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Wimalawansa SJ. Infections and Autoimmunity-The Immune System and Vitamin D: A Systematic Review. Nutrients 2023; 15:3842. [PMID: 37686873 PMCID: PMC10490553 DOI: 10.3390/nu15173842] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Both 25-autoimmunity and(25(OH)D: calcifediol) and its active form, 1,25-dihydroxyvitamin D (1,25(OH)2D: calcitriol), play critical roles in protecting humans from invasive pathogens, reducing risks of autoimmunity, and maintaining health. Conversely, low 25(OH)D status increases susceptibility to infections and developing autoimmunity. This systematic review examines vitamin D's mechanisms and effects on enhancing innate and acquired immunity against microbes and preventing autoimmunity. The study evaluated the quality of evidence regarding biology, physiology, and aspects of human health on vitamin D related to infections and autoimmunity in peer-reviewed journal articles published in English. The search and analyses followed PRISMA guidelines. Data strongly suggested that maintaining serum 25(OH)D concentrations of more than 50 ng/mL is associated with significant risk reduction from viral and bacterial infections, sepsis, and autoimmunity. Most adequately powered, well-designed, randomized controlled trials with sufficient duration supported substantial benefits of vitamin D. Virtually all studies that failed to conclude benefits or were ambiguous had major study design errors. Treatment of vitamin D deficiency costs less than 0.01% of the cost of investigation of worsening comorbidities associated with hypovitaminosis D. Despite cost-benefits, the prevalence of vitamin D deficiency remains high worldwide. This was clear among those who died from COVID-19 in 2020/21-most had severe vitamin D deficiency. Yet, the lack of direction from health agencies and insurance companies on using vitamin D as an adjunct therapy is astonishing. Data confirmed that keeping an individual's serum 25(OH)D concentrations above 50 ng/mL (125 nmol/L) (and above 40 ng/mL in the population) reduces risks from community outbreaks, sepsis, and autoimmune disorders. Maintaining such concentrations in 97.5% of people is achievable through daily safe sun exposure (except in countries far from the equator during winter) or taking between 5000 and 8000 IU vitamin D supplements daily (average dose, for non-obese adults, ~70 to 90 IU/kg body weight). Those with gastrointestinal malabsorption, obesity, or on medications that increase the catabolism of vitamin D and a few other specific disorders require much higher intake. This systematic review evaluates non-classical actions of vitamin D, with particular emphasis on infection and autoimmunity related to the immune system.
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Affiliation(s)
- Sunil J Wimalawansa
- Medicine, Endocrinology & Nutrition, Cardiometabolic & Endocrine Institute, North Brunswick, NJ 08902, USA
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Chiappini E, Santamaria F, Marseglia GL, Marchisio P, Galli L, Cutrera R, de Martino M, Antonini S, Becherucci P, Biasci P, Bortone B, Bottero S, Caldarelli V, Cardinale F, Gattinara GC, Ciarcià M, Ciofi D, D'Elios S, Di Mauro G, Doria M, Indinnimeo L, Lo Vecchio A, Macrì F, Mattina R, Miniello VL, Del Giudice MM, Morbin G, Motisi MA, Novelli A, Palamara AT, Panatta ML, Pasinato A, Peroni D, Perruccio K, Piacentini G, Pifferi M, Pignataro L, Sitzia E, Tersigni C, Torretta S, Trambusti I, Trippella G, Valentini D, Valentini S, Varricchio A, Verga MC, Vicini C, Zecca M, Villani A. Prevention of recurrent respiratory infections : Inter-society Consensus. Ital J Pediatr 2021; 47:211. [PMID: 34696778 PMCID: PMC8543868 DOI: 10.1186/s13052-021-01150-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs.Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs.
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Affiliation(s)
- Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy.
| | - Francesca Santamaria
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia IRCCS San Matteo foundation, Pavia, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Renato Cutrera
- Respiratory Unit, Academic Pediatric Department, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy
| | - Maurizio de Martino
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Antonini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Paolo Becherucci
- Family Pediatrician, Local Health Unit, Lastra a Signa, Florence, Italy
| | - Paolo Biasci
- Family Pediatrician, Local Health Unit, Livorno, Italy
| | - Barbara Bortone
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | | | - Martina Ciarcià
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Daniele Ciofi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Mattia Doria
- Family Pediatrician, Local Health Unit, Chioggia, Venice, Italy
| | - Luciana Indinnimeo
- Pediatric Department "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Andrea Lo Vecchio
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Macrì
- Department of Pediatrics "Sapienza", University of Rome, Rome, Italy
| | - Roberto Mattina
- Department of Biomedical, Surgical, and Odontoiatric Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Guido Morbin
- Family Pediatrician, Local Health Unit, Trento, Italy
| | - Marco Antonio Motisi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Andrea Novelli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Anna Teresa Palamara
- Department of Public Health and Infectious Diseases, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Panatta
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Angela Pasinato
- Family Pediatrician, Local Health Unit, Torri di Quartesolo, Vicenza, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Massimo Pifferi
- Department of Pediatrics Pulmonology and Allergology Section University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Sitzia
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Chiara Tersigni
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Trambusti
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giulia Trippella
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Diletta Valentini
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sandro Valentini
- Family Pediatrician, Local Health Unit, Colle Val d'Elsa, Siena, Italy
| | | | - Maria Carmen Verga
- Family Pediatrician, Local Health Unit Salerno, Vietri sul Mare, Salerno, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Marco Zecca
- Pediatric Hematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Villani
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Pulvirenti G, Parisi GF, Manti S, Licari A, del Giudice MM, Salpietro C, Marseglia GL, Leonardi S. The Immunomodulatory Role of Vitamin D in Respiratory Diseases. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666191114144230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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The growing interest in the new role of vitamin D, particularly as an immunomodulatory
factor, has spurred basic research and the development of clinical trials to better understand the
influence of supplementation on various diseases. Vitamin D is an important nutrient factor in human
health due to its role in calcium metabolism regulation, cellular growth, differentiation and its
fundamental discovered activity in immune functions. It has influenced different diseases,
particularly inflammatory and autoimmune diseases, through immune response regulation,
modulating innate and adaptive immunity.
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The aim of this review was to explore the role of vitamin D in the main respiratory diseases in
children such as asthma, chronic rhinosinusitis, cystic fibrosis and recurrent respiratory infections.
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Affiliation(s)
- Giulio Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sara Manti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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