Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children

Mary Aglipay, Catherine S. Birken, Patricia C. Parkin, Mark B. Loeb, Kevin Thorpe, Yang Chen, Andreas Laupacis, Muhammad Mamdani, Colin Macarthur, Jeffrey S Hoch, Tony Mazzulli, Jonathon L. Maguire

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trialwas conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada. INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTS Among 703 participants who were randomized (mean age, 2.7 years, 57.7%boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95%CI, 0.91-1.19) for the high-dose group and 1.03 (95%CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95%CI, 0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95%CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95%CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95%CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95%CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95%CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95%CI, 35.4-38.2 ng/mL) in the standard-dose group. CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections.

Original languageEnglish (US)
Pages (from-to)245-254
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume318
Issue number3
DOIs
StatePublished - Jul 18 2017
Externally publishedYes

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Vitamin D
Respiratory Tract Infections
Laboratory Infection
Respiratory System
Incidence
Ontario
Infection
Serum
Nose
Human Influenza
Canada
Epidemiologic Studies
Primary Health Care
Research
25-hydroxyvitamin D

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children. / Aglipay, Mary; Birken, Catherine S.; Parkin, Patricia C.; Loeb, Mark B.; Thorpe, Kevin; Chen, Yang; Laupacis, Andreas; Mamdani, Muhammad; Macarthur, Colin; Hoch, Jeffrey S; Mazzulli, Tony; Maguire, Jonathon L.

In: JAMA - Journal of the American Medical Association, Vol. 318, No. 3, 18.07.2017, p. 245-254.

Research output: Contribution to journalArticle

Aglipay, M, Birken, CS, Parkin, PC, Loeb, MB, Thorpe, K, Chen, Y, Laupacis, A, Mamdani, M, Macarthur, C, Hoch, JS, Mazzulli, T & Maguire, JL 2017, 'Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children', JAMA - Journal of the American Medical Association, vol. 318, no. 3, pp. 245-254. https://doi.org/10.1001/jama.2017.8708
Aglipay, Mary ; Birken, Catherine S. ; Parkin, Patricia C. ; Loeb, Mark B. ; Thorpe, Kevin ; Chen, Yang ; Laupacis, Andreas ; Mamdani, Muhammad ; Macarthur, Colin ; Hoch, Jeffrey S ; Mazzulli, Tony ; Maguire, Jonathon L. / Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children. In: JAMA - Journal of the American Medical Association. 2017 ; Vol. 318, No. 3. pp. 245-254.
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abstract = "IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trialwas conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada. INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTS Among 703 participants who were randomized (mean age, 2.7 years, 57.7{\%}boys), 699 (99.4{\%}) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95{\%}CI, 0.91-1.19) for the high-dose group and 1.03 (95{\%}CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95{\%}CI, 0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95{\%}CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95{\%}CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95{\%}CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95{\%}CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95{\%}CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95{\%}CI, 35.4-38.2 ng/mL) in the standard-dose group. CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections.",
author = "Mary Aglipay and Birken, {Catherine S.} and Parkin, {Patricia C.} and Loeb, {Mark B.} and Kevin Thorpe and Yang Chen and Andreas Laupacis and Muhammad Mamdani and Colin Macarthur and Hoch, {Jeffrey S} and Tony Mazzulli and Maguire, {Jonathon L.}",
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TY - JOUR

T1 - Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children

AU - Aglipay, Mary

AU - Birken, Catherine S.

AU - Parkin, Patricia C.

AU - Loeb, Mark B.

AU - Thorpe, Kevin

AU - Chen, Yang

AU - Laupacis, Andreas

AU - Mamdani, Muhammad

AU - Macarthur, Colin

AU - Hoch, Jeffrey S

AU - Mazzulli, Tony

AU - Maguire, Jonathon L.

PY - 2017/7/18

Y1 - 2017/7/18

N2 - IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trialwas conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada. INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTS Among 703 participants who were randomized (mean age, 2.7 years, 57.7%boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95%CI, 0.91-1.19) for the high-dose group and 1.03 (95%CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95%CI, 0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95%CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95%CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95%CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95%CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95%CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95%CI, 35.4-38.2 ng/mL) in the standard-dose group. CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections.

AB - IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trialwas conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada. INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTS Among 703 participants who were randomized (mean age, 2.7 years, 57.7%boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95%CI, 0.91-1.19) for the high-dose group and 1.03 (95%CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95%CI, 0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95%CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95%CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95%CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95%CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95%CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95%CI, 35.4-38.2 ng/mL) in the standard-dose group. CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections.

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