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Clinician Article

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Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.

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• Martineau AR
• Jolliffe DA
• Hooper RL
• Greenberg L
• Aloia JF
• Bergman P, et al.

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Clinical Comments

Family Medicine (FM)/General Practice (GP)

As a family physician in area with high prevalence of Vitamin D deficiency, I find this strong and well done meta-analysis added to the importance and pleiotropic action of vitamin D. However, I am not sure if this study will change the practice as the vitamin D supplementation is recommended for more important issues (e.g., hypocalcemia).

Family Medicine (FM)/General Practice (GP)

Clearly, this article underscores the need to request vitamin D levels in a family practice setting. Vitamin D has always been considered as a use or not use based on some arthritis and osteoporosis conditions. This study is quite convincing to support the recommendation of vitamin D testing and utilization of vitamin D supplementation to prevent acute respiratory tract infections.

General Internal Medicine-Primary Care(US)

This is news to me. As a doctor practicing in the Pacific Northwest, I believe this will change my practice. I had previously focused on patients with or at risk for falls for vitamin D levels.

Infectious Disease

This large individual patient meta-analysis showed a clinically useful reduction in respiratory infection in subjects taking vitamin D supplements, and the effect was largest in those with low initial levels of vitamin D. This has important public health implications.

Pediatric Neonatology

As a neonatologist, I cannot understand the reticence I see occasionally with some colleagues about starting babies on oral daily vitamin supplements. I'm not aware of a significant downside, the opportunity for better bone health is real, and now this. All babies should be on vitamins.

Pediatrics (General)

This very large and carefully "vetted" meta-analysis should prove that Vitamin D supplementation (especially in those with Vitamin D deficiency) helps prevent acute respiratory tract infections. However, the drawbacks of this study for the average clinician are the very complex statistical analyses involved, and with the very large number of clinical participants, only very small differences between treated vs control group values can reach (very) high levels of statistical significance. An example is Table 2 where the % difference between infections in the control vs intervention group is only 42.2 vs 40.3%, yet the P value is < 0.003; or Table 5 with only a 3% difference. Also, as the authors themselves point out, a caveat is that various study definitions were used to define acute respiratory tract infection, and confirmatory radiologic, microbiologic / virologic testing was not done in most of the individual studies.

Public Health

Although there remains some heterogeneity in the results, the risk of Vit D supplementation is low and the benefit is of public health importance. We seem to have enough evidence to change policy either in advising a daily supplement (especially to those as risk for deficiency) as well as food supplementation.

Respirology/Pulmonology

This meta-analysis of RCTs finds that Vitamin D supplementation reduced the risk of acute respiratory tract infections, but only when given as daily or weekly doses and not as a high dose bolus. No effects on adverse consequences of RTIs were observed. Results were driven by children and those who were Vitamin D deficient. Substantial statistical heterogeneity was observed and the main paper does not make it clear whether the subgroup analyses account for this heterogeneity. Therefore, it is not clear whether this study answers the clinical question. These results would not seem enough to support Vitamin D supplementation in the general population for this purpose (although there may be other reasons for doing so).

Respirology/Pulmonology

As an adult pulmonologist in the midwest where vitamin D insufficiency/deficiency is common, this study validates my tendency to obtain levels in less active individuals who are home-bound and tend toward vitamin-D-poor diets.

Respirology/Pulmonology

This is a well conducted study with high quality evidence. The results are very promising. With little side effects of Vit D3 supplementation for very low levels of serum Vit D, further recommendations on screening for Vit D deficiency in high risk patients with recurrent acute respiratory tract infections must be considered.