Vitamin and micronutrient intake and the risk of community-acquired pneumonia in US women

Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study

Community-acquired pneumonia (CAP) is a common respiratory disease in children. This prospective cohort study of 110 children with CAP and 100 healthy children investigated the relationship between the levels of vitamin A, D and E and inflammatory markers, such as tumour necrosis factor (TNF-a), interleukin-1 (IL-1), interleukin-10 (IL-10), neutrophils (NE) and C-reactive protein (CRP), in CAP. The haemoglobin, leukocyte concentration, NE, monocytes and CRP concentration in the CAP group showed significant differences (P < 0.05). The levels of vitamin A, D and E in the CAP group were lower than those in the control group, while the levels of TNF-a and IL-1 were higher than in the control group; the differences were statistically significant (P < 0.05). The IL-10 levels showed no significant differences (P > 0.05). Pearson analysis revealed that the vitamin A, D and E levels were all correlated with the TNF-a, IL-10 and CRP levels (P < 0.05). The vitamin A, D and E levels of the CAP children were lower than those of the healthy children. Thus, the content of fat-soluble vitamins is correlated with the secretion of TNF-a and IL-10. The research provides a new direction for the prevention, diagnosis and treatment of CAP.

The levels of vitamins and cytokines in serum of elderly patients with community-acquired pneumonia: A case-control study

Background and Aims

The community acquired pneumonia (CAP) is a common disease with high incidence rate and mortality among the elderly. This study aims to explore the association between vitamins, cytokines, and CAP infected by different pathogens in Handan First Hospital.

Methods

The subjects of this study were elderly patients with community-acquired pneumonia in Handan First Hospital and healthy elderly people in the community from February 2018 to December 2019. The study include 234 CAP patients and 180 healthy elderly people. The differences between the healthy and CAP groups were analyzed by blood routine test, urine routine test, Liquid chromatography tandem mass spectrometry (LC-MS/MS) detection of vitamin level, and Enzyme linked immunosorbent assay (ELISA) detection of cytokine level. Sputum culture was used to detect pathogens.

Results

According to our results, there was no significant difference in the contents of vitamin A, vitamin D, vitamin E, and vitamin C in serum between the healthy and CAP elderly. However, compared with the control group, the levels of serum cytokines of IL-2, IL-17, and TGF-β in the CAP patients were significantly increased. In addition, IL-17 was positively correlated with white blood cells, neutrophils, platelet/lymphocyte ratio and neutrophil/lymphocyte ratio of CAP patients, and negatively correlated with lymphocytes. The four pathogens with the highest positive rates were Streptococcus pneumoniae, Klebsiella pneumoniae, Mycoplasma pneumoniae and H. influenza. In patients with S. pneumoniae infection, the IL-2, IL-17, and TGF-β levels were significantly higher than the levels in the control group; IL-17 was also significantly increased in the serum of patients infected with M. pneumoniae, K. pneumoniae, and H. influenza.

Conclusions

There is no direct association between vitamins in serum and community acquired pneumonia (CAP). However, the cytokines are closely related to the clinical indicators and pathogens of CAP patients, which can provide references for the diagnosis, prognosis and treatment of CAP patients.

Vitamin D intake and all-cause and cause-specific mortality in Japanese men and women: the Japan Public Health Center-based prospective study

