COVID-19 and Vitamin D
The COVID-19 pandemic is the issue of the day.
Some believe that vitamin D may make a difference in terms of getting infected, the severity of infections, and mortality in the event of severe infection.
The goal of this document is to make the science more readily available.
To do this, we have surveyed the scientific literature, gathered abbreviated excerpts from the scientific literature from the abstracts and studies to highlight the basic conclusions, organized the excerpts around ten basic questions (listed below), and provided links to the original texts from which the abstracts were taken in the event that the reader may want to get more information or cross-check the excerpts.
Notes on the work include:
- The scientific literature if evolving. More research is coming out every day. This document provides information up to the end of June 2020.
- Many studies are being released in preliminary form without peer review, because of the urgency in making information available. There may be errors in the work, although this is viewed as unlikely. There may be editorial and other corrections in going from preliminary to final form. Because of these changes, some of the excerpts provided here may be different from the final excerpts.
- To make the documents more readable and comprehensible, minor changes have been made in some documents to address the following:
- widespread use of acronyms (these are expanded where not defined in the extracts from the report or abstract);
- the use of technical terms (these are defined);
- different ways of describing vitamin D in the blood (these are standardized to 25-hydroxyvitamin D);
- different units of measurement for vitamin D in the blood, which are standardized to nanomoles per litre [nmol/l], with the nanograms per millilitre indicated through a tooltip while hovering over the nanomole per litre number;
- different units for measuring the strength of supplements (international units [IU}versus micrograms [MCG]), which are standardized to international units with micrograms indicated through a tooltip while hovering over the international unit number.
- Some articles address more than one questions. These articles are repeated, with excerpts relevant to a specific key question included.
Questions and Answers
1. Does vitamin D make a difference with respiratory track infections generally?
Commentary: If it does, then it will be worth exploring whether it also makes a difference with COVID-19.
Answer: In studies related to viral and bacterial respiratory infections prior to COVID-19, blood levels of vitamin D made a difference.
A concern with COVID-10 come winter is that it could interact with seasonal influenza, and worsen outcomes for those who also have COVID-19. Thus, regardless of Vitamin D's impact on COVID-19, it may be useful for individuals to have adequate levels of Vitamin D to address seasonal influenza.
- Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis Authors: Jaykaran Charan, Jagdish P. Goyal,1 Deepak Saxena,2 and Preeti Yadav Publisher: Journal of Pharmacology & Pharmacotherapeutics Date: 2012-10 Abstract Excerpt: ...Events of respiratory tract infections were significantly lower in vitamin D group as compared to control group [Odds ratio = 0.582 (0.417 – 0.812) P = 0.001] according to random model. Results were similar in fixed model. On separate analysis of clinical trials dealing with groups of children and adults, beneficial effect of vitamin D was observed in both, according to fixed model [Odds ratio = 0.579 (0.416 – 0.805), P = 0.001 and Odd ratio = 0.653 (0.472 – 0.9040, P = 0.010 respectively]. On using random model beneficial effect persisted in children's group but became nonsignificant in adults group [Odds ratio = 0.579 (0.416 – 0.805), P = 0.001 and Odd ratio = 0.544 (0.278 – 1.063) P = 0.075 respectively]...Vitamin D supplementation decreases the events related to respiratory tract infections. There is need of more well conducted clinical trials to reach to a certain conclusion. Source: Abstract and Full Report
- Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data
Authors: Adrian R Martineau, David A Jolliffe, Richard L Hooper, Lauren Greenberg, John F Aloia, Peter Bergman, Gal Dubnov-Raz, Susanna Esposito, Davaasambuu Ganmaa, Adit A Ginde, Emma C Goodall, Cameron C Grant, Christopher J Griffiths, Wim Janssens, Ilkka Laaksi, Semira Manaseki-Holland, David Mauger, David R Murdoch, Rachel Neale, Judy R Rees, Steve Simpson Jr, Iwona Stelmach, Geeta Trilok Kumar, Mitsuyoshi Urashima, Carlos A Camargo Jr
