I read with great interest the recently published randomised control trial (RCT) on vitamin D supplementation for severe pneumonia [1]. I would like to add that owing to the ability of vitamin D to inhibit M. tuberculosis in macrophages by inducing autophagy [2], its role in control of tuberculosis is also being investigated. Similar to pneumonia, observational studies indicate that vitamin D deficient patients are more likely to be affected with tuberculosis. Three RCT’s on the role of vitamin D in tuberculosis [3-5] have been conducted with considerable differences in results. The Denmark study [4], did not find any improvement in clinical outcome or mortality with the use of vitamin D as a supplement in a dose of 100,000 IU at 0,5 and 8 months. All these studies have been conducted in adults. Moreover, they have a small sample size and are underpowered. None of them have been conducted in India. The genotype of vitamin D receptors and consequently the metabolism also might differ in India compared to that of Europeans, these studies were carried out. This is important when viewed in the light of the study by Martineau, et al. [3], which found that a dose as high as 2.5 mg vitamin D hastened the sputum culture conversion exclusively in the subgroup of the population which had tt genotype of the TaqI vitamin D receptor polymorphism.

Role of vitamin D supplementation needs to be studied in Indian children with tuberculosis.

1. Choudhury N, Gupta P. Vitamin D supplementation for severe pneumonia – A randomized controlled trial. Indian Pediatr. 2012;49:449-54.

2. Campbell GR, Spector SA. Vitamin D inhibits human immunodeficiency virus type 1 and Mycobacterium tuberculosis infection in macrophages through the induction of autophagy. PLoS Pathog 2012;8: e1002689.

3. Martineau AR, Timms PM, Bothamley GH, Hanifa Y, Islam K, Claxton AP, et al. High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial. Lancet. 2011;377:242-50.

4. Wejse C, Gomes VF, Rabna P, Gustafson P, Aaby P, Lisse IM, et al. Vitamin D as supplementary treatment for tuberculosis: a double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med. 2009;179:843-50.

5. Martineau AR, Wilkinson RJ, Wilkinson KA, Newton SM, Kampmann B, Hall BM, et al. A single dose of vitamin D enhances immunity to mycobacteria. Am J Respir Crit Care Med. 2007;176:208-13.