Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Aug 21;16(17):3020.
doi: 10.3390/ijerph16173020.

Acute Respiratory Tract Infection and 25-Hydroxyvitamin D Concentration: A Systematic Review and Meta-Analysis

Hai Pham  1   2 , Aninda Rahman  3   4 , Azam Majidi  3   4 , Mary Waterhouse  3 , Rachel E Neale  3   4
Affiliations
Meta-Analysis

Acute Respiratory Tract Infection and 25-Hydroxyvitamin D Concentration: A Systematic Review and Meta-Analysis

Hai Pham et al. Int J Environ Res Public Health. .

Abstract

Observational studies and randomised controlled studies suggest that vitamin D plays a role in the prevention of acute respiratory tract infection (ARTI); however, findings are inconsistent and the optimal serum 25-hydroxyvitamin D (25(OH)D) concentration remains unclear. To review the link between 25(OH)D concentration and ARTI, we searched PubMed and EMBASE databases to identify observational studies reporting the association between 25(OH)D concentration and risk or severity of ARTI. We used random-effects meta-analysis to pool findings across studies. Twenty-four studies were included in the review, 14 were included in the meta-analysis of ARTI risk and five in the meta-analysis of severity. Serum 25(OH)D concentration was inversely associated with risk and severity of ARTI; pooled odds ratios (95% confidence interval) were 1.83 (1.42-2.37) and 2.46 (1.65-3.66), respectively, comparing the lowest with the highest 25(OH)D category. For each 10 nmol/L decrease in 25(OH)D concentration, the odds of ARTI increased by 1.02 (0.97-1.07). This was a non-linear trend, with the sharpest increase in risk of ARTI occurring at 25(OH)D concentration < 37.5 nmol/L. In conclusion, there is an inverse non-linear association between 25(OH)D concentration and ARTI.

Keywords: 25-hydroxyvitamin D; acute infection; meta-analysis; observational studies; respiratory infection; systematic review; vitamin D.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The Prisma flowchart for study selection process. Note: ARTI = acute respiratory tract infection.
Figure 2
Figure 2
Forest plot displaying odds ratios (OR) and 95% confidence intervals (95% CI) for the association between 25(OH)D concentration and acute respiratory tract infection, comparing the lowest versus the highest 25(OH)D category.
Figure 3
Figure 3
Forest plot displaying odds ratios (OR) and 95% confidence intervals (95% CI) of acute respiratory tract infection risk per 10 nmol/L decrease in 25(OH)D concentration.
Figure 4
Figure 4
Dose-response relationship between serum 25(OH)D concentration and odds ratio of acute respiratory tract infection (p for non-linearity = 0.029). Lines with long dashes represent the upper and lower confidence interval for the fitted non-linear trend (solid line).
Figure 5
Figure 5
Forest plot displaying odds ratios (OR) and 95% confidence interval (95% CI) for the association between 25(OH)D concentration and (A) severe acute respiratory tract infection, and (B) mortality, comparing the lowest versus the highest 25(OH)D category.
Figure 6
Figure 6
Forest plot displaying odds ratios (95% confidence intervals) for the association between 25(OH)D concentration and (A) (i) upper respiratory tract infection, and (ii) lower respiratory tract infection; (B) (i) self-reported, and (ii) clinically confirmed acute respiratory tract infection; (C) acute respiratory tract infection in studies with (i) mean 25(OH)D concentration ≥ 60 nmol/L, and (ii) mean 25(OH)D concentration < 60 nmol/L; and (D) acute respiratory tract infection in studies with (i) crude or non-fully adjusted effect estimate; and (ii) fully adjusted effect estimate; comparing the lowest versus the highest 25(OH)D category.
Figure 7
Figure 7
The funnel plot to check for publication bias.
See this image and copyright information in PMC

References

    1. Heikkinen T., Jarvinen A. The common cold. Lancet. 2003;361:51–59. doi: 10.1016/S0140-6736(03)12162-9. - DOI - PMC - PubMed
    1. WHO Review of global influenza activity, October 2016–October 2017. Wkly. Epidemiol. Rec. 2017;92:761–779. - PubMed
    1. LRICollaborators Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect. Dis. 2017;17:1133–1161. doi: 10.1016/S1473-3099(17)30396-1. - DOI - PMC - PubMed
    1. Australian Government, Department of Health. [(accessed on 26 April 2019)]; Available online: http://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surv....
    1. Telcian A.G., Zdrenghea M.T., Edwards M.R., Laza-Stanca V., Mallia P., Johnston S.L., Stanciu L.A. Vitamin D increases the antiviral activity of bronchial epithelial cells in vitro. Antivir. Res. 2017;137:93–101. doi: 10.1016/j.antiviral.2016.11.004. - DOI - PubMed

Publication types