Vitamin D Supplementation Decreases Acute Respiratory Tract Infections

by | Mar 30, 2017 | 2017, Lung Health, Respiratory Health, Vitamin D - Infections & Immunity

Written by James C. Morton Jr, Staff Writer. In a meta-analysis review of randomized double-blind, placebo-controlled, clinical research studies, Vitamin-D supplements significantly decreased incidence of acute respiratory tract infection (40.3%) compared to placebo group.  

lung healthAcute respiratory tract infections are bacterial or viral infections of the upper or lower respiratory system of the body. These infections cause inflammation in the lining of the membrane in the nostrils, vocal cords in the larynx (upper) mostly caused by rhinovirus), and the airways of the trachea bronchi and alveoli of the lungs (lower) mostly caused by influenza that can lead to pneumonia and death 1. Bacteria and viruses can spread through the air or by direct contact. It is estimated that pneumonia is the cause for one fifth of the 10.6 million deaths per year of children under 5 years of age, and the estimated healthcare cost in the United States ranges from $1.9 to $11.2 billion a year 2,3. Patients with acute respiratory tract infections present with low serum concentration levels of Vitamin-D (25-hydroxyvitamin D) 4.

The most popular treatment approach for acute respiratory tract infection patients is the use of prescription medication related to an antibiotic. The inappropriate use of antibiotics has led to antibiotic resistance and contributed to illnesses and an estimated 25,000 deaths a year 5.

Fortunately, a 2017 meta-analysis 6 revealed that Vitamin D supplementation, when given at doses less than 25nmol/L, reduces the risk of acute respiratory tract infections that can potentially lead to respiratory problems, pneumonia, or death. The meta-analyses consisted of 25 studies involving 10.933 participants from 14 countries on four continents. The participants ranged in age from birth to 95 years. The 25 studies range in time duration from 7 weeks to 1.5 years.

They received the one of the following dosages:

  • Bolus dose = 10,000 IU
  • < 25 nmol/L
  • ³ 25 nmol/L

Researchers noted the following: p-value 0.05 = significant, ARTI = Acute Respiratory Tract Infection percent for at least one incidence.

Dosage% ARTI/Control (Placebo)% ARTI/ Experimental Group (Vitamin-D)P-Value of Difference
< 25 nmol/L55% (137 out of 249)40.5% (117 out of 289)p = 0.002
>25 nmol/L35.7% (1027 out of 1639)59.1% (1179 out of 1995)p = 0.015
Bolus Injection (10,000 UI)35.7% (994 out of 2786)36.4% (1097 out of 3014)p = 0.67

The overall percentage of ARTI with the control group was 42.2% (2204 out of 5225), and 40.3% for the experimental group with a p-value difference of 0.003.

There was an overall protective effect of vitamin D supplementation against acute respiratory tract infection (p<0.001). Greater protective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses (but not in those receiving one or more bolus doses) (p=0.05) Also, the protective effects against acute respiratory tract infection in this group were strongest in those with profound vitamin D deficiency at baseline (less than 25 nmoL/) (p=0.006).

When suggesting how vitamin D benefits those with acute respiratory tract infections, researchers pointed to its metabolic synthesis in the body to increase and support the antimicrobial peptides that respond to viral and bacterial invasions in the body 6,7. It induces autophagy and synthesizes nitrogen and reactive oxygen intermediates to help with immunity to respiratory pathogens 8(10). Vitamin-D also benefits those with asthma exacerbations and chronic obstructive pulmonary disease (COPD) 9-11. Researchers also concluded that the adverse effects, like hypercalcemia and renal stones, were related to large bolus dosages. A limitation of the study was the participants lost to follow-up and those not completing the questionnaires.

Source: Martineau et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.BMJ 2017;356:i6583 http://dx.doi.org/10.1136/bmj.i6583  (http://creativecommons.org/licenses/by/4.0) 

Click here to read the full text study.

Posted March 30, 2017.

References:

  1. Medicine JH. Upper Respiratory Infection. 2017; Overview of upper respiratory infections. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/upper_respiratory_infection_uri_or_common_cold_90,P02966/. Accessed February 27, 2017, 2017.
  2. Simoes EAF, Cherian T, Chow J, Shahid-Salles SA, Laxminarayan R, TJ J. Acute Respiratory Infections in Children. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 25. 2006; 2nd edition:https://www.ncbi.nlm.nih.gov/books/NBK11786/. Accessed March 1, 2017, 2017.
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  4. Harris AM, Hicks LA, Qaseem A. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and PreventionAppropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults. Annals of internal medicine. 2016;164(6):425-434.
  5. CDC. Antibiotic/Antimicrobial Resistance. 2017; Overview of drug resistance. Available at: https://www.cdc.gov/drugresistance/. Accessed March 4, 2017, 2017.
  6. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. bmj. 2017;356:i6583.
  7. Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, Hunninghake GW. Respiratory epithelial cells convert inactive vitamin D to its active form: potential effects on host defense. The Journal of Immunology. 2008;181(10):7090-7099.
  8. Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240-4270.
  9. Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. The Cochrane Library. 2016.
  10. Lehouck A, Mathieu C, Carremans C, et al. High Doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary diseasea randomized trial. Annals of internal medicine. 2012;156(2):105-114.
  11. Martineau AR, James WY, Hooper RL, et al. Vitamin D 3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. The lancet Respiratory medicine. 2015;3(2):120-130.