Abstract
Pulmonary tuberculosis, caused by Mycobacterium tuberculosis, is a significant public health issue, especially in developing countries, affecting millions of people every year. Despite the development of many antitubercular antibiotics and increased awareness of preventive methods, it is still a major cause of mortality worldwide. Vitamin D, a micronutrient known to have a major role in bone and calcium metabolism, has also shown its immunomodulatory effects to suppress mycobacterial growth. We conducted a systematic review and meta-analysis of the available evidence to explore the association between vitamin D levels and tuberculosis. We performed a systematic search for articles from inception to May 2021 in multiple databases. We included 26 studies in our qualitative synthesis and 12 studies in meta-analysis or quantitative synthesis. In our meta-analysis, we used a random-effect model to calculate the odds ratio (OR) of vitamin D deficiency in tuberculosis patients compared to the healthy controls. On pooled analysis, we found that the odds of the participants having vitamin D deficiency was 3.23 times more in tuberculosis patients compared to the healthy group (OR=3.23, CI = 1.91-5.45, p<0.0001). Thus, we concluded that there is an association between low levels of vitamin D and tuberculosis infections. We suggest conducting long-term prospective cohort studies in tuberculosis endemic countries to better understand the causal relationship between vitamin D deficiency and tuberculosis.
Highlights
BackgroundTuberculosis (TB), an infectious disease, is one of the top 10 causes of worldwide death, ranking above human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
To explore more about the vitamin D deficiency and tuberculosis association, we have systematically identified, examined, and pooled the community-and hospital-based studies that performed a comparative study of serum vitamin D in tuberculosis patients and healthy controls
A total of 8101 participants were included in our data synthesis; 4203 were people with TB and 3898 were healthy volunteers
Summary
Tuberculosis (TB), an infectious disease, is one of the top 10 causes of worldwide death, ranking above human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In 2020, around 10 million people became ill, and 1.4 million died from TB [1,2]. The geographical distribution of TB in 2019 was 44% in the South-East Asia regions, 25% in Africa, 18% in Western Pacific, 8.2% in Eastern Mediterranean, 2.9% in the Americas, and 2.5% in Europe [2]. Immunomodulatory and anti-proliferative responses modulated by active 1,25-dihydroxy vitamin D were seen more than two decades ago. More understanding has been established in recent years regarding the effects of vitamin D in the pathophysiology and possible prevention of human disease, including TB [4]
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