Vitamin D and respiratory tract infections

Last updated

Associations have been shown between vitamin D levels and several respiratory tract infections suggesting that vitamin D deficiency may predispose to infection. Outbreaks of respiratory infections occur predominantly during months associated with lower exposure to the sun. The Institute of Medicine concluded in a 2011 report that the existing data were "not consistently supportive of a causal role" for vitamin D in reducing the risk of infection. Other studies suggest that vitamin D supplementation can provide a protective role in reducing the incidence or severity of respiratory infections. [1] [2]

Contents

Vitamin D deficiency has long been associated with tuberculosis. [3] [4] Beneficial effects of supplemental vitamin D for patients with COPD have also been shown. [5]

Ultraviolet radiation and vitamin D

An inverse association between exposure to the sun and upper respiratory tract infections was first proposed in 1926 by Smiley, who theorized that seasonality of infection was caused by “disordered vitamine metabolism in the human...directly due to a lack of solar radiation during the dark months of winter.” [6] Studies of Dutch [7] and Russian [8] subjects have also indicated a correlation of ultraviolet light exposure and relative absence of infection. However, the seasonality of infections such as influenza may also be explicable by other factors. For example, low absolute humidity favours the survival of the influenza virus. [9] A review by authors from the University of Maryland School of Pharmacy suggested that while low-dose vitamin D supplementation was unlikely to be harmful, "sensible sun exposure" was "an inexpensive and enjoyable way" to ensure healthy levels of vitamin D. [10]

Evidence

Evidence both for and against an association of vitamin D and respiratory infections has been reported. Early studies of vitamin D and mice came to different conclusions, with one group reporting a link and the other no link between deficiency and infection. [10] More recent studies of humans have also had divergent results. People with the lowest blood vitamin D levels reported having significantly more recent colds or cases of the flu chronic respiratory disorders, especially those who had pre-existing respiratory ailments [11] Children who took vitamin D3 supplements daily in winter were 42% less likely to get infected with seasonal flu than those who were given a placebo. [12] Mongolian schoolchildren who drank vitamin D fortified milk during winter reported having fewer colds than those who received non-fortified milk. [13] Another study found no effect of vitamin D supplementation on the incidence or severity of upper respiratory tract infections. Authors of one of the positive studies also stressed that their results would need to be confirmed in clinical trials before vitamin D could be recommended to prevent infections. [14]

The Institute of Medicine released a comprehensive, peer-reviewed report on calcium and vitamin D in 2011. The conclusion of the report was that the existing studies did not provide strong or consistent evidence for a link between vitamin D deficiency and respiratory tract infections. The authors stated that data from randomised controlled trials would be needed, showing a dose response to vitamin D supplementation, before recommendations could be considered. [15]

A 2017 individual-participant meta-analysis of 25 randomized controlled trials (11,321 total participants) concluded "Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit." Doses used in the constituent studies that used daily dosing ranged from 300 to 4000 IU/day (7.5-100 μg/day). [1]

Vitamin D supplementation

Proponents of the vitamin D hypothesis have recommended dietary supplements (5,000 International Units (IU)/day for adults and 1,000 IU/day for every 25 pounds of body weight in children) and suggested that larger doses (2,000 IU/kg/day for 3–4 days) could be used to treat influenza. [16] [17] It has been noted that large doses of vitamin D can lead to hypercalcemia and that "single megadoses" of vitamin D, while not especially harmful, may be associated with an increased risk of bone fractures. [10] The authors of this review suggested that supplementation should be offered only to those with verified deficiencies or to promote muscular and skeletal health in elderly patients. [10] Benefits have not been shown in children with asthma. [18]

Related Research Articles

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

Vitamin E is a group of eight fat soluble compounds that include four tocopherols and four tocotrienols. Vitamin E deficiency, which is rare and usually due to an underlying problem with digesting dietary fat rather than from a diet low in vitamin E, can cause nerve problems. Vitamin E is a fat-soluble antioxidant which may help protect cell membranes from reactive oxygen species. Worldwide, government organizations recommend adults consume in the range of 3 to 15 mg per day. As of 2016, consumption was below recommendations according to a worldwide summary of more than one hundred studies that reported a median dietary intake of 6.2 mg per day for alpha-tocopherol.

Tocopherols are a class of organic compounds comprising various methylated phenols, many of which have vitamin E activity. Because the vitamin activity was first identified in 1936 from a dietary fertility factor in rats, it was named tocopherol, from Greek τόκοςtókos 'birth' and φέρεινphérein 'to bear or carry', that is 'to carry a pregnancy', with the ending -ol signifying its status as a chemical alcohol.

<span class="mw-page-title-main">Vitamin A</span> Essential nutrient

Vitamin A is a fat-soluble vitamin and an essential nutrient for animals. The term "vitamin A" encompasses a group of chemically related organic compounds that includes retinol, retinal, retinoic acid, and several provitamin (precursor) carotenoids, most notably beta-carotene. Vitamin A has multiple functions: it is essential for embryo development and growth, for maintenance of the immune system, and for vision, where it combines with the protein opsin to form rhodopsin – the light-absorbing molecule necessary for both low-light and color vision.