While higher circulating 25-hydroxyvitamin D concentrations have been reported to be associated with decreased risk of all-cause mortality, evidence on dietary vitamin D intake is limited and inconsistent. We investigated whether vitamin D intake is associated with all-cause and cause-specific mortality among Japanese adults. Participants were 42,992 men and 50,693 women who responded to the second survey of the Japan Public Health Center-based Prospective Study (1995-1998) and who were followed up for mortality through 2018. Dietary intake was ascertained using a validated food frequency questionnaire. Hazard ratios of deaths from the second survey to December 2018 were estimated using Cox proportional hazard regression analysis. During follow-up, we identified 22,630 deaths. Overall, the third and fourth quintiles, but not the highest quintile, of vitamin D intake were each associated with a significantly lower risk of all-cause mortality. In subgroups characterized by low sunlight exposure, risk of all-cause mortality decreased linearly with increasing vitamin D intake. The multivariable-adjusted hazard ratios (95% confidence intervals) of all-cause mortality for the highest versus lowest quintile of vitamin D intake were 0.87 (0.79-0.95) in women and 0.88 (0.79-0.97) in residents of higher latitude areas. Lower risk was also observed for all-cause mortality in participants with hypertension and for heart disease mortality in those with higher calcium intake. Higher vitamin D intake was associated with decreased risk of ischemic stroke and pneumonia mortality. Higher dietary vitamin D was associated with a lower risk of mortality among individuals with low sunlight exposure or hypertension. Individuals with potentially low vitamin D may benefit from increasing dietary vitamin D intake for the prevention of premature death.

Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis

Background

Preventing respiratory tract infections (RTIs) could have profound effects on quality of life, primary care workload, antibiotic prescribing and stewardship. We aimed to identify factors that increase and decrease RTI acquisition within Organisation for Economic Cooperation and Development (OECD) member countries.

Methods

Systematic search of Medline, Embase, Cochrane and ISI Web of Knowledge for studies conducted up to July 2020 reporting predisposing factors for community RTI acquisition. Pooled odds ratios were calculated using a random-effects model.

Results

23 studies investigated risk factors associated with community-acquired pneumonia (n = 15); any RTI (n = 4); influenza like illness (n = 2); and lower RTI (n = 2). Demographic, lifestyle and social factors were: underweight BMI (pooled odds ratio (OR_p 2.14, 95% CI 1.58 to 2.70, p = 0.97); male sex (OR_p 1.30, 95% CI 1.27 to 1.33, p = 0.66); contact with pets (OR_p 1.35, 95% CI 1.16 to 1.54, p = 0.72); contact with children (OR_p 1.35, 95% CI 1.15 to 1.56, p = 0.05); and ex-smoking status (OR_p 1.57, 95% CI 1.26 to 1.88, p = 0.76). Health-related factors were: chronic liver condition (OR_p 1.30, 95% CI 1.09 to 1.50, p = 0.34); chronic renal condition (OR_p 1.47, 95% CI 1.09 to 1.85, p = 0.14); and any hospitalisation in previous five years (OR_p 1.64, 95% CI 1.46 to 1.82, p = 0.66).

Conclusions

We identified several modifiable risk factors associated with increased likelihood of acquiring RTIs in the community, including low BMI, contact with children and pets. Modification of risk factors and increased awareness of vulnerable groups could reduce morbidity, mortality and antibiotic use associated with RTIs.

PROSPERO registration

CRD42019134176.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06954-3.

Comment on "Therapeutic target and molecular mechanism of vitamin C-treated pneumonia: a systematic study of network pharmacology" by R. Li, C. Guo, Y. Li, X. Liang, L. Yang and W. Huang, Food Funct., 2020, , 4765

This Comment raises concerns about the article "Therapeutic target and molecular mechanism of vitamin C-treated pneumonia: a systematic study of network pharmacology".

Association of Vitamin D Status with the Severity and Mortality of Community-Acquired Pneumonia in Iran during 2016-2017: A Prospective Cohort Study

BACKGROUND

Community-acquired pneumonia (CAP) is a common disease considered as a major public health problem. It causes considerable morbidity and mortality despite antibiotic treatments. Hospital admission of CAP patients is a significant financial burden and many efforts are ongoing to decrease hospital stay durations. Vitamin D deficiency is associated with increased risk of respiratory infections. This study was designed to determine the association of vitamin D status with hospitalized CAP patient mortality and disease severity.

