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Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory

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One fifth of Indigenous infants born in the Northern Territory are hospitalised with an acute lower respiratory infection (ALRI) during their first year of life.1 Several international studies have reported an inverse relationship between cord blood vitamin D levels and infant respiratory infections.24 As exposure to sunshine is the most important influence on vitamin D status, there has been little consideration of the relationship between vitamin D status and disease in the tropical north of Australia.

Vitamin D is produced in the skin after exposure to sunlight. Subsequent hydroxylation in the liver yields the dominant circulating vitamin D metabolite, 25(OH)D3. The discovery that vitamin D receptors are widely distributed throughout human tissues and that several cell types, including those of the immune system, can synthesise the active vitamin D metabolite (1,25(OH)2D) from 25(OH)D3 has prompted renewed interest in the role of vitamin D. Vitamin D is required for innate (antimicrobial peptide production) and adaptive (favours response by Th2 effector T cells) immune responses.5 These may be particularly important in the respiratory tract of the developing infant, and perhaps relevant to the relationship between cord blood vitamin D levels and…