Effect of adjunctive single high-dose vitamin D3 on outcome of community-acquired pneumonia in hospitalised adults: The VIDCAPS randomised controlled trial

Slow, Sandy; Epton, Michael; Storer, Malina; Thiessen, Rennae; Lim, Steven; Wong, James; Chin, Paul; Tovaranonte, Pleayo; Pearson, John; Chambers, Stephen; Murdoch, David R.; Jardine, David L.; Pithie, Alan; Warren, Christopher; Faville, Suzanne; Shankar, Avinesh; Cameron, Evan Wm.; Evans, Tom; Mooi, Pamela; McDonald, C. H.; Chan, Huan; Llewelyn, J. G.; Liu, Mengmeng

doi:10.1038/s41598-018-32162-2

Cited by 19 publications

(26 citation statements)

References 22 publications

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“… 29 Vitamin D had no impact on the duration of symptoms among community-dwelling adults in the USA 45 and New Zealand, 29 older UK adults and their carers, 38 and among patients admitted for pneumonia in New Zealand. 35 The pooled per cent difference in duration was −6% (95% CI −9% to −2%; p=0.003, figure 3 ). There was no significant heterogeneity (I 2 =7%), and no evidence of publication bias on inspection of the funnel plot.…”

Section: Resultsmentioning

confidence: 97%

Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis

Abioye¹,

Bromage²,

Fawzi³

2021

BMJ Glob Health

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Acute respiratory tract infections (ARIs) are a leading cause of ill-health and death globally. Individual or multiple micronutrients have been shown to modulate immune function and affect the risk and severity of a number of infectious diseases. We systematically reviewed the evidence on the impact of micronutrient supplements to reduce the occurrence of ARIs and shorten the duration of ARI symptoms among adults. Random effects meta-analyses were conducted to estimate the pooled effects of vitamin D, vitamin C, zinc and multiple micronutrient supplementation (MMS) on the occurrence of ARIs and the duration of ARI symptoms. Vitamin D supplementation reduced the risk of ARI (risk ratio (RR)=0.97; 95% CI 0.94 to 1.00; p=0.028) and shortened the duration of symptoms (per cent difference: −6% (95% CI −9% to −2%; p=0.003)). The RR of vitamin D to prevent ARI was farther from the null when diagnosis was based on clinical diagnosis or laboratory testing, compared with self-report and when the loading dose was <60 000 IU. Vitamin C supplementation reduced the risk of ARIs (RR=0.96; 95% CI 0.93 to 0.99; p=0.01) and shortened the duration of symptoms (per cent difference: −9% (95% CI −16% to −2%; p=0.014)). The effect of vitamin C on preventing ARI was stronger among men and in middle-income countries, compared with women and high-income countries, respectively. Zinc supplementation did not reduce the risk of ARIs but shortened the duration of symptoms substantially (per cent difference: −47% (95% CI −73% to −21%; p=0.0004)). Our synthesis of global evidence from randomised controlled trials indicates that micronutrient supplements including zinc, vitamins C and D, and multiple micronutrient supplements may be modestly effective in preventing ARIs and improving their clinical course. Further research is warranted to better understand the effectiveness that individual or multiple micronutrients have on SARS-CoV-2 infection and treatment outcomes.

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Section: Resultsmentioning

confidence: 97%

Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis

Abioye¹,

Bromage²,

Fawzi³

2021

BMJ Glob Health

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“…For the present meta‐analysis, our search identified a total of 282 studies that were assessed for eligibility; of these, 13 studies 28,29,33–43 with a total of 4786 randomized participants fulfilled the eligibility criteria (Figure 1). Although 3 studies 19,34,38 were extracted from records, identified through a systematic review, 23 we did not extract any valid data from the study conducted by Rajshekhar et al 19…”

Section: Resultsmentioning

confidence: 99%

“…Another aspect that has to be considered was the prevalence of malnutrition, as underlying malnutrition may affect the state of immunity and hence blunt the vitamin D effect. Of these, only 5 studies [34][35][36]39,40 did report the malnutrition situation in either vitamin D or control groups, causing difficulty in correlating the effect of vitamin D supplementation in malnourished patients. Low vitamin D status is an independent risk factor for treatment failure and delayed recovery from severe lower respiratory infections.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of High‐Dose Vitamin D Supplementation as an Adjuvant Treatment on Pneumonia: Systematic Review and a Meta‐Analysis of Randomized Controlled Studies

et al. 2020

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The purpose of this meta-analysis was to summarize randomized controlled trial (RCT) evidence and evaluate the efficacy and safety of vitamin D (VD) supplementation as an adjunct to antibiotics for the treatment of pneumonia. Data sources published from the inception dates up to January 2020 were searched. RCTs of VD supplementation of any duration, age, and dosing regimen type were eligible for inclusion if data on pneumonia were collected. Thirteen studies (4786 randomized participants) fulfilled eligibility criteria. VD supplementation significantly increased levels of serum 25(OH)D (mean difference = 15.97; 95% CI, 7.49-24.44; P = .002) and reduced incidence of repeat episodes of pneumonia (risk ratio [RR] = 0.68; 95% CI, 0.50-0.93; P = .02). Subgroup analysis revealed VD supplementation had more reducing effects on repeat episodes of pneumonia among participants in trials in which the population were children (RR = 0.66; 95% CI, 0.48-0.90), duration <3 months (RR = 0.55; 95% CI, 0.33-0.91), or dose of VD <300,000 IU (RR = 0.51; 95% CI, 0.29-0.89). Although our results suggested that VD supplementation had a positive effect on recovery rate of pneumonia (RR = 1.28; 95% CI, 0.94-1.74; I 2 = 13%), there was no statistical difference (P = .12). High-dose VD intervention may have an effect on reducing the incidence rate of repeat episodes of pneumonia by enhancing immune efficacy, although more population studies are needed to support that VD supplementation has therapeutic effects on pneumonia itself.

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“…Achieved 25(OH)D in the treatment arm was 40 ng/mL. [90] Increased production of pro-inflammatory cytokines such as IL-6…”

Section: Clinical Characteristics Findings From Vitamin D Supplementamentioning

confidence: 98%

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

et al. 2020

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The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D 3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D 3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

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Effect of adjunctive single high-dose vitamin D3 on outcome of community-acquired pneumonia in hospitalised adults: The VIDCAPS randomised controlled trial

Cited by 19 publications

References 22 publications

Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis

Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis

Efficacy of High‐Dose Vitamin D Supplementation as an Adjuvant Treatment on Pneumonia: Systematic Review and a Meta‐Analysis of Randomized Controlled Studies

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

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