Randomized Trial of Vitamin D Supplementation and Risk of Acute Respiratory Infection in Mongolia

Camargo, Carlos A.; Ganmaa, Davaasambuu; Frazier, A. Lindsay; Kirchberg, Franca F.; Stuart, Jennifer; Kleinman, Ken; Sumberzul, Nyamjav; Rich‐Edwards, Janet W.

doi:10.1542/peds.2011-3029

Cited by 266 publications

(240 citation statements)

References 24 publications

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“…One trial of Mongolian children with profound vitamin D deficiency (17.5 nmol/L) found a reduction of 0.35 respiratory tract infections over 3 months. 38 …”

Section: Belief 3: Vitamin D Reduces Respiratory Tract Infections Obsmentioning

confidence: 99%

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Allan

Cranston²,

Lindblad

et al. 2016

J GEN INTERN MED

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Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highestlevel evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/ meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.

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“…One trial of Mongolian children with profound vitamin D deficiency (17.5 nmol/L) found a reduction of 0.35 respiratory tract infections over 3 months. 38 …”

Section: Belief 3: Vitamin D Reduces Respiratory Tract Infections Obsmentioning

confidence: 99%

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Allan

Cranston²,

Lindblad

et al. 2016

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…In addition, supplementation with vitamin D can prevent seasonal influenza 13 and acute respiratory infections in children. 39 An investigation 40 based on data from the National Hospital Discharge Survey showed that the seasonal incidence of sepsis increased 16.5% in the winter (P < .05), especially sepsis due to respiratory infections. Although 25-hydroxyvitamin D levels were not assessed in that study, 40 vitamin D deficiency through decreased sun exposure in winter months may play a role.…”

Section: Multivariate Analysismentioning

confidence: 99%

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Rech

Hunsaker

Rodriguez

2014

American Journal of Critical Care

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Background Vitamin D has immunomodulating properties. Objective To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality. Methods In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality. Results Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality. Conclusion Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.

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“…2. People who do not supplement may expect to have greater susceptibility to infectious diseases such as tuberculosis (39) and viruses (40)(41)(42) , which have been shown to respond to vitamin D supplementation in clinical trials through improved innate immunity, with increased production of cathelicidin and other natural bacteriocides. 3.…”

Section: Harms Consequent Upon False Inference Of Reverse Causationmentioning

confidence: 99%

Controlled trials of vitamin D, causality and type 2 statistical error

Gillie

2014

Public Health Nutr.

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Two recent studies published in The Lancet (Autier et al. (2013) 76-89 and Bolland et al. (2014) Lancet Diabetes Endocrinol 2, 307-320) have concluded that low levels of vitamin D are not a cause but a consequence of ill health brought about by reduced exposure to the sun, an association known as 'reverse causality'. The scientific evidence and reasoning for these conclusions are examined here and found to be faulty. A null result in a clinical trial of vitamin D in adults need not lead to a conclusion of reverse causation when low vitamin D is found in observational studies of the same disease earlier in life. To assume an explanation of reverse causality has close similarities with type 2 statistical error.Lancet Diabetes Endocrinol 2,

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Randomized Trial of Vitamin D Supplementation and Risk of Acute Respiratory Infection in Mongolia

Abstract: Vitamin D supplementation significantly reduced the risk of ARIs in winter among Mongolian children with vitamin D deficiency.

Cited by 266 publications

References 24 publications

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Controlled trials of vitamin D, causality and type 2 statistical error

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