<span class="mw-page-title-main">Retinol</span> Chemical compound

Retinol, also called vitamin A1, is a fat-soluble vitamin in the vitamin A family that is found in food and used as a dietary supplement. Retinol or other forms of vitamin A are needed for vision, cellular development, maintenance of skin and mucous membranes, immune function and reproductive development. Dietary sources include fish, dairy products, and meat. As a supplement it is used to treat and prevent vitamin A deficiency, especially that which results in xerophthalmia. It is taken by mouth or by injection into a muscle. As an ingredient in skin-care products, it is used to reduce wrinkles and other effects of skin aging.

<span class="mw-page-title-main">Common cold</span> Common viral infection of the upper respiratory tract

The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally, those with other health problems may develop pneumonia.

<span class="mw-page-title-main">Dietary supplement</span> Product providing additional nutrients

A dietary supplement is a manufactured product intended to supplement a person's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources, or that are synthetic. The classes of nutrient compounds in supplements include vitamins, minerals, fiber, fatty acids, and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, and so are not nutrients per se, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. The European Commission has also established harmonized rules to help insure that food supplements are safe and appropriately labeled.

<span class="mw-page-title-main">Cholecalciferol</span> Vitamin D3, a chemical compound

Cholecalciferol, also known as vitamin D3 and colecalciferol, is a type of vitamin D that is made by the skin when exposed to sunlight; it is found in some foods and can be taken as a dietary supplement.

<span class="mw-page-title-main">Ergocalciferol</span> Vitamin D2, a chemical compound

Ergocalciferol, also known as vitamin D2 and nonspecifically calciferol, is a type of vitamin D found in food and used as a dietary supplement. As a supplement it is used to prevent and treat vitamin D deficiency. This includes vitamin D deficiency due to poor absorption by the intestines or liver disease. It may also be used for low blood calcium due to hypoparathyroidism. It is used by mouth or injection into a muscle.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Medical condition

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Multivitamin</span> Dietary supplement containing vitamins

A multivitamin is a preparation intended to serve as a dietary supplement with vitamins, dietary minerals, and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids, or injectable formulations. Other than injectable formulations, which are only available and administered under medical supervision, multivitamins are recognized by the Codex Alimentarius Commission as a category of food.

<span class="mw-page-title-main">Lower respiratory tract infection</span> Medical term

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.

<span class="mw-page-title-main">Vitamin D toxicity</span> Human disease

Vitamin D toxicity, or hypervitaminosis D is the toxic state of an excess of vitamin D. The normal range for blood concentration in adults is 20 to 50 nanograms per milliliter (ng/mL).

<span class="mw-page-title-main">Nutrition and pregnancy</span> Nutrient intake and dietary planning undertaken before, during and after pregnancy

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception as well as throughout pregnancy and breastfeeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.

<span class="mw-page-title-main">Respiratory tract infection</span> Infectious disease affecting nose, throat and lungs

Respiratory tract infections (RTIs) are infectious diseases involving the lower or upper respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection or a lower respiratory tract infection. Lower respiratory infections, such as pneumonia, tend to be far more severe than upper respiratory infections, such as the common cold.

<span class="mw-page-title-main">Vitamin A deficiency</span> Disease resulting from low Vitamin A concentrations in the body

Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Nyctalopia is one of the first signs of VAD, as the vitamin has a major role in phototransduction; but it is also the first symptom that is reversed when vitamin A is consumed again. Xerophthalmia, keratomalacia, and complete blindness can follow if the deficiency is more severe.

In epidemiology, ecological studies are used to understand the relationship between outcome and exposure at a population level, where 'population' represents a group of individuals with a shared characteristic such as geography, ethnicity, socio-economic status of employment. What differentiates ecological studies from other studies is that the unit analysis being studied is the group, therefore inferences cannot be made about individual study participants. On the other hand, details of outcome and exposure can be generalized to the population being studied. Examples of such studies include investigating associations between units of grouped data, such as electoral wards, regions, or even whole countries.

<span class="mw-page-title-main">Vitamin D deficiency</span> Human disorder

Vitamin D deficiency or hypovitaminosis D is a vitamin D level that is below normal. It most commonly occurs in people when they have inadequate exposure to sunlight, particularly sunlight with adequate ultraviolet B rays (UVB). Vitamin D deficiency can also be caused by inadequate nutritional intake of vitamin D; disorders that limit vitamin D absorption; and disorders that impair the conversion of vitamin D to active metabolites, including certain liver, kidney, and hereditary disorders. Deficiency impairs bone mineralization, leading to bone-softening diseases, such as rickets in children. It can also worsen osteomalacia and osteoporosis in adults, increasing the risk of bone fractures. Muscle weakness is also a common symptom of vitamin D deficiency, further increasing the risk of fall and bone fractures in adults. Vitamin D deficiency is associated with the development of schizophrenia.