METHODS

This prospective cohort study examined 180 CAP patients admitted to a teaching Hospital in Tehran, Iran during 2016-2017. Their demographic and anthropometric characteristics were recorded. The disease severity was evaluated based on CURB-65. Vitamin D status was determined by measuring by serum 25-hydroxylated vitamin D (25(OH)D) with ELISA. The patients were followed for 30 days to evaluate their vitality.

RESULTS

One hundred and eighty pneumonia patients, including 104 males and 84 females, were recruited from respiratory disease, infectious disease, emergency, and ICU wards. Nearly 18% of the patients were current smokers. The CAP severity, evaluated by CURB-65, was determined to be non-severe in 74.4% of the patients. Patients were classified as vitamin D sufficient, insufficient, or deficient. Thirty percent of the patients were vitamin D sufficient, 18% were insufficient, and 52% were deficient. Thirty-day mortality was 40% (72 cases). Mortality was greater in males than in females (47.1% vs. 30.3%, p=0.03). The disease was significantly less severe in the patients who survived than in those who did not. The vitamin D status differed between males and females (p=0.027). The vitamin D status was lower in the more severe cases than in the less (p=0.036), and vitamin D deficiency was more prevalent in patients who died than in those who lived. Vitamin D concentration was negatively correlated with hospital stay duration. The 25(OH)D concentration was significantly greater in patients who survived than in those who did not (p<0.001).

CONCLUSION

Pneumonia severity and mortality risk were greater and hospital stays longer in vitamin D-deficient patients than in those with higher vitamin D status.

Observational longitudinal study of symptom burden and time for recovery from community-acquired pneumonia reported by older adults surveyed nationwide using the CAP Burden of Illness Questionnaire

BACKGROUND

Millions of older adults who develop community-acquired pneumonia (CAP) each year survive, but there is a large knowledge gap on the burden of CAP and the recovery process in survivors from the patient perspective.

METHODS

The newly developed CAP Burden of Illness Questionnaire was administered through a Web survey to a nationwide sample of US adults aged ≥50 years who were recently diagnosed with CAP. Survey respondents with unresolved symptoms or other CAP-related health problems completed a second survey 30 days later; a third survey was completed another 30 days later by respondents with unresolved symptoms or problems. Nationally representative results describing the average time to recovery of symptoms and other CAP-related problems were achieved using post-stratification weights.

RESULTS

Five hundred participants completed the initial survey. The time to resolution for the CAP symptoms of weakness, shortness of breath, and tiredness exceeded 3 weeks on average. There was an average of 13 days of absenteeism, and 3 weeks (mean =21 days) before achieving full work/activity productivity after CAP. For participants with health conditions that worsened from pneumonia, chronic emphysema and chronic obstructive pulmonary disease took the longest to return to baseline (mean =60 and 52.4 days, respectively).

CONCLUSION

The results from this study demonstrate that older adults surviving a CAP episode experience a significant multi-symptom illness with long recovery periods to achieve pre-CAP health and productivity. These findings highlight the need for further research on effective clinician-patient communication, the need for patient-centered outcomes in clinical trials for CAP therapeutics, adequate home care during the recovery process, and the pursuit of CAP prevention strategies.

Effects of dietary vitamin A content on antibody responses of feedlot calves inoculated intramuscularly with an inactivated bovine coronavirus vaccine

OBJECTIVE

To investigate effects of low dietary vitamin A content on antibody responses in feedlot calves inoculated with an inactivated bovine coronavirus (BCoV) vaccine.

ANIMALS

40 feedlot calves.

PROCEDURES

Calves were fed diets containing high (3,300 U/kg) or low (1,100 U/kg) amounts of vitamin A beginning on the day of arrival at a feedlot (day 0) and continuing daily until the end of the study (day 140). Serum retinol concentrations were evaluated in blood samples obtained throughout the study. Calves were inoculated IM with an inactivated BCoV vaccine on days 112 and 126. Blood samples obtained on days 112 and 140 were used for assessment of BCoV-specific serum IgG1, IgG2, IgM, and IgA titers via an ELISA.

