维生素 D 补充剂预防老年人急性呼吸道感染：系统评价和荟萃分析。

Vitamin D supplementation for prevention of acute respiratory infections in older adults: A systematic review and meta-analysis.

机构信息

Drug Clinical Trial Institution, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China.

Department of Education and Science, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China.

出版信息

PLoS One. 2024 May 24;19(5):e0303495. doi: 10.1371/journal.pone.0303495. eCollection 2024.

DOI:10.1371/journal.pone.0303495

PMID:38787821

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11125479/

Abstract

BACKGROUND

Acute respiratory infections (ARIs) have a substantial impact on morbidity, healthcare utilization, and functional decline among older adults. Therefore, we systematically reviewed evidence from randomized controlled trials (RCTs) to evaluate the efficacy and safety of vitamin D supplementation in preventing ARIs in older adults.

METHODS

PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched until 1 February 2024. RCTs evaluating the use of vitamin D supplements to protect older adults from ARIs were included. Two reviewers independently screened papers, extracted the data and assessed the risk of bias. Data were summarised as relative risks (RRs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Random effects meta-analyses were used to synthesise the results. GRADE was used to evaluate the quality of evidence. All the analysis were performed with Stata version 17.

RESULTS

Twelve trials (41552 participants) were included in the meta-analysis. It showed that vitamin D supplementation probably does not reduce the incidence of ARIs (RR, 0.99; 95% CI, 0.97-1.02, I2 = 0%; moderate certainty). No significant effect of vitamin D supplementation on the risk of ARI was observed for any of the subgroups defined by baseline 25(OH)D concentration, control treatments, dose frequency, study duration, and participants' condition. However, there was a possibility, although not statistically significant, that vitamin D may reduce the risk of ARI in patients with a baseline 25(OH)D concentration <50 nmol/L (OR, 0.90; 95% CI, 0.79-1.04, I2 = 14.7%). Additionally, vitamin D supplements might result in little to no difference in death due to any cause, any adverse event, hypercalcinemia, and kidney stones.

CONCLUSIONS

Vitamin D supplementation among older adults probably results in little to no difference in the incidence of ARIs. However, further evidence is needed, particularly for individuals with vitamin D deficiency and populations residing in low and middle income countries.

TRIAL REGISTRATION

This study was registered on PROSPERO (CRD42023451265).

摘要

背景

急性呼吸道感染（ARI）会对老年人的发病率、医疗保健利用和功能下降产生重大影响。因此，我们系统地回顾了随机对照试验（RCT）的证据，以评估维生素 D 补充剂预防老年人 ARI 的疗效和安全性。

方法

检索了 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov，检索截至 2024 年 2 月 1 日。纳入了评估维生素 D 补充剂用于保护老年人免受 ARI 的 RCT。两位评审员独立筛选文献、提取数据并评估偏倚风险。数据以相对风险（RR）或比值比（OR）及其相应的 95%置信区间（CI）进行总结。使用随机效应荟萃分析综合结果。使用 GRADE 评估证据质量。所有分析均使用 Stata 版本 17 进行。

结果

纳入了 12 项试验（41552 名参与者）进行荟萃分析。结果表明，维生素 D 补充剂可能不会降低 ARI 的发生率（RR，0.99；95%CI，0.97-1.02，I2 = 0%；中等确定性）。根据基线 25（OH）D 浓度、对照治疗、剂量频率、研究持续时间和参与者状况定义的任何亚组，维生素 D 补充对 ARI 风险均无显著影响。然而，虽然没有统计学意义，但维生素 D 可能会降低基线 25（OH）D 浓度<50 nmol/L 的患者发生 ARI 的风险（OR，0.90；95%CI，0.79-1.04，I2 = 14.7%）。此外，维生素 D 补充剂可能不会对任何原因导致的死亡、任何不良事件、高钙血症和肾结石的发生率产生影响。