<span class="mw-page-title-main">Vitamin D</span> Group of fat-soluble secosteroids

Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and for many other biological effects. In humans, the most important compounds in this group are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol).

<span class="mw-page-title-main">COVID-19 drug repurposing research</span> Drug repurposing research related to COVID-19

Drug repositioning is the repurposing of an approved drug for the treatment of a different disease or medical condition than that for which it was originally developed. This is one line of scientific research which is being pursued to develop safe and effective COVID-19 treatments. Other research directions include the development of a COVID-19 vaccine and convalescent plasma transfusion.

References

  1. 1 2 Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, et al. (January 2019). "Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis". Health Technology Assessment . 23 (2): 1–44. doi:10.3310/hta23020. PMC   6369419 . PMID   30675873.
  2. ↑ Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. (February 2017). "Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data". BMJ. 356: i6583. doi:10.1136/bmj.i6583. PMC   5310969 . PMID   28202713.
  3. ↑ Luong K, Nguyen LT (June 2011). "Impact of vitamin D in the treatment of tuberculosis". The American Journal of the Medical Sciences. 341 (6): 493–8. doi:10.1097/MAJ.0b013e3182070f47. PMID   21289501. S2CID   18802134.
  4. ↑ Nnoaham KE, Clarke A (February 2008). "Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis". International Journal of Epidemiology. 37 (1): 113–9. CiteSeerX   10.1.1.513.3969 . doi:10.1093/ije/dym247. PMID   18245055.
  5. ↑ Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR (April 2019). "Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials". Thorax. 74 (4): 337–345. doi: 10.1136/thoraxjnl-2018-212092 . PMID   30630893.
  6. ↑ Smiley DF. Seasonal factors in the incidence of the acute respiratory infections. Am J Hyg 1926;6:621-6, p. 626
  7. ↑ Termorshuizen F, Wijga A, Gerritsen J, Neijens HJ, van Loveren H (October 2004). "Exposure to solar ultraviolet radiation and respiratory tract symptoms in 1-year-old children". Photodermatol Photoimmunol Photomed. 20 (5): 270–1. doi:10.1111/j.1600-0781.2004.00110.x. PMID   15379879. S2CID   6674965.
  8. ↑ Gigineĭshvili GR, Il’in NI, Suzdal’nitskiĭ RS, Levando VA. The use of UV irradiation to correct the immune system and decrease morbidity in athletes [in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult 1990 May-Jun:30-3.
  9. ↑ Shaman J, Kohn M (March 2009). "Absolute humidity modulates influenza survival, transmission, and seasonality" (PDF). Proc. Natl. Acad. Sci. U.S.A. 106 (9): 3243–8. Bibcode:2009PNAS..106.3243S. doi: 10.1073/pnas.0806852106 . PMC   2651255 . PMID   19204283.
  10. 1 2 3 4 Haines ST, Park SK (April 2012). "Vitamin D supplementation: what's known, what to do, and what's needed". Pharmacotherapy. 32 (4): 354–82. doi:10.1002/phar.1037. PMID   22461123. S2CID   25985630.
  11. ↑ Ginde AA, Mansbach JM, Camargo CA (February 2009). "Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey". Archives of Internal Medicine. 169 (4): 384–90. doi:10.1001/archinternmed.2008.560. PMC   3447082 . PMID   19237723.
  12. ↑ Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H (May 2010). "Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren". The American Journal of Clinical Nutrition. 91 (5): 1255–60. doi: 10.3945/ajcn.2009.29094 . PMID   20219962.
  13. ↑ Camargo; et al. (August 2012). "Randomized Trial of Vitamin D Supplementation and Risk of Acute Respiratory Tract Infection in Mongolia". Pediatrics. 130 (3): e561–7. doi:10.1542/peds.2011-3029. PMID   22908115. S2CID   3092825.
  14. ↑ Ginde AA, Mansbach JM, Camargo CA (February 2009). "Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey". Arch. Intern. Med. 169 (4): 384–90. doi:10.1001/archinternmed.2008.560. PMC   3447082 . PMID   19237723.
  15. ↑ DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board. A. Catharine Ross, Christine L. Taylor, Ann L. Yaktine, and Heather B. Del Valle, Editors. Institute of Medicine of the National Academies, 2011.
  16. ↑ Cannell JJ, Vieth R, Umhau JC, et al. (December 2006). "Epidemic influenza and vitamin D". Epidemiol. Infect. 134 (6): 1129–40. doi:10.1017/S0950268806007175. PMC   2870528 . PMID   16959053.
  17. ↑ Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E (2008). "On the epidemiology of influenza". Virol. J. 5: 29. doi: 10.1186/1743-422X-5-29 . PMC   2279112 . PMID   18298852.
  18. ↑ Yakoob MY, Salam RA, Khan FR, Bhutta ZA (November 2016). "Vitamin D supplementation for preventing infections in children under five years of age". The Cochrane Database of Systematic Reviews. 2016 (11): CD008824. doi:10.1002/14651858.cd008824.pub2. PMC   5450876 . PMID   27826955.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.