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 language | English (US) |
|---|---|
| Pages (from-to) | 245-254 |
| Number of pages | 10 |
| Journal | JAMA - Journal of the American Medical Association |
| Volume | 318 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jul 18 2017 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Medicine(all)
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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 journal › Article
}
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.
UR - http://www.scopus.com/inward/record.url?scp=85025807547&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85025807547&partnerID=8YFLogxK
U2 - 10.1001/jama.2017.8708
DO - 10.1001/jama.2017.8708
M3 - Article
C2 - 28719693
AN - SCOPUS:85025807547
VL - 318
SP - 245
EP - 254
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0002-9955
IS - 3
ER -