Background/Aims A low vitamin D level has been associated with metabolic syndrome and diabetes. However, an association between a low vitamin D level and nonalcoholic fatty liver disease (NAFLD) has not yet been definitively established. This study aimed to characterize the relationship between a vitamin D level and NAFLD in Korea.
Methods A cross-sectional study involving 6,055 health check-up subjects was conducted. NAFLD was diagnosed on the basis of typical ultrasonographic findings and a history of alcohol consumption.
Results The subjects were aged 51.7±10.3 years (mean±SD) and 54.7% were female. NAFLD showed a significant inverse correlation with the vitamin D level after adjusting for age and sex [odds ratio (OR)=0.85, 95% confidence interval (CI)=0.75–0.96]. The age- and sex-adjusted prevalence of NAFLD decreased steadily with increasing vitamin D level [OR=0.74, 95% CI=0.60–0.90, lowest quintile (≤14.4 ng/mL) vs highest quintile (≥28.9 ng/mL), p for trend <0.001]. Multivariate regression analysis after adjusting for other metabolic factors revealed that NAFLD showed a significant inverse correlation with both the vitamin D level (>20 ng/mL) [OR=0.86, 95% CI=0.75-0.99] and the quintiles of the vitamin D level in a dose-dependent manner (p for trend=0.001).
Conclusions The serum level of vitamin D, even when within the normal range, was found to be inversely correlated with NAFLD in a dose-dependent manner. Vitamin D was found to be inversely correlated with NAFLD independent of known metabolic risk factors. These findings suggest that vitamin D exerts protective effects against NAFLD.
Citations
Citations to this article as recorded by
Gut microbiota, vitamin metabolism, and metabolic dysfunction-associated liver disease: mechanisms, interactions, and therapeutic strategies YuShuang SU, Min SHI, BangYi YANG, Hong ZHOU SCIENTIA SINICA Vitae.2026; 56(1): 154. CrossRef
Non-Alkolik Yağlı Karaciğer Hastalığında İnsülin Direnci, Oksidatif Stres ve Enflamasyon: D Vitamini ve Omega-3 Yağ Asitlerinin Etkileri Eda Keskin Akdeniz Medical Journal.2026;[Epub] CrossRef
Correlation between Serum 25 (OH) D Levels with Insulin Resistance and Metabolic Associated Fatty Liver Disease - A Retrospective Study based on Chinese Patients with Newly Diagnosed Type 2 Diabetes Mellitus Xin Zhao, Jianbin Sun, Sixu Xin, Xiumei Xu, Xiaomei Zhang Current Diabetes Reviews.2025;[Epub] CrossRef
The brain-eye-liver axis during spaceflight: implications of hepatic dysfunction in spaceflight associated neuro-ocular syndrome Sinem Helvacıoğlu Akyüz, Ben Cools, Joshua Ong, Ethan Waisberg, Ryung Lee, Andrew G. Lee, Mathieu Vinken Life Sciences in Space Research.2025; 47: 164. CrossRef
Association of 25‐Hydroxyvitamin D With Metabolic Dysfunction‐Associated Fatty Liver Disease: Results From NHANES 2017–2018 Xiaojuan Rao, Xinxin Zhang, Shuo Li, Bo Huang, Junhe Wang, Jingqiu Cui, Ming Liu, Tiekun Yan, Suraiya Saleem International Journal of Endocrinology.2025;[Epub] CrossRef
Association of vitamin D levels with metabolic dysfunction-associated fatty liver disease in children aged 12–18 years Xuejie Gao, Yuyun Chen, Xinrui Wang, Yuehang Chen, Xiaoyan Chen, Haibo Li, Hong Ye Frontiers in Nutrition.2025;[Epub] CrossRef
Beyond bones: Revisiting the role of vitamin D in chronic liver disease Rodrigo Guerrero-Guerrero, Osvely Mendez-Guerrero, Anaisa Carranza-Carrasco, Farid Tejeda, Astrid Ardon-Lopez, Nalu Navarro-Alvarez World Journal of Hepatology.2025;[Epub] CrossRef
Vitamin D was Superior to Omega-3 as a Simvastatin Adjuvant in Improving Blood Lipids and Atherogenic Index in Type-I Dyslipidemic Rats Devy LIANTO, Yulia Yusrini DJABIR, Bethania Octaresya MUSTAMU, Aryadi ARSYAD Turkish Journal of Pharmaceutical Sciences.2024; 20(6): 390. CrossRef
