Negligible effect of vitamin D supplementation on exacerbation in patients with chronic obstructive pulmonary disease: meta-analysis

Nutritional Support of Chronic Obstructive Pulmonary Disease

Background: COPD is a heterogenous disease of the respiratory tract caused by diverse genetic factors along with environmental and lifestyle-related effects such as industrial dust inhalation and, most frequently, cigarette smoking. These factors lead to airflow obstruction and chronic respiratory symptoms. Additionally, the increased risk of infections exacerbates airway inflammation in COPD patients. As a consequence of the complex pathomechanisms and difficulty in treatment, COPD is among the leading causes of mortality both in the western countries and in the developing world. Results: The management of COPD is still a challenge for the clinicians; however, alternative interventions such as smoking cessation and lifestyle changes from a sedentary life to moderate physical activity with special attention to the diet may ameliorate patients' health. Here, we reviewed the effects of different dietary components and supplements on the conditions of COPD. Conclusions: COPD patients are continuously exposed to heavy metals, which are commonly present in cigarette smoke and polluted air. Meanwhile, they often experience significant nutrient deficiencies, which affect the detoxification of these toxic metals. This in turn can further disrupt nutritional balance by interfering with the absorption, metabolism, and utilization of essential micronutrients. Therefore, awareness and deliberate efforts should be made to check levels of micronutrients, with special attention to ensuring adequate levels of antioxidants, vitamin D, vitamin K2, magnesium, and iron, as these may be particularly important in reducing the risk of COPD development and limiting disease severity.

How Important Is Vitamin D Supplementation in the Prevention of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Review

This review examines the efficacy of vitamin D supplementation in preventing exacerbations in patients with chronic obstructive pulmonary disease (COPD), a major global contributor to morbidity and mortality. Exacerbations, often caused by infections, significantly worsen outcomes and elevate healthcare costs. Given its immunomodulatory properties, vitamin D has been hypothesized to reduce exacerbations, particularly in populations with vitamin D deficiency. A systematic search of multiple databases was performed in February 2024 and evidence was synthesized from four systematic reviews with meta-analyses and one recent randomized controlled trial. Findings indicate that vitamin D supplementation does not generally reduce exacerbation rates in COPD patients. However, in patients with baseline 25-hydroxyvitamin D (25(OH)D) serum levels below 10 ng/mL, one meta-analysis reported a significant (p=0.006) reduction in moderate-to-severe exacerbations following supplementation. Variability in study designs, dosages, and follow-up durations limit the generalizability of these findings. Nevertheless, clinical guidelines recommend screening and supplementing vitamin D in COPD patients, particularly those with severe deficiency. Clinicians should consider the low cost and risk of vitamin D supplementation and its potential benefits in reducing exacerbations in such patients.

Vitamin D Supplementation: A Review of the Evidence Arguing for a Daily Dose of 2000 International Units (50 µg) of Vitamin D for Adults in the General Population

Vitamin D deficiency is considered a public health problem due to its worldwide high prevalence and adverse clinical consequences regarding musculoskeletal health. In addition, vitamin D may also be crucial for the prevention of certain extraskeletal diseases. Despite decades of intensive scientific research, several knowledge gaps remain regarding the precise definition of vitamin D deficiency and sufficiency, the health benefits of improving vitamin D status, and the required vitamin D intakes. Consequently, various societies and expert groups have released heterogeneous recommendations on the dosages for vitamin D supplementation. In this brief narrative review, we outline and discuss recent advances regarding the scientific evidence arguing for a daily vitamin D supplementation with 2000 international units (IU) (50 µg) of vitamin D3 to prevent and treat vitamin D deficiency. According to data from randomized controlled trials (RCTs), such a dose may improve some health outcomes and is sufficient to raise and maintain serum 25(OH)D concentrations above 50 nmol/L (20 ng/mL) and above 75 nmol/L (30 ng/mL) in >99% and >90% of the general adult population, respectively. According to large vitamin D RCTs, there are no significant safety concerns in supplementing such a dose for several years, even in individuals with an already sufficient vitamin D status at baseline. A daily vitamin D supplementation with 2000 IU (50 µg) may be considered a simple, effective, and safe dosage to prevent and treat vitamin D deficiency in the adult general population.