Publisher: British Medical Journal
Abstract Excerpt: ...Vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants (adjusted odds ratio 0.88... (P)rotective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses (adjusted odds ratio 0.81...) but not in those receiving one or more bolus doses (adjusted odds ratio 0.97...). Among those receiving daily or weekly vitamin D, protective effects were stronger in those with baseline 25-hydroxyvitamin D levels < 25 nmol/L(10 mg/ml)(adjusted odds ratio 0.30...) than in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (10 ng/ml)(adjusted odds ratio 0.75....) Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted odds ratio 0.98... Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit. Source: Abstract and Full Report
- Vitamin D deficiency 2.0: an update on the current status worldwide
Authors: Karin Amrein, Mario Scherkl1, Magdalena Hoffmann, Stefan Neuwersch-Sommeregger, Markus Köstenberger, Adelina Tmava Berisha, Gennaro Martucci, Stefan Pilz1, Oliver Malle1
Publisher: European Journal of Clinical Nutrition
Abstract Excerpt: ... Severe vitamin D deficiency with a 25-hydroxyvitamin D concentration below <: 30 nmol/L 12 ng/mldramatically increases the risk of excess mortality, infections, and many other diseases, and should be avoided whenever possible. The data on a benefit for mortality and prevention of infections, at least in severely deficient individuals, appear convincing. Vitamin D is clearly not a panacea, and is most likely efficient only in deficiency. Given its rare side effects and its relatively wide safety margin, it may be an important, inexpensive, and safe adjuvant therapy for many diseases, but future large and well-designed studies should evaluate this further... Source: Abstract and Full Report
- Vitamin D supplementation could prevent and treat influenza, coronavirus, and
Authors: William B. Grant, Henry Lahore, Sharon L. McDonnell, Carole A. Baggerly, Christine B. French, Jennifer L. Aliano, And Harjit P. Bhattoa
... Observational and supplementation trials have reported higher 25-hydroxyVitamin D concentrations associated with reduced risk of dengue, hepatitis, herpesvirus, hepatitis B and C viruses, human immunodeficiency virus, influenza, respiratory syncytial virus infections, and pneumonia. Results of a community field trial reported herein indicated that 25-hydroxyVitamin D concentrations above 125 nmol/l 50 ng/ml... vs. <50 nmol/l 20 ng/mlwere associated with a 27% reduction in influenza-like illnesses. From the available evidence, we hypothesize that raising serum 25-hydroxyVitamin D concentrations through vitamin D supplementation could reduce the incidence, severity, and risk of death from influenza, pneumonia, and the current COVID-19 epidemic. Source: Pubmed Abstract Source: Abstract and Full Report Source: Abstract and Full Report [PDF]
- A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19)
Authors: Kakodkar P, Kaka N, Baig MN
Abstract Extract: ... Level I evidence ... showed that there is a 12% overall protective effect of vitamin D supplementation against bacterial and viral acute respiratory tract infection ... These protective effects increased to 19% in those individuals on the daily or weekly regimen of vitamin D compared to those dosing on a monthly bolus of vitamin D ... Furthermore, there is a 70% protective effect when vitamin D deficiency is corrected with supplementation ... This result is pertinent to the majority of individuals residing in the northern latitudes that experience vitamin D deficiency (serum 25-hydroxyVitamin D < 25 nmol/L 10 ng/ml) due to extended periods of lack of sunlight. Source: Pubmed Abstract Source: Abstract and Full Report
2. If yes, why does Vitamin D reduce the incidence of or severity of respiratory track infections generally?.
Commentary: Many studies can demonstrate relationship between Vitamin D deficiency and respiratory track infections. Understanding mechanisms through which Vitamin D reduces respiratory track infections can help establish the causal relationship between taking Vitamin D and better outcomes from respiratory track infections.
Answer to the Question: Several mechanisms have been identified to explain how Vitamin D works to reduce respiratory track infections and their severity.
