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Both High And Low Serum Vitamin D Concentrations Are Associated With Tuberculosis: A Case–control Study In Greenland

Nina O. Nielsen, Turid Skifte, Mikael Andersson, Jan Wohlfahrt, Bolette Søborg, Anders Koch, Mads Melbye, Karin Ladefoged

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Vitamin D deficiency has been associated with increased risk of tuberculosis (TB). Changes from a traditional to a Westernised diet among Greenlanders have resulted in reduced serum vitamin D, leading to considerations of whether preventive vitamin D supplementation should be introduced. The association between vitamin D status and TB was examined to assess the feasibility of vitamin D supplementation in Greenland. This was examined in a case–control study involving seventy-two matched pairs of TB patients (cases) and controls aged 8–74 years. Cases were diagnosed with TB during 2004–6 based on clinical findings in combination with either (1) positiveMycobacterium tuberculosisculture, (2) characteristic X-ray abnormalities together with a positive tuberculin skin test or a positive interferon-γ release assay or (3) characteristic histology. Controls were individually matched on age ( ± 5 years), sex and district. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured and OR of TB were the outcome. Compared with individuals with 25(OH)D concentrations between 75 and 140 nmol/l, individuals with concentrations < 75 nmol/l (OR 6·5; 95 % CI 1·8, 23·5) or>140 nmol/l (OR 6·5; 95 % CI 1·9, 22·2) had higher risks of active TB (P = 0·003; adjustment for alcohol and ethnicity). Supplementing individuals with low vitamin D to normalise serum 25(OH)D concentrations was estimated to result in a 29 % reduction in the number of TB cases. The study indicated that vitamin D supplementation may be beneficial to individuals with insufficient vitamin D concentrations but may increase the risk of TB among individuals with normal or high concentrations.