The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis

Abstract

BackgroundIn recent years, the pleiotropic roles of vitamin D have been highlighted in various diseases. However, the association between serum vitamin D and COPD is not well studied. This updated systematic review and meta-analysis aimed to assess the relationship between vitamin D and the risk, severity, and exacerbation of COPD.MethodsA systematic literature search was conducted in PubMed, Medline, EMBASE, Chinese National Knowledge Infrastructure, Wanfang, and Weipu databases. The pooled risk estimates were standardized mean difference (SMD) with 95% confidence interval (CI) for vitamin D levels and odds ratio (OR) with 95% CI for vitamin D deficiency. Meta-regression and subgroup analyses were performed on latitude, body mass index, and assay method.ResultsA total of 21 studies, including 4,818 COPD patients and 7,175 controls, were included. Meta-analysis showed that lower serum vitamin D levels were found in COPD patients than in controls (SMD: −0.69, 95% CI: −1.00, −0.38, P<0.001), especially in severe COPD (SMD: −0.87, 95% CI: −1.51, −0.22, P=0.001) and COPD exacerbation (SMD: −0.43, 95% CI: −0.70, −0.15, P=0.002). Vitamin D deficiency was associated with increased risk of COPD (OR: 1.77, 95% CI: 1.18, 2.64, P=0.006) and with COPD severity (OR: 2.83, 95% CI: 2.00, 4.00, P<0.001) but not with COPD exacerbation (OR: 1.17, 95% CI: 0.86, 1.59, P=0.326). Assay methods had significant influence on the heterogeneity of vitamin D deficiency and COPD risk.ConclusionSerum vitamin D levels were inversely associated with COPD risk, severity, and exacerbation. Vitamin D deficiency is associated with increased risk of COPD and severe COPD but not with COPD exacerbation. It is worth considering assay methods in the heterogeneity sources analysis of association between vitamin D deficiency and COPD.

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

“…Clinical Severe cases associated with pneumonia Inverse correlation for CAP [68,69] Increased production of pro-inflammatory cytokines such as IL-6 Inverse correlation [70,71] Increased CRP Inverse correlation [72,73] Increased risk of sepsis Inverse correlation [74,75] Risk of ARDS Inverse correlation [76,77] Risk of heart failure Inverse correlation [78,79] Risk of diabetes mellitus Inverse correlation [67,80] Epidemiological Began in December 2019 in China, spread mainly to northern midlatitude countries Low 25(OH)D values in winter [48,81] Males have higher incidence and much higher CFRs than females Smoking reduces 25(OH)D [82] CFR increases with age Chronic disease rates increase with age; vitamin D plays a role in reducing risk of chronic diseases [83] Higher CFR for diabetics Diabetics may have lower 25(OH)D [84] Higher CFR for diabetics Lower 25(OH)D associated with increased risk of incidence [85] Higher CFR for hypertension Lower 25(OH)D may be associated with increased risk of incidence [86] Higher CFR for cardiovascular disease Lower 25(OH)D associated with increased risk of incidence and death [87] Higher CFR for chronic respiratory disease For COPD patients, 25(OH)D inversely correlated with risk, severity, and exacerbation [88] Found at higher rates in regions with elevated air pollution Air pollution associated with lower 25(OH)D concentrations [89] Note: 25-hydroxyvitamin D ((25(OH)D); acute respiratory distress syndrome (ARDS); community-acquired pneumonia (CAP); case-fatality rate (CFR); interleukin 6 (IL-6); chronic obstructive pulmonary disease (COPD); C-reactive protein (CRP); vitamin D deficiency (VDD). Table 3 lists some findings for vitamin D supplementation in reducing the clinical effects of COVID-19 infection found from treating other diseases.…”

Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential?

“…Clear associations have been found between vitamin D status and COPD. Indeed, meta-analysis reported inverse associations between vitamin D levels and COPD risk and COPD severity (Zhu 2016). Also epidemiologic studies reported a strong relationship between vitamin D levels and pulmonary function (FEV1 and FVC) [70][71][72].…”

Prevalence of vitamin D deficiency in chronic obstructive pulmonary disease and it’s correlation with forced expiratory volume in one second: a tertiary care centre study

“…14 Higher COPD stage patients had high prevalence of vitamin D deficiency as they are more likely to stay indoors, have longer smoking history, anorectic, and take oral glucocorticoids, which reduce the levels of vitamin D. The mean FEV1 volume (%) decreases as the degree of vitamin D deficiency increases. 20 The meanFEV1 volume (%) were 83.15±11.53, 60.97±17.47, 30.71±7.96 insufficient, deficient and severe deficient patients ( The mean FEV1 volume in serum vitamin D deficient COPD patients was lower than sufficient COPD patients (1.550±0.55 vs 1.650±-0.58, p=0.45).…”

“…During this period, total 104 patients were included in this study who met the inclusion and exclusion criteria as per the study protocol. (20) 0 (0%) 20 (100%) GOLD 4 (14) 0 (0%) 14 (100%) The mean Vitamin D value of the study population was 20.77ng/ml (±11.74). Minimum vitamin D level was 5.6 ng/ml and maximum value was 43.9ng/ml.…”