- Vitamin D and Immune Function Authors: Barbara Prietl, Gerlies Treiber, Thomas R. Pieber, and Karin Amrein Publisher: Nutrients Date: 2013-07 Abstract Extract: Vitamin D metabolizing enzymes and vitamin D receptors are present in many cell types including various immune cells such as antigen-presenting-cells, T cells, B cells and monocytes. In vitro data show that, in addition to modulating innate immune cells, vitamin D also promotes a more tolerogenic immunological status. In vivo data from animals and from human vitamin D supplementation studies have shown beneficial effects of vitamin D on immune function, in particular in the context of autoimmunity... Source: Pubmed Abstract Source: Abstract and Full Report
- Vitamin D Modulation of Innate Immune Responses to Respiratory Viral Infections? Authors: Mihnea T Zdrenghea, Heidi Makrinioti, Cristina Bagacean, Andy Bush, Sebastian L Johnston, Luminita A Stanciu Publisher: Date: 2016-10-07 Abstract Extract: Vitamin D, in addition to its classical functions in bone homeostasis, has a modulatory and regulatory role in multiple processes, including host defense, inflammation, immunity, and epithelial repair. Patients with respiratory disease are frequently deficient in vitamin D, implying that supplementation might provide significant benefit to these patients. Respiratory viral infections are common and are the main trigger of acute exacerbations and hospitalization in children and adults with asthma and other airways diseases. Respiratory monocytes/macrophages and epithelial cells constitutively express the vitamin D receptor. Vitamin D, acting through this receptor, may be important in protection against respiratory infections. Whether the in vitro findings can be translated into a substantial in vivo benefit still remains uncertain. Here we review the in vitro data on the role of vitamin D in antiviral innate immunity, the data concerning the deficient levels of vitamin D in lung diseases, and the in vivo role of supplementation as protection against respiratory viral infections in healthy individuals and in patients with chronic respiratory diseases. Finally, we suggest ways of improving the effectiveness of vitamin D as an adjuvant in the prevention and treatment of acute respiratory infections. Source: Pubmed Abstract
- Vitamin D supplementation could prevent and treat influenza, coronavirus, and pneumonia infections Authors: William B. Grant, Henry Lahore, Sharon L. McDonnell, Carole A. Baggerly, Christine B. French, Jennifer L. Aliano, And Harjit P. Bhattoa Publisher: MDPI Date: 2020-03-15 Abstract Excerpt ... Vitamin D can reduce the risk of viral epidemics and pandemics in several ways. First, higher 25-hydroxyVitamin D concentrations reduce the risk of many chronic diseases, including cancers, cardiovascular disease, chronic respiratory tract infections (RTIs), diabetes mellitus, and hypertension. Patients with chronic diseases have significantly higher risk of death from RTIs than otherwise healthy people. Second, vitamin D reduces risk of RTIs through three mechanisms: maintaining tight junctions, killing enveloped viruses through induction of cathelicidin and defensins, and reducing production of proinflammatory cytokines by the innate immune system, thereby reducing the risk of a cytokine storm leading to pneumonia... Source: Pubmed Abstract Source: Abstract and Full Report Source: Abstract and Full Report [PDF]
- Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths
Authors: Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP
Abstract Extract: ... Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines...
