Vitamin D supplementation may safely reduce the overall risk for acute respiratory infection compared with placebo, but the risk reduction is small and the relevance of these findings to coronavirus disease 2019 (COVID-19) is unknown and requires additional investigation. This is according to research published in Lancet Diabetes Endocrinology.

Since the COVID-19 pandemic began, interest in the role of vitamin D in reducing acute respiratory infections has increased. Results of randomized controlled trials, though, have been heterogenous and variable, with some demonstrating protection and others reporting findings that are null. Results of a 2017 meta-analysis indicated the potential protective effect of vitamin D supplementation. Researchers sought to build on those results by conducting a new systematic review and meta-analysis of studies conducted since December 31, 2015.

The primary study outcome was the proportion of patients who had one or more acute respiratory infection (upper, lower, or location unclassified). Secondary outcomes included the proportion of participants who experienced one or more upper or lower respiratory infection, emergency department visit, hospitalization, or both for an acute respiratory infection, death due to acute respiratory infection or respiratory failure, antibiotic use, absence from school or work, serious adverse events, death, and potential adverse reactions to vitamin D.


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The analysis included 46 studies representing 75,541 patients. Thirty-five studies compared the effects of vitamin D regimen with placebo, 5 compared higher- and lower-dose vitamin D with placebo groups, and 6 compared the effects of higher dose vitamin D with lower-dose vitamin D regimens.

Primary outcome data were obtained for 98.1% of 49,419 available participants.

In the 35 studies that measured baseline 25(OH)D concentrations, mean levels ranged from 18.9 to 90.9 nmol/L. Across studies, vitamin D was administered through variable routes, including oral dosing, weekly dosing, bolus dosing once every month to once every 3 months, and combination bolus and daily dosing.

A significantly lower proportion of participants who were taking vitamin D supplements had 1 or more acute respiratory infections compared with those taking placebos (61.3% vs 62.3%; odds ratio [OR], 0.92; 95% CI, 0.86-0.99). The heterogeneity effect for these data was moderate (I2=35.6%).

For secondary comparisons of high vs low dose vitamin D supplementation, no significant differences in the proportion of at least one acute respiratory infection was noted between participant groups (68.2% vs 64.6%; OR, 0.87; 95% CI, 0.73-1.04; I2=0.0%).

In order to investigate the reasons for the heterogeneity of the effect for the primary comparison (vitamin D vs placebo), researchers conducted an analysis stratified by 2 participant level factors (baseline 25(OH)D concentration and age) and 4 trial-level factors (dose, dose frequency, trial duration, and presence or absence of airway disease). Four of these factors—baseline 25(OH)D concentration, dose, dose frequency, and trial duration—were prespecified in study protocols and two—age and presence or absence of airway infections—were exploratory analyses.

Compared with placebo groups, there was no significant effect of vitamin D supplementation on the risk of having 1 or more acute respiratory infection in participants with baseline 25(OH)D concentrations of less than 25 nmol/L, 25 to 49.9 nmol/L, 50 to 74.9 nmol/L, or greater than 75 nmol/L (ORs, 0.81, 1.04, 0.88, 0.76, and 1.00, respectively).

A significant protective effect of vitamin D supplementation was seen on the risk for developing one or more acute respiratory infection compared with placebo, particularly in trials where vitamin D was given daily (OR 0.78) compared with weekly dosing or bolus dosing once a month or once every 3 months (ORs, 0.97 and 0.98).

Significant protective effects were also noted against the risk of having one or more acute respiratory infection vs placebo in trials that were not restricted only to participants with asthma or chronic obstructive pulmonary disease (COPD).

The meta-analysis for secondary outcomes included only the results of placebo-controlled trials. Without considering participant- or trial-level factors, vitamin D supplementation did not demonstrate a significant effect on the proportion of participants who experienced 1 or more upper or lower respiratory infection, used antibiotics to treat an infection, reported absence from school or work, or had been admitted to the hospital, or who went to the emergency department.

Study limitations include the analysis of aggregate trial-level, rather than individual participant-level data due to the need for results in the face of the COVID-19 pandemic, a lack of participant-level data on race, ethnicity, or obesity as potential effect-modifiers, and an inability to account for other factors that might influence the protective effect of supplementation.

“This updated meta-analysis…showed a significant overall protective effect of this intervention compared with a placebo control,” the researchers wrote. “In contrast to findings of our previous meta-analysis of individual participant-level data, we did not see a protective effect…among participants with the lowest baseline 25(OH)D concentrations.”

