Health for life

Treating infection-prone patients over a 12-month period with high doses of vitamin D reduces their risk of developing respiratory tract infection – and consequently their antibiotic requirement. This according to a new study by researchers at Karolinska Institutet and Karolinska University Hospital published in the online scientific journal BMJ Open.

"Our research can have important implications for patients with recurrent infections or a compromised immune defence, such as a lack of antibodies, and can also help to prevent the emerging resistance to antibiotics that come from overuse," says Peter Bergman, researcher at Karolinska Institutets Department of Laboratory Medicine and doctor at Karolinska University Hospitals Immunodeficiency Unit. "On the other hand, there doesnt seem to be anything to support the idea that vitamin D would help otherwise healthy people with normal, temporary respiratory tract infections."

Vitamin D is synthesised in the skin through exposure to sunlight and obtained through certain foods. In Sweden there is a seasonal variation in vitamin D in the blood, the trough coming during the darker half of the year. Studies have shown that low levels of vitamin D can increase the risk of infection, and it has long been known that the vitamin can also activate the immune defence.

For the present study now published in BMJ Open the researchers examined whether treatment with vitamin D can prevent and relieve respiratory tract infections in particularly infection-prone patients. All the 140 participants from the Immunodeficiency Unit had symptoms of disease in their respiratory tracts for at least 42 days prior to the study. The patients were randomly divided into two groups, one of which received vitamin D in relatively high doses, the other a placebo. They were also asked to keep a diary recording their state of health every day during the year-long study period.

The results show that symptoms of respiratory tract infection declined by almost a quarter and the use of antibiotics by almost half. Vitamin D treatment was also tolerated well by all patients and gave no serious side-effects.

The effect of vitamin D on respiratory tract infection is controversial, and a major study from New Zeeland published recently in the scientific journal JAMA found that it did not reduce the incidence or severity of viral respiratory tract infections. However, the present study differs from the JAMA study in several important respects, which could explain their different results. The JAMA study examined a group of healthy people with initially normal levels of vitamin D in the blood, and used bolus dose administration (i.e. large doses on fewer occasions), which is thought to be less effective that daily doses.

"However, the most important difference is probably due to the fact that our participants had much lower initial levels of vitamin D than those in the New Zealand study," says Dr Anna-Carin Norlin, doctoral student and co-lead author of the study along with Dr Bergman. "There is evidence from previous studies that vitamin D supplements are only effective in patients who fall well below the recommended level, which also suggests that it would be wise to check the vitamin D levels of patients with recurrent infections."

Publication: Vitamin D3 supplementation in patients with frequent respiratory tract infections - a randomized and double blind intervention study, Bergman P*, Norlin AC*, Hansen S, Rekha RS, Agerberth B, Björkhem-Bergman L, Ekström L, Lindh JD, Andersson J (*equal contribution), BMJ Open, online 13 December 2012.

Infections are difficult to manage for a healthy person, let alone someone with diabetes. Illness can cause blood glucose levels to rise and makes managing those levels even more challenging.

Now a study set to appear in the August 1 issue of Clinical Infectious Diseases adds to the reservoir of clinical data supporting the notion that people with diabetes get sick more often than people without the disease.

The study found that people with either type 1 or type 2 diabetes had a greater risk for infection (specifically of the respiratory tract, urinary tract, and skin and mucous membranes) than people without diabetes.

The lead author of the study, Leonie Muller, advises physicians to "be aware of the fact that diabetes patients have an increased risk of common infections." She recommends that people with diabetes take preventative measures such as getting the flu vaccine, drinking plenty of fluids, and not hesitating to contact a physician at the earliest sign of an infection.

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For a summary of the study:
Study Shows Increased Risk of Common Infections in Diabetic Patients

For the study itself (abstract only, subscription required for full article):
Increased Risk of Common Infections in Patients with Type 1 and Type 2 Diabetes Mellitus