Effects of plant natural products on metabolic-associated fatty liver disease and the underlying mechanisms: a narrative review with a focus on the modulation of the gut microbiota Tianqi Cai, Xinhua Song, Xiaoxue Xu, Ling Dong, Shufei Liang, Meiling Xin, Yuhong Huang, Linghui Zhu, Tianxing Li, Xueke Wang, Yini Fang, Zhengbao Xu, Chao Wang, Meng Wang, Jingda Li, Yanfei Zheng, Wenlong Sun, Lingru Li Frontiers in Cellular and Infection Microbiology.2024;[Epub] CrossRef
Overall and Sex-Specific Associations of Serum Lipid-Soluble Micronutrients with Metabolic Dysfunction-Associated Steatotic Liver Disease among Adults in the United States Weiwen Chai, Meng-Hua Tao Nutrients.2024; 16(8): 1242. CrossRef
Serum 25-hydroxyvitamin D levels and the risk of non-alcoholic fatty liver Qi Sheng, Huanchen Shi, Shousheng Liu, Likun Zhuang, Zhenzhen Zhao, Yongning Xin Saudi Journal of Gastroenterology.2023; 29(1): 39. CrossRef
Relationship Between Vitamin D Deficiency and Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study From a Tertiary Care Center in Northern India Manoj Kumar, Ashwin Parchani, Ravi Kant, Arindam Das Cureus.2023;[Epub] CrossRef
Vitamin D/vitamin D receptor pathway in non-alcoholic fatty liver disease Jingqi Liu, Yang Song, Ye Wang, Huashan Hong Expert Opinion on Therapeutic Targets.2023; 27(11): 1145. CrossRef
Calcifediol During Pregnancy Improves Maternal and Fetal Availability of Vitamin D Compared to Vitamin D3 in Rats and Modifies Fetal Metabolism Antonio Gázquez, María Sánchez-Campillo, Alejandro Barranco, Ricardo Rueda, Jia P. Chan, Matthew J. Kuchan, Elvira Larqué Frontiers in Nutrition.2022;[Epub] CrossRef
The Role of Vitamin D and Vitamin D Binding Protein in Chronic Liver Diseases Tudor Lucian Pop, Claudia Sîrbe, Gabriel Benţa, Alexandra Mititelu, Alina Grama International Journal of Molecular Sciences.2022; 23(18): 10705. CrossRef
Vitamin D levels are not associated with non-alcoholic fatty liver disease severity in a Brazilian population Jeniffer Danielle M. Dutra, Quelson Coelho Lisboa, Silvia Marinho Ferolla, Carolina Martinelli M. L. Carvalho, Camila Costa M. Mendes, Teresa Cristina A. Ferrari, Cláudia Alves Couto International Journal for Vitamin and Nutrition Research.2021; 91(5-6): 411. CrossRef
A randomized controlled clinical trial comparing calcitriol versus cholecalciferol supplementation to reduce insulin resistance in patients with non-alcoholic fatty liver disease Laleh Mahmoudi, Sara Asadi, Zahra Al-Mousavi, Ramin Niknam Clinical Nutrition.2021; 40(5): 2999. CrossRef
Body weight gain rather than body weight variability is associated with increased risk of nonalcoholic fatty liver disease Eun Ju Cho, Su Jong Yu, Gu Cheol Jung, Min-Sun Kwak, Jong In Yang, Jeong Yoon Yim, Goh Eun Chung Scientific Reports.2021;[Epub] CrossRef
To the question of the pathogenetic mechanisms of the influence of obesity on the level of vitamin D L. A. Suplotova, V. A. Avdeeva, L. Y. Rozhinskaya Obesity and metabolism.2021; 18(2): 169. CrossRef
Low Vitamin D Level was Associated with Non-alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus Vahid Sheikhi, Zahra Heidari Shiraz E-Medical Journal.2021;[Epub] CrossRef
Association and interaction between vitamin D level and metabolic syndrome for non-alcoholic fatty liver disease Salam Bennouar, Abdelghani Bachir Cherif, Amel Kessira, Djamel Eddine Bennouar, Samia Abdi Journal of Diabetes & Metabolic Disorders.2021; 20(2): 1309. CrossRef
Fatty Liver Index for Predicting Nonalcoholic Fatty Liver Disease in an Asymptomatic Korean Population Eun-Ju Cho, Gu-Cheol Jung, Min-Sun Kwak, Jong-In Yang, Jeong-Yoon Yim, Su-Jong Yu, Goh-Eun Chung Diagnostics.2021; 11(12): 2233. CrossRef
Associations of Dietary Lipid-Soluble Micronutrients with Hepatic Steatosis among Adults in the United States Weiwen Chai, Sarah Eaton, Heather E. Rasmussen, Meng-Hua Tao Biomedicines.2021; 9(9): 1093. CrossRef