Source: Pubmed Abstract
- A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19) Authors: Kakodkar P, Kaka N, Baig MN Publisher: Cureus Date: 2020-04-06 Abstract Extract: Vitamin D is known to mitigate the scope of acquired immunity and regenerate endothelial lining. This may be beneficial in minimizing the alveolar damage caused in ARDS (Acute Respiratory Distress System)... Source: Pubmed Abstract Source: Abstract and Full Report
- COVID-19 and vitamin D-Is there a link and an opportunity for intervention? Author: Jakovac H Publisher: American Journal of Physiology Endocrinology and Metabolism Date: 2020-05-01 Abstract Excerpt: ... a large number of well-established data showed antiviral effects of vitamin D, which can interfere directly with viral replication, but also can act in an immunomodulatory and anti-inflammatory way. The latter effects could be crucial for their assumptive beneficial effects during SARS-CoV-2 infection, since it seems that SARS-CoV-2 initially uses immune evasion mechanisms, which in some patients is followed by immune hyperreaction and cytokine storm, as a common pathogenic mechanism of acute respiratory disease syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) development, regardless of the etiological factor. In that sense, the protective effect of vitamin D has been reported in many conditions associated with pneumonia, cytokine hyperproduction, and ARDS, and vitamin D was recently proposed as a repurposed drug for influenza A H5N1 virus-induced lung injury. Additionally, some studies suggest the effectiveness of vitamin D as an adjuvant therapy along with antiretroviral agents in HIV-infected patients. Furthermore, vitamin D pretreatment was beneficial in animal models of ARDS, reducing lung permeability by modulation of renin-angiotensin system activity and ACE2 expression. The role of vitamin D in the context of viral infections is also supported by findings of certain vitamin D receptor gene (VDR) alleles that are associated with increased susceptibility to respiratory infections, as well as with the progression of HIV infection... Source: Pubmed Abstract
- Improving vitamin D status in the management of COVID-19 Authors: Maryam Ebadi & Aldo J. Montano-Loza Publisher: European Journal of Clinical Nutrition (2020) Date: 2020-05-12 Article Excerpt: ... Considering the range of beneficial effects ascribed to vitamin D, its safety and ease of administration, as well as direct effects of vitamin D on immune cell proliferation and activity, pulmonary ACE2 expression and reducing surface tension, evaluation of vitamin D supplementation as an adjuvant therapeutic intervention could be of substantial clinical and economic significance. Empiric intervention with vitamin D is a clinical decision that can be justified by low serum levels and the risk of impaired immune system. Importantly, improvement in circulating 25-hydroxyvitamin D levels opens possibilities for slowing disease progression or even improving survival of patients... Source: Full Report
3. Do these mechanisms for respiratory track infections in general work also apply to COVID-19?
Commentary: COVID-19 is different from bacterial infections, and other viral infections. This raises the question whether Vitamin D also works for COVID 19
Answer to the Question: Several studies link Vitamin D deficiency to increased risks of COVID-19 infections and their severity.
- Vitamin D on Prevention and Treatment of COVID-19 (COVITD-19) Author/Sponsor: Manuel Castillo Garzón/Universidad de Granada Publisher: ClinicalTrials.gov Date: First Posted: 2020-04-03 Update Posted 2020-04-07 Brief Summary: ...Reduced levels of vitamin D in calves were positioned as the main cause of bovine coronavirus infection in the past. Therefore, it seems plausible that the use of vitamin D as a nutritional ergogenic aid could be a potential intervention to fight against COVID-19 infected patients which remain asymptomatic or which have non-severe and severe symptoms... Source: Study Details
- The Role of Vitamin D in Suppressing Cytokine Storm in COVID-19 Patients and Associated Mortality Authors: Ali Daneshkhah, Adam Eshein, Hariharan Subramanian1, Hemant K. Roy, Vadim Backman Publisher: medrxiv Date: 2020-04-10 Abstract Excerpt: To investigate the possible role of Vitamin D (Vit D) deficiency via unregulated inflammation in COVID-19 complications and associated mortality. ... We observed an inverse correlation (correlation coefficient ranging from -0.84 to -1) between high C-Reactive Protein and 25-hydroxyVitamin D. Age and the family income status also correlated to high C-Reactive Protein and subjects with higher age and lower family income presented more incidences of high C-Reactive Protein. Our