Vitamin D deficiency is associated with apolipoprotein A1 levels in patients with young-onset type 2 diabetes mellitus

doi:10.4239/wjd.v16.i6.105558

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World Journal of Diabetes

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Observational Study

World J Diabetes. Jun 15, 2025; 16(6): 105558
Published online Jun 15, 2025. doi: 10.4239/wjd.v16.i6.105558

Table 1 Comparison of the clinical and laboratory data between the type 2 diabetes mellitus patients and no-diabetes mellitus patients, n (%)

	Overall (n = 1284)	No-DM (n = 642)	T2DM (n = 642)	P value
Age (years)	33.00 (29.00, 36.00)	33.00 (30.00, 36.00)	33.00 (29.00, 36.00)	0.499
Female	465 (36.2)	237 (36.9)	228 (35.5)	0.642
Smoking	253 (19.7)	89 (13.9)	164 (25.5)	< 0.001
Alcohol	182 (14.2)	56 (8.7)	126 (19.6)	< 0.001
CVD	6 (0.5)	1 (0.2)	5 (0.8)	0.22
HBP	137 (10.7)	28 (4.4)	109 (17.0)	< 0.001
Hyperlipemia	291 (22.7)	19 (3.0)	272 (42.4)	< 0.001
Fatty liver	440 (34.3)	51 (7.9)	389 (60.6)	< 0.001
Hyperuricemia	155 (12.1)	41 (6.4)	114 (17.8)	< 0.001
Obesity	133 (10.4)	21 (3.3)	112 (17.4)	< 0.001
Osteopenia	17 (1.3)	0 (0.0)	17 (2.6)	< 0.001
CKD	158 (12.3)	30 (4.7)	128 (19.9)	< 0.001
25VitD, ng/mL	16.63 (12.57, 22.63)	17.41 (13.16, 23.96)	15.90 (11.77, 21.21)	< 0.001
25VitD class				< 0.001
Normal	114 (8.9)	63 (9.8)	51 (7.9)
Insufficient	328 (25.5)	194 (30.2)	134 (20.9)
Deficient	679 (52.9)	321 (50.0)	358 (55.8)
Severely deficient	163 (12.7)	64 (10.0)	99 (15.4)
25VitD2, ng/mL	0.48 (0.19, 0.85)	0.50 (0.22, 0.88)	0.46 (0.18, 0.84)	0.344
25VitD3, ng/mL	16.10 (12.00, 21.60)	16.70 (12.61, 23.08)	15.30 (11.20, 20.40)	< 0.001
LDL-C, mmol/L	2.78 (2.19, 3.45)	2.71 (2.17, 3.34)	2.88 (2.23, 3.54)	0.01
HDL-C, mmol/L	1.04 (0.87, 1.28)	1.15 (0.98, 1.41)	0.94 (0.78, 1.13)	< 0.001