Association between advanced fibrosis in fatty liver disease and overall mortality based on body fat distribution Goh Eun Chung, Nam Ju Heo, Donghee Kim, Min‐Sun Kwak, Jeong Yoon Yim, Joo Sung Kim, Aijaz Ahmed Journal of Gastroenterology and Hepatology.2020; 35(1): 90. CrossRef
A genome-wide association study on liver enzymes in Korean population Ji Yeon Seo, Jong-Eun Lee, Goh Eun Chung, Eunsoon Shin, Min-Sun Kwak, Jong In Yang, Jeong Yoon Yim, Zongli Xu PLOS ONE.2020; 15(2): e0229374. CrossRef
The risk of atrial fibrillation in patients with non-alcoholic fatty liver disease and a high hepatic fibrosis index Hyo Eun Park, Heesun Lee, Su-Yeon Choi, Hua Sun Kim, Goh Eun Chung Scientific Reports.2020;[Epub] CrossRef
Nonalcoholic Fatty Liver Disease Is Associated with Benign Prostate Hyperplasia Goh Eun Chung, Jeong Yoon Yim, Donghee Kim, Min-Sun Kwak, Jong In Yang, Boram Park, Seong Joon An, Joo Sung Kim Journal of Korean Medical Science.2020;[Epub] CrossRef
Vitamin D supplementation for nonalcoholic fatty liver disease in type 2 diabetes mellitus Shengju Wang, Baochao Cai, Xuke Han, Yang Gao, Xiaoran Zhang, Ruili Wang, Yuan Zhang, Qiu Chen Medicine.2020; 99(19): e20148. CrossRef
Correlation between serum 25‑OH vitamin D expression and non‑alcoholic fatty liver disease Jiayan Cai, Zhenyu Zhang, Jingqi Liu, Xueling Xiao, Chizhen Wang, Manxiang Deng, Luling Chen Experimental and Therapeutic Medicine.2020;[Epub] CrossRef
Is vitamin D receptor a druggable target for non-alcoholic steatohepatitis? Ying Cao, Xiang-Bing Shu, Zemin Yao, Guang Ji, Li Zhang World Journal of Gastroenterology.2020; 26(38): 5812. CrossRef
The association of genetic polymorphisms with nonalcoholic fatty liver disease in a longitudinal study Goh Eun Chung, Eunsoon Shin, Min-Sun Kwak, Jong In Yang, Jong-Eun Lee, Eun Kyung Choe, Jeong Yoon Yim BMC Gastroenterology.2020;[Epub] CrossRef
Clinical significance of hepatic steatosis according to coronary plaque morphology: assessment using controlled attenuation parameter Hyo Eun Park, Heesun Lee, Su-Yeon Choi, Min-Sun Kwak, Jong In Yang, Jeong Yoon Yim, Goh Eun Chung Journal of Gastroenterology.2019; 54(3): 271. CrossRef
Dietary patterns are associated with the prevalence of nonalcoholic fatty liver disease in Korean adults Goh Eun Chung, Jiyoung Youn, Young Sun Kim, Jung Eun Lee, Sun Young Yang, Joo Hyun Lim, Ji Hyun Song, Eun Young Doo, Joo Sung Kim Nutrition.2019; 62: 32. CrossRef
Vitamin D status and non-alcoholic fatty liver disease in patients with type 1 diabetes E. Cipponeri, N. Vitturi, V. Mariano, F. Boscari, S. Galasso, C. Crepaldi, G. P. Fadini, S. Vigili de Kreutzenberg, M. C. Marescotti, E. Iori, F. Cavallin, L. Sartori, A. Baritussio, A. Avogaro, D. Bruttomesso Journal of Endocrinological Investigation.2019; 42(9): 1099. CrossRef
Association between Vitamin D Status and Non-Alcoholic Fatty Liver Disease: A Population-Based Study Shiying LIU, Yuxiu LIU, Bo WAN, Haoyang ZHANG, Sumei WU, Zheng ZHU, Yanjie LIN, Mingfang WANG, Nanwen ZHANG, Su LIN, Yueyong ZHU Journal of Nutritional Science and Vitaminology.2019; 65(4): 303. CrossRef
Short-term Dietary Interventions for the Management of Nonalcoholic Fatty Liver Caroline S. Stokes, Frank Lammert, Marcin Krawczyk Current Medicinal Chemistry.2019; 26(19): 3483. CrossRef
Association between Vitamin D Levels and Nonalcoholic Fatty Liver Disease: Potential Confounding Variables Lucia Pacifico, John F. Osborn, Enea Bonci, Pasquale Pierimarchi, Claudio Chiesa Mini-Reviews in Medicinal Chemistry.2019; 19(4): 310. CrossRef
The relationship between 25-hydroxyvitamin D concentration and liver enzymes in overweight or obese adults: Cross-sectional and interventional outcomes Negar Naderpoor, Aya Mousa, Maximilian de Courten, Robert Scragg, Barbora de Courten The Journal of Steroid Biochemistry and Molecular Biology.2018; 177: 193. CrossRef
