Vitamin D response time is 3-6 months, not much benefit in first 4 months – RCT

Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children

JAMA. 2017;318(3):245-254. doi:10.1001/jama.2017.8708

Table 2 found Influenza 2X less likely for 2,000 IU vs 400 IU

Outrageous titles reporting on this study

High-Dose Vitamin D May Not Curb Kids' Colds

High-dose vitamin D fails against young children's upper respiratory infections

High-dose vitamin D may not reduce cold risk in young children: study

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* Both groups achieved sufficient vitamin D levels by the end of the trial (4-9 months) * There doubtless would have been a big difference if compared to children without any supplementation * Normal RTI rate is 3/year. Both low dose and high dose children in this study had only 1 RTI/year * That is, both 400 IU and 2,000 IU reduced RTI by 3 X Suspect that the children in this study had one or more of the following 1. Children were outdoors more in the middle of the day in the summer 1. Parents supplemented children with Vitamin D 1. Children were getting several glasses a day of full-fat milk * Skim milk results in far less vitamin D getting into the body 1. See also VitaminDWiki * Overview Colds and flu and Vitamin D * Respiratory infections reduced by 63 percent with 4000 IU vitamin D daily - RCT Dec 2012 * * * *Note: This study did not notice a difference until about 4 months, which was the length of study on this page* * * Vitamin D and Respiratory Tract Infections – meta-analysis with charts June 2013 * Respiratory tract infection eliminated in 36 percent of people by 4000 IU of Vitamin D – RCT Sept 2015 * Acute respiratory tract infections prevented by vitamin D (even when ignoring the dose size – Meta-analysis Feb 2017 * Half the risk of Influenza -A in infants taking 1200 IU of vitamin D for 4 months – RCT Jan 2018 * Vitamin D and Respiratory Tract Infections – meta-analysis with charts June 2013 * Reduced viral respiratory tract infections by half by having more than 38 ng of vitamin D – June 2010 * Respiratory infection in infant was 7 X more likely if low cord Vitamin D – March 2017 * Search "Respiratory Tract Infection" 413 items as of July 2017

Mary Aglipay, MSc1; Catherine S. Birken, MD2,3,4,5; Patricia C. Parkin, MD2,3,4,5; et al Mark B. Loeb, MD, MSc6,7; Kevin Thorpe, MMath8,9; Yang Chen, MA, MSc8; Andreas Laupacis, MD8,10,11; Muhammad Mamdani, MPH, PharmD8; Colin Macarthur, PhD2,3,4,5; Jeffrey S. Hoch, PhD4,8,12; Tony Mazzulli, MD13,14; Jonathon L. Maguire, MD, MSc1,2,3,4,8; for the TARGet Kids! Collaboration

Key Points

• Question Does high-dose vitamin D supplementation (2000 IU/d) help to prevent wintertime viral upper respiratory tract infections compared with standard-dose vitamin D supplementation (400 IU/d) among preschool children?

• Findings In this multisite randomized clinical trial that included 703 children, the number of wintertime laboratory-confirmed viral upper respiratory tract infections was higher in the high-dose group than the standard-dose group, not a statistically significant difference.

• Meaning Vitamin D dosing higher than 400 IU/d may not be indicated for preventing wintertime viral upper respiratory tract infections in children.

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 trial was 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 /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.

clinicaltrials: NCT01419262

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