TG, mmol/L	1.52 (0.98, 2.45)	1.31 (0.81, 1.97)	1.78 (1.18, 2.94)	< 0.001
No HDL-C, mmol/L	3.68 (2.95, 4.51)	3.47 (2.77, 4.21)	3.95 (3.13, 4.84)	< 0.001
Apolipoprotein A1, g/L	1.19 (1.04, 1.42)	1.27 (1.13, 1.52)	1.11 (0.98, 1.28)	< 0.001
Apolipoprotein B, g/L	0.89 (0.72, 1.09)	0.83 (0.67, 1.01)	0.96 (0.77, 1.18)	< 0.001
ApoB/ApoA1	0.70 (0.54, 0.94)	0.62 (0.47, 0.78)	0.83 (0.62, 1.06)	< 0.001
Free fatty acids, μmol/L	503.50 (374.00, 662.00)	488.00 (355.00, 633.50)	530.00 (397.75, 693.75)	0.001
lipoprotein, mg/L	103.00 (48.75, 207.25)	102.00 (51.00, 215.50)	108.00 (47.00, 202.75)	0.489
UA, μmol/L	363.00 (284.00, 432.00)	358.00 (276.00, 422.75)	369.00 (291.00, 438.75)	0.012
Glu, mmol/L	5.20 (4.64, 7.18)	4.80 (4.46, 5.15)	7.08 (5.34, 9.79)	< 0.001
ALB, g/L	41.60 (38.10, 44.80)	43.60 (40.02, 45.90)	40.00 (37.30, 42.80)	< 0.001
ALT, U/L	24.00 (14.00, 48.00)	21.00 (13.00, 34.75)	30.00 (17.00, 62.00)	< 0.001
AST, U/L	22.00 (17.00, 32.00)	21.00 (17.00, 26.00)	24.00 (16.25, 41.75)	< 0.001
ALP, U/L	78.00 (63.00, 95.00)	76.00 (61.00, 92.75)	79.00 (65.00, 97.00)	0.087
Scr, μmol/L	69.10 (56.60, 79.50)	71.50 (58.28, 81.22)	67.10 (55.47, 76.60)	< 0.001
eGFR, mL/minute/1.73 m²	118.51 (106.40, 130.59)	114.67 (103.85, 128.66)	121.81 (110.17, 132.13)	< 0.001
Ca, mmol/L	2.32 (2.23, 2.39)	2.34 (2.27, 2.41)	2.28 (2.20, 2.36)	< 0.001
P, mmol/L	1.25 (1.11, 1.40)	1.22 (1.09, 1.36)	1.27 (1.14, 1.44)	< 0.001
iPTH, pg/mL	33.40 (24.20, 45.32)	33.50 (24.00, 45.60)	33.10 (24.40, 44.92)	0.605
Hemoglobin, g/L	147.00 (130.00, 158.00)	146.00 (129.00, 157.00)	147.00 (131.00, 159.00)	0.024
White blood cell, × 10⁹/L	7.02 (5.80, 8.53)	6.81 (5.62, 8.24)	7.23 (6.09, 8.71)	< 0.001
PLT, × 10⁹/L	238.00 (199.00, 280.00)	240.00 (201.25, 280.00)	237.00 (196.25, 280.00)	0.344

