Vitamin D
Does Vitamin D Affect Risk of Developing Autoimmune Disease?: A Systematic Review

https://doi.org/10.1016/j.semarthrit.2010.07.009Get rights and content

Objectives

We evaluated the epidemiologic evidence that vitamin D may be related to human autoimmune disease risk.

Methods

PubMed, limited to English from inception through April 2010, was searched using keywords: “vitamin D,” “autoimmune,” and autoimmune disease names. We summarized in vitro, animal, and genetic association studies of vitamin D in autoimmune disease pathogenesis. We sorted epidemiologic studies by design and disease and performed a systematic review of (a) cross-sectional data concerning vitamin D level and autoimmune disease; (b) interventional data on vitamin D supplementation in autoimmune diseases; and (c) prospective data linking vitamin D level or intake to autoimmune disease risk.

Results

Vitamin D has effects on innate and acquired immune systems, and vitamin D receptor polymorphisms have been associated with various autoimmune diseases. In experimental animal models, vitamin D supplementation can prevent or forestall autoimmune disease. Of 1446 studies identified and screened, 76 studies examined vitamin D levels in autoimmune disease patients, particularly with active disease, and compared with controls. Nineteen observational or interventional studies assessed the effect of vitamin D supplementation as therapy for various autoimmune diseases (excluding psoriasis and vitiligo) with a range of study approaches and results. The few prospective human studies performed conflict as to whether vitamin D level or intake is associated with autoimmune disease risk. No interventional trials have investigated whether vitamin D affects human autoimmune disease risk.

Conclusions

Cross-sectional data point to a potential role of vitamin D in autoimmune disease prevention, but prospective interventional evidence in humans is still lacking.

Section snippets

Methods

We searched the PubMed database from inception through April 2010 restricted to English language and human studies with the following search terms “vitamin D AND”; “autoimmune disease”; “autoimmunity”; “rheumatoid arthritis”; “spondylitis”; “spondyloarthropathy”; “psoriatic arthritis”; “systemic lupus erythematosis”; “scleroderma”; “systemic sclerosis”; “myositis”; “dermatomyositis”; “polymyositis”; “vasculitis”; “polymyalgia rheumatica”; “type 1 diabetes”; “multiple sclerosis”; “autoimmune

Results

We identified 1446 potentially relevant studies through our literature search and sorted and reviewed them as in Figure 1. Two hundred forty-two were immediately excluded as irrelevant to this review, leaving 1204 that were reviewed in further detail. Basic science and in vitro studies, genetic studies, ecological studies, and studies of biomarkers of inflammation were reviewed and summarized in the text. The human epidemiologic studies were sorted into epidemiologic studies of vitamin D levels

Conclusions

Understanding of the pluripotent immunomodulating and anti-inflammatory effects of vitamin D is advancing. Despite the in vitro and animal evidence for vitamin D's potential to decrease systemic inflammation and prevent autoimmune disease in humans, there remains insufficient human data to firmly support the hypothesis that vitamin D intake is related to the risk of developing autoimmune disease. Data from laboratory studies and cross-sectional and observational epidemiologic investigations

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    The VITamin D and OmegA-3 TriaL (VITAL) is being conducted by our research group at Brigham and Women's Hospital, Harvard Medical School (PI: JoAnn E. Manson, MD, DrPH). VITAL is funded by the National Institutes of Health (National Cancer Institute, National Heart Lung and Blood Institute, and other institutes and agencies are cosponsors (5U01CA138962)). The VITAL ancillary study on autoimmune disease incidence is funded by the National Institute of Arthritis and Musculoskeletal Diseases (R01 AR059086) and is being conducted by Karen H. Costenbader, MD, MPH (PI) and colleagues at Brigham and Women's Hospital, Harvard Medical School. Study vitamin D supplements are donated by Pharmavite LLC of Northridge, California.

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