Pneumology - Original Articles Open access

Vitamin D deficiency in patients with tuberculosis: prevalence, risk factors and treatment outcomes

Authors

Published
18 June 2026
Issue
Early Access
Section
Pneumology - Original Articles

Abstract

Although vitamin D deficiency is common in tuberculosis (TB) patients, several studies demonstrated that it may not influence treatment response. The aim of this study was to evaluate the prevalence and risk factors of vitamin D deficiency in a group of TB patients and to assess whether vitamin D deficiency influences TB treatment outcomes. All patients ≥18 years of age undergoing TB treatment at the Alvorada Pulmonology Department were invited to participate in the study. Blood samples were collected to check the level of vitamin D. TB treatment outcomes were collected. In total, 106 patients met the inclusion criteria and were included in the study. The mean vitamin D level was 35.1±16.4 ng/mL. The vitamin D status was classified as normal in 63 (59.4%) patients, insufficiency in 26 (24.5%), deficiency in 12 (11.3%), and severe deficiency in 5 (4.7%). The prevalence of vitamin D deficiency was 16.0%. HIV and diabetes mellitus were more frequent in groups with insufficient and deficient vitamin D compared with the group with normal vitamin D (p=0.041 and p=0.011, respectively). Cured TB case as the treatment outcome was registered less frequently in the group with deficient vitamin D (p=0.016), with confounding factors being HIV and diabetes mellitus. In conclusion, 16.0% of TB patients had vitamin D deficiency in the present study, and HIV and diabetes mellitus were factors associated with vitamin D insufficiency and deficiency. The wide variation in results between studies probably reflects regional variations, which emphasizes the need to understand the local reality. More robust studies are needed to evaluate the effect of vitamin D deficiency on treatment cure rates.

Ethics Approval

The study was approved by the Ethics Committee at HCPA (number 20220397).

References

  1. Friis H, Range N, Changalucha J, et al. Vitamin D status among pulmonary TB patients and non-TB controls: a cross-sectional study from Mwanza, Tanzania. PLoS One 2013;8:e81142. DOI: https://doi.org/10.1371/journal.pone.0081142
  2. Rockett KA, Brookes R, Udalova I, et al. 1,25-dihydroxyvitamin D3 induces nitric oxide synthase and suppresses growth of Mycobacterium tuberculosis in a human macrophage-like cell line. Infect Immun 1998;66:5314-21. DOI: https://doi.org/10.1128/IAI.66.11.5314-5321.1998
  3. Lin Y, Bai Y, Zhang T, et al. Unfavourable treatment outcomes in tuberculosis patients with different vitamin D status and blood glucose levels in a programme setting in China. Trop Med Int Heal 2020;25:373-9. DOI: https://doi.org/10.1111/tmi.13355
  4. Sloan DJ, Mwandumba HC, Kamdolozi M, et al. Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes. Int J Tuberc Lung Dis 2015;19:904-11. DOI: https://doi.org/10.5588/ijtld.15.0071
  5. Mehta S, Mugusi FM, Bosch RJ, et al. Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study. BMJ Open 2013;3:e003703. DOI: https://doi.org/10.1136/bmjopen-2013-003703
  6. MacEda EB, Gonçalves CCM, Andrews JR, et al. Serum vitamin D levels and risk of prevalent tuberculosis, incident tuberculosis and tuberculin skin test conversion among prisoners. Sci Rep 2018;8:997. DOI: https://doi.org/10.1038/s41598-018-19589-3
  7. Aibana O, Huang CC, Aboud S, et al. Vitamin D status and risk of incident tuberculosis disease: a nested case-control study, systematic review, and individual-participant data meta-analysis. PLoS Med 2019;16:e1002907. DOI: https://doi.org/10.1371/journal.pmed.1002907
  8. Talat N, Perry S, Parsonnet J, et al. Vitamin D deficiency and tuberculosis progression. Emerg Infect Dis 2010;16:853-5. DOI: https://doi.org/10.3201/eid1605.091693
  9. Junaid K, Rehman A. Impact of vitamin D on infectious disease-tuberculosis-a review. Clin Nutr Exp 2019;25:1-10. DOI: https://doi.org/10.1016/j.yclnex.2019.02.003
  10. Sutaria N, Liu CT, Chen TC. Vitamin D status, receptor gene polymorphisms, and supplementation on tuberculosis: a systematic review of case-control studies and randomized controlled trials. J Clin Transl Endocrinol 2014;1:151–60. DOI: https://doi.org/10.1016/j.jcte.2014.08.001
  11. Kafle S, Basnet AK, Karki K, et al. Association of vitamin D deficiency with pulmonary tuberculosis: a systematic review and meta-analysis. Cureus 2021;13:e17883. DOI: https://doi.org/10.7759/cureus.17883
  12. Bekele A, Gebreselassie N, Ashenafi S, et al. Daily adjunctive therapy with vitamin D3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia. J Intern Med 2018;284:292-306. DOI: https://doi.org/10.1111/joim.12767
  13. Zeng J, Wu G, Yang W, et al. A serum vitamin D level <25nmol/L pose high tuberculosis risk: a meta-analysis. PLoS One 2015;10:e0126014. DOI: https://doi.org/10.1371/journal.pone.0126014
  14. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006;116:2062-72. DOI: https://doi.org/10.1172/JCI29449
  15. Nouri-Vaskeh M, Sadeghifard S, Saleh P, et al. Vitamin D deficiency among patients with tuberculosis: a cross-sectional study in Iranian-azari population. Tanaffos 2019;18:11-7.
  16. Wejse C, Olesen R, Rabna P, et al. Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls. Am J Clin Nutr 2007;86:1376-83. DOI: https://doi.org/10.1093/ajcn/86.5.1376
  17. Martineau AR, Nhamoyebonde S, Oni T, et al. Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa. Proc Natl Acad Sci U S A 2011;108:19013-7. DOI: https://doi.org/10.1073/pnas.1111825108
  18. Ministério de Saúde. Boletim epidemiológico tuberculose 2026. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2026/boletim-epidemiologico-de-tuberculose-numero-especial-mar-2026.pdf/view.
  19. Jiménez-Sousa MA, Martínez I, Medrano LM, et al. Vitamin D in human immunodeficiency virus infection: Influence on immunity and disease. Front Immunol 2018;9:458. DOI: https://doi.org/10.3389/fimmu.2018.00458
  20. Visuthranukul J, Phansuea P, Buranakityanon P, et al. Prevalence and risk factors of vitamin D deficiency among living with HIV adults receiving antiretroviral treatment in tropical area: Cross-sectional study. Heliyon 2023;9:e19537. DOI: https://doi.org/10.1016/j.heliyon.2023.e19537
  21. Mangal DK, Shaikh N, Tolani H, et al. Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis. BMJ Nutr Prev Heal 2025;8:334-44. DOI: https://doi.org/10.1136/bmjnph-2024-000950
  22. Salih YA, Rasool MT, Ahmed IH, Mohammed AA. Impact of vitamin D level on glycemic control in diabetes mellitus type 2 in Duhok. Ann Med Surg 2021;64:102208. DOI: https://doi.org/10.1016/j.amsu.2021.102208

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