RESULTS

The low vitamin A diet reduced serum retinol concentrations between days 112 and 140. After the BCoV inoculation and booster injections, predominantly serum IgG1 antibodies were induced in calves fed the high vitamin A diet; however, IgG1 titers were compromised at day 140 in calves fed the low vitamin A diet. Other isotype antibodies specific for BCoV were not affected by the low vitamin A diet.

CONCLUSIONS AND CLINICAL RELEVANCE

Dietary vitamin A restriction increases marbling in feedlot cattle; however, its effect on antibody responses to vaccines is unknown. A low vitamin A diet compromised the serum IgG1 responses against inactivated BCoV vaccine, which suggested suppressed T-helper 2-associated antibody (IgG1) responses. Thus, low vitamin A diets may compromise the effectiveness of viral vaccines and render calves more susceptible to infectious disease.

A prospective study of sleep duration and pneumonia risk in women

STUDY OBJECTIVE

Experimental data suggest sleep deprivation may impair host immunity. We sought to assess the effect of poor sleep on pneumonia risk.

DESIGN

Prospective, observational cohort study.

PARTICIPANTS

56,953 female nurses (ages 37 to 57 years old) participating in the Nurses' Health Study II cohort free of cancer, cardiovascular disease, diabetes, and asthma with no prior history of pneumonia.

MEASUREMENTS AND RESULTS

At baseline, participants reported their average sleep duration and whether this quantity was adequate for them. Questionnaires ascertaining a new pneumonia diagnosis were mailed every 2 years. Cases required physician diagnosis and chest radiograph confirmation. Cox proportional hazards models were used to assess the relative risk for incident pneumonia over 4 years. Over 217,500 person-years, 977 cases of pneumonia were identified. Relative to 8-h sleepers, both short and long sleep durations were associated with elevated pneumonia risk. The age-adjusted relative risk for pneumonia was 1.70 (95% CI 1.30-2.23) in those sleeping ≤ 5 h and 1.49 (95% CI 1.12-1.98) in those sleeping ≥ 9 h. After adjusting for potential confounders, the relative risks were 1.39 (95% CI: 1.06-1.82) in those sleeping ≤ 5 h and 1.38 (95% CI 1.04-1.84) in those sleeping ≥ 9 h. Perceived inadequate sleep was also associated with pneumonia with a relative risk of 1.50 (95% CI 1.29-1.74) in multivariate models.

CONCLUSIONS

Both reduced and prolonged habitual sleep durations are associated with increased risk of pneumonia. Further research is needed to understand how sleep habits can influence immunity.

Ingestion of micronutrient fortified breakfast cereal has no influence on immune function in healthy children: a randomized controlled trial

BACKGROUND

This study investigated the influence of 2-months ingestion of an "immune" nutrient fortified breakfast cereal on immune function and upper respiratory tract infection (URTI) in healthy children during the winter season.

METHODS

Subjects included 73 children (N=42 males, N=31 females) ranging in age from 7 to 13 years (mean±SD age, 9.9±1.7 years), and 65 completed all phases of the study. Subjects were randomized to one of three groups--low, moderate, or high fortification--with breakfast cereals administered in double blinded fashion. The "medium" fortified cereal contained B-complex vitamins, vitamins A and C, iron, zinc, and calcium, with the addition of vitamin E and higher amounts of vitamins A and C, and zinc in the "high" group. Immune measures included delayed-typed hypersensitivity, global IgG antibody response over four weeks to pneumococcal vaccination, salivary IgA concentration, natural killer cell activity, and granulocyte phagocytosis and oxidative burst activity. Subjects under parental supervision filled in a daily log using URTI symptoms codes.

RESULTS

Subjects ingested 3337±851 g cereal during the 2-month study, which represented 14% of total diet energy intake and 20-85% of selected vitamins and minerals. Despite significant increases in nutrient intake, URTI rates and pre- to- post-study changes in all immune function measures did not differ between groups.

