Vitamin E and Beta-Carotene Supplementation and Hospital-Treated Pneumonia Incidence in Male Smokers

Hemilä, Harri; Virtamo, Jarmo; Albanês, Demetrius; Kaprio, Jaakko

doi:10.1378/chest.125.2.557

Cited by 66 publications

(100 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17, 34 Individuals with vitamin deficiencies are at increased risk for respiratory infections, 10 and vitamin supplementation has been shown to decrease the rate of respiratory infections in certain populations. [11][12][13][14][15][16][18][19][20] Micronutrients can improve cell-mediated immunity and reduce oxidative stress. 35 Vitamin E supplementation in healthy, well-nourished adults increased delayed hypersensitivity responses, response to hepatitis B vaccine, lymphocyte proliferation, and decreased formation of immunosuppressive prostaglandins.…”

Section: Discussionmentioning

confidence: 99%

“…Information on dietary and supplemental vitamin intake was first ascertained in 1991and updated every 4 years using a semi-quantitative food frequency questionnaire. Women were excluded from the analysis if they had incomplete questionnaires (12,360), had pneumonia prior to the baseline in 1991 (14,156), died prior to 1991 (37), or if they had a history of conditions known to affect pneumonia risk (6,953), including cancer, cardiovascular disease (MI, stroke, or arterial surgery), or asthma diagnosed either prior to or during the study period.…”

Section: Study Populationmentioning

confidence: 99%

“…[11][12][13][14][15][16] Other studies have found no benefit with vitamin supplementation in reducing the rate of respiratory infections. 6, 17-20 Merchant and colleagues demonstrated that vitamin E intake from food sources, but not total intake, was inversely associated with pneumonia risk in US men.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vitamin and Micronutrient Intake and the Risk of Community-Acquired Pneumonia in US Women

Neuman

Willett

Curhan

2007

The American Journal of Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Vitamin and Micronutrient Intake and the Risk of Community-Acquired Pneumonia in US Women

Neuman

Willett

Curhan

2007

The American Journal of Medicine

View full text Add to dashboard Cite

show abstract

“…[5,39] Our results raise the possible protective benefit of supplementing a diet with olive oil or other products high in oleic acid. Furthermore, our study demonstrates the importance of controlling for the non-essential fatty acids in future studies examining DHA and EPA.…”

Section: Discussionmentioning

confidence: 67%

Fatty acid intake and the risk of community-acquired pneumonia in U.S. women

Alperovich¹,

Neuman

Willett

et al. 2007

Nutrition

View full text Add to dashboard Cite

Objective-Despite substantial progress in the treatment of community-acquired pneumonia, there are limited data on dietary risk factors. Fatty acid intake may influence community-acquired pneumonia risk by modulating the immune system. Our study prospectively examined the association between fatty acid intake and community-acquired pneumonia risk.Research Methods & Procedures-The study population included 83,165 women from the Nurses' Health Study II cohort who were between the ages of 27 and 44 in 1991. The women reported lifestyle habits on biennial questionnaires and dietary intake every four years by validated semiquantitative food frequency questionnaires (FFQ). There were 925 pneumonia cases over 10 years of follow-up. We examined independent associations for six fatty acids using Cox proportional hazards regression.Results-Women in the highest quintile of palmitic acid intake had a 54% greater risk of pneumonia compared to the lowest quintile: multivariate relative risk (RR)=1.54; 95% confidence interval (CI): 1.12, 2.12; p for trend = 0.002. Oleic acid intake was inversely associated with pneumonia risk (highest quintile multivariate RR=0.75; 95% CI: 0.55, 1.04; p for trend = 0.02). Women in the highest quintile of docosahexanoic acid (DHA) and eicosapentanoic acid (EPA) intake had a 24% greater risk of community-acquired pneumonia than the lowest quintile (multivariate RR=1.24; 95% CI: 1.00, 1.55; p for trend = 0.08). No significant associations were found for linoleic acid, alpha-linolenic acid, or DHA alone.Conclusions-Fatty acid intake may affect the risk of community-acquired pneumonia in young and middle-aged women. Higher dietary intake of palmitic acid and possibly DHA and EPA may increase the risk of community-acquired pneumonia in women while higher oleic acid intake may decrease the risk.

show abstract

“…In the ATBC Study participants who had initiated smoking at later age, vitamin E reduced pneumonia incidence in those who quit smoking during the follow-up by 79% (95% CI: 40% to 93%), but had no effect on those who continued smoking (95% CI: 47% to +19%) [5].…”

mentioning

confidence: 99%

Conclusions about intervention effects should not be based on surrogate end points

Hemilä¹

2007

Free Radical Biology and Medicine

View full text Add to dashboard Cite

Experts of controlled clinical trials argue that decisions on medical interventions should be based on clinically relevant outcomes and not on surrogates such as laboratory measurements. There are quite a few examples in which the effect on a surrogate end point substantially diverged from the effect on a clinically relevant outcome [1,2].In this respect, the recent paper by Bruno et al. is problematic as it proposed higher vitamin E intakes for smokers on the basis of greater disappearance rate of -tocopherol in the plasma of smokers [3]. The disappearance rate is a surrogate end point with no validated relation to any clinically relevant outcome.In our analyses of the ATBC Study cohort, we found that smoking modifies the effect of 50 mg/day vitamin E supplementation; however, the modification takes place in the direction opposite to that proposed by Bruno et al. In the 72-year-old ATBC Study participants who smoked 15 cigarettes per day at baseline, vitamin E supplementation increased common cold incidence by 42% (95% CI: +18% to +70%), whereas in those who smoked less, vitamin E reduced common cold incidence by 29% (95% CI: 9% to 46%) [4].Similarly, smoking modified the effect of vitamin E on pneumonia incidence. In the ATBC Study participants who had initiated smoking at later age, vitamin E reduced pneumonia incidence in those who quit smoking during the follow-up by 79% (95% CI: 40% to 93%), but had no effect on those who continued smoking (95% CI: 47% to +19%) [5].Thus, in the case of these two respiratory infections, vitamin E supplementation appeared beneficial for those who were smoking less, but it was harmful or ineffective for those who smoked heavily at baseline or continued smoking during the follow-up. These findings with clinically relevant outcomes thus contradict the surrogate-based proposal by Bruno et al. that smokers would benefit of higher vitamin E intakes and it would seem necessary for them to consume at least 15 mg/day of vitamin E [3]. Furthermore, the current US RDA recommendation level for vitamin E, 15 mg/day, is not based on any clinically relevant outcome either and is arbitrary [6]. The divergence in the effects of vitamin E supplementation in the ATBC Study cohort indicates that caution should be maintained in any proposals that people should increase their consumption of vitamin E until its effects are better understood.

show abstract

Vitamin E and Beta-Carotene Supplementation and Hospital-Treated Pneumonia Incidence in Male Smokers

Cited by 66 publications

References 38 publications

Vitamin and Micronutrient Intake and the Risk of Community-Acquired Pneumonia in US Women

Vitamin and Micronutrient Intake and the Risk of Community-Acquired Pneumonia in US Women

Fatty acid intake and the risk of community-acquired pneumonia in U.S. women

Conclusions about intervention effects should not be based on surrogate end points

Contact Info

Product

Resources

About