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Inverse relation between vitamin D and serum total immunoglobulin G in the Scandinavian Cystic Fibrosis Nutritional Study



The hallmark of cystic fibrosis (CF) is chronic lung inflammation. The severity of lung disease is closely correlated with immunoglobulin G (IgG) levels. Beyond its contribution to the bone health, the importance of vitamin D has not been fully recognized owing to the lack of human studies providing evidence of its benefit. In the context of the recently described immunomodulatory functions of vitamin D, we aimed to assess the relationship between vitamin D and IgG levels.


Eight hundred and ninety-six CF patients were included (0.53–65.9 years) from seven centers in Denmark, Norway and Sweden. Serum 25-hydroxyvitamin D (25OHD) and total IgG were measured, spirometry was carried out and vitamin D intake data were gathered using a 7-day dietary food record. Multiple linear regression analyses were performed for IgG and forced expiratory volume in 1λs (FEV1) as dependent variables, and serum 25OHD, daily food and supplemented vitamin D sources of intake as independent variables. The model was controlled for age, gender, genotype, CF-related diabetes, season, infection/colonization status, long-term oral corticosteroid treatment, long-term treatment with macrolide antibiotics, pancreatic insufficient phenotype and body mass index z-score.


Serum total IgG levels were negatively associated with serum 25OHD (adjusted R2=0.376; beta=−0.02; P<0.001), supplemented vitamin D intake per kg bodyweight (adjusted R2=0.375; beta=−0.82; P<0.001) and total vitamin D intake per kg bodyweight (adjusted R2=0.398; beta=−0.60; P=0.002). Serum 25OHD was positively associated with FEV1 (adjusted R2=0.308; beta=0.0007; P=0.025).


Increasing vitamin D intake may positively modulate inflammation in CF. This study supports the proposed role of vitamin D in the immune system during infection and substantiates prospective studies.

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We thank all the participating dietitians for their work with the food records, all the nurses for their practical input into the nutritional study, the CF patients in each center who have patiently participated in this study, Jan Kowalski for reviewing the statistical methods and Professor Åke Nilsson for valuable remarks on the final version of the manuscript. This work was supported by Swedish Heart Lung Foundation, Stiftelsen Frimurare-Barnhuset i Stockholm, Karolinska Institutet, Norwegian and Swedish Cystic Fibrosis Associations and by an unrestricted grant from Solvay Pharma, which has made the meetings of the SCFSC possible. Financial support was further provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and the Karolinska Institutet. The funding sources did not participate in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

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Correspondence to T Pincikova.

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Contributors: TP had full access to all of the data in the study and takes responsibility for the integrity of the data, the accuracy of the data analysis and final content of the paper. TP and LH had the main responsibility for the vitamin D study. The study was designed by TP and LH. TP developed the statistical model for data analysis, analyzed data, interpreted results and wrote the manuscript with the contribution of KN and LH. Patients were enrolled by all co-authors. FK was in charge of the IL-10 analyses. Food records were analyzed by KN and IEM. All authors critically read and commented on the manuscript. All authors read and approved the final manuscript. The Scandinavian CF Nutritional Study was designed by the Scandinavian CF Consortium, and LH being mainly responsible.

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Scandinavian Cystic Fibrosis Study Consortium

Oslo, Norway: Pål Leyell Finstad, Per Kristian Knudsen, Bjørn Skrede, Olav-Trond Storrøsten and Nils-Olav Hermansen.

Bergen, Norway: Gjermund Fluge and Birger N Lærum.

Gothenburg, Sweden: Anders Lindblad, Birgitta Strandvik and Marita Giljam.

Stockholm, Sweden: Lena Hjelte, Anne Geborek and Ferenc Karpati.

Lund, Sweden: Lena Mared and Peter Meyer.

Uppsala, Sweden: Mary Kämpe, Marie Johannesson and Annika Hollsing.

Aarhus, Denmark: Hanne Vebert Olesen and Oluf Schiøtz.

Copenhagen, Denmark: Tacjana Pressler, Bo Mölholm and Niels Høiby.

Scandinavian Cystic Fibrosis Dietitians

Oslo, Norway: Inger Elisabeth Moen and Torild Grønnerud.

Bergen, Norway: Henriette Santi.

Gothenburg, Sweden: Ellen Karlge-Nilsson.

Uppsala, Sweden: Jenny Stålhammmar.

Stockholm, Sweden: Kristina Nilsson, Anna Andersson and Anna Husing-Winkler.

Lund, Sweden: Mikael Nilsson.

Aarhus, Denmark: Anne Mørch Olesen.

Copenhagen, Denmark: Jane Sundstrup.

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Pincikova, T., Nilsson, K., Moen, I. et al. Inverse relation between vitamin D and serum total immunoglobulin G in the Scandinavian Cystic Fibrosis Nutritional Study. Eur J Clin Nutr 65, 102–109 (2011).

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  • cystic fibrosis
  • food
  • forced expiratory flow rates
  • immunity
  • immunoglobulin G
  • vitamin D

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