“The vitamin D dosing regimen of most benefit was daily and used standard doses (400-1000 IU) for up to 12 months. The relevance of these findings to COVID-19 is not known and requires further investigation,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Jolliffe DA, Camargo Jr CA, Sluyter JD, et al. Vitamin D supplementation to prevent acute respiratory infections: A systematic review and meta-analysis of aggregate data from randomized controlled trials. Published online March 30, 2021. Lancet Diabetes Endocrinol. doi: 10.1016/S2213-8587(21)00051-6.

This article originally appeared on Endocrinology Advisor



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6 thoughts on “Vitamin D Supplementation May Lead to Small Risk Reduction for Acute Respiratory Infections”
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  3. If discovering a spotter or acquiring help bars is difficult, then the best alternative is to perform the smith machine close grip bench press.
    When setting up the grip, individuals typically make the mistake of gripping very slender, that is comprehensible contemplating the name of the train, however,
    slender in this case is defined as “shoulder-width”.
    A shoulder-width grip allows for a full range of motion, full contraction of the muscles in addition to
    less stress on the joints. While this exercise could be effective at concentrating
    on the triceps and internal chest muscle tissue, it also has some disadvantages compared to other bench
    press variations. During the shut grip benchpress the
    triceps will be taken by way of a full vary of motion and will
    be working the hardest on the top of the motion simply before you lockout the
    elbow.
    Altering your grip on the barbell curl shifts the primary target
    to the often-neglected forearm extensors, helping construct
    both measurement and strength. The barbell reverse curl targets these
    smaller extensor muscle tissue and the brachialis—a
    very important muscle beneath the biceps that enhances general higher arm thickness and definition. With this
    variation, maintain your wrists straight, management
    the lowering, and avoid momentum. Our triceps are the first muscle group involved within the close-grip bench press (1).
    The muscle covers the rear of our upper arms, and its primary function is elbow extension (straightening
    of the arm), which occurs as we press the barbell from the
    bottom (2). As briefly mentioned above, a better grip on the
    bar places the triceps at a mechanical benefit, forcing the muscle to produce
    a lot of the force essential to move the weight.
    Because of this, it’s a well-liked exercise among bodybuilders and power
    athletes who wish to build arm energy and measurement. At lockout, make sure your wrists, elbows, and shoulders are in alignment.
    If you’re pushing the bar too far forward or again,
    then you’re doubtless accumulating unnecessary
    fatigue because of poor bar path. As a common rule of thumb, you’ll sometimes want
    to ensure that your bar’s contact level permits the wrists
    to be stacked over the elbows. This will present you with higher positioning for loading and using the triceps.
    Though weightlifters and crossfitters do not bench press competitively, elbow extension is
    an important energy they want to stay strong
    when doing the clear and jerk. This is also useful for anybody training in a house gym where house or budget may
    not permit multiple equipment pieces.
    The functions of the lats are extension, adduction, and
    medial rotation of the shoulders. Nonetheless, reverse
    grip rows are predominantly a shoulder extension train. The barbell upright row is a compound train that targets the muscular
    tissues of the shoulder and higher back, together with the deltoids,
    trapezius, in addition to the rhomboids, and
    even the biceps. As with the close-grip flat bench urgent, bringing your hands nearer
    collectively (till they’re roughly shoulder-width apart) on the push-up
    increases elbow extension and extension — shifting
    the load to your triceps. The close grip bench press
    shifts the load more to your triceps and fewer to your chest and anterior deltoids.
    You need to make sure your arms are strong enough to perform
    the move safely and correctly.
    On a private degree, I’ve been dedicating myself to the world of
    powerlifting for the past 15 years, having each competed and coached on the highest stage.

    Elena Popadic has labored throughout the fitness industry for over 6 years, is co-host of the Squats and Thoughts 
    podcast and trains and competes as a powerlifter. She has a BSc in Life Sciences from McMaster College,
    a Postgrad Certificate in Public Relations from Humber Faculty and is presently pursuing a
    MSc Occupational Therapy at Western College.
    The amount of reps you do will depend on the hundreds you select, guaranteeing that you are difficult your self adequately and getting 1-3 reps
    shy of failure. Verify out my article on Tips On How To Switch From Powerlifting To Weightlifting.

    We’ve obtained something for everyone… from newbies to experienced lifters.
    Allowing your elbows to flare out wide shifts the emphasis away from the triceps and can lead to shoulder discomfort.
    The Shut Grip Bench Press is a great variation of the conventional Bench Press, homing
    in on triceps energy with a precision that its wide-grip counterpart might not provide.
    This focused engagement additionally contributes to a more balanced and powerful
    higher body, capable of handling both on a daily basis actions
    and rigorous workout routines. By intentionally activating and concentrating on the muscular tissues concerned, you’re in a position to
    keep away from improper technique, minimize the likelihood of accidents, and optimize muscle constructing potential.

