Correlation between Vitamin D Levels and Recurrent Lower Respiratory Tract Infection in Children: A Cross-sectional Study

Abstract

Introduction: Vitamin D is a vital nutrient with immunomodulatory effects that may impact susceptibility to infections. Lower Respiratory Tract Infections (LRTI) are among the leading causes of morbidity and mortality in children. However, there is limited research exploring the relationship between vitamin D levels and LRTI in children in India. Aim: To find a correlation between vitamin D levels and recurrent LRTI in children aged 6 months to 5 years. Materials and Methods: A cross-sectional study was conducted in the Pediatric ward of Bokaro General Hospital in Jharkhand, India, between June 2019 and May 2020. A total of 222 children aged 6 months to 5 years diagnosed with recurrent LRTI were enrolled as cases (n=111), while other children in the same age group who were admitted with different diagnoses and required blood sampling were enrolled as controls (n=111) after obtaining parental consent. The blood levels of 25-hydroxy vitamin D [25(OH)D] were estimated and compared for both groups. Qualitative data were analysed using the chi-square test, while the Pearson’s correlation coefficient was used to compute the correlation between quantitative variables. Results: Among a total of 222 children, the majority 53 (47.7%), exhibited Vitamin D Deficiency (VDD), while most controls, 44 (39.6%) had normal vitamin D levels (p-value=0.03). The mean vitamin D level in the case group was significantly lower (p-value=0.022) compared to the control group. The VDD was found in 36 (39.13%) of the 92 cases with 2-3 episodes of LRTI, whereas it was observed in 17 (89.47%) of the 19 cases with 4-5 LRTI episodes (p-value=0.001). A significant inverse correlation was noted between the number of LRTI episodes and vitamin D levels (r-value=0.53, p-value<0.01). Conclusion: The present study reinforces the role of VDD and insufficiency in the occurrence of recurrent LRTI in children. Therefore, all children diagnosed with recurrent LRTI should be checked for their vitamin D status and should receive repletion therapy in addition to antibiotic treatment if found to be vitamin D deficient.

Keywords

• immunomodulation
• nutrition
• respiratory infections
• vitamin d insufficiency