What does this research mean for the field?

High-dose vitamin D demonstrates the greatest efficacy among nutritional supplements for preventing respiratory tract infections in children, whereas low-dose vitamin D, vitamin A, and zinc show no significant benefit over placebo. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the effectiveness of various nutritional supplements in preventing respiratory infections in children through a systematic review and network meta-analysis.

May 18, 2026BMC Infectious Diseases0 citationsOpen Access

Comparative efficacy of nutritional supplements for the prevention of respiratory tract infections in children: a systematic review and network meta-analysis

YXYanmin XingNankai University DHDongdong HuangNankai University LNLele NiuNankai University

Key Points

This research aims to evaluate the effectiveness of various nutritional supplements in preventing respiratory infections in children through a systematic review and network meta-analysis.
Conducted a systematic search on databases including PubMed and Cochrane Library up to September 2025
Included 19 randomized controlled trials involving 11,576 children under 18 years
Used traditional and Bayesian network meta-analysis with random-effects models to calculate odds ratios.
High-dose vitamin D showed a potential reduction in the risk of respiratory infections with OR = 0.76, 95% CrI (0.61, 0.94)
League table results indicated HVD ranked highest with a 82.44% SUCRA probability
No significant differences were found between low-dose vitamin D, vitamin A, zinc, and placebo.

Abstract

This study employs a network meta-analysis to compare the effectiveness of multiple nutritional supplements in preventing childhood respiratory infections. Systematically searched PubMed, Embase, Cochrane Library, Web of Science from their inception to 1 September 2025. Included studies were randomized controlled trials evaluating nutritional supplements for preventing respiratory infections in children under 18 years old. The primary outcome was the incidence of respiratory infections. Traditional meta-analysis and Bayesian network meta-analysis were conducted using random-effects models to calculate odds ratios (OR) and their 95% credible intervals (CrI). The cumulative sorted rank curve area (SUCRA) was used to rank the efficacy of each intervention. The Cochrane risk of bias tool was applied to assess the quality of included studies. A total of 19 articles involving 11, 576 children were included. Direct comparison meta-analysis showed no statistically significant differences between low-dose vitamin D, vitamin A, vitamin A combined with zinc, zinc, and placebo. Network meta-analysis formed a closed-loop network, and local inconsistency tests revealed no significant differences in either direct or indirect comparisons. The league table indicated a trend toward reduced risk of childhood respiratory infections with high-dose vitamin D (HVD) compared to placebo OR = 0. 76, 95% CrI (0. 61, 0. 94). The cumulative ordered probability (SUCRA) for each intervention was: HVD (82. 44%) > LVD (64. 81%) > Iron (57. 2%) > VAZinc (54. 56%) > Probiotics (52. 49%) > Zinc (42. 5%) > VA (23. 31%). This study indicates that among the various nutritional interventions included, HVD demonstrated the greatest potential effect in preventing respiratory infections in children. Direct comparison meta-analyses revealed no statistically significant differences between LVD, VA, VAZinc, zinc, and placebo. A network meta-analysis further supported these findings, with league table and SUCRA rankings indicating HVD may offer the optimal efficacy among all interventions. Not applicable.

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