//Winter Vitamin D Update

Winter Vitamin D Update

Vitamin D
Essential role in immunomodulation
Innate and adaptive immune systems
Enhances innate immunity, immune peptides, anti-viral effects, disrupt viral envelopes
Suppressing the excessive expression of proinflammatory cytokines
Regulating the expression of ACE2 receptors
Epidemiological and clinical evidence, incidence, severity and mortality
Low levels
Hypertension, diabetes, cancer, cardiovascular diseases

Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study

https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub

50 patients treated with calcifediol

One required admission to the ICU (2%)

No deaths

All discharged, without complications

26 untreated patients

13 required ICU (50 %)

2 died

Calcifediol clinical trial, 1,000 patients, 15 hospitals

https://sevilla.abc.es/andalucia/cordoba/sevi-coronavirus-cordoba-calcifediol-ensayo-clinico-1000-pacientes-15-hospitales-probara-eficacia-farmaco-contra-covid-202010091322_noticia.html?ref=https:%2F%2Fwww.youtube.com

Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection

The Journal of Clinical Endocrinology & Metabolism (Accepted, 27th October 2020)

https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827

To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19

Analyze the possible influence of vitamin D status on disease severity

Retrospective

Case-control

216 COVID-19 patients

197 population-based controls

Results

Vitamin D deficiency was defined as serum 25OHD levels less than 20 ng/ml (50 nmol/L)

COVID patients group

Mean levels 13.8 ng/ml. (34.5 nmol/L)

82.2% vitamin D deficient

Community control group

Mean levels 20.9 ng/ml (52.25 nmol/L) (p less than 0.0001)

47.2% vitamin D deficient

Blood levels lower in men than in women

Evidence of protective role of Ultraviolet-B (UVB) radiation in reducing COVID-19 deaths (Nature scientific reports, 19th October 2020)

https://www.nature.com/articles/s41598-020-74825-z

Ultraviolet-B (UVB) radiation, mediated by vitamin D synthesis

Dataset of 152 countries over 108 days (nā€‰=ā€‰6,524)

A permanent unit increase in UVI is associated with a 1.2 percentage points decline in daily growth rates of cumulative COVID-19 deaths

and a 1.0 percentage points decline in the CFR daily growth rate

Globally
Minus 12% of cumulative COVID-19 deaths

Minus 38% on CFR

We find a significant negative association between UVI and COVID-19 deaths

indicating evidence of the protective role of UVB in mitigating COVID-19 deaths

If confirmed via clinical studies, then the possibility of mitigating COVID-19 deaths via sensible sunlight exposure or vitamin D intervention would be very attractive

Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239799

Association between serum 25-hydroxyvitamin D levels and its effect on adverse clinical outcomes

n = 235

Results

Based on CDC criteria, among our study patients, 74% had severe COVID-19 infection and 32.8% were vitamin D sufficient.

Vitamin D sufficiency

25(OH)D less than 30 ng/ml. (75 nmol/L)

Reduction in clinical severity

Inpatient mortality

Serum levels of C-reactive protein (CRP)

Increase in lymphocyte percentage

Vitamin D insufficiency in southern Arizona (American Journal of Clinical Nutrition)

https://academic.oup.com/ajcn/article/87/3/608/4633323

Population 26.1 ng/ml (65.25 nmol/L)

Below 20 ng/ml (50 nmol/L)

Blacks 55%

Hispanics 37.6%

Whites 22.7%

Also more obesity in first two groups

Adult Health Status Among Native American Families Participating in the Growing Resilience Home Garden Study (CDC August 22, 2019)

https://www.cdc.gov/pcd/issues/2019/19_0021.htm

Northern Arapaho and Eastern Shoshone tribes sharing the Wind River Indian Reservation (WRIR) in Wyoming reportedly die 30 years earlier than whites in the state

Nearly 80% of adults had deficient vitamin D levels ( less than 20 ng/mL; n = 167) (50 nmol/L)

Obesity

Waist circumference, associated with higher risk of obesity-related disease

Women 95%

Men 80%

Hypertension

Diabetes

EVMS CRITICAL CARE COVID-19 MANAGEMENT PROTOCOL

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

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