analysis determined a possible link between high C-Reactive Protein and Vit D deficiency and calculated an OR of 1.8 with 95%CI (1.2 to 2.6) among the elderly (age greater than or equal to 60 yo) in low-income families and an OR of 1.9 with 95%CI (1.4 to 2.7) among the elderly (age greater than or equal to 60 yo) in high-income families. COVID-19 patient-level data shows a notable OR of 3.4 with 95%CI (2.15 to 5.4) for high C-Reactive Protein in severe COVID-19 patients...Given that C-Reactive Protein is a surrogate marker for cytokine storm and is associated with Vit D deficiency, based on retrospective data and indirect evidence we see a possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine storm.... Source: Abstract and Full Report
- Covid-19 and Vitamin D Supplementation: a Multicenter Randomized Controlled Trial of High Dose Versus Standard Dose Vitamin D3 in High-risk COVID-19 Patients (CoVitTrial) Author/Sponsor: University Hospital, Angers; Collaborator: Mylan Laboratories Publisher: ClinicalTrials.gov Date: Update Posted 2020-05-06 Brief Summary:...Preclinical research suggests that the SARS-Cov-2 virus enters cells via the angiotensin converting enzyme 2 (ACE2). Coronavirus viral replication downregulates ACE2, thereby dysregulating the renin-angiotensin system (RAS) and leading to a cytokine storm in the host, causing acute respiratory distress syndrome (ARDS)....Research also shows that vitamin D plays a role in balancing RAS and in reducing lung damage. On the contrary, chronic hypovitaminosis D induces pulmonary fibrosis through activation of RAS. Similarly, hypovitaminosis D has been strongly associated in the literature with ARDS, as well as with a pejorative vital prognosis in resuscitation but also in geriatric units, and with various comorbidities associated to deaths during SARS-Cov-2 infections. Conversely, vitamin D supplementation has been reported to increase immunity and to reduce inflammatory responses and the risk of acute respiratory tract infections... Source: Study Details
- Tripartite combination of potential pandemic mitigation agents: Vitamin D, Quercetin, and Estradiol manifest properties of candidate medicinal agents for mitigation of the severity of pandemic COVID-19 defined by genomics-guided tracing of SARS-CoV-2 targets in human cells Author: Gennadi Glinsky Publisher: Chemrxiv Date: Preprint revised 2020-05-11 Abstract: Genes required for SARS-CoV-2 entry into human cells, ACE2 and FURIN, were employed as baits to build genomics-guided molecular maps of up-stream regulatory elements, their expression and functions in human body ... Repressors and activators of the ACE2 and FURIN genes were identified based on the analyses of gene silencing and overexpression experiments as well as relevant transgenic mouse models. Panels of repressors ... and activators ... were then employed to identify existing drugs manifesting gene expression signatures of the potential coronavirus infection mitigation agents. Using this strategy, Vitamin D and Quercetin have been identified as putative COVID-19 mitigation agents... In agreement with this notion, ... Vitamin D may interfere with functions of 19 of 27 (70%) of the SARS-CoV-2 proteins by altering expression of 84 of 332 (25%) of human genes encoding protein targets of SARS-CoV-2. Considering the potential effects of both Quercetin and Vitamin D, the inference could be made that functions of 25 of 27 (93%) of SARS-CoV-2 proteins in human cells may be altered. ... [G]ene expression profiles of Vitamin D and Quercetin activities and their established safety records as over-the-counter medicinal substances strongly argue that they may represent viable candidates for further considerations of their potential utility as COVID-19 pandemic mitigation agents.... Source: Full Report
- Vitamin D Receptor stimulation to reduce Acute Respiratory Distress Syndrome (ARDS) in patients with Coronavirus SARS-CoV-2 infections: Revised Ms SBMB 2020_166
Author: Quesada-Gomez JM, Castillo ME, Bouillon R
Publisher: J Steroid Biochem Mol Biol.
Abstract: Based on many preclinical studies and observational data in humans, ARDS may be aggravated by vitamin D deficiency and tapered down by activation of the vitamin D receptor. Several randomized clinical trials using either oral vitamin D or oral Calcifediol (25OHD) are ongoing. Based on a pilot study, oral calcifediol may be the most promising approach. These studies are expected to provide guidelines within a few months.
Source: Free PMC article
- The possible pathophysiology mechanism of cytokine storm in elderly adults with COVID-19 infection: the contribution of "inflame-aging"
Author: Meftahi GH, Jangravi Z, Sahraei H, Bahari Z
Publisher: Inflamm Res.
