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Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
PLoS One 2013; 8(6):e65835Plos

Abstract

BACKGROUND

Low levels of 25-OH vitamin D are associated with respiratory tract infection (RTI). However, results from randomized controlled trials are inconclusive. Therefore, we performed a systematic review and meta-analysis to assess the preventive effect of vitamin D supplementation on RTI.

METHODS

Randomized, controlled trials of vitamin D for prevention of RTI were used for the analysis. The risks of within-trial and publication bias were assessed. Odds ratios of RTI were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q and I(2). Meta-regressions and subgroup analyses were used to assess the influence of various factors on trial outcome. The pre-defined review protocol was registered at the PROSPERO international prospective register of systematic reviews, registration number CRD42013003530.

FINDINGS

Of 1137 citations retrieved, 11 placebo-controlled studies of 5660 patients were included in the meta-analysis. Overall, vitamin D showed a protective effect against RTI (OR, 0.64; 95% CI, 0.49 to 0.84). There was significant heterogeneity among studies (Cohran's Q p<0.0001, I(2) = 72%). The protective effect was larger in studies using once-daily dosing compared to bolus doses (OR = 0.51 vs OR = 0.86, p = 0.01). There was some evidence that results may have been influenced by publication bias.

INTERPRETATION

Results indicate that vitamin D has a protective effect against RTI, and dosing once-daily seems most effective. Due to heterogeneity of included studies and possible publication bias in the field, these results should be interpreted with caution.

Authors+Show Affiliations

Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden ; Department of Medicine, Center for Infectious Medicine (CIM), Karolinska Institutet, Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23840373

Citation

Bergman, Peter, et al. "Vitamin D and Respiratory Tract Infections: a Systematic Review and Meta-Analysis of Randomized Controlled Trials." PloS One, vol. 8, no. 6, 2013, pp. e65835.
Bergman P, Lindh AU, Björkhem-Bergman L, et al. Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE. 2013;8(6):e65835.
Bergman, P., Lindh, A. U., Björkhem-Bergman, L., & Lindh, J. D. (2013). Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PloS One, 8(6), pp. e65835. doi:10.1371/journal.pone.0065835.
Bergman P, et al. Vitamin D and Respiratory Tract Infections: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE. 2013;8(6):e65835. PubMed PMID: 23840373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AU - Bergman,Peter, AU - Lindh,Asa U, AU - Björkhem-Bergman,Linda, AU - Lindh,Jonatan D, Y1 - 2013/06/19/ PY - 2013/03/19/received PY - 2013/04/30/accepted PY - 2013/7/11/entrez PY - 2013/7/11/pubmed PY - 2013/7/11/medline SP - e65835 EP - e65835 JF - PloS one JO - PLoS ONE VL - 8 IS - 6 N2 - BACKGROUND: Low levels of 25-OH vitamin D are associated with respiratory tract infection (RTI). However, results from randomized controlled trials are inconclusive. Therefore, we performed a systematic review and meta-analysis to assess the preventive effect of vitamin D supplementation on RTI. METHODS: Randomized, controlled trials of vitamin D for prevention of RTI were used for the analysis. The risks of within-trial and publication bias were assessed. Odds ratios of RTI were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q and I(2). Meta-regressions and subgroup analyses were used to assess the influence of various factors on trial outcome. The pre-defined review protocol was registered at the PROSPERO international prospective register of systematic reviews, registration number CRD42013003530. FINDINGS: Of 1137 citations retrieved, 11 placebo-controlled studies of 5660 patients were included in the meta-analysis. Overall, vitamin D showed a protective effect against RTI (OR, 0.64; 95% CI, 0.49 to 0.84). There was significant heterogeneity among studies (Cohran's Q p<0.0001, I(2) = 72%). The protective effect was larger in studies using once-daily dosing compared to bolus doses (OR = 0.51 vs OR = 0.86, p = 0.01). There was some evidence that results may have been influenced by publication bias. INTERPRETATION: Results indicate that vitamin D has a protective effect against RTI, and dosing once-daily seems most effective. Due to heterogeneity of included studies and possible publication bias in the field, these results should be interpreted with caution. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23840373/Vitamin_D_and_Respiratory_Tract_Infections:_A_Systematic_Review_and_Meta_Analysis_of_Randomized_Controlled_Trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0065835 DB - PRIME DP - Unbound Medicine ER -