CVD: Cardiovascular disease; HBP: Hypertension; CKD: Chronic kidney disease; 25VitD: 25-hydroxy vitamin D; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglycerides; ApoB: Apolipoprotein B; ApoA1: Apolipoprotein A1; UA: Uric acid; Glu: Glucose; ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; Scr: Serum creatinine; eGFR: Estimated glomerular filtration rate (calculated using the 2009 Chronic Kidney Disease Epidemiology Collaboration formula); Ca: Blood calcium; P: Blood phosphorus; iPTH: Parathyroid hormone; PLT: Platelets.

Table 2 Comparison of the clinical and laboratory data between the four groups, n (%)

	Overall (n = 642)	VitD normal (n = 51)	VitD insufficient (n = 134)	VitD deficient (n = 358)	VitD severely deficient (n = 99)	P value
Age (years)	33.0 (29.0, 36.0)	33.0 (29.5, 35.5)	35.0 (31.0, 38.0)	33.0 (28.0, 36.0)	31.0 (27.0, 35.0)	< 0.001
Female	228 (35.5)	31 (60.8)	33 (24.6)	118 (33.0)	46 (46.5)	< 0.001
Smoking	164 (25.5)	11 (21.6)	40 (29.9)	91 (25.4)	22 (22.2)	0.511
Alcohol	126 (19.6)	10 (19.6)	39 (29.1)	60 (16.8)	17 (17.2)	0.02
CVD	5 (0.8)	2 (3.9)	1 (0.7)	2 (0.6)	0 (0.0)	0.057
HBP	109 (17.0)	4 (7.8)	22 (16.4)	67 (18.7)	16 (16.2)	0.277
Hyperlipemia	272 (42.4)	13 (25.5)	65 (48.5)	155 (43.3)	39 (39.4)	0.037
Fatty liver	389 (60.6)	17 (33.3)	83 (61.9)	225 (62.8)	64 (64.6)	0.001
Hyperuricemia	114 (17.8)	7 (13.7)	23 (17.2)	64 (17.9)	20 (20.2)	0.799
Obesity	112 (17.4)	7 (13.7)	23 (17.2)	64 (17.9)	18 (18.2)	0.901
Osteopenia	17 (2.6)	2 (3.9)	3 (2.2)	12 (3.4)	0 (0.0)	0.285
CKD	128 (19.9)	9 (17.6)	28 (20.9)	73 (20.4)	18 (18.2)	0.923
25VitD, ng/mL	15.90 (11.77, 21.21)	35.46 (32.13, 41.36)	23.51 (21.51, 26.17)	15.08 (12.71, 17.31)	7.82 (6.11, 9.05)	< 0.001
25VitD2, ng/mL	0.46 (0.18, 0.84)	0.53 (0.26, 0.69)	0.52 (0.21, 0.90)	0.47 (0.19, 0.90)	0.33 (0.04, 0.63)	0.006
25VitD3, ng/mL	15.30 (11.20, 20.40)	34.20 (31.10, 40.55)	22.70 (20.90, 25.30)	14.18 (11.83, 16.50)	7.29 (5.92, 8.41)	< 0.001
LDL-C, mmol/L	2.88 (2.23, 3.54)	2.95 (2.42, 3.33)	2.88 (2.18, 3.53)	2.87 (2.22, 3.52)	2.92 (2.37, 3.64)	0.909
HDL-C, mmol/L	0.94 (0.78, 1.13)	1.34 (0.90, 1.86)	0.94 (0.76, 1.14)	0.93 (0.79, 1.09)	0.92 (0.79, 1.09)	< 0.001
TG, mmol/L	1.78 (1.18, 2.94)	2.54 (1.40, 3.23)	1.97 (1.33, 3.39)	1.70 (1.15, 2.92)	1.50 (1.04, 2.33)	0.007