Study Conclusions: ... it seems that young adults have balanced between pro-inflammatory and anti-inflammatory cytokine networks (Fig. 1). Therefore, their balanced immune system can limit the progression of COVID-19 infection. However, elderly patients do not have the same balanced immune response as young adults... with advancing age, the immune system appears to maintain a condition of mild inflammation. So, the activation of the body with pathogens, such as COVID-19 infection can exaggeratedly increase the amplitude of the immune response, which is known as a cytokine storm. As mentioned above, alteration of ACE2 receptor expression, oxidative stress, adipose tissue- and immune-senescent cell activity, lack of VD content, as well as decrease of autophagy and mitophagy may contribute to high amplitude of the immune response to external challengers in elderly adults. This high amplitude of the immune response in elderly adults can favor induction of the cytokine storm and death in severe and critical cases of COVID-19 infection...
Source: Free PMC article
- Possible role of vitamin D in Covid-19 infection in pediatric population
Panfili FM, Roversi M, D'Argenio P, Rossi P, Cappa M, Fintini D
Publisher: J Endocrinol Invest.
Abstract: Vitamin D proved to interact both with the innate immune system, by activating Toll-like receptors (TLRs) or increasing the levels of cathelicidins and ß-defensins, and adaptive immune system, by reducing immunoglobulin secretion by plasma cells and pro-inflammatory cytokines production, thus modulating T cells function....we suggest that vitamin D supplementation might play a role in the prevention and/or treatment to SARS-CoV-2 infection disease, by modulating the immune response to the virus both in the adult and pediatric population.
Source: Free PMC article Free PMC article. Review.
- AhR and IDO1 in pathogenesis of Covid-19 and the "Systemic AhR Activation Syndrome" Translational review and therapeutic perspectives
Author: Turski WA, Wnorowski A, Turski GN, Turski CA, Turski L
Publisher: Restor Neurol Neurosci.
Abstract: ...After entry into cells, corona viruses (CoV) activate aryl hydrocarbon receptors (AhRs) by an indoleamine 2,3-dioxygenase (IDO1)-independent mechanism, bypassing the IDO1-kynurenine-AhR pathway. The IDO1-kynurenine-AhR signaling pathway is used by multiple viral, microbial and parasitic pathogens to activate AhRs and to establish infections. AhRs enhance their own activity through an IDO1-AhR-IDO1 positive feedback loop prolonging activation induced by pathogens. Direct activation of AhRs by CoV induces immediate and simultaneous up-regulation of diverse AhR-dependent downstream effectors, and this, in turn, results in a "Systemic AhR Activation Syndrome" (SAAS) consisting of inflammation, thromboembolism, and fibrosis, culminating in multiple organ injuries, and death... We hypothesize that elimination of factors known to up-regulate AhRs, or implementation of measures known to down-regulate AhRs, should decrease severity of infection. ...medications in clinical use such as dexamethasone may down-regulate both AhR and IDO1 genes, as calcitriol/vitamin D3 may down-regulate the AhR gene, and tocopherol/vitamin E may down-regulate the IDO1 gene. Supplementation of calcitriol should therefore be subjected to epidemiological studies and tested in prospective trials for prevention of CoV infections, as should tocopherol, whereas dexamethasone could be tried in interventional trials...
- A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: Implications for a potential treatment for COVID-19
Author: Malek Mahdavi A
Publisher: Rev Med Virol.
Abstract: ... Angiotensin-converting enzyme 2 (ACE2), a part of the renin-angiotensin system (RAS), serves as the major entry point into cells for SARS-CoV-2 which attaches to human ACE2, thereby reducing the expression of ACE2 and causing lung injury and pneumonia. Vitamin D, a fat-soluble-vitamin, is a negative endocrine RAS modulator and inhibits renin expression and generation. It can induce ACE2/Ang-(1-7)/MasR axis activity and inhibits renin and the ACE/Ang II/AT1R axis, thereby increasing expression and concentration of ACE2, MasR and Ang-(1-7) and having a potential protective role against acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Therefore, targeting the unbalanced RAS and ACE2 down-regulation with vitamin D in SARS-CoV-2 infection is a potential therapeutic approach to combat COVID-19 and induced ARDS.
