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Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls^1,2,3

¹ From the Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau (CW, RO, PR, PK, PG, PA, and MS); the Infectious Disease Research Unit, Skejby (CW, RO, and PLA) and the Department of Internal Medicine, Silkeborg (HG), Aarhus University Hospital, Aarhus, Denmark; the Department of Human Nutrition, Faculty of Life Science (PK) and the Department of Infectious Diseases (MS), University of Copenhagen, Copenhagen, Denmark; and the Infectious Diseases Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden (PG)

Background: Little is known regarding vitamin D deficiency (VDD) in African populations and in tuberculosis (TB) patients. VDD has been shown to be associated with TB.

Objective: We aimed to compare the degree of vitamin D insufficiency (VDI) and VDD in TB patients and healthy adult controls in a West African population.

Design: An unmatched case-control study was performed at a Demographic Surveillance Site in Guinea-Bissau. Serum 25-hydroxyvitamin D₃ [25(OH)D₃] concentrations were measured in 362 TB patients and in 494 controls.

Results: Hypovitaminosis D [25(OH)D₃ 75 nmol/L] was more common in TB patients, but VDD [25(OH)D₃ 50 nmol/L] was more common and more severe in controls. We observed hypovitaminosis D in 46% (167/362) of the TB patients and in 39% (193/494) of the controls; the relative risk (RR) of hypovitaminosis D was 1.18 (95% CI: 1.01, 1.38). VDD was observed in 8.5% (31/362) of the TB patients and in 13.2% (65/494) of the controls. The RR was 0.65 (95% CI: 0.43, 0.98), mainly because severe VDD [25(OH)D₃ 25 nmol/L] was observed in only 1 of 362 TB patients (0.2%) and in 24 of 494 controls (4.9%). After adjustment for background factors, hypovitaminosis D was not more frequent in TB patients than in healthy controls, but the mean serum 25(OH)D₃ concentration remained lower.

Conclusions: Hypovitaminosis D was highly prevalent in TB patients and in healthy controls living at 12 °N; severe VDD was rare in TB patients. The finding indicates that the serum 25(OH)D₃ concentration is associated with TB infection, but whether this role is a symptom or is causal was not established.

Key Words: Hypovitaminosis D • 25-hydroxyvitamin D • tuberculosis • Guinea-Bissau

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