PLoS Medicine (Sep 2019)

Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis.

  • Omowunmi Aibana,
  • Chuan-Chin Huang,
  • Said Aboud,
  • Alberto Arnedo-Pena,
  • Mercedes C Becerra,
  • Juan Bautista Bellido-Blasco,
  • Ramesh Bhosale,
  • Roger Calderon,
  • Silvia Chiang,
  • Carmen Contreras,
  • Ganmaa Davaasambuu,
  • Wafaie W Fawzi,
  • Molly F Franke,
  • Jerome T Galea,
  • Daniel Garcia-Ferrer,
  • Maria Gil-Fortuño,
  • Barbará Gomila-Sard,
  • Amita Gupta,
  • Nikhil Gupte,
  • Rabia Hussain,
  • Jesus Iborra-Millet,
  • Najeeha T Iqbal,
  • Jose Vicente Juan-Cerdán,
  • Aarti Kinikar,
  • Leonid Lecca,
  • Vidya Mave,
  • Noemi Meseguer-Ferrer,
  • Grace Montepiedra,
  • Ferdinand M Mugusi,
  • Olumuyiwa A Owolabi,
  • Julie Parsonnet,
  • Freddy Roach-Poblete,
  • Maria Angeles Romeu-García,
  • Stephen A Spector,
  • Christopher R Sudfeld,
  • Mark W Tenforde,
  • Toyin O Togun,
  • Rosa Yataco,
  • Zibiao Zhang,
  • Megan B Murray

DOI
https://doi.org/10.1371/journal.pmed.1002907
Journal volume & issue
Vol. 16, no. 9
p. e1002907

Abstract

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BackgroundFew studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk.Methods and findingsWe assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. For each case, we randomly selected four controls from among contacts who did not develop TB disease, matching on gender and year of age. We also conducted a one-stage individual-participant data (IPD) meta-analysis searching PubMed and Embase to identify prospective studies of vitamin D and TB disease until June 8, 2019. We included studies that assessed vitamin D before TB diagnosis. In the primary analysis, we defined vitamin D deficiency as 25-(OH)D 75nmol/L. We estimated the association between baseline vitamin D status and incident TB using conditional logistic regression in the Lima cohort and generalized linear mixed models in the meta-analysis. We further defined severe vitamin D deficiency as 25-(OH)D ConclusionOur findings suggest vitamin D predicts TB disease risk in a dose-dependent manner and that the risk of TB disease is highest among HIV-positive individuals with severe vitamin D deficiency. Randomized control trials are needed to evaluate the possible role of vitamin D supplementation on reducing TB disease risk.