Weekly cholecalciferol supplementation results in significant reductions in infection risk among the vitamin D deficient: results from the CIPRIS pilot RCT

Simpson, Steve; Mei, Ingrid van der; Stewart, Niall; Blizzard, Leigh; Tettey, Prudence; Taylor, Bruce

doi:10.1186/2055-0928-1-7

Cited by 17 publications

(36 citation statements)

References 36 publications

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“…The pooled summary estimate of six studies [ 35 , 36 , 38 – 41 ] showed a marginal mean reduction in symptom duration (MD -0.06 days; 95% CI -0.29 to 0.18) in the vitamin D group compared to placebo, which was not statistically significant ( Fig 5 ).…”

Section: Resultsmentioning

confidence: 98%

“…Five studies [ 35 , 36 , 38 , 39 , 41 ] assessed severity of RTI symptoms on various scales. Definitions applied to assess symptom severity were as follows: the average self-rated score of symptom severity on a scale of 1 to 7 (1 = very mild, 3 = mild, 5 = moderate, 7 = severe) [ 35 ], the sum of seven consecutive daily severity scores [ 36 , 39 ], and the mean severity score on a scale from 1–5 (1 = healthy and 5 = very ill) [ 38 ] and 0–5 (0 = no symptoms and 5 = most severe symptoms) [ 41 ], respectively. The pooled OR of 0.95 (95% CI 0.76 to 1.18) suggests less pronounced severity in the vitamin D group, but this result did not reach statistical significance ( Fig 7 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies specifically addressed at least one of the following: hypercalcemia [ 27 , 33 ], hyperphosphatemia [ 41 , 42 , 45 ], or nephrolithiasis [ 33 , 38 , 41 , 42 , 45 ]. Nine of ten cases with mild hypercalcemia occurred in the same trial with concomitant calcium administration [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Effect of Vitamin D3 Supplementation on Respiratory Tract Infections in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2016

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ObjectiveVitamin D supplementation may be a simple preventive measure against respiratory tract infections (RTIs) but evidence from randomized controlled trials is inconclusive. We aimed to systematically summarize results from interventions studying the protective effect of vitamin D supplementation on clinical and laboratory confirmed RTIs in healthy adults and children.MethodsMedline, EMBASE, CENTRAL, and CINAHL were screened from inception until present (last updated in January 2016) completed by a search of the grey literature, clinical trial registers and conference abstracts. We included randomized trials comparing vitamin D versus placebo or no treatment. Two independent reviewers were responsible for study selection and data extraction. Cochrane’s risk of bias tool and the GRADE approach were used for quality assessment. Estimates were pooled with random-effects models. Heterogeneity was explored by sub-group and meta-regression analyses.ResultsOf 2627 original hits, 15 trials including 7053 individuals were ultimately eligible. All used oral cholecalciferol. We found a 6% risk reduction with vitamin D3 supplementation on clinical RTIs, but the result was not statistically significant (RR 0.94; 95% CI 0.88 to 1.00). Heterogeneity was large (I-square 57%) and overall study quality was low. There were too few studies to reliably assess a potential risk reduction of laboratory confirmed RTI. Evidence was insufficient to demonstrate an association between vitamin D supplementation and risk of clinical RTI in sub-groups with vitamin D deficiency.ConclusionsIn previously healthy individuals vitamin D supplementation does not reduce the risk of clinical RTIs. However, this conclusion is based on a meta-analysis where the included studies differed with respect to population, baseline vitamin D levels and study length. This needs to be considered when interpreting the results. Future trials should focus on vitamin D deficient individuals and apply more objective and standardized outcome measurements.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Effect of Vitamin D3 Supplementation on Respiratory Tract Infections in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2016

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“…Simpson et al reported that a protective vitamin D effect (20 000 IU/wk cholecalciferol 17 wk during winter) towards acute infections (respiratory, gastrointestinal, urinary tract, eye, ear, skin, and cold sore infections) could only be observed in the subgroup of healthy adults with initial 25(OH)D levels <40 nmol/L (n = 4 of 34 healthy adults) . No microbiological verification of symptoms was available.…”

