Revisiting the association between vitamin D deficiency and active tuberculosis: A prospective case-control study in Taiwan

Meng-Shiuan Hsu; Tzu-Chien Chung; Ping-Huai Wang; Shih-Lung Cheng; Yen-Wen Wu; Jung-Cheng Hsu; Bing-Hsiean Tzeng; Heng-Hsu Lin; Chung-Ming Tu; Fang-Yeh Chu; Chi-Tai Fang

doi:10.1016/j.jmii.2024.03.005

Revisiting the association between vitamin D deficiency and active tuberculosis: A prospective case-control study in Taiwan

J Microbiol Immunol Infect. 2024 Mar 28:S1684-1182(24)00068-9. doi: 10.1016/j.jmii.2024.03.005. Online ahead of print.

Authors

Affiliations

¹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Section of Infectious Disease, Far Eastern Memorial Hospital, New Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ Department of Internal Medicine, Section of Chest Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
⁴ Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan.
⁵ Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan; Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan.
⁶ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University School of Medicine, Taipei, Taiwan. Electronic address: fangct@ntu.edu.tw.

PMID: 38594108
DOI: 10.1016/j.jmii.2024.03.005

Abstract

Background: To revisit the association between vitamin D deficiency (VDD, defined as serum 25(OH)D < 20 ng/ml) and incident active tuberculosis (TB), after two potentially underpowered randomized trials showed statistically non-significant 13%-22% decrease in TB incidence in vitamin D supplementation groups.

Methods: We prospectively conducted an age/sex-matched case-control study that accounting for body-mass index (BMI), smoking, and other confounding factors to examine the association between VDD and active TB among non-HIV people in Taiwan (latitude 24°N), a high-income society which continues to have moderate TB burden.

Results: We enrolled 62 people with incident active TB and 248 people in control group. The TB case patients had a significantly higher proportion of VDD compared to the control group (51.6% vs 29.8%, p = 0.001). The 25(OH)D level was also significantly lower in TB patients compared to control group (21.25 ± 8.93 ng/ml vs 24.45 ± 8.36 ng/ml, p = 0.008). In multivariable analysis, VDD (adjusted odds ratio [aOR]: 3.03, p = 0.002), lower BMI (aOR: 0.81, p < 0.001), liver cirrhosis (aOR: 8.99, p = 0.042), and smoking (aOR: 4.52, p = 0.001) were independent risk factors for incident active TB.

Conclusions: VDD is an independent risk factor for incident active TB. Future randomized trials examining the effect of vitamin D supplementation on TB incidence should focus on people with a low BMI or other risk factors to maximize the statistical power.

Keywords: 25(OH)D; Body mass index; Liver cirrhosis; Smoking; Tuberculosis; Vitamin D deficiency.