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The synergistic effects of vitamin D and estradiol deficiency on metabolic syndrome in Chinese postmenopausal women

Huang, Hui MD1,*; Guo, Jing MD, PhD2,*; Chen, Qingyu MD, PhD3; Chen, Xiaotong MD3; Yang, Yabo MD, PhD1; Zhang, Wangjian PhD4; Liu, Yong MD5; Chen, Xiaoli MD, PhD1; Yang, Dongzi MD, PhD1

doi: 10.1097/GME.0000000000001370
Original Study: PDF Only

Objective: Recent studies show that vitamin D (VitD) deficiency is associated with metabolic syndrome (MetS). Current evidence suggests that estrogen and VitD have similar physiological functions and potentially interact with bone health. We investigated the association between estradiol (E2) and 25-hydroxyvitamin-D [25(OH)D] with MetS and its components in Chinese postmenopausal women.

Methods: In this cross-sectional study, we examined 616 postmenopausal women (aged 49-86 y) from southern China who were not taking estrogen and VitD/calcium supplements. At the end of data collection, serum E2 and 25(OH)D were measured for each participant. MetS was defined according to the 2006 International Diabetes Federation standard.

Results: There was a positive correlation between 25(OH)D and E2. Higher 25(OH)D was associated with a favorable lipid profile, blood pressure, and glucose level. E2 was negatively associated with cholesterol, triglycerides, and blood pressure. The odds ratio for MetS was 2.19 (95% CI, 1.19-4.01, P value for trend=0.009) for deficient compared with sufficient women after multivariable adjustment. This association remained unchanged after further adjusting for E2 levels. After stratified analysis by VitD status, low E2 increased MetS risk in women with VitD deficiency (odds ratio = 3.49, 95% CI, 1.45-8.05 for the lowest vs the highest tertile).

Conclusions: These results suggest a synergistic role of VitD and E2 deficiency in MetS in Chinese postmenopausal women.

1Reproductive Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

2Reproductive Medical Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China

3Health Examination Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

4Department of Environmental Health Sciences, University at Albany, State University of New York, NY

5Pediatric Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.

*HH and JG equally contributed to this work and should be regarded as co-first authors.

Address correspondence to: Dongzi Yang, MD, PhD, and Xiaoli Chen, MD, PhD, Reproductive Medical Center, Sun Yat-Sen Memorial hospital, Sun Yat-Sen university, Guangzhou 510120, China. E-mails:;

Received 25 February, 2019

Revised 15 April, 2019

Accepted 15 April, 2019

Authors’ contributions: HH and JG participated in the project conception, data collection, data analysis, and manuscript writing/editing. XTC and QC participated in the data collection and data analysis. YY and YL were involved in blood sample testing. XLC and WZ were involved in statistical analysis of the results and revision of the paper. DY (the supervisor of the project) participated in the project conception, manuscript writing/editing, and revision of the article. All authors saw and approved the final version.

Funding/support: The study was supported by 2012 Chinese Nutrition Society (CNS) Nutrition Research Foundation—DSM Research Fund (CNS2014048B); the National Natural Science Youth Fund (81703784); Guangdong science and technology program (2016A020216011).

Financial disclosure/conflicts of interest: None reported.

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© 2019 by The North American Menopause Society.