Association between vitamin D and the prevalence of human papillomavirus infection in women in the United States: The National Health and Nutrition Examination Survey 2003-2006
The associations between certain micronutrients and human papillomavirus (HPV) infections have been studied and reported on in the past. None of those studies, however, focused on vitamin D although sufficient amounts of vitamin D contribute to protection against various infections by enhancing host immunity; thus, the objective of this study was to assess the association between vitamin D and prevalent cervicovaginal HPV infection. The National Health and Nutrition Examination Survey (NHANES) 2003-2006 data were used for this project. We included 2351 sexually active women aged 20 to 59 years with either positive or negative results of cervicovaginal HPV infection and available data on serum 25-hydroxyvitamin D (25(OH)D) levels (ng/ml) in analyses. Our exposure, serum 25(OH)D, was evaluated in both continuous and categorical forms. Serum 25(OH)D was categorized into severe vitamin D deficiency (<12 ng>/ml), vitamin D deficiency (12-19 ng/ml), vitamin D insufficiency (20-29 ng/ml), and vitamin D sufficiency (<30 ng>/ml). Our outcomes were 2 different groups of cervicovaginal HPV infection, i.e., 1) any of 13 HPV types considered high-risk for cervical cancer ("high-risk HPV"), and 2) any of 4 HPV types in the quadrivalent vaccine ("vaccine-type HPV"). Weighted logistic regression was used to estimate the association between serum 25(OH)D and HPV infections. After adjusting for age and race/ethnicity, there were lower odds of high-risk HPV infection when women had increasing levels of serum 25(OH)D (adjusted odds ratio (aOR), 0.86; 95% Confidence Interval (CI), 0.78-0.96 per 10ng/ml increase in serum 25(OH)D). Also, the odds of high-risk HPV infection were increased in women with vitamin D deficiency (aOR, 1.41;95% CI, 1.02-1.97) compared to women with sufficient vitamin D after adjusting for age, race/ethnicity, and marital status. The odds of vaccine-type HPV infection were increased in all vitamin D categories below vitamin D sufficiency (< 30ng/ml) after adjusting for age and race/ethnicity. For example, the odds of vaccine-type HPV infection were substantially increased in severe vitamin D deficiency (aOR, 3.11; 95% CI, 1.39-7.00) compared to vitamin D sufficiency. Given our finding of an inverse association between serum 25(OH)D and the odds of cervicovaginal HPV infection, future prospective studies should investigate potential causal mechanisms driving the relationship.
Womens studies|Public health|Epidemiology
Shim, Jinhee, "Association between vitamin D and the prevalence of human papillomavirus infection in women in the United States: The National Health and Nutrition Examination Survey 2003-2006" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1586836.