Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial

Abstract

SummaryBackgroundVitamin D has a role in regulating immune function, and its deficiency is a suggested risk factor for childhood pneumonia. Our aim was to assess whether oral supplementation of vitamin D3 (cholecalciferol) will reduce the incidence and severity of pneumonia in a high-risk infant population.MethodsWe did a randomised placebo-controlled trial to compare oral 100 000 IU (2·5 mg) vitamin D3 with placebo given to children aged 1–11 months in Kabul, Afghanistan. Randomisation was by use of a computer-generated list. Vitamin D or placebo was given by fieldworkers once every 3 months for 18 months. Children presenting at the study hospital with signs of pneumonia had their diagnosis confirmed radiographically. Our primary outcome was the first or only episode of radiologically confirmed pneumonia. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00548379.Findings1524 children were assigned to receive vitamin D3 and 1522 placebo. There was no significant difference between the incidence of first or only pneumonia between the vitamin D (0·145 per child per year, 95% CI 0·129–0·164) and the placebo group (0.137, 0·121–0·155); the incidence rate ratio was 1·06 (95% CI 0·89–1·27). From 652 children during five separate periods of testing serum calcifediol, only one child in each of two testing periods had results greater than 375 nmol/L in the intervention group—a toxic level.InterpretationsQuarterly bolus doses of oral vitamin D3 supplementation to infants are not an effective intervention to reduce the incidence of pneumonia in infants in this setting.FundingWellcome Trust and British Council.

Efficacy of vitamin D in children with pneumonia: a randomized control trial study

“…Similar to our study another Indian study by Choudhary and Gupta, used vitamin D for 5 days and compared with placebo in cases with pneumonia showed there is no effect in the time of recovery from the disease [19]. Another study from Afghanistan on the role of supplementing vitamin D in the incidence of childhood pneumonia and its severity, showed no additional beneficial effect of vitamin D when given to children with pneumonia [9].…”

“…Other sources are egg yolk, fatty fish such as tuna, sardines or сod liver oil [8]. The binding of vitamin D to its receptors results in increased intracellular formation of antimicrobial compounds, such as cathelicidins which serve a critical role in innate immunity against invasive bacterial infection [9]. Charan et al reported that vitamin D induces monocyte differentiation and inhibits lymphocyte proliferation thus increasing the immunity.…”

“…On exposure of the human skin to UBV light from the sun, it synthesizes most of the vitamin D required in the body. Other sources are egg yolk, fatty fish such as tuna, sardinеs or сod liver oil [8,9]. Daily recommended dose of Vit D is 400 IU in children.…”

“…For the treatment of rickets its dose is 300,000 IU and 600,000 IU for children aged less than 1 year and more than one year respectively and for respiratory tract infection its dose is 100,000 IU [10]. Vitamin D has been shown to be effective in increasing the immunity and reducing the incidence of respiratory tract infections as shown by several studies [9,11]. Therefore, this study is carried out to determine the effect of vitamin D supplementation on duration of hospitalization in children with pneumonia and on the recurrence of pneumonia within 90 days of discharge.…”

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

“…The RCT of highest quality and greatest application to western populations, Murdoch 2012, 36 found that vitamin D supplementation over two winters did not reduce cold or flu illness in 322 New Zealand university and/or health care workers. The majority of other trials, including a large trial of infants in Kabul Afghanistan, 37 did not find a reduction in respiratory infections. One trial of Mongolian children with profound vitamin D deficiency (17.5 nmol/L) found a reduction of 0.35 respiratory tract infections over 3 months.…”