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Epidemiology

Association of vitamin D with respiratory outcomes in Canadian children

Abstract

Background/objectives:

Vitamin D modifies airway inflammation and appears to be important in building immunity against respiratory infections, and so is potentially beneficial in asthma. However, to date results from studies investigating the relationship of vitamin D with respiratory outcomes are inconsistent. The objective of this study was to determine the association of vitamin D with current wheeze, ever asthma and lung function.

Subjects/Methods:

Data on 1213 children aged 6–12 years, from the Canadian Health Measures Survey, were considered for the study. Serum 25-hydroxy vitamin D (25(OH)D) levels were categorized into three categories: 49 nmol/l (low); 50–74 nmol/l (moderate); and 75 nmol/l (high).

Results:

Children in the low and high 25(OH)D categories were more likely to report current wheeze in comparison to those in the moderate category (odds ratio (OR): 3.26, 95% confidence interval (CI): 1.16–9.17 and OR: 2.14, 95% CI: 1.07–4.28, respectively). The results for the association between 25(OH)D levels and ever asthma were similar to those observed for current wheeze, except that a significant association was observed only in the lower category. The rate of increase in forced expiratory volume in one second and forced vital capacity with age was greater in the moderate category.

Conclusions:

Children in both low and high 25(OH)D categories had increased risk of current wheeze and reduced rate of change in lung function with age in comparison to the moderate category, raising the possibility of a U-shaped association between vitamin D levels and respiratory health. Clearer guidelines for optimal vitamin D levels are required to improve respiratory health in children.

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References

  1. WHO. Asthma Fact sheet N307. World Health Organization: Geneva, 2011. Available at www.who.int/mediacentre/factsheets/fs307/en/index.html (accessed 16 October 2013).

  2. Litonjua AA . Fat-soluble vitamins and atopic disease: what is the evidence? Proc Nutr Soc 2012; 71: 67–74.

    Article  CAS  Google Scholar 

  3. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733–743.

    Article  Google Scholar 

  4. Gergen PJ, Weiss KB . The increasing problem of asthma in the United States. Am Rev Respir Dis 1992; 146: 823–824.

    Article  CAS  Google Scholar 

  5. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998; 12, 315–335.

  6. Kay AB . Allergy and allergic diseases. First of two parts. N Engl J Med 2001; 344: 30–37.

    Article  CAS  Google Scholar 

  7. Maziak W . The asthma epidemic and our artificial habitats. BMC Pulm Med 2005; 5: 5.

    Article  Google Scholar 

  8. Bäck O, Blomquist HK, Hernell O, Stenberg B . Does vitamin D intake during infancy promote the development of atopic allergy? Acta Derm Venereol 2009; 89: 28–32.

    Article  Google Scholar 

  9. Torres-Borrego J, Moreno-Solís G, Molina-Terán AB . Diet for the prevention of asthma and allergies in early childhood: much ado about something? Allergol Immunopathol 2012; 4: 244–252.

    Article  Google Scholar 

  10. Hewison M . Vitamin D and the immune system: new perspectives on an old theme. Rheum Dis Clin North Am 2012; 381: 125–139.

    Article  Google Scholar 

  11. Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311: 1770–1773.

    Article  CAS  Google Scholar 

  12. Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med 2009; 179: 765–771.

    Article  CAS  Google Scholar 

  13. van Oeffelen AA, Bekkers MB, Smit HA, Kerkhof M, Koppelman GH, Haveman-Nies A et al. Serum micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol 2011; 22: 784–793.

    Article  CAS  Google Scholar 

  14. Bener A, Ehlayel MS, Tulic MK, Hamid Q . Vitamin D deficiency as a strong predictor of asthma in children. Int Arch Allergy Immunol 2012; 157: 168–175.

    Article  CAS  Google Scholar 

  15. Milner JD, Stein DM, McCarter R, Moon RY . Early infant multivitamin supplementation is associated with increased risk for food allergy and asthma. Pediatrics 2004; 114: 27–32.

    Article  Google Scholar 

  16. Rothers J, Wright AL, Stern DA, Halonen M, Camargo CA Jr . Cord blood 25-hydroxyvitamin D levels are associated with aeroallergen sensitization in children from Tucson, Arizona. J Allergy Clin Immunol 2011; 128: 1093–1099.

    Article  CAS  Google Scholar 

  17. Oren E, Banerji A, Camargo CA Jr . Vitamin D and atopic disorders in an obese population screened for vitamin D deficiency. J Allergy Clin Immunol 2008; 121: 533–534.

    Article  CAS  Google Scholar 

  18. Lewis E, Fernandez C, Nella A, Hopp R, Gallagher JC, Casale TB . Relationship of 25-hydroxyvitamin D and asthma control in children. Ann Allergy Asthma Immunol 2012; 108: 281–282.

    Article  Google Scholar 

  19. Erkkola M, Kaila M, Nwaru BI, Kronberg-Kippilä C, Ahonen S, Nevalainen J et al. Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children. Clin Exp Allergy 2009; 39: 875–882.

    Article  CAS  Google Scholar 

  20. Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S et al. Maternal vitamin D intake during pregnancy and early childhood wheezing. Am J Clin Nutr 2007; 85: 853–859.

    Article  CAS  Google Scholar 

  21. Gale CR, Robinson SM, Harvey N, Javaid MK, Jiang B, Martyn CN et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008; 62: 68–77.

    Article  CAS  Google Scholar 

  22. Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, Rich-Edwards JW, Weiss ST, Gold DR et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr 2007; 85: 788–795.