No HDL-C, mmol/L	3.95 (3.13, 4.84)	3.95 (3.33, 4.56)	4.09 (3.42, 4.86)	3.92 (3.08, 4.86)	3.86 (3.04, 4.69)	0.331
Apolipoprotein A1, g/L	1.11 (0.98, 1.28)	1.58 (1.12, 2.36)	1.11 (0.98, 1.41)	1.10 (0.98, 1.24)	1.08 (0.92, 1.19)	< 0.001
Apolipoprotein B, g/L	0.96 (0.77, 1.18)	1.00 (0.84, 1.15)	0.99 (0.82, 1.20)	0.95 (0.77, 1.18)	0.90 (0.74, 1.17)	0.322
ApoB/ApoA1	0.83 (0.62, 1.06)	0.61 (0.46, 0.84)	0.83 (0.61, 1.05)	0.86 (0.65, 1.08)	0.82 (0.65, 1.10)	< 0.001
Free fatty acids, μmol/L	530 (398, 694)	512 (433, 608)	526 (372, 682)	525 (393,685)	571 (411, 758)	0.302
Lipoproteina, mg/L	108 (47, 203)	116 (44, 188)	92 (35, 232)	117 (47, 201)	101 (61, 201)	0.885
UA, μmol/L	369 (291, 439)	316 (272, 386)	368 (292, 424)	373 (295, 440)	373 (284, 475)	0.089
Glu, mmol/L	7.08 (5.34, 9.79)	5.46 (4.40, 7.34)	6.81 (5.26, 9.34)	7.32 (5.52, 9.92)	7.71 (5.66, 10.30)	< 0.001
ALB, g/L	40.0 (37.3, 42.8)	38.1 (35.1, 41.8)	40.7 (38.0, 43.8)	40.1 (37.8, 42.7)	39.1 (35.7, 42.2)	0.019
ALT, U/L	30.0 (17.0, 62.0)	22.0 (11.5, 59.0)	28.0 (18.0, 60.8)	31.0 (18.0, 62.0)	34.0 (16.0, 65.5)	0.211
AST, U/L	24.0 (16.3, 41.8)	23.0 (15.0, 33.0)	23.0 (17.0, 33.8)	24.0 (17.0, 42.8)	27.0 (16.0, 46.0)	0.329
ALP, U/L	79.0 (65.0, 97.0)	80.0 (65.5, 96.0)	82.0 (65.0, 101.8)	78.0 (64.0, 96.0)	76.0 (64.0, 97.5)	0.528
Scr, μmol/L	67.1 (55.5, 76.6)	57.7 (48.1, 70.3)	70.1 (60.6, 80.0)	68.1 (56.5, 76.7)	61.0 (52.0, 73.9)	< 0.001
eGFR, mL/minute/1.73 m²	121.81 (110.17, 132.13)	125.11 (119.47, 132.95)	117.11 (108.36, 128.38)	121.09 (109.86, 132.74)	124.97 (116.59, 132.42)	0.015
Ca, mmol/L	2.28 (2.20, 2.36)	2.29 (2.21, 2.36)	2.29 (2.22, 2.36)	2.28 (2.20, 2.36)	2.27 (2.17, 2.34)	0.147
P, mmol/L	1.27 (1.14, 1.44)	1.27 (1.18, 1.44)	1.28 (1.14, 1.42)	1.28 (1.15, 1.44)	1.25 (1.10, 1.44)	0.613
iPTH, pg/mL	33.1 (24.4, 44.9)	25.4 (17.4, 31.8)	30.2 (23.4, 40.6)	34.5 (26.4, 46.0)	38.1 (26.7, 46.1)	< 0.001
Hemoglobin, g/L	147 (131, 159)	132 (119, 152)	151 (139, 160)	148 (133, 160)	144 (130, 156)	0.001
White blood cell, × 10⁹/L	7.23 (6.09, 8.71)	8.54 (6.43, 9.68)	7.00 (6.09, 8.46)	7.14 (6.02, 8.48)	7.99 (6.30, 9.04)	0.004
PLT, × 10⁹/L	237 (196, 280)	224 (192, 258)	233 (192, 277)	237 (198, 276)	256 (207, 318)	0.011