    It enhances grip strength, addresses forearm energy imbalances, and builds forearm and grip power.
    Keep your wrists neutral to avoid unnecessary
    pressure, and modify your grip width for consolation. The
    JM Press blends the benefits of a close-grip bench press and a skullcrusher, making it
    a superb alternative for triceps hypertrophy whereas permitting for heavy loading.
    It targets the triceps with minimal shoulder strain,
    making it a favorite among powerlifters.
    Aim to train your triceps two to three occasions per week, utilizing
    a combination of barbell, dumbbell, cable, band, and bodyweight workouts to keep the muscles challenged
    from completely different angles.
    It’s an excellent option for constructing lockout power and lowering shoulder strain. To build well-rounded triceps, your exercise ought to
    include actions that successfully engage all three heads, making
    certain balanced improvement and maximizing muscle growth.
    Having someone spot you or at least having one thing that can take
    the burden of the bar permits you to really feel confident when lifting.
    Not having both of these when performing the exercise means that you
    won’t be succesful of fully commit to each set , depriving your self
    of potential muscle acquire. You wish to push all
    the way in which to the purpose of failure with confidence that you just aren’t going to
    hurt your self. You could choose to perform this exercise on a Smith Machine in its place, that is discussed beneath.

    This train provides an effective way to coach
    the chest, especially for these who experience shoulder pain.
    But it nonetheless includes pushing the load ahead, meaning we can’t totally
    have interaction the lengthy heads of our triceps.
    One of the primary variations between the regular bench press
    and the close-grip bench press is that instead of working your whole chest, it emphasizes the
    higher chest. This makes the close-grip bench press a fantastic lift
    for people with lagging higher chests. This means that the barbell tends to come back down lower on our torso, changing the dynamics of the carry
    and causing totally different muscular tissues to be emphasised.
    When you’re performing the Close Grip Bench Press, a key muscle
    group you’re focusing on is the triceps brachii, which are the
    muscles on the back of your upper arm.
    This makes the close-grip bench press one of many very best lifts for constructing greater shoulders.
    In fact, it could be even better than the incline bench
    press and overhead press for bulking up our
    entrance delts. What’s attention-grabbing is
    that the close-grip bench press challenges your upper chest and shoulders at lengthy muscle lengths—in a totally stretched position—which is right for exciting muscle development.
    That could, speculatively, make it better than the incline bench press for bulking up your shoulders and higher chest.
    After all, the incline bench press cuts
    out the very bottom of the vary of motion on the bench press,
    failing to give us a lot of a stretch. While it’s tempting to load the barbell with heavy weights to speed up muscle progress, starting with heavy bench pressing can result in a breakdown in approach and improve the risk of damage.

    However, many lifters feel pain and discomfort in their wrist and forearm because of a totally supinated grip
    on a regular barbell. Many bodybuilders have relied
    on the usual barbell curl for many years to
    strengthen their biceps. The shut grip standing barbell curl has some
    distinct benefits over the wide-grip standing barbell curl that you may not have thought of.
    The first concern most run into is the way to carry the barbell properly on the anterior torso.

    Moreover, many athletes usually are not prepared for the calls
    for positioned on the trunk and backbone,
    contemplating the importance of proper brace and posture when performing the entrance squat.
    The entrance squat will help improve the strength of the back and trunk, and the motion will also drive athletes
    to brace appropriately and implement strict form. In Distinction To the again squat, where the trunk can help mitigate spinal flexion, athletes can only tolerate a lot spinal flexion in the course
    of the lift before they lose control of the barbell.

    Not Like the standard bench press, the narrower grip places
    a heightened emphasis on the triceps whereas still recruiting the chest and shoulders.
    This makes it an excellent movement for athletes trying to improve
    lockout energy, bodybuilders aiming for outlined arms,
    and health fanatics in search of well-rounded pressing
    power. Professional athletes will regularly perform compound workouts such because the shut grip bench press as it relates to their
    sporting necessities. For example in rugby or wrestling, you will need to often push heavy opponents away from you.
    This requires your entire body to have the flexibility to provide and exhibit drive,
    which is precisely what you coaching when performing the shut grip bench press.
    The close-grip dumbbell bench press is a well-liked variation of the dumbbell bench press.

