Association of all-cause and specific-cause mortality with diabetes mellitus in adults with vitamin D deficiency

Saffar Soflaei, Sara; Jafarpour, Soheyla; Alimi, Rasoul; Sahranavard, Toktam; Ghayour-Mobarhan, Emad; Seyed Hosseini, Parsa; Hatamzadeh, Hossein; Ebrahimi, Mahmoud; Moohebati, Mohsen; Ferns, Gordon A; Esmaily, Habibollah; Ghaour-mobarhan, Majid

doi:10.30483/rjm.2026.254709.1473

Association of all-cause and specific-cause mortality with diabetes mellitus in adults with vitamin D deficiency

Articles in Press

Document Type : Original Article

Authors

Sara Saffar Soflaei ¹^{, 2}

Soheyla Jafarpour ³

Rasoul Alimi ⁴

Toktam Sahranavard ²^{, 5}

Emad Ghayour-Mobarhan ⁶

Parsa Seyed Hosseini ¹

Hossein Hatamzadeh ⁷

Mahmoud Ebrahimi ¹^{, 8}

Mohsen Moohebati ¹^{, 8}

Gordon A Ferns ⁹

Habibollah Esmaily ¹⁰^{, 11}

Majid Ghaour-mobarhan ¹^{, 2}

¹ Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

² International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁴ Department of Epidemiology and Biostatistics, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

⁵ Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

⁶ Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

⁷ Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁸ Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁹ Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK.

¹⁰ Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

¹¹ Social Determinants of Health Research center, Mashhad University of Medical Sciences, Mashhad, Iran.

10.30483/rjm.2026.254709.1473

Abstract

Background: There is increasing evidence indicating that vitamin D deficiency may contribute to the development of Type 2 Diabetes Mellitus (T2DM) by affecting insulin sensitivity, insulin secretion, and inflammation.

Objectives: We have investigated the association between vitamin D deficiency, T2DM, and mortality outcomes.

Methods: The study was conducted on a sample of 846 subjects, derived from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Participants were considered as vitamin D deficient with vitamin D levels of less than 20 ng/ml. Over 10 years, participants were followed up every three years. The cause of death was identified using the death register of the Iranian Ministry of Health and Education and the death cause questionnaire. The study examined the relationship between T2DM and mortality using descriptive statistics, chi-square tests, and Cox proportional hazard regression analysis.

Results: During the 10-year follow-up, 44 participants died from all causes, 15 from cancer, and 14 from cardiovascular causes. There was a significant association between diabetes and all-cause mortality, even after adjustment for age and sex yielding an HR of 2.07 (P=0.039). Vitamin D deficiency was associated with diabetes-related mortality (HR=3.16, P=0.038), but this link is not true for individuals who had vitamin D levels of more than 20 ng/ml. This association extends to mortality because of cancer (HR=3.64, P=0.025), but not cardiovascular mortality.

Conclusion: Our findings underscore the potential role of vitamin D deficiency in the mortality risk of diabetics. Future research should further explore the mechanistic links between vitamin D deficiency, T2DM, and mortality outcomes to inform targeted interventions and improve clinical management strategies.

Keywords

Mortality

Diabetes mellitus

Vitamin D deficiency

Cohort study

Subjects

Nutritional Sciences

Acknowledgments: We would like to thank MUMS for its financial support.

Availability of data and materials: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of interests: The authors declare no conflict of interest.

Consent for publication: Not applicable.

Ethics approval and consent to participate: The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The Ethics Committee of the Mashhad University of Medical Sciences approved the study after all participants provided informed consent (IR.MUMS.MEDICAL.REC.1395.458).

Financial disclosure: Mashhad University of Medical Sciences (MUMS).

Author contributions: Conceptualization: [SSS, MGM, MM]; Methodology: [RA, HE]; Formal analysis and investigation: [ME, EGM, RA, SSS, RKA, PSH]; Writing - original draft preparation: [SJ, TS, HH]; Writing - review and editing: [SSS, GAF]; Funding acquisition: [MGM, MM]; Supervision: [MGM, HE]. All authors checked and approved the final version of the manuscript for publication in the present journal.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Association of all-cause and specific-cause mortality with diabetes mellitus in adults with vitamin D deficiency

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Articles in Press, Accepted Manuscript
Available Online from 24 April 2026