Table 3 Comparison of the clinical and laboratory data between high- and low-apolipoprotein A1 groups, n (%)

	Overall (n = 642)	ApoA1 ≥ 1 g/L (n = 440)	ApoA1 < 1 g/L (n = 202)	P value
Age (years)	33.00 (29.00, 36.00)	33.00 (29.00, 37.00)	33.00 (28.00, 36.00)	0.436
Female	228 (35.51)	194 (44.09)	34 (16.83)	< 0.001
Smoking	164 (25.55)	88 (20.00)	76 (37.62)	< 0.001
Alcohol	126 (19.63)	70 (15.91)	56 (27.72)	< 0.001
CVD	5 (0.78)	2 (0.45)	3 (1.49)	0.370
HBP	109 (16.98)	74 (16.82)	35 (17.33)	0.873
Fatty liver	389 (60.59)	235 (53.41)	154 (76.24)	< 0.001
Obesity	112 (17.45)	74 (16.82)	38 (18.81)	0.536
Hyperuricemia	114 (17.76)	78 (17.73)	36 (17.82)	0.977
25VitD, ng/mL	15.90 (11.77, 21.21)	16.54 (12.54, 21.51)	15.07 (11.01, 19.96)	0.001
25VitD class				0.003
Normal	51 (7.94)	45 (10.23)	6 (2.97)
Insufficient	134 (20.87)	89 (20.23)	45 (22.28)
Deficient	358 (55.76)	248 (56.36)	110 (54.46)
Severely deficient	99 (15.42)	58 (13.18)	41 (20.30)
LDL-C, mmol/L	2.88 (2.23, 3.54)	2.89 (2.27, 3.54)	2.83 (2.12, 3.53)	0.239
HDL-C, mmol/L	0.94 (0.78, 1.13)	1.04 (0.90, 1.26)	0.76 (0.67, 0.84)	< 0.001
TG, mmol/L	1.78 (1.18, 2.94)	1.73 (1.11, 2.82)	1.86 (1.29, 3.60)	0.009
No HDL-C, mmol/L	3.95 (3.13, 4.84)	3.91 (3.15, 4.72)	4.11 (3.11, 5.01)	0.152
Apolipoprotein B, g/L	0.96 (0.77, 1.18)	0.94 (0.77, 1.18)	0.98 (0.75, 1.17)	0.780
Free fatty acids, μmol/L	530.00 (397.75, 693.75)	530.00 (389.00, 680.50)	526.00 (416.25, 710.50)	0.118
Lipoproteina, mg/L	108.00 (47.00, 202.75)	116.00 (50.75, 209.25)	88.00 (37.75, 194.25)	0.104
UA, μmol/L	369.00 (291.00, 438.75)	361.50 (279.50, 432.00)	377.00 (314.25, 453.75)	0.003
Glu, mmol/L	7.08 (5.34, 9.79)	6.72 (5.15, 9.56)	7.66 (5.93, 10.24)	0.001
ALB, g/L	40.00 (37.30, 42.80)	40.30 (37.30, 43.00)	39.60 (37.32, 42.00)	0.138
ALT, U/L	30.00 (17.00, 62.00)	28.00 (15.00, 56.00)	39.50 (21.00, 74.50)	< 0.001
AST, U/L	24.00 (16.25, 41.75)	23.00 (16.00, 38.00)	27.50 (18.00, 46.75)	0.002
ALP, U/L	79.00 (65.00, 97.00)	77.00 (63.00, 96.00)	82.50 (68.25, 99.75)	0.015
Scr, μmol/L	67.10 (55.47, 76.60)	64.75 (53.30, 75.60)	70.50 (63.47, 77.77)	< 0.001
eGFR, mL/minute/1.73 m²	121.81 (110.17, 132.13)	122.26 (110.72, 132.44)	120.67 (109.75, 130.25)	0.442
Ca, mmol/L	2.28 (2.20, 2.36)	2.29 (2.21, 2.37)	2.27 (2.19, 2.33)	0.002
P, mmol/L	1.27 (1.14, 1.44)	1.28 (1.16, 1.44)	1.25 (1.09, 1.42)	0.051
iPTH, pg/mL	33.10 (24.40, 44.92)	32.70 (24.20, 45.02)	34.45 (24.92, 44.70)	0.542
Hemoglobin, g/L	147.00 (131.00, 159.00)	145.00 (129.00, 158.00)	151.50 (140.00, 160.00)	< 0.001
White blood cell, × 10⁹/L	7.23 (6.09, 8.71)	7.28 (6.06, 8.76)	7.16 (6.14, 8.68)	0.958
PLT, × 10⁹/L	237.00 (196.25, 280.00)	239.50 (196.75, 285.25)	230.50 (196.50, 271.00)	0.313

CVD: Cardiovascular disease; HBP: Hypertension; 25VitD: 25-hydroxy vitamin D; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglycerides; ApoA1: Apolipoprotein A1; UA: Uric acid; Glu: Glucose; ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; Scr: Serum creatinine; eGFR: Estimated glomerular filtration rate (calculated using the 2009 Chronic Kidney Disease Epidemiology Collaboration formula); Ca: Blood calcium; P: Blood phosphorus; iPTH: Parathyroid hormone; PLT: Platelets.