    It’s a good suggestion to make use of a spotter
    till you grasp the correct close-grip bench
    press type, or it can end result in injuries. The incline shut grip bench
    press is a variation of the standard shut grip bench press.
    In which the bench is ready to an incline,
    usually between 15 and forty five levels. Strongman competitors additionally do lots
    of urgent actions that require strong arms and chest strength which can be built
    via the close grip bench.
    Prepare to maximise your energy with our unique 13-week power training program.

    Snatch Grip Shrugs is a little-used variation aside from probably Olympic weightlifters.
    Barbell Shrugs are probably the greatest workouts for concentrating on the
    higher traps. The higher traps play a crucial role in strengthening and supporting the neck area.

    The close-grip bench press is one of my favorite pressing variations when my lockout is struggling or I just
    want a break from the standard barbell bench.

    Honestly, I feel like lots of lifters forget in regards to the close-grip press and the
    way great it might be. The setup for an in depth grip bench press is very related to that of a daily bench press with slight changes to the location of your palms.
    One benefit to including shut grip bench work, significantly
    for powerlifters, is that you could simply transition from common to close grip bench
    press without any additional set up or equipment.
    A lesser recognized advantage of the shut grip bench press
    is a larger activation of the upper chest region, as decided by Barnett et.
    If you battle with locking out your elbows on the end of the
    bench press (including incline or decline bench), you could profit from including close grip bench
    press into your program. The close grip bench press was included in my article on the Greatest Bench Press Variations.

    Will the close-grip bench press train muscular tissues outdoors of the three offered above?
    Nonetheless, you’re doubtless not going to program this train for muscular
    tissues exterior of the three main major muscular tissues above.

    For instance, if your wrists are behind the elbows on the bottom of your close-grip bench press then it could be price exploring bringing the barbell down additional in your chest to stack the
    wrists and elbows better. The lockout portion of the bench press is heavily
    reliant on elbow extension, which is managed by the triceps.
    Due To This Fact, focusing on tricep power would enhance this portion of the carry
    which is especially of interest to powerlifting athletes.

    This creates a relatively short decrease again lever and less decrease again stress.
    If overhand bent-over rows cause back ache, you could find the
    reverse grip variation more comfortable. If you’re
    new to the exercise or have shoulder concerns, begin with gentle weights or choose alternative
    workout routines which would possibly be easier in your joints.
    Primarily, the alternative exercise should activate
    the triceps brachii both as a significant part
    of a compound motion or as the singular focus in the case of an isolation sort various train. This is among the most common questions you will
    hear if you walk into any health club. Having the flexibility to bench press massive weights has always been a fast approach to get respect within the gym, and as a powerlifter it is a talent that’s
    absolutely needed to build the biggest whole potential.

    Maintain your back straight and carry smoothly, avoiding sudden actions.
    This train targets the lower part of the chest while still emphasizing the triceps, just like the standard shut grip bench press.
    If you may be new to performing an in depth grip bench press, you
    could need to apply a number of modifications to make the train simpler.

    It could probably be harmful if you use too much weight or
    use an improper bench press hand place. For example, should you normally
    lift 100lbs (50lbs on every side), begin with 35-40lbs on all sides.
    Add or subtract 5lbs from all sides until you arrive at a weight you’re
    comfortable with. You should be succesful of maintain correct kind throughout the carry – that’s extra
    important than the quantity of weight you’re lifting. Begin by mendacity on the
    bench, together with your again straight (not arched) and your
    legs firmly positioned on the bottom. Hold the barbell while it’s nonetheless on the rack, keeping your arms shoulder-width aside.
    The close-grip barbell press can be carried out in numerous ways to
    swimsuit your fitness level and your selection.
    Though the extensive grip bench press is a coveted raise by health club goers and aggressive athletes alike, the close-grip bench press
    can additionally be a fantastic strength and muscle builder.

    However, it does include an necessary limitation which might be extra vital to some lifters and never as important
    to others. No worries.The dumbbell close grip bench press is the variation for you!

    Load up two dumbbells with palms going through towards each
    other and proceed to lower them to the bottom of your chest.Pause
    for one second before powering the weights back up.
    The narrow grip locations a lot of the workload on the
    triceps for max muscle improvement.
    These workout routines enable athletes to boost the specificity of their training in various methods,
    resulting in fast enhancements in energy and athletic growth.
    The barbell drag curl retains the bar near your physique as you
    curl, rather than curling it in an arc. This refined shift retains your arms in place, eliminating momentum and placing more pressure on the biceps.

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