":"Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: A systematic review and meta-analysis","volume":"95","author":"Tripkovic","year":"2012","journal-title":"Am. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/15\/3291\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:18:42Z","timestamp":1760127522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/15\/3291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":54,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["nu15153291"],"URL":"https:\/\/doi.org\/10.3390\/nu15153291","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}