Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Bergman, Peter; Lindh, Åsa; Björkhem‐Bergman, Linda; Lindh, Jonatan D.

doi:10.1371/journal.pone.0065835

Cited by 387 publications

(382 citation statements)

References 43 publications

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“…Three recent systematic reviews/meta-analyses [30][31][32] (Table 2) have explored vitamin D supplementation and RTIs. The Bergman 2013 30 and Charan 2012 31 reviews concluded that vitamin D provided a protective effect against RTIs.…”

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

confidence: 99%

“…The third, Mao 2013, 32 found no effect. All three studies have weaknesses in design and implementation, but the first two 30,31 have the greatest concerns. For example, they included RCTs from heterogeneous populations: children under the age of 3 with pneumonia from an impoverished area of Afghanistan and healthy adult volunteers from Long Island, New York.…”

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

confidence: 99%

“…32 Bergman 2013 30 and Charan 2012 31 also included the influenza A-only results (with a 47 % reduction) from one study 34 rather than all flu outcomes (with a 3 % reduction) as reported by Mao 2013. 32 All in all, the Bergman 2013 30 and Charan 2012 31 results are unreliable, particularly for healthy western populations. The Mao 2013 32 meta-analysis was not without concern-for example, 75 % of the weighting was given to one of the seven trials.…”

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

confidence: 99%

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

confidence: 99%

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

confidence: 99%

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

confidence: 99%

See 1 more Smart Citation

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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“…Recently, two systematic reviews demonstrated that vitamin D intake reduced significantly the risk of respiratory tract infections; however, these reviews did not assess the direct association between vitamin D and AVB [16,22].…”

Section: Discussionmentioning

confidence: 99%

“…Bergman et al [16] performed a meta-analysis, which included 11 studies with a total of 5,660 participants, providing evidence that supplement with vitamin D reduced significantly the risk of infections of the respiratory tract (odds ratio [16]; this study reviewed infections of the respiratory tract in general, not appraising AVB separately.…”

Section: Introductionmentioning

confidence: 99%

Efeitos da vitamina D na prevenção da bronquiolite viral aguda: revisão sistemática

Rueda

Sarria-Icaza

Scottá

et al. 2015

Sci Med

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Aims: Published evidence suggests that Vitamin D supplementation may have a protective effect on infectious disease of the lower respiratory tract. The objective of this review was to critically appraise the effects of vitamin D intake in the prevention of acute viral bronchiolitis in children. Methods: We searched the databases Medline, EMBASE, Web of Science, LILACS, and Cochrane Central Register of Controlled Trials, until December 2014, using the keywords: "Vitamin D" or cholecalciferol or ergocalciferol and "bronchiolitis, viral" or "viral bronchiolitis" or "bronchiolitides, viral" or "viral bronchiolitides". Studies evaluating the effect of vitamin D intake in the prevention of acute viral bronchiolitis in young children were included. Studies with less than two weeks of intervention and review articles were excluded. Results: The search identified 241 articles, among which 20 articles were selected for full reading and two articles were included in the systematic review, comprising 296 children. No study measured serum levels of vitamin D. One of the included studies was a clinical trial, where the number of episodes of acute viral bronchiolitis was significantly lower in children supplemented with vitamin D (Group I: mean 0.6±0.7 Group II: mean 1.4±0.9; P=0.001). The other, a case-control study, did not find a significant relationship between the occurrence of acute viral bronchiolitis cases and the intake of vitamin D (odds ratio 1.7, 95% confidence interval 0.7-4.0). Conclusions: Current scientific evidence is insufficient to prove clinical benefits of vitamin D in preventing acute viral bronchiolitis.KEY WORDS: vitamin D; bronchiolitis, viral; infant; child. RESUMOObjetivos: Evidências publicadas sugerem que a suplementação da vitamina D pode ter efeito protetor nas infecções do trato respiratório inferior. O objetivo desta revisão foi avaliar os efeitos da ingestão de vitamina D na prevenção da bronquiolite viral aguda em crianças. Métodos: Foram feitas buscas nas bases de dados Medline, EMBASE, Web of Science, LILACS e Cochrane Central Register of Controlled Trials, até dezembro de 2014, usando os descritores "Vitamin D" ou cholecalciferol ou ergocalciferol e "bronchiolitis, viral" ou "viral bronchiolitis" ou "bronchiolitides, viral" ou "viral bronchiolitides". Foram incluídos estudos que avaliaram o efeito da ingesta da vitamina D na prevenção da bronquiolite viral aguda em crianças. Estudos com intervenção menor que duas semanas e artigos de revisão foram excluídos. Resultados: A busca identificou 241 artigos, entre os quais 20 artigos foram selecionados para leitura na íntegra e dois artigos foram incluídos na revisão sistemática, incluindo 296 crianças. Nenhum estudo mediu os níveis séricos de vitamina D. Um dos estudos incluídos foi um ensaio clinico, no qual o número de episódios de bronquiolite foi significativamente menor nas crianças suplementadas com vitamina D (Grupo I: média 0,6±0,7 Grupo II: média 1,4 ±0,9; P=0,001). No outro, um estudo de casos e controles, não se encontrou rel...

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Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children

Aglipay

Birken

Parkin

et al. 2017

JAMA

122

114

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for the TARGet Kids! Collaboration IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada.INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May.MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTSAmong 703 participants who were randomized (mean age, 2.7 years, 57.7% boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95% CI, 0.91-1.19) for the high-dose group and 1.03 (95% CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95% CI, −0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95% CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95% CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95% CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95% CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95% CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95% CI, 35.4-38.2 ng/mL) in the standard-dose group.CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections.

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Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 387 publications

References 43 publications

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

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

Efeitos da vitamina D na prevenção da bronquiolite viral aguda: revisão sistemática

Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children

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