Nonalcoholic fatty liver disease and advanced fibrosis are associated with left ventricular diastolic dysfunction Goh Eun Chung, Jeong-Hoon Lee, Heesun Lee, Min Kyung Kim, Jeong Yoon Yim, Su-Yeon Choi, Yoon Jun Kim, Jung-Hwan Yoon, Donghee Kim Atherosclerosis.2018; 272: 137. CrossRef
Vitamin D and the Liver—Correlation or Cause? Jeremy T. Keane, Harendran Elangovan, Rebecca A. Stokes, Jenny E. Gunton Nutrients.2018; 10(4): 496. CrossRef
Alcoholic liver disease and vitamin D deficiency Gianni Testino, Silvia Leone, Sharmila Fagoonee Minerva Medica.2018;[Epub] CrossRef
Vitamin D and Related Deficiencies, Sarcopenia and Visceral Obesity in Obese People with NAFLD Mihaela Petrova Gastroenterology & Hepatology: Open Access.2018;[Epub] CrossRef
Reply to: “The association between sarcopenia and non-alcoholic fatty liver disease” Bo Kyung Koo, Donghee Kim, Sae Kyung Joo, Jung Ho Kim, Mee Soo Chang, Byeong Gwan Kim, Kook Lae Lee, Won Kim Journal of Hepatology.2017; 66(1): 244. CrossRef
Is Vitamin D an Independent Risk Factor of Nonalcoholic Fatty Liver Disease?: a Cross-Sectional Study of the Healthy Population Danbee Park, Hyuktae Kwon, Seung-Won Oh, Hee-Kyung Joh, Seung-sik Hwang, Jin Ho Park, Jae Moon Yun, Hyejin Lee, Goh Eun Chung, Sangjoon Ze, Jae Hong Park, Yeseul Bae, Arang Lee Journal of Korean Medical Science.2017; 32(1): 95. CrossRef
Vitamin D in liver disease: Current evidence and potential directions Harendran Elangovan, Sarinder Chahal, Jenny E. Gunton Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease.2017; 1863(4): 907. CrossRef
Association between nephrolithiasis and fatty liver detected on non-enhanced CT for clinically suspected renal colic Abdel-Rauf Zeina, Limor Goldenberg, Alicia Nachtigal, Rabea Hasadia, Walid Saliba Clinical Imaging.2017; 43: 148. CrossRef
The Association between Vitamin D Insufficiency and Nonalcoholic Fatty Liver Disease: A Population-Based Study Yeonjung Ha, Seong Hwang, Kyu Rim Nutrients.2017; 9(8): 806. CrossRef
Active form of vitamin D ameliorates non-alcoholic fatty liver disease by alleviating oxidative stress in a high-fat diet rat model Chong-gui Zhu, Ya-xin Liu, Hao Wang, Bao-ping Wang, Hui-qi Qu, Bao-li Wang, Mei Zhu Endocrine Journal.2017; 64(7): 663. CrossRef
Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study Dong Hyun Sinn, Danbee Kang, Hye Ryoun Jang, Seonhye Gu, Soo Jin Cho, Seung Woon Paik, Seungho Ryu, Yoosoo Chang, Mariana Lazo, Eliseo Guallar, Juhee Cho, Geum-Youn Gwak Journal of Hepatology.2017; 67(6): 1274. CrossRef
Pleiotropic protective effects of Vitamin D against high fat diet-induced metabolic syndrome in rats: One for all Dalia K. Mostafa, Rasha A. Nasra, Noha Zahran, Mohammed T. Ghoneim European Journal of Pharmacology.2016; 792: 38. CrossRef
Docosahexanoic Acid Plus Vitamin D Treatment Improves Features of NAFLD in Children with Serum Vitamin D Deficiency: Results from a Single Centre Trial Claudia Della Corte, Guido Carpino, Rita De Vito, Cristiano De Stefanis, Anna Alisi, Stefano Cianfarani, Diletta Overi, Antonella Mosca, Laura Stronati, Salvatore Cucchiara, Massimiliano Raponi, Eugenio Gaudio, Christopher D. Byrne, Valerio Nobili, Jee-Fu PLOS ONE.2016; 11(12): e0168216. CrossRef
Metabolic aspects of adult patients with nonalcoholic fatty liver disease Ludovico Abenavoli, Natasa Milic, Laura Di Renzo, Tomislav Preveden, Milica Medić-Stojanoska, Antonino De Lorenzo World Journal of Gastroenterology.2016; 22(31): 7006. CrossRef
Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions Maria Grazia Clemente, Claudia Mandato, Marco Poeta, Pietro Vajro World Journal of Gastroenterology.2016; 22(36): 8078. CrossRef
First
Prev
