Impact of Vitamin A and Carotenoids on the Risk of Tuberculosis Progression

Aibana, Omowunmi; Franke, Molly F.; Huang, Chuan-Chin; Galea, Jerome T; Calderón, Róger; Zhang, Zibiao; Becerra, Mercedes C.; Smith, Emily R.; Ronnenberg, Alayne G.; Contreras, Carmen; Yataco, Rosa; Lecca, Leonid; Murray, Megan

doi:10.1093/cid/cix476

Cited by 78 publications

(51 citation statements)

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“…27, [40][41][42] We also note previous studies have reported that low vitamin A is a strong predictor of incident TB disease. 23,43 In a previous analysis of the Lima cohort, we found vitamin A deficiency conferred a 10-fold increase in TB disease risk, 11 and here we show that adjustment for vitamin A modestly attenuates the impact of vitamin D. Similarly, Tenforde et al also reported that adjusting for vitamin A levels attenuated the effect of vitamin D on TB disease risk. 23 This raises the possibility that vitamin D levels correlate with other micronutrients implicated in the pathogenesis of TB and these micronutrients may be potent mediators of increased TB risk.…”

Section: Discussionsupporting

confidence: 73%

“…13 We used univariate and multivariate conditional logistic regression models to evaluate the association between baseline VDD and risk of TB disease. Because we had previously observed that vitamin A deficiency increases TB risk in this cohort, 11 we also adjusted for vitamin A levels.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the study design and methods are described elsewhere 11,12 and presented in the appendix (p 1). We enrolled a prospective cohort of household contacts (HHCs) of index TB patients in Lima, Peru between September 2009 and August 2012.…”

Section: Study Setting and Populationmentioning

confidence: 99%

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Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis

Aibana

Huang

Aboud

et al. 2018

Preprint

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Background: Few studies have evaluated the association between pre-existing vitamin D deficiency (VDD) and incident TB. We assessed the impact of baseline vitamin D on TB risk. Methods:We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6751 household contacts of TB patients in Peru. We also conducted a one-stage individual participant data meta-analysis searching PubMed and Embase for studies of vitamin D and TB until December 31, 2017. We included studies that assessed vitamin D before TB diagnosis. We defined VDD as 25-(OH)D <50 nmol/L, insufficiency as 50-75 nmol/L and sufficiency as >75nmol/L. We estimated the association between vitamin D and incident TB using conditional logistic regression in the Peru cohort and generalized linear mixed models in the meta-analysis. Findings:In Peru, baseline VDD was associated with a statistically insignificant increase in incident TB (aOR 1·70, 95% CI 0·84-3·46; p=0·14). We identified seven studies for the meta-analysis and analyzed 3544 participants. Individuals with VDD and very low vitamin D (<25nmol/L) had increased TB risk (aOR 1·48, 95% CI 1·04-2·10; p=0·03 and aOR 2·08, 95% CI 0·88-4·92; p trend=0·02 respectively). Among HIV-positive patients, VDD and very low vitamin D conferred a 2-fold (aOR 2.18, 95% CI 1·22-3·90; p=0·01) and 4-fold (aOR 4·28, 95% CI 0·85-21·44; p trend=0·01) increased risk of TB respectively.Interpretation: Our findings suggest vitamin D predicts TB risk in a dose-dependent manner and vitamin D supplementation may play a role in TB prevention. Evidence before this studyNumerous studies have found lower serum vitamin D levels among patients with active TB disease compared to healthy controls. However, research has not clarified whether low vitamin D increases TB risk or whether TB disease leads to decreased vitamin D levels. We conducted PubMed and Medline searches for all studies available through December 31, 2017 on the association between vitamin D status and TB disease. We included the following keywords: "vitamin D," "vitamin D deficiency," "hypovitaminosis D," "25-hydroxyvitamin D," "1,25-dihydroxyvitamin D," "vitamin D2," "vitamin D3," "ergocalciferol," "cholecalciferol," and "tuberculosis." We found only seven studies had prospectively evaluated the impact of baseline vitamin D levels on risk of progression to TB disease.We report here the results of a case control study nested within a large prospective longitudinal cohort study of household contacts of TB cases and the results of an individual participant data (IPD) metaanalysis of available evidence on the association between vitamin D levels and incident TB disease. Added value of this studyWe demonstrated that low vitamin D levels predicts risk of future progression to TB disease in a dosedependent manner. Implications of all the available evidenceThese findings suggest the possibility that vitamin D supplementation among individuals at high risk for developing TB disease might play a role in TB prevention efforts.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis

