Interstitial lung disease 1.5X more likely to last 10 years if low Vitamin D– June 2018

MESA 2016 - little problem if > 30 ng of Vitamin D

Abstract 15057: Vitamin D Deficiency is Independently Associated With Subclinical Interstitial Lung Disease: The Multi-Ethnic Study of Atherosclerosis (MESA)
Circulation. 2016;134:A15057
Samuel M Kim, Di Zhao, Pamela L Lutsey, Eliseo Guallar, Anna Podolanczuk, Steven M Kawut, Ganesh Raghu, Ian de Boer, Bryan Kesternbaum, David J Lederer, Erin D Michos
Background: Vitamin D deficiency and interstitial lung disease (ILD) have both been associated with cardiovascular disease (CVD). Yet, the relationship between vitamin D and ILD is not well known. Vitamin D deficiency may be a risk factor for ILD since vitamin D has anti-inflammatory properties. We hypothesized that 25-hydroxyvitamin D [25(OH)D] deficiency will be independently associated with subclinical ILD in a large population-based cohort study.

Methods: We studied 6302 MESA participants without clinical CVD who had baseline serum 25[OH]D levels and cardiac CTs that included partial lung fields in 2000-2002. Some participants had follow up cardiac CT scans at Exams 2-4 and a full lung CT scan at Exam 5 (2010-2012), with an average number of scans of 2.1 (1.0). Subclinical ILD was defined quantitatively as log-transformed volume (continuous) of high attenuation areas (HAA) between -600 and -250 Hounsfield units adjusted for lung volume. We used mixed model effect methods to assess the longitudinal association between baseline 25(OH)D stratified into three groups (<20, 20-29, ≥30 ng/ml) with HAA change. We also examined non-concurrent cross sectional relationship between baseline 25(OH)D and presence of interstitial lung abnormalities (ILA) (yes/no) determined qualitatively by radiologists from full lung CTs at Exam 5. We adjusted for demographics, smoking, and lifestyle factors.

Results: The mean (SD) age of our cohort was 62.2(10) years, 53% were women. Over a median follow up of 3.6 years, participants with lower 25(OH)D levels had increased progression of HAA [Figure]. Compared to those with replete levels (≥30 ng/ml), 25(OH)D deficiency (<20 ng/ml) was associated with increased HAA volume [exponentiated HAA ratio 1.02 (1.01, 1.03)] and with presence of ILAs [RR 1.43 (1.01, 2.02)].

Conclusions: Vitamin D deficiency was independently and modestly associated with subclinical ILD based on increased HAA volume and ILAs on high resolution CT scans.

MESA (Multi-Ethnic Study of Atherosclerosis) 2018

((Serum 25-Hydroxyvitamin D Concentrations Are Associated with Computed Tomography Markers of Subclinical Interstitial Lung Disease among Community-Dwelling Adults in the Multi-Ethnic Study of Atherosclerosis (MESA)__
The Journal of Nutrition,
Samuel M Kim Di Zhao Anna J Podolanczuk Pamela L Lutsey Eliseo Guallar Steven M Kawut R Graham Barr Ian H de Boer Bryan R Kestenbaum David J Lederer


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Background: Activated vitamin D has anti-inflammatory properties. 25-Hydroxyvitamin D [25(OH)D] deficiency might contribute to subclinical interstitial lung disease (ILD).

Objective: We examined associations between serum 25(OH)D concentrations and subclinical ILD among middle-aged to older adults who were free of cardiovascular disease at baseline.

We studied 6302 Multi-Ethnic Study of Atherosclerosis (MESA) participants who had baseline serum 25(OH)D concentrations and computed tomography (CT) imaging spanning ≤ 10 y. Baseline cardiac CT scans (2000–2002) included partial lung fields. Some participants had follow-up cardiac CT scans at exams 2–5 and a full-lung CT scan at exam 5 (2010–2012), with a mean ± SD of 2.1 ± 1.0 scans. Subclinical ILD was defined quantitatively as high-attenuation areas (HAAs) between –600 and –250 Hounsfield units. We assessed associations of 25(OH)D with adjusted HAA volumes and HAA progression. We also examined associations between baseline 25(OH)D and the presence of interstitial lung abnormalities (ILAs) assessed qualitatively (yes or no) from full-lung CT scans at exam 5. Models were adjusted for sociodemographic characteristics, lifestyle factors (including smoking), and lung volumes.

The cohort's mean ± SD characteristics were 62.2 ± 10 y for age, 25.8 ± 10.9 ng/mL for 25(OH)D concentrations, and 28.3 ± 5.4 for body mass index (kg/m2); 53% were women, with 39% white, 27% black, 22% Hispanic, and 12% Chinese race/ethnicities. Thirty-three percent had replete (≥30 ng/mL), 35% intermediate (20 to <30 ng/mL), and 32% deficient (<20 ng/mL) 25(OH)D concentrations. Compared with those with replete concentrations, participants with 25(OH)D deficiency had greater adjusted HAA volume at baseline (2.7 cm3; 95% CI: 0.9, 4.5 cm3) and increased progression over a median of 4.3 y of follow-up (2.7 cm3; 95% CI: 0.9, 4.4 cm3) (P < 0.05). 25(OH)D deficiency was also associated with increased prevalence of ILAs 10 y later (OR: 1.5; 95% CI: 1.1, 2.2).

Vitamin D deficiency is independently associated with subclinical ILD and its progression, based on both increased HAAs and ILAs, in a community-based population. Further studies are needed to examine whether vitamin D repletion can prevent ILD or slow its progression.

The MESA cohort design is registered at as NCT00005487.

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