Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis
Year: 2019
Type: review
Abstract: ABSTRACT Background Few studies have evaluated the association between pre-existing vitamin D deficiency (VDD) and incident TB. We assessed the impact of baseline vitamin D on TB risk. Methods We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6751 household contacts of TB patients in Peru. We also conducted a one-stage individual participant data meta-analysis searching PubMed and Embase for studies of vitamin D and TB until December 31, 2017. We included studies that assessed vitamin D before TB diagnosis. We defined VDD as 25–(OH)D <50 nmol/L, insufficiency as 50–75 nmol/L and sufficiency as >75nmol/L. We estimated the association between vitamin D and incident TB using conditional logistic regression in the Peru cohort and generalized linear mixed models in the meta-analysis. Findings In Peru, baseline VDD was associated with a statistically insignificant increase in incident TB (aOR 1·70, 95% CI 0·84–3·46; p=0·14). We identified seven studies for the meta-analysis and analyzed 3544 participants. Individuals with VDD and very low vitamin D (<25nmol/L) had increased TB risk (aOR 1·48, 95% CI 1·04–210; p =0· 03 and aOR 2 08, 95% CI 0·88–4·92; p trend=002 respectively). Among HIV-positive patients, VDD and very low vitamin D conferred a 2-fold (aOR 2.18, 95% CI 1· 22–3·90; p=0· 01) and 4-fold (aOR 4·28, 95% CI 0·85–21·44; p trend=0·01) increased risk of TB respectively. Interpretation Our findings suggest vitamin D predicts TB risk in a dose-dependent manner and vitamin D supplementation may play a role in TB prevention. Funding National Institute of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Dental and Craniofacial Research (NIDCR), Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Foundation, Ujala Foundation, Wyncote Foundation, NIH - Fogarty International Center Program of International Training Grants in Epidemiology Related to AIDS, NIAID Byramjee Jeejeebhoy Medical College HIV Clinical Trials Unit, NIAID’s Baltimore-Washington-India Clinical Trials Unit, National Commission on Biotechnology, the Higher Education Commission, International Research Support Initiative Program of the Higher Education Commission Government of Pakistan, the Bill and Melinda Gates Foundation, and the NIH Fogarty International Center. Research in Context Evidence before this study Numerous studies have found lower serum vitamin D levels among patients with active TB disease compared to healthy controls. However, research has not clarified whether low vitamin D increases TB risk or whether TB disease leads to decreased vitamin D levels. We conducted PubMed and Medline searches for all studies available through December 31, 2017 on the association between vitamin D status and TB disease. We included the following keywords: “vitamin D,” “vitamin D deficiency,” “hypovitaminosis D,” “25-hydroxyvitamin D,” “1,25-dihydroxyvitamin D,” “vitamin D2,” “vitamin D3,” “ergocalciferol,” “cholecalciferol,” and “tuberculosis.” We found only seven studies had prospectively evaluated the impact of baseline vitamin D levels on risk of progression to TB disease. We report here the results of a case control study nested within a large prospective longitudinal cohort study of household contacts of TB cases and the results of an individual participant data (IPD) metaanalysis of available evidence on the association between vitamin D levels and incident TB disease. Added value of this study We demonstrated that low vitamin D levels predicts risk of future progression to TB disease in a dose-dependent manner. Implications of all the available evidence These findings suggest the possibility that vitamin D supplementation among individuals at high risk for developing TB disease might play a role in TB prevention efforts.
Source: PLoS Medicine
Authors: Omowunmi Aibana, Chuan-Chin Huang, Said Aboud, Alberto Arnedo-Pena, Mercedes C. Becerra, Juan Bautista Bellido-Blasco, Ramesh Bhosale, Roger Calderon, Silvia Chiang, Carmen Contreras, Ganmaa Davaasambuu, Wafaie W. Fawzi, Molly F. Franke, Jerome T. Galea, Daniel Garcia-Ferrer, Maria Gil-Fortuño, Barbará Gomila-Sard, Amita Gupta, Nikhil Gupte, Rabia Hussain, Jesus Iborra-Millet, Najeeha T. Iqbal, Jose Vicente Juan-Cerdán, Aarti Kinikar, Leonid Lecca, Vidya Mave, Noemi Meseguer-Ferrer, Grace Montepiedra, Ferdinand M. Mugusi, Olumuyiwa A. Owolabi, Julie Parsonnet, Freddy Roach-Poblete, Maria Angeles Romeu-García, Stephen A. Spector, Christopher R. Sudfeld, Mark W. Tenforde, Toyin O. Togun, Rosa Yataco, Zibiao Zhang, Megan B. Murray
Institutions: The University of Texas Health Science Center at Houston, Harvard University, Muhimbili University of Health and Allied Sciences, Aga Khan University, Brown University, Brigham and Women's Hospital, Hospital Regional de Antofagasta, University of South Florida, Fundación Hospital Provincial de Castellón, Johns Hopkins University, Johns Hopkins Medicine, London School of Hygiene & Tropical Medicine, Stanford Medicine, Stanford University, B. J. Medical College & Sassoon Hospital, University of California San Diego, University of Washington, McGill University
Language: English
Topic: Vitamin D Research Studies
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funders: Bill and Melinda Gates Foundation, Bristol-Myers Squibb, GlaxoSmithKline, Gilead Sciences, Wyncote Foundation, International Maternal Pediatric Adolescent AIDS Clinical Trials Network, Higher Education Commision, Pakistan, National Institutes of Health, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1052163596, G1524308034, G2697936944, G2977511333, G3217561614, G3262353703, G3342746445, AIDS Clinical Trials Group Network, Metabolic factors that control the spectrum of human tuberculosis, Byramee Jeejeebhoy Medical College (BJMC), Pune, India: Clinical Trials Unit, Teens on TB Treatment: Predicting Adherence through Clinical Decision Analysis, Cryptococcal antigen screening for the prevention of cryptococcal meningitis in the HIV "treat-and-treat" era: A prospective cohort and semi-quantitative lateral flow assay validation study, Epidemiology and transmission dynamics of MDR/XDR tuberculosis, G4853082081, G5000393273, PREVENTION MATERNAL TO INFANT HIV TRANSMISSION IN INDIA, G5255846033, Impact of Malnutrition on HIV Treatment Failure in Resource-Limited Settings, Epidemiology of multidrug-resistant tuberculosis in Peru, G5916562515, Trial of Vitamins in HIV Progression and Transmission, G7140252821, G7639421118, Host Genetic Factors Associated with CNS Disease of HIV-Infected Children, G8384097198, SDMC - IMPAACT Leadership Group, Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections, International Maternal, Adolescent and Pediatric Therapeutics Clinical Trials Network, HIV and Other Infectious Consequences of Substance Use, Johns Hopkins University Baltimore India Clinical Trail Unit (JHUBI CTU), Brown University Community and Clinical Research Training Program, CURE CTU, IMPAACT Leadership Group
OpenAlex ID: W2972899386