The Role of Vitamin D in the Severity and Control of Asthma in Children
and Adolescents: A Systematic Review and Meta-analysis
Abstract
Background: Vitamin D may contribute to the balance in between
regulatory and suppressive functions of T cells to modulate the
inflammatory process in asthma. Objective: To assess serum
vitamin D levels and their relationship with asthma control, asthma
severity and its anti-inflammatory effect in children. Methods:
This systematic review was based on articles published between 2009 and
August 2022. Children under 18 years old with asthma were included.
Results: The initial database search identified 2,015
manuscripts. Through screening identified only 25 eligible articles, but
only eight studies met criteria for inclusion in the meta-analysis. The
analysis revealed that in six studies involving 588 participants, mean
25-hydroxyvitamin D levels were lower in children with uncontrolled
asthma compared to those with controlled asthma, with a mean difference
of -5.07 (-8.57, -1.57) and a high rate of heterogeneity I
2 = 89%. In five studies comprising 362 patients, the
relationship between vitamin D and asthma severity was assessed. Lower
levels of vitamin D were associated with a higher risk of severe asthma
in children, with a mean difference of -6.00 (-8.09, -3.90) and
substantial heterogeneity (90%, p<0.00001). In most
patients, no significant correlation was found between vitamin D and
lung function. Furthermore, serum vitamin D showed an association with
interleukins and with regulatory T lymphocytes. Conclusion:
Vitamin D plays a critical role in reducing asthma attacks. However,
more randomized studies are necessary for a thorough evaluation and
definitive recommendation for vitamin D supplementation.