    Article  CAS  Google Scholar 

  23. Pike KC, Inskip HM, Robinson S, Lucas JS, Cooper C, Harvey NC et al. Maternal late-pregnancy serum 25-hydroxyvitamin D in relation to childhood wheeze and atopic outcomes. Thorax 2012; 67: 950–956.

    Article  Google Scholar 

  24. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011; 96: 53–58.

    Article  CAS  Google Scholar 

  25. IOM (Institute of Medicine). Dietary Reference Intakes for Calcium and Vitamin D. The National Academies Press: Washington, DC, 2011.

  26. Tremblay M, Wolfson M, Gorber SC . Canadian Health Measures Survey: rationale, background and overview. Health Rep 2007; 18 (Suppl): 7–20.

    PubMed  Google Scholar 

  27. Statistics Canada. Canadian Health Measures Survey (CHMS) Data User Guide: Cycle 1. Statistics Canada: Ottawa (ON), 2011. www23.statcan.gc.ca/imdb-bmdi/pub/document/5071_D2_T1_V1-eng.htm (accessed 4 November 2013).

  28. Bryan S, St-Denis M, Wojtas D . Canadian Health Measures Survey: clinic operations and logistics. Health Rep 2007; 18 (Suppl): 53–70.

    PubMed  Google Scholar 

  29. Wood SN . Generalized Additive Models: An Introduction With R. Chapman & Hall/CRC: New York, NY, 2006.

    Book  Google Scholar 

  30. Harrington LE, Mangan PR, Weaver CT . Expanding the effector CD4 T-cell repertoire: the Th17 lineage. Curr Opin Immunol 2006; 18: 349–356.

    Article  CAS  Google Scholar 

  31. Daniel C, Sartory NA, Zahn N, Radeke HH, Stein JM . Immune modulatory treatment of TNBS colitis with calcitriol is associated with a change of a Th1/Th17 to a Th2 and regulatory T cell profile. J Pharmacol Exp Ther 2008; 324: 23–33.

    Article  CAS  Google Scholar 

  32. Holtzman MJ . Asthma as a chronic disease of the innate and adaptive immune systems responding to viruses and allergens. J Clin Invest 2012; 122: 2741–2748.

    Article  CAS  Google Scholar 

  33. Morales E, Romieu I, Guerra S, Ballester F, Rebagliato M, Vioque J et al. INMAProject. Maternal vitamin D status in pregnancy and risk of lower respiratory tract infections, wheezing, and asthma in offspring. Epidemiology 2012; 23: 64–71.

    Article  Google Scholar 

  34. Alyasin S, Momen T, Kashef S, Alipour A, Amin R . The relationship between serum 25 hydroxy vitamin D levels and asthma in children. Allergy Asthma Immunol Res 2011; 3: 251–255.

    Article  CAS  Google Scholar 

  35. Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A et al. Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma. Am J Respir Crit Care Med 2011; 184: 1342–1349.

    Article  CAS  Google Scholar 

  36. Camargo CA Jr, Ingham T, Wickens K, Thadhani R, Silvers KM, Epton MJ et al. New Zealand Asthma and Allergy Cohort Study Group. Cord-blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma. Pediatrics 2011; 127: e180–e187.

    Article  Google Scholar 

  37. Searing DA, Leung DY . Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol Allergy Clin North Am 2010; 30: 397–409.

    Article  Google Scholar 

  38. Matheu V, Bäck O, Mondoc E, Issazadeh-Navikas S . Dual effects of vitaminD-induced alteration of TH1/TH2 cytokine expression: enhancing IgE production and decreasing airway eosinophilia in murine allergic airway disease. J Allergy Clin Immunol 2003; 112: 585–592.

    Article  CAS  Google Scholar 

  39. Radlović N, Mladenović M, Simić D, Radlović P . Vitamin D in the light of current knowledge. Srp Arh Celok Lek 2012; 140: 110–114.

    Article  Google Scholar 

  40. Lips P . Interaction between vitamin D and calcium. Scand J Clin Lab Invest Suppl 2012; 243: 60–64.

    PubMed  Google Scholar 

  41. Bouillon R . Why modest but widespread improvement of the vitamin D status is the best strategy? Best Pract Res Clin Endocrinol Metab 2011; 25: 693–702.

    Article  CAS  Google Scholar 

  42. Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007; 158: 1–235.

    Google Scholar 

  43. Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S . Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Rep 2010; 21: 47–55.

    PubMed  Google Scholar 

  44. Infinite Gravity. Canadian City and Town Geographic Coordinates. Infinite Gravity: Maple Ridge (BC), 2004. Available at www.infinitegravity.ca/mapdata/canada.asp (accessed 16 October 2013).

  45. Climate & Temperature: Canada, 2012. climatemps.com. Available at http://www.climatetemp.info/canada/ (accessed 16 October 2013).

  46. Webb AR, Kline L, Holick MF . Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988; 67: 373–378.

    Article  CAS  Google Scholar 

  47. Brehm JM, Acosta-Pérez E, Klei L, Roeder K, Barmada M, Boutaoui N et al. Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children. Am J Respir Crit Care Med 2012; 186: 140–146.

    Article  CAS  Google Scholar 

  48. Searing DA, Zhang Y, Murphy JR, Hauk PJ, Goleva E, Leung DY . Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. J Allergy Clin Immunol 2010; 125: 995–1000.

    Article  CAS  Google Scholar 

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Acknowledgements

The research and analysis are based on the data from Statistics Canada and opinions expressed herein do not represent the views of Statistics Canada.

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Correspondence to A Senthilselvan.

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Niruban, S., Alagiakrishnan, K., Beach, J. et al. Association of vitamin D with respiratory outcomes in Canadian children. Eur J Clin Nutr 68, 1334–1340 (2014). https://doi.org/10.1038/ejcn.2014.121

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