Vitamin D and respiratory tract infections

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Associations have been shown between

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]

Vitamin D deficiency has long been associated with

COPD have also been shown.[5]

Ultraviolet radiation and vitamin D

An inverse association between exposure to the sun and

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

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]

References

  1. ^
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  3. S2CID 18802134
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  4. PMID 18245055
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  5. PMID 30630893
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  6. ^ Smiley DF. Seasonal factors in the incidence of the acute respiratory infections. Am J Hyg 1926;6:621-6, p. 626
  7. S2CID 6674965
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  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. PMID 19204283
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  10. ^
    S2CID 25985630
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  11. PMID 19237723
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  12. PMID 20219962
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  13. S2CID 3092825
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  14. PMID 19237723
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  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. PMID 16959053
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  17. PMID 18298852
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  18. PMID 27826955
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