Inflammation modifies the association of obesity with circulating 25-hydroxyvitamin D levels in cancer survivors

OBJECTIVE: Obesity, inflammation, and circulating 25-hydroxyvitamin D (25-OHD) have distinct roles in cancer prognosis. We investigated their interplay by evaluating the associations of body mass index (BMI) with circulating 25-OHD levels in cancer survivors, and determining whether associations were modified by inflammation, defined by C-reactive protein (CRP) levels. METHODS: Data on cancer survivors were aggregated from the U.S. National Health and Nutrition Examination Survey (2001–2010). Multivariable linear regression models were used to evaluate the associations of BMI with circulating 25-OHD. We stratified the analyses by CRP levels: low <1.0mg/L, moderate 1.0–3.0mg/L and high >3.0–9.9mg/L. RESULTS: Among 1,305 cancer survivors (mean age=60.8 years, mean BMI=28.0 kg/m(2)), circulating 25-OHD levels were 8.74 nmol/L lower (95%CI: 4.71 to 12.77) in cancer survivors with BMI ≥30kg/m(2) compared to those with BMI <25kg/m(2). This association was, however, limited to those with moderate CRP (−9.90 nmol/L, 95% CI: −16.45 to −3.36) and high CRP (−11.61 nmol/L, 95% CI: −18.71 to −5.05), but not among those with low CRP levels (−5.31 nmol/L, 95% CI: −12.66 to 2.04). CONCLUSIONS: A greater understanding of the interplay between 25-OHD and inflammation in cancer survivors with obesity should allow for targeted secondary prevention and help improve prognosis in these patients.