High doses of vitamin D reduce incidence of ARI

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High doses of vitamin D reduce the incidence of acute respiratory illness (ARI) in older, long-term care residents, a University of Colorado clinical trial found.

The findings of the clinical trial could help reduce one of the leading causes of serious illness, debilitation and death among patients in nursing homes and other long-term care facilities.

“After studying these patients for a year, we found a 40% reduction in acute respiratory illness among those who took higher doses of vitamin D,” said the study’s lead author, Dr Adit Ginde, professor of emergency medicine at the University of Colorado School of Medicine. “Vitamin D can improve the immune system’s ability to fight infections because it bolsters the first line of defence of the immune system.”

Ginde said in older people that first line of defence is often impaired. But vitamin D can reinforce it and prevent illnesses like pneumonia, influenza and bronchitis.

It may also prevent infections and exacerbations of Chronic Obstructive Pulmonary Disease (COPD) like emphysema.

At the same time, Ginde found that those who received higher doses of vitamin D also saw an increase in falls. The falls were lower in those given smaller doses rather than higher monthly doses of vitamin D.

The clinical trial, the first to examine vitamin D’s impact on respiratory infections in nursing home residents, looked at 107 patients with an average age of 84 over a 12 month period. Of those, 55 received high doses of vitamin D or 100,000 units monthly (averaging 3,300-4,300 units daily). And 52 received lower doses averaging between 400-1,000 units daily. Those with higher doses saw ARIs cut nearly in half. They also had over double the incidence of falls, the study said.

“This finding requires a confirmatory trial, including whether high daily doses of vitamin D, rather than high monthly doses, makes patients less likely to fall,” Ginde said.

But Ginde said the primary finding that vitamin D can reduce ARI is a major step forward in treating these dangerous infections. “This is a potentially life-saving discovery,” Ginde said. “There is very little in a doctor’s arsenal to battle ARI, especially since most are viral infections where antibiotics don’t work. But vitamin D seems able to potentially prevent these infections.”

He cautioned that the study is not definitive proof that vitamin D can prevent ARI but it suggests that it can and at little risk to the patient.

“If our results are confirmed by a larger trial, high dose vitamin D, ideally using daily dosing to minimise fall risk, has the potential for substantial public health benefit through ARI prevention for the large and growing population of long term care residents,” Ginde said.

Abstract
Objectives: To determine the efficacy and safety of high-dose vitamin D supplementation for prevention of acute respiratory infection (ARI) in older long-term care residents.
Design: Randomized controlled trial investigating high-dose vs standard-dose vitamin D from 2010 to 2014.
Setting: Colorado long-term care facilities.
Participants: Long-term care residents aged 60 and older (n = 107).
Intervention: The high-dose group received monthly supplement of vitamin D3 100,000 IU, the standard-dose group received a monthly placebo (for participants taking 400–1,000 IU/d as part of usual care) or a monthly supplement of 12,000 IU of vitamin D3 (for participants taking Measurements: The primary outcome was incidence of ARI during the 12-month intervention. Secondary outcomes were falls and fractures, 25-hydroxyvitamin D levels, hypercalcemia, and kidney stones.
Results: Participants (55 high dose, 52 standard dose) were randomized and included in the final analysis. The high-dose group had 0.67 ARIs per person-year and the standard-dose group had 1.11 (incidence rate ratio (IRR) = 0.60, 95% confidence interval (CI) = 0.38–0.94, P = .02). Falls were more common in the high-dose group (1.47 per person-year vs 0.63 in standard-dose group; IRR = 2.33, 95% CI = 1.49–3.63, P < .001). Fractures were uncommon and similar in both groups (high dose 0.10 vs standard dose 0.19 per person-year; P = .31). Mean trough 25-hydroxyvitamin D levels during the trial were 32. ng/mL in the high-dose group and 25.1 ng/mL in the standard-dose group. There was no hypercalcemia or kidney stones in either group.
Conclusion: Monthly high-dose vitamin D3 supplementation reduced the incidence of ARI in older long-term care residents but was associated with a higher rate of falls without an increase in fractures.

Authors
Adit A Ginde, Patrick Blatchford, Keith Breese, Lida Zarrabi, Sunny Linnebur, Jeffrey Wallace, Robert Schwartz

University of Colorado Anschutz Medical Campus material
Journal of the American Geriatrics Society abstract


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