British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

Both high and low serum vitamin D concentrations are associated with tuberculosis: a case–control study in Greenland

Nina O. Nielsena1 c1, Turid Skiftea2, Mikael Anderssona1, Jan Wohlfahrta1, Bolette Søborga1, Anders Kocha1, Mads Melbyea1 and Karin Ladefogeda3

a1 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark

a2 National Board of Health in Greenland, Nuuk, Greenland

a3 Medical Department, Queen Ingrid's Hospital, Nuuk, Greenland


Vitamin D deficiency has been associated with increased risk of tuberculosis (TB). Changes from a traditional to a Westernised diet among Greenlanders have resulted in reduced serum vitamin D, leading to considerations of whether preventive vitamin D supplementation should be introduced. The association between vitamin D status and TB was examined to assess the feasibility of vitamin D supplementation in Greenland. This was examined in a case–control study involving seventy-two matched pairs of TB patients (cases) and controls aged 8–74 years. Cases were diagnosed with TB during 2004–6 based on clinical findings in combination with either (1) positive Mycobacterium tuberculosis culture, (2) characteristic X-ray abnormalities together with a positive tuberculin skin test or a positive interferon-γ release assay or (3) characteristic histology. Controls were individually matched on age ( ± 5 years), sex and district. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured and OR of TB were the outcome. Compared with individuals with 25(OH)D concentrations between 75 and 140 nmol/l, individuals with concentrations < 75 nmol/l (OR 6·5; 95 % CI 1·8, 23·5) or>140 nmol/l (OR 6·5; 95 % CI 1·9, 22·2) had higher risks of active TB (P = 0·003; adjustment for alcohol and ethnicity). Supplementing individuals with low vitamin D to normalise serum 25(OH)D concentrations was estimated to result in a 29 % reduction in the number of TB cases. The study indicated that vitamin D supplementation may be beneficial to individuals with insufficient vitamin D concentrations but may increase the risk of TB among individuals with normal or high concentrations.

(Received January 13 2010)

(Revised May 10 2010)

(Accepted May 12 2010)

(Online publication June 17 2010)


c1 Corresponding author: Dr Nina O. Nielsen, fax +45 32 68 31 65, email


Abbreviations: 25(OH)D, 25-hydroxyvitamin D; 1,25(OH)2D, 1,25-dihydroxyvitamin D; TB, tuberculosis