CONCLUSIONS

Data from this study indicate that ingestion of breakfast cereal fortified with a micronutrient blend for two winter months by healthy, growing children does not significantly influence biomarkers for immune function or URTI rates.

IL-2 and IL-10 gene polymorphisms are associated with respiratory tract infection and may modulate the effect of vitamin E on lower respiratory tract infections in elderly nursing home residents

BACKGROUND

Vitamin E supplementation may be a potential strategy to prevent respiratory tract infections (RIs) in the elderly. The efficacy of vitamin E supplementation may depend on individual factors including specific single nucleotide polymorphisms (SNPs) at immunoregulatory genes.

OBJECTIVE

We examined whether the effect of vitamin E on RIs in the elderly was dependent on genetic backgrounds as indicated by SNPs at cytokine genes.

DESIGN

We used data and DNA from a previous vitamin E intervention study (200 IU vitamin E or a placebo daily for 1 y) in elderly nursing home residents to examine vitamin E-gene interactions for incidence of RI. We determined the genotypes of common SNPs at IL-1beta, IL-2, IL-6, IL-10, TNF-alpha, and IFN-gamma in 500 participants. We used negative binomial regression to analyze the association between genotype and incidence of infection.

RESULTS

The effect of vitamin E on lower RI depended on sex and the SNP at IL-10 -819G-->A (P = 0.03 for interaction for lower RI). Furthermore, we observed that subjects with the least prevalent genotypes at IL-2 -330A-->C (P = 0.02 for upper RI), IL-10 -819G-->A (P = 0.08 for upper RI), and IL-10 -1082C-->T (P < 0.001 for lower RI in men) had a lower incidence of RI independent of vitamin E supplementation.

CONCLUSIONS

Studies that evaluate the effect of vitamin E on RIs should consider both genetic factors and sex because our results suggest that both may have a significant bearing on the efficacy of vitamin E. Furthermore, common SNPs at cytokine genes may contribute to the individual risk of RIs in the elderly. This trial was registered at clinicaltrials.gov as NCT00758914.

Environmental risk factors for community-acquired pneumonia hospitalization in older adults

OBJECTIVES

To investigate the risk of hospitalization for pneumonia in older adults in relation to biophysical environmental factors.

DESIGN

Population-based case control study with collection of personal interview data.

SETTING

Hamilton, Ontario, and Edmonton, Alberta, Canada.

PARTICIPANTS

Seven hundred seventeen people aged 65 and older hospitalized for community-acquired pneumonia (CAP) from September 2002 to April 2005 and 867 controls aged 65 and older randomly selected from the same communities as the cases.

MEASUREMENTS

Odds ratios (ORs) for risk of pneumonia in relation to environmental and other variables.

RESULTS

Exposure to secondhand smoke in the previous month (OR=1.73, 95% confidence interval (CI)=1.04-2.90); poor nutritional score (OR=1.83, 95% CI=1.19-2.80); alcohol use per month (per gram; OR=1.69, 95% CI=1.08-2.61); history of regular exposure to gases, fumes, or chemicals at work (OR=3.69, 95% CI=2.37-5.75); history of regular exposure to fumes from solvents, paints, or gasoline at home (OR=3.31, 95% CI=1.59-6.87); and non-English language spoken at home (OR=5.31, 95% CI=2.60-10.87) were associated with a greater risk of pneumonia hospitalization in multivariable analysis. Age, congestive heart failure, chronic obstructive lung disease, dysphagia, renal disease, functional status, use of immunosuppressive disease medications, and lifetime history of smoking of more than 100 cigarettes were other variables associated with hospitalization for pneumonia.

CONCLUSION

In elderly people, present and past exposures in the physical environmental are associated with hospitalization for CAP.

Management of community acquired pneumonia

New studies assess the effectiveness of vitamins for prevention and initial antibiotic coverage for atypical pathogens