Impact of Vitamin D and Zinc Deficiencies in Tropical Arboviral Diseases: A Systematic Review and Meta-Analysis

Abstract

Background: Dengue, Zika, and Chikungunya remain a persistent burden across tropical
regions. Dengue accounts for roughly 400 million cases and 40,000 deaths each year. While
Zika and Chikungunya are less deadly, they still lead to long-term health problems such as
joint pain and birth defects. Studies reveal that vitamin D and zinc affect both viral
replication and immune function. We aim to study whether low vitamin D and zinc levels
predict worse outcomes.
Methods: A comprehensive search was conducted, and we drew on both PubMed and
Scopus available through 2025, following PRISMA 2020. Studies were eligible if they
reported serum vitamin D and zinc levels in patients diagnosed with Dengue or Zika. Effect
sizes were pooled using a Der Simonian–Laird random-effects approach, yielding odds ratios
(ORs) and mean differences (MDs). Heterogeneity was assessed with Cochran’s Q and I2
metrics.
Results: Forty-eight studies met the inclusion criteria (N=9,028). Across both nutrients,
lower serum levels tracked closely with worse clinical outcomes. Vitamin D deficiency was
associated with a higher risk of severe Dengue (OR 2.33, 95% CI 1.99-2.72, I2=0%).
Similarly, among zinc-deficient patients, particularly children, the odds of severe disease
were nearly 2.6 times higher (OR 2.57, 95% CI 2.04-3.23). Furthermore, supplementation
reduced hospitalization by an average of 1.65 days (95% CI: −2.29 to −1.01). Studies on
Chikungunya and Zika were limited, with insufficient data to perform a pooled analysis.
Conclusion: In this study, we highlight how nutritional status affects arboviral disease. Lack
of nutrition, such as vitamin D and zinc, was statistically associated with a higher risk of
severe Dengue and hospitalization duration. Moreover, further extensive research on
Chikungunya and Zika viruses is needed.