Nutrition and the Upper Respiratory Tract

Study authors and n

Type of study, vitamin D dosage, and duration of intervention



Aloia and Li-Ng (2007), n = 204

3-year RCT using 2,000 IU/day of vitamin D3 in African American women

Number of flu or cold episodes in the treated group were 1/3 of the placebo group (8 vs 26, respectively)

Significant reduction of reported flu; small sample

Avenell et al. (2007), n = 1,700

RCT using 800 IU D3/day for 24–62 months

No difference in infection or antibiotic usage in previous week

Small dose

Li-Ng et al. (2009), n = 162

RCT using 2,000 IU vitamin D3/day for 12 weeks

No significant difference in incidence of flu or cold symptoms

With this dose regimen, it may take more than 3 months to achieve adequate vitamin D levels

Urashima et al. (2010), n = 334

RCT using 1,200 IU vitamin D3/day in school children for 4 months

RR of 0.58 compared with control group (p = 0.04). Asthma attacks significantly reduced in treatment group (p = 0.006)

Significant reduction of influenza A but not influenza B

Laaksi et al. (2010), n = 164

RCT using 400 IU vitamin D3/day for 6 months

No statistically significant difference in days off (p = 0.06); supplemented group reported as healthier

Low vitamin D supplement and supplemented group almost showed a significant result

Martineau et al. (2011), n = 126

RCT – 100,000 IU vitamin D3 at baseline, 12, 28, and 42 days

No significant difference in time to sputum culture conversion (p = 0.14). Reduction in upper respiratory infection (p = 0.06)

Sputum culture conversion hastened in tt genotype of the Taql VDR polymorphism (p = 0.02)

Majak et al. (2011), n = 48

RCT of a single dose of 500 IU D3/day

A significant reduction in acute infective asthma exacerbations due to an upper respiratory infection (p = 0.029)

Children with a decreased 25(OH)D level eight times more likely to have an asthma exacerbation

Camargo et al. (2012), n = 247

RCT of 300 IU D3/day in vitamin D-deficient Mongolian children

Incidence of upper respiratory tract infections halved

Urashima and colleagues gave 334 Japanese school children vitamin D3 1,200 IU daily or placebo (Urashima et al. 2010). There was a 50 % reduction in children who were diagnosed with influenza A (primary outcome). However, if one combines the number of cases of influenza A and influenza B, there was no reduction in total influenza infections between the vitamin D treated and the control group. Laaksi and colleagues supplemented 164 young Finnish men with only 400 IU/day of vitamin D3. Absence from duty due to respiratory tract infection and number of days absent was lower in the treated group. The proportion of subjects without any days absent was slightly higher in the vitamin D supplementation group (Laaksi et al. 2010). Martineau and colleagues used high-dose vitamin D3 in the treatment of pulmonary TB (Martineau et al. 2011). The number of people who had upper respiratory tract infection symptoms was recorded. One of seventy-one patients receiving at least one dose of vitamin D3 as compared to 6 of 70 receiving at least one dose of placebo reported symptoms. This secondary outcome was of borderline statistical significance (p = 0.06). In a recent RCT of 247 Mongolian children with vitamin D deficiency in winter, vitamin D supplementation halved the risk of upper respiratory infections (Camargo et al. 2012).

In the randomized controlled trial (RCT) where Japanese children were given 1,200 IU daily or placebo, children with a previous diagnosis of asthma, there was also a significant reduction in number of asthma attacks (Urashima et al. 2010); only 2 asthmatic children taking vitamin D and 12 taking placebo had “asthma attacks.” Recently, Majak and colleagues reported in an RCT on the role of vitamin D supplementation (vitamin D3 500 IU daily) vs placebo for 6 months in Polish children with newly diagnosed asthma (Majak et al. 2011); the investigators observed a significant reduction in asthma exacerbations due to acute upper respiratory tract infections (p = 0.029).

Vitamin D deficiency has been linked to an increased incidence of atopy including allergic rhinitis (Ehlayel et al. 2011). However, Hyppönen and colleagues have reported that regular vitamin D supplementation (≥2,000 IU/day) of Finnish infants increases the risk of developing allergic rhinitis and asthma at the age of 31 (Hyppönen et al. 2004). In a separate study in the UK, they also linked deficient (<25 nmol/L) and excessively high (>135 nmol/L) serum 25(OH)D levels with elevated serum IgE levels (Hyppönen et al. 2009). The relationships of vitamin D with allergy appear complex, but a possible “U” shape relationship exists with both low and high 25(OH)D levels predisposing to atopy (Bartley 2010).

A number of RCTs are currently underway worldwide investigating the role of vitamin D supplementation in upper respiratory infection and allergic disease (Bartley 2010). While preliminary data appears promising, optimal 25(OH)D levels and vitamin D treatment regimens for the prevention and/or management of respiratory infections remain to be determined.

14.9 Conclusions

Increasing evidence indicates that probiotics, zinc, and vitamin D supplementation could be important clinically. The diagnosis of zinc deficiency in clinical practice can be difficult (Gibson et al. 2008). A number of trials investigating the role of vitamin D supplementation in the prevention of upper respiratory disease are currently underway. Increasing evidence indicates that in vitamin D-deficient patients, vitamin D supplementation can be beneficial in the prevention of upper respiratory tract infection particularly in asthmatic children.


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May 18, 2017 | Posted by in Uncategorized | Comments Off on Nutrition and the Upper Respiratory Tract

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