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Background <p>Lower serum 25-hydroxyvitamin D ([25(OH)D]) levels may be associated with a higher risk of premature mortality in patients with sarcopenia; however, this relationship remains inadequately characterized in U.S. populations.</p> Methods <p>Data were from 9,561 participants in NHANES 2011–2018. Sarcopenia was defined using FNIH criteria (appendicular lean mass/BMI). Weighted multivariable logistic regression was used to examine the association between serum 25(OH)D levels and sarcopenia prevalence. Among participants with sarcopenia, premature mortality (death before age 75) was assessed by linking data to the National Death Index; weighted Cox proportional hazards models estimated hazard ratios (HRs) for the association between 25(OH)D levels and premature mortality risk. The proportional hazards assumption was verified using Schoenfeld residuals, with a Weibull parametric model applied as a sensitivity analysis. Dose-response relationships were evaluated using restricted cubic splines, and subgroup analyses with interaction tests were performed to explore differences across key subgroups.</p> Results <p>After multivariable adjustment (adjusting for demographics, lifestyle factors, comorbidities, and laboratory biomarkers), serum 25(OH)D levels were inversely associated with the prevalence of sarcopenia (OR = 0.989 per 1 nmol/L increase; 95% CI: 0.983–0.995; <i>P</i> &lt; 0.001), with this inverse association being more pronounced in males. Among the 828 participants with sarcopenia, 17 premature deaths were documented (2.1%). Higher serum 25(OH)D levels suggested a trend toward reduced premature mortality risk (HR = 0.964, 95% CI: 0.928–1.001, <i>P</i> = 0.051), which was further supported by sensitivity analysis (<i>P</i> = 0.028). No significant interactions were observed for mortality, although analyses were limited by low statistical power.</p> Conclusions <p>Serum 25(OH)D levels were independently and inversely associated with sarcopenia prevalence, with each 1 nmol/L increase reducing risk by 1.07% (OR = 0.989), particularly in males. Higher 25(OH)D levels also trended toward reduced premature mortality in sarcopenic patients (HR = 0.964, <i>P</i> = 0.051; sensitivity analysis <i>P</i> = 0.028). Thus, monitoring serum 25(OH)D may have potential value in sarcopenia management, though further validation is needed.</p>

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Association of serum 25-hydroxyvitamin D concentrations with premature mortality in adult U.S. patients with sarcopenia

  • 期刊论文

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  • 发表日期：

    2026年7月20日

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  • Jianwei Huang,
  • Tingxiao Zhao,
  • Yanlei Li,
  • Shanggao Xie,
  • Mingxiang Kong

摘要

Background

Lower serum 25-hydroxyvitamin D ([25(OH)D]) levels may be associated with a higher risk of premature mortality in patients with sarcopenia; however, this relationship remains inadequately characterized in U.S. populations.

Methods

Data were from 9,561 participants in NHANES 2011–2018. Sarcopenia was defined using FNIH criteria (appendicular lean mass/BMI). Weighted multivariable logistic regression was used to examine the association between serum 25(OH)D levels and sarcopenia prevalence. Among participants with sarcopenia, premature mortality (death before age 75) was assessed by linking data to the National Death Index; weighted Cox proportional hazards models estimated hazard ratios (HRs) for the association between 25(OH)D levels and premature mortality risk. The proportional hazards assumption was verified using Schoenfeld residuals, with a Weibull parametric model applied as a sensitivity analysis. Dose-response relationships were evaluated using restricted cubic splines, and subgroup analyses with interaction tests were performed to explore differences across key subgroups.

Results

After multivariable adjustment (adjusting for demographics, lifestyle factors, comorbidities, and laboratory biomarkers), serum 25(OH)D levels were inversely associated with the prevalence of sarcopenia (OR = 0.989 per 1 nmol/L increase; 95% CI: 0.983–0.995; P < 0.001), with this inverse association being more pronounced in males. Among the 828 participants with sarcopenia, 17 premature deaths were documented (2.1%). Higher serum 25(OH)D levels suggested a trend toward reduced premature mortality risk (HR = 0.964, 95% CI: 0.928–1.001, P = 0.051), which was further supported by sensitivity analysis (P = 0.028). No significant interactions were observed for mortality, although analyses were limited by low statistical power.

Conclusions

Serum 25(OH)D levels were independently and inversely associated with sarcopenia prevalence, with each 1 nmol/L increase reducing risk by 1.07% (OR = 0.989), particularly in males. Higher 25(OH)D levels also trended toward reduced premature mortality in sarcopenic patients (HR = 0.964, P = 0.051; sensitivity analysis P = 0.028). Thus, monitoring serum 25(OH)D may have potential value in sarcopenia management, though further validation is needed.