Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort

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  • Christine Chew
  • Apinya Lertratanakul
  • Peggy Wu
  • Murray Urowitz
  • Dafna D Gladman
  • Paul R Fortin
  • Sang-Cheol Bae
  • Ann E Clarke
  • Sasha Bernatsky
  • John G Hanly
  • David Isenberg
  • Anisur Rahman
  • Jorge Sanchez-Guerrero
  • Juanita Romero-Diaz
  • Joan Merrill
  • Daniel Wallace
  • Ellen Ginzler
  • Munther Khamashta
  • Ola Nived
  • Andreas Jönsen
  • Kristjan Steinsson
  • Susan Manzi
  • Ken Kalunian
  • Mary Anne Dooley
  • Michelle Petri
  • Cynthia Aranow
  • Ronald van Vollenhoven
  • Thomas Stoll
  • Graciela S Alarcón
  • S Sam Lim
  • Guillermo Ruiz-Irastorza
  • Christine A Peschken
  • Anca D Askanase
  • Diane L Kamen
  • Murat İnanç
  • Rosalind Ramsey-Goldman
  • Ian N Bruce

Colleges, School and Institutes


Objectives: Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance.

Methods: The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10–36 nmol/l), T2 (37–60 nmol/l) and T3 (61–174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels.

Results: Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance.

Conclusions: MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.


Original languageEnglish
Article numberkeab090
Early online date8 Feb 2021
Publication statusE-pub ahead of print - 8 Feb 2021


  • Pharmacology (medical), Rheumatology

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