Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis
doi: https://doi.org/10.1101/481739
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Download the PDF from VitaminDWiki
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 disease risk.
Methods: We nested a case-control study within a prospective cohort of household contacts of TB patients in Peru. We also conducted a one-stage individual participant data meta-analysis searching PubMed and Embase to identify studies of vitamin D and TB disease 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, we analyzed 180 cases and 709 controls and found baseline VDD increased TB risk (aOR 1.70, 95% CI 0.84-3.46; p=0.14). For the meta-analysis, we identified seven studies and analyzed 3544 participants.
Individuals with VDD and very low vitamin D (< 25nmol/L) had increased TB risk (aOR 1.48, 95% CI 1.04-2.10; p=0.03 and aOR 2.08, 95% CI 0.88-4.92; p trend=0.02 respectively).
Among HIV-positive patients, VDD and very low vitamin D levels 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.