Table 4 Univariate and multivariate logistic regression analyses for independent factors associated with apolipoprotein A1 in type 2 diabetes mellitus patients

Variables	Univariate logistic regression analyses					multivariate logistic regression analyses
Variables	β value	SE	Z value	P value	OR (95%CI)	β value	SE	Z value	P value	OR (95%CI)
Sex
Male					1.00 (Reference)					1.00 (Reference)
Female	-1.36	0.21	-6.44	< 0.001	0.26 (0.17-0.39)	-0.98	0.36	-2.73	0.006	0.38 (0.19-0.76)
Smoking
0					1.00 (Reference)					1.00 (Reference)
1	0.88	0.19	4.69	< 0.001	2.41 (1.67-3.49)	0.43	0.24	1.78	0.075	1.54 (0.96-2.47)
Alcohol
0					1.00 (Reference)					1.00 (Reference)
1	0.71	0.20	3.46	< 0.001	2.03 (1.36-3.03)	0.03	0.26	0.11	0.916	1.03 (0.62-1.72)
Hyperlipemia
0					1.00 (Reference)					1.00 (Reference)
1	0.54	0.17	3.15	0.002	1.72 (1.23-2.41)	0.04	0.20	0.18	0.856	1.04 (0.70-1.54)
Fatty liver
0					1.00 (Reference)					1.00 (Reference)
1	1.03	0.19	5.39	< 0.001	2.80 (1.93-4.07)	0.19	0.24	0.79	0.432	1.21 (0.76-1.92)
25VitD class
Normal					1.00 (Reference)					1.00 (Reference)
Insufficient	1.33	0.47	2.83	0.005	3.79 (1.50-9.56)	0.79	0.54	1.46	0.144	2.20 (0.77-6.30)
Deficient	1.20	0.45	2.67	0.007	3.33 (1.38-8.03)	0.57	0.52	1.11	0.266	1.78 (0.65-4.88)
Severely deficient	1.67	0.48	3.47	< 0.001	5.30 (2.07-13.59)	1.23	0.56	2.22	0.026	3.43 (1.16-10.20)
UA, μmol/L	0.01	0.00	3.26	0.001	1.01 (1.01-1.01)	-0.00	0.00	-0.31	0.754	1.00 (1.00-1.00)
Glu, mmol/L	0.04	0.02	1.98	0.048	1.04 (1.01-1.08)	-0.01	0.02	-0.57	0.570	0.99 (0.94-1.03)
ALT, U/L	0.01	0.00	2.95	0.003	1.01 (1.01-1.01)	-0.01	0.00	-0.12	0.901	1.00 (0.99-1.01)
AST, U/L	0.01	0.00	2.85	0.004	1.01 (1.01-1.01)	0.01	0.01	1.00	0.319	1.01 (1.00-1.02)
Scr, μmol/L	0.02	0.01	3.23	0.001	1.02 (1.01-1.03)	-0.00	0.01	-0.55	0.581	1.00 (0.98-1.01)
Ca, mmol/L	-2.02	0.70	-2.87	0.004	0.13 (0.03-0.53)	-2.78	0.92	-3.03	0.002	0.06 (0.01-0.38)
Hemoglobin, g/L	0.02	0.00	4.00	< 0.001	1.02 (1.01-1.03)	-0.01	0.01	-1.34	0.179	0.99 (0.98-1.00)
HDL-C class
0					1.00 (Reference)					1.00 (Reference)
1	3.46	0.51	6.72	< 0.001	31.77 (11.59-87.06)	3.09	0.54	5.75	< .001	22.00 (7.67-63.13)
TG, mmol/L	0.12	0.03	3.97	< 0.001	1.13 (1.06-1.19)	0.06	0.03	1.74	0.082	1.06 (0.99-1.12)

25VitD: 25-hydroxy vitamin D; UA: Uric acid; Glu: Glucose; ALT: Alanine transaminase; AST: Aspartate aminotransferase; Scr: Serum creatinine; Ca: Blood calcium; HDL-C: High-density lipoprotein cholesterol; TG: Triglycerides; OR: Odds ratio; CI: Confidence interval.

Citation: Hu Y, Shao LN, Zheng J, Zhang XM, Song YX, Xing YB. Vitamin D deficiency is associated with apolipoprotein A1 levels in patients with young-onset type 2 diabetes mellitus. World J Diabetes 2025; 16(6): 105558
URL: https://www.wjgnet.com/1948-9358/full/v16/i6/105558.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i6.105558