//Vitamin D, Large scale studies

Vitamin D, Large scale studies

Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study (Federation of European Biochemical Societies Journal)

https://febs.onlinelibrary.wiley.com/doi/full/10.1111/febs.15495

Vitamin D deficiency is a worldwide pandemic

To evaluate associations of plasma 25(OH)D levels with the likelihood of coronavirus disease infection and hospitalization

N = 7, 807

February 1st to April 30th, 2020

Participants had one previous blood test for the plasma 25(OH)D level

Suboptimal’ or ‘low’ plasma 25(OH)D. Below 30 ng/mL

Sufficiency more than 30 ng/ml. (75 nmol/L)

Insufficiency, 20 – 29 ng/ml

Deficiency less than 20 ng/ml (50 nmol/L)

7, 807 individuals

Risk by age and sex were as expected

Obesity not significantly associated with increased risk for COVID‐19 infection or hospitalization

Sufficient vitamin D levels

7, 025 tested negative

Low vitamin D levels

782 tested positive

Increased likelihood of COVID‐19 infection
Odds ratio (OR) of 1.45

Increased likelihood of hospitalisation
OR of 1.95

We concluded that low plasma 25(OH)D levels appear to be an independent risk factor for COVID‐19 infection and hospitalization.

The link between vitamin D deficiency and Covid-19 in a large population

https://www.medrxiv.org/content/10.1101/2020.09.04.20188268v1.full.pdf

52, 405 infected patients

524, 050 controls

Greater incidence of COVID-19 with lower vitamin D levels

Highest infection prevalence with lowest vitamin D levels

A significant protective effect in those who had supplemented over the previous 4 months

Joint Guidance on Vitamin D in the Era of COVID-19 from the ASBMR, AACE, Endocrine Society, ECTS, NOF, and IOF

Spend at least 15-30 minutes with direct sun exposure each day

Most older and younger adults can safely take 400-1000 IU daily

Vitamin-D and COVID-19: do deficient risk a poorer outcome? (Lancet)

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30183-2/fulltext?fbclid=IwAR0qzV-kiZcVRQ-KeBAkru6hpGUUVVhbywbU3YgV_KSNaE7X7DVmblO9ysk

Comparing data across nations, mortality from COVID-19 is clearly higher in some countries than in others

Relative vitamin D status of populations

Vitamin D supplementation could be especially important for older people

Functions

Calcium and phosphate balance

Affecting bone growth and turnover

Low vitamin D status

Associated with increased susceptibility to infectious disease

Notably, upper respiratory tract infections

Treating the lowest levels gives most percentage benefit

Vitamin D and COVID-19

Virus emerged and started its spread in the northern hemisphere at the end of 2019

When levels of 25-hydroxyvitamin D are lowest

COVID-19 mortality was significantly associated with vitamin D status in different populations

Nordic countries, widespread fortification of foods

Italy and Spain, prevalence of vitamin D deficiency, surprisingly common

Black and minority ethnic people

UK, more than four times more likely to die from COVID-19

In COVID

Vitamin D supports production of antimicrobial peptides in the respiratory epithelium

Might help to reduce the inflammatory response

Vitamin D is known to interact angiotensin- converting enzyme 2

SARS-CoV-2 down regulates expression of ACE2

Vitamin D promotes expression of this gene

Rose Anne Kenny

Trinity College Dublin

Lead investigator of the Irish Longitudinal Study on Ageing

The circumstantial evidence is very strong

we don’t have randomised controlled trial evidence, but how long do you want to wait in the context of such a crisis?

We know vitamin D is important for musculoskeletal function, so people should be taking it anyway

Vitamin D supplements should normally be given to care home residents unless there is an extremely good reason not to do so.

Adrian Martineau

Queen Mary University of London

At best vitamin D deficiency will only be one of many factors involved in determining outcome of COVID-19

but it’s a problem that could be corrected safely and cheaply

there is no downside to speak of, and good reason to think there might be a benefit

Vitamin D dose

IU mcg
400 10mcg
800 20mcg
1,000 25mcg
2,000 50mcg
4,000 100mcg