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S102 Vitamin d supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data
  1. AR Martineau1,
  2. DA Jolliffe1,
  3. RL Hooper1,
  4. L Greenberg1,
  5. JF Aloia2,
  6. P Bergman3,
  7. G Dubnov-Raz4,
  8. S Esposito5,
  9. D Ganmaa6,
  10. EC Goodall7,
  11. C Grant8,
  12. W Janssens9,
  13. I Laaksi10,
  14. S Manaseki-Holland11,
  15. D Murdoch1,
  16. RE Neale12,
  17. JR Rees13,
  18. S Simpson14,
  19. I Stelmach15,
  20. G Trilok Kumar16,
  21. M Urashima17,
  22. CA Camargo18
  1. 1Queen Mary University of London, London, UK
  2. 2Winthrop University Hospital, New York, USA
  3. 3Karolinska Institute, Stockholm, Sweden
  4. 4Edmond and Lily Safra Children’s Hospital, Tel Hashomer, Israel
  5. 5Università degli Studi di Milano, Milan, Italy
  6. 6Harvard School of Public Health, Boston, USA
  7. 7McMaster University, Ontario, Canada
  8. 8University of Auckland, Auckland, New Zealand
  9. 9Universitair ziekenhuis Leuven, Leuven, Belgium
  10. 10University of Tampere, Tampere, Finland
  11. 11University of Birmingham, Birmingham, UK
  12. 12QIMR Berghofer Medical Research Institute, Brisbane, Australia
  13. 13Geisel School of Medicine at Dartmouth, Lebanon, USA
  14. 14University of Tasmania, Hobart, Australia
  15. 15Medical University of Lodz, Lodz, Poland
  16. 16University of Delhi, Delhi, India
  17. 17Jikei University School of Medicine, Tokyo, Japan
  18. 18Harvard Medical School, Boston, USA

Abstract

Introduction and objectives Randomised controlled trials of vitamin D to prevent acute respiratory infection have yielded mixed results. We conducted an individual patient data (IPD) meta-analysis to identify factors that may explain this heterogeneity.

Methods We performed an IPD meta-analysis of 25 trials of vitamin D supplementation with incidence of acute respiratory infection as a pre-specified outcome (total 11,321 participants, aged 0 to 95 years). We used one-step logistic regression with random effects adjusting for age, sex, study duration and clustering by study. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of acute respiratory infection varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen.

Results IPD were obtained for 10,933/11,321 (96.6%) participants. Vitamin D supplementation reduced risk of acute respiratory infection among all participants (adjusted Odds Ratio [aOR] 0.88, 95% CI: 0.81 to 0.96, P = 0.003; P for heterogeneity < 0.001). Sub-group analysis revealed a strong protective effect among individuals with baseline 25(OH) D < 25 nmol/L (aOR 0.62, 95% CI: 0.45 to 0.83, P = 0.002), not seen among those with higher levels (aOR 0.91, 95% CI: 0.78 to 1.05; Pinteraction = 0.01). A protective effect was also seen in individuals receiving daily or weekly vitamin D without additional bolus doses (aOR 0.81, 95% CI: 0.72 to 0.91, P < 0.001), but not in those receiving one or more bolus doses (aOR 0.97, 95% CI: 0.86 to 1.10, Pinteraction = 0.05). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (aOR 0.98, 95% CI: 0.80 to 1.20, P = 0.83). The body of evidence contributing to these analyses was assessed as being of high quality.

Conclusions Vitamin D supplementation was safe, and it protected against acute respiratory infection overall. Very deficient individuals and those not receiving bolus doses experienced the most benefit.

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