Section: Vitamin D Supplementation In Preventing Aris In Healthy Peoplementioning

confidence: 99%

Vitamin D modulation of innate immune responses to respiratory viral infections

et al. 2016

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Vitamin D, in addition to its classical functions in bone homeostasis, has a modulatory and regulatory role in multiple processes, including host defense, inflammation, immunity, and epithelial repair. Patients with respiratory disease are frequently deficient in vitamin D, implying that supplementation might provide significant benefit to these patients. Respiratory viral infections are common and are the main trigger of acute exacerbations and hospitalization in children and adults with asthma and other airways diseases. Respiratory monocytes/macrophages and epithelial cells constitutively express the vitamin D receptor. Vitamin D, acting through this receptor, may be important in protection against respiratory infections. Whether the in vitro findings can be translated into a substantial in vivo benefit still remains uncertain. Here we review the in vitro data on the role of vitamin D in antiviral innate immunity, the data concerning the deficient levels of vitamin D in lung diseases, and the in vivo role of supplementation as protection against respiratory viral infections in healthy individuals and in patients with chronic respiratory diseases. Finally, we suggest ways of improving the effectiveness of vitamin D as an adjuvant in the prevention and treatment of acute respiratory infections.

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“…Moreover, in three trials with initial 25OHD levels <50 nmol/l [ 54 , 60 , 68 ], the odds ratio of vitamin D effectiveness was 0.55 (95 % CI 0.20–1.55), indicating that initial 25OHD level may also influence vitamin D effectiveness. Notably, Simpson et al [ 67 ] reported that a protective vitamin D effect could only be observed in the subgroup of individuals with initial 25OHD levels <40 nmol/l. In these individuals, vitamin D resulted in a 44 % reduction in infection risk ( P = 0.007).…”

Section: Clinical Associations Of Vitamin D With Acute Airway Infectimentioning

confidence: 99%

Vitamin D and airway infections: a European perspective

et al. 2016

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Vitamin D has immuno-modulatory properties, and deficient levels of circulating 25-hydroxyvitamin D (<30 nmol/l) may contribute to increased risk of infectious illnesses. This narrative review summarises data on vitamin D status in Europe and updates results of randomised controlled trials (RCTs) regarding vitamin D and airway infections such as tuberculosis (TB) and acute upper respiratory tract infection. In Europe, the prevalence of vitamin D deficiency is up to 37 % in the general population and up to 80 % in nursing home residents and non-European immigrants. Half of TB patients have a migration background. While results of RCTs do not support the concept of beneficial adjunctive effects of vitamin D supplements in anti-TB treatment [odds ratio (OR) = 0.86; 95 % CI 0.62–1.19], the few published RCTs on the prophylaxis of TB suggest some protective vitamin D effects in individuals with deficient circulating 25-hydroxyvitamin D levels. Regarding acute respiratory tract infection, RCTs indicate a significant risk reduction by vitamin D supplements [OR = 0.65; 95 % confidence interval (CI) 0.50–0.85]. There is evidence that daily administration is more effective than high-dose bolus administration [OR = 0.48 (95 % CI 0.30–0.77) vs. OR = 0.87 (95 % CI 0.67–1.14)] and that individuals with deficient or insufficient (30–50 nmol/l) circulating 25-hydroxyvitamin D levels benefit most. Several vitamin D effects on innate immunity may explain these protective effects. In summary, there is possible evidence from RCTs for protective vitamin D effects on TB and likely evidence for protective effects on acute airway infection. Since vitamin D deficiency is prevalent in Europe, especially in institutionalised individuals and non-European immigrants, daily oral vitamin D intake, e.g. 1000 international units, is an inexpensive measure to ensure adequate vitamin D status in individuals at risk.

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Weekly cholecalciferol supplementation results in significant reductions in infection risk among the vitamin D deficient: results from the CIPRIS pilot RCT

Abstract: Background: Observational studies suggest vitamin D deficiency may contribute to the risk of acute infections. We undertook a randomised controlled trial (RCT) of cholecalciferol supplementation as an intervention against acute infections.

Cited by 17 publications

References 36 publications

Effect of Vitamin D3 Supplementation on Respiratory Tract Infections in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effect of Vitamin D3 Supplementation on Respiratory Tract Infections in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Vitamin D modulation of innate immune responses to respiratory viral infections

Vitamin D and airway infections: a European perspective

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