Aibana

Huang

Aboud

et al. 2018

Preprint

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“…Vitamin A deficiency increases the risk of being infected with TB. It has been shown that up to 10 fold increases of TB cases among household contacts of patients with tuberculosis in Lima, Peru are deficient in vitamin A [146]. In a study of Moroccan populations a significantly lower plasma retinol concentration in TB patients compared to healthy controls was observed [147].…”

Section: Additional Micronutrients and Tbmentioning

confidence: 98%

Host-Directed Therapy as a Novel Treatment Strategy to Overcome Tuberculosis: Targeting Immune Modulation

et al. 2020

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Tuberculosis (TB) is one of the leading causes of mortality and morbidity, particularly in developing countries, presenting a major threat to the public health. The currently recommended long term treatment regimen with multiple antibiotics is associated with poor patient compliance, which in turn, may contribute to the emergence of multi-drug resistant TB (MDR-TB). The low global treatment efficacy of MDR-TB has highlighted the necessity to develop novel treatment options. Host-directed therapy (HDT) together with current standard anti-TB treatments, has gained considerable interest, as HDT targets novel host immune mechanisms. These immune mechanisms would otherwise bypass the antibiotic bactericidal targets to kill Mycobacterium tuberculosis (Mtb), which may be mutated to cause antibiotic resistance. Additionally, host-directed therapies against TB have been shown to be associated with reduced lung pathology and improved disease outcome, most likely via the modulation of host immune responses. This review will provide an update of host-directed therapies and their mechanism(s) of action against Mycobacterium tuberculosis.

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“…Vitamin A has a protective effect against tuberculosis. Its deficiency is correlated with the occurrence of tuberculosis in a dose-dependent manner [46]. In bioactive form, alltrans retinoic acid induces antimicrobial responses in M. tuberculosis-infected via dendritic cells [47].…”

Section: Introductionmentioning

confidence: 99%

Role of vitamin A in health and illness

Marzęda¹,

Łuszczki²

2019

J Pre Clin Clin Res.

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Introduction. Vitamin A is an essential substance for human well-being and survival. It plays a crucial role in many physiological processes, including growth and differentiation of target tissues, reproduction, proper functioning of the retina and modulation of the immune system. Vitamin A deficiency leads to increased risk of severe infections, numerous diseases and pathological conditions, including disorders of vision, bones, epithelial tissue and immunity. It remains one of the main causes of preventable blindness in children. Nonetheless, excessive intake of vitamin A can also cause serious health problems. Objective. The aim of this study is to describe and summarize current knowledge about the role of vitamin A in the human organism, as well as to provide general information on its supplementation. State of Knowledge. Vitamin A is a group of similar organic compounds that cannot be synthesized in the human body, and therefore has to be included in the diet. Vitamin A influences the human body since foetal life. Both deficiency and an excess of vitamin A may cause serious complications. The main sources of the vitamin are meat, fish, poultry and dairy products. Its precursors, such as carotenoids, are present in fruit and vegetables. It is stored mainly in the liver and adipose tissue. Vitamin A has antioxidative attributes. Conclusion. An adequate intake of vitamin A is crucial for maintaining health and well-being, and deficiency as well as overdose of this vitamin may cause serious complications and diseases.

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Impact of Vitamin A and Carotenoids on the Risk of Tuberculosis Progression

Abstract: Key PointsVitamin A deficiency was associated with a 10-fold increase in risk of developing TB disease after household exposure. Vitamin A supplementation among high risk individuals might represent an effective means of preventing progression from TB infection to TB disease.

Cited by 78 publications

References 47 publications

Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis

Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis

Host-Directed Therapy as a Novel Treatment Strategy to Overcome Tuberculosis: Targeting Immune Modulation

Role of vitamin A in health and illness

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