Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PLoS One. 2013 Jun 19;8(6):e65835. doi: 10.1371/journal.pone.0065835. Print 2013.

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.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Dietary Supplements
  • Female
  • Humans
  • Male
  • Odds Ratio
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / prevention & control*
  • Treatment Outcome
  • Vitamin D / administration & dosage*

Substances

  • Vitamin D

Grant support

The work was financially supported by Karolinska Institutet (PB, LBB, JDL), Stockholm County Council (PB, LBB, JDL), Magnus Bergwall (PB) and Åke Wiberg foundations (PB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.