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Meta-Analysis
. 2016 Oct 19:11:2597-2607.
doi: 10.2147/COPD.S101382. eCollection 2016.

The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis

Min Zhu  1 , Ting Wang  1 , Chengdi Wang  1 , Yulin Ji  1
Affiliations
Meta-Analysis

The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis

Min Zhu et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: In recent years, the pleiotropic roles of vitamin D have been highlighted in various diseases. However, the association between serum vitamin D and COPD is not well studied. This updated systematic review and meta-analysis aimed to assess the relationship between vitamin D and the risk, severity, and exacerbation of COPD.

Methods: A systematic literature search was conducted in PubMed, Medline, EMBASE, Chinese National Knowledge Infrastructure, Wanfang, and Weipu databases. The pooled risk estimates were standardized mean difference (SMD) with 95% confidence interval (CI) for vitamin D levels and odds ratio (OR) with 95% CI for vitamin D deficiency. Meta-regression and subgroup analyses were performed on latitude, body mass index, and assay method.

Results: A total of 21 studies, including 4,818 COPD patients and 7,175 controls, were included. Meta-analysis showed that lower serum vitamin D levels were found in COPD patients than in controls (SMD: -0.69, 95% CI: -1.00, -0.38, P<0.001), especially in severe COPD (SMD: -0.87, 95% CI: -1.51, -0.22, P=0.001) and COPD exacerbation (SMD: -0.43, 95% CI: -0.70, -0.15, P=0.002). Vitamin D deficiency was associated with increased risk of COPD (OR: 1.77, 95% CI: 1.18, 2.64, P=0.006) and with COPD severity (OR: 2.83, 95% CI: 2.00, 4.00, P<0.001) but not with COPD exacerbation (OR: 1.17, 95% CI: 0.86, 1.59, P=0.326). Assay methods had significant influence on the heterogeneity of vitamin D deficiency and COPD risk.

Conclusion: Serum vitamin D levels were inversely associated with COPD risk, severity, and exacerbation. Vitamin D deficiency is associated with increased risk of COPD and severe COPD but not with COPD exacerbation. It is worth considering assay methods in the heterogeneity sources analysis of association between vitamin D deficiency and COPD.

Keywords: COPD; exacerbation; meta-analysis; risk; severity; vitamin D.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of study selection. Abbreviation: CNKI, Chinese National Knowledge Infrastructure.
Figure 2
Figure 2
Meta-analysis of serum vitamin D levels in COPD patients compared with controls. Note: Stratified analysis based on latitude degree. Abbreviations: SMD, standardized mean difference; CI, confidence interval.
Figure 3
Figure 3
Meta-analysis of vitamin D deficiency in COPD patients compared with controls. Note: Stratified analysis based on assay methods. Abbreviations: OR, odds ratio; CI, confidence interval; LC-MS/MS, liquid chromatography electrospray ionization tandem mass spectrometry; ELISA, enzyme-linked immunosorbent assay; NA, not available.
Figure 4
Figure 4
Meta-analysis of serum vitamin D levels in severe–very severe COPD patients compared with mild–moderate COPD patients. Abbreviations: SMD, standardized mean difference; CI, confidence interval.
Figure 5
Figure 5
Meta-analysis of serum vitamin D levels in AECOPD patients compared with stable COPD patients. Abbreviations: AECOPD, acute exacerbation COPD; SMD, standardized mean difference; CI, confidence interval.
See this image and copyright information in PMC

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