4. Is there a relationship between vitamin D levels of people infected with COVID 19 and different populations?
Commentary: If there is a relationship, it is worthwhile to look at the impact of Vitamin D levels on COVID-19. To understand the disease, it is also worthwhile to understand why this relationship exists so that outcomes can be improved.
Answer to Question: Studies of the COVID-19 infections and severity suggest a relationship between COVID-19 infections and severity when one looks at populations in terms of geography (e.g. country-level and latitude-level infections), demographics (e.g. age, gender, skin colour), and health status (e.g. obesity).
- Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths
Authors: Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP
Date: 2020-04-02... Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D ... concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25-hydroxyVitamin D concentration... To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25-hydroxyVitamin D concentrations, followed by 5000 IU/d. The goal should be to raise 25-hydroxyVitamin D concentrations above 100-150 nmol/L 40-60 ng/mL. For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful... Source: Pubmed Abstract Source: Abstract
- Vitamin D Insufficiency is Prevalent in Severe COVID-19 Authors: Frank H. Lau, Rinku Majumder, Radbeh Torabi, Fouad Saeg, Ryan Hoffman, Jeffrey D. Cirillo, Patrick Greiffenstein Publisher: Medrix Date: 2020-04-24 Abstract Excerpt:... Vitamin D Insufficiency is highly prevalent in severe COVID-19 patients. Vitamin D Insufficiency and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction. Thus, we suggest that prospective, randomized controlled studies of Vitamin D Insufficiency in COVID-19 patients are warranted. Source: Medrix
- The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality Authors: Petre Cristian Ilie, Simina Stefanescu & Lee Smith Publisher: Aging Clinical and Experimental Research (2020) Date: 2020-05-06 Abstract Exerpt: ... The mean levels of vitamin D for 20 European countries and morbidity and mortality caused by COVID-19 were acquired. Negative correlations between mean levels of vitamin D ... in each country and the number of COVID-19 cases ... were observed. Vitamin D levels are severely low in the aging population especially in Spain, Italy and Switzerland.... Source: Abstract and Full Report
- Vitamin D and Inflammation: Potential Implications for Severity of Covid-19
Author: Laird E, Rhodes J, Kenny RA
Publisher: Ir Med J.
Abstract: Counter-intuitively, lower latitude and typically 'sunny' countries such as Spain and Italy (particularly Northern Italy), had low mean concentrations of 25hydroxyVitamin D and high rates of vitamin D deficiency. These countries have also been experiencing the highest infection and death rates in Europe. The northern latitude countries (Norway, Finland, Sweden) which receive less UVB sunlight than Southern Europe, actually had much higher mean 25hydroxyVitamin D concentrations, low levels of deficiency and for Norway and Finland, lower infection and death rates. The correlation between 25-hydroxyvitamin D concentration and mortality rate reached conventional significance ... Optimising vitamin D status to recommendations by national and international public health agencies will certainly have benefits for bone health and potential benefits for Covid-19...
- Scientific Strabismus' or Two Related Pandemics: COVID-19 & Vitamin D Deficiency Authors: Kara M, Ekiz T, Ricci V, Kara Ö, Chang KV, Özçakar L Publisher: British Journal of Nutrition Date: 2020-05-12 Abstract Excerpt: ... A quadratic relationship was found between the prevalences of vitamin D deficiency in most commonly affected countries by COVID-19 and the latitudes. Vitamin D deficiency is more common in the subtropical and midlatitude countries than the tropical and high latitude countries. The most commonly affected countries with severe vitamin D deficiency are from the subtropical (Saudi Arabia; 46%, Qatar; 46%, Iran; 33.4%, Chile; 26.4%) and midlatitude (France; 27.3%, Portugal; 21.2% and Austria; 19.3%) regions. Severe vitamin D deficiency was found to be nearly 0% in some high latitude countries (e.g. Norway, Finland, Sweden, Denmark and Netherlands). Accordingly, we would like to call attention to the possible association between severe vitamin D deficiency and mortality pertaining to COVID-19. Given its rare side effects and relatively wide safety, prophylactic vitamin D supplementation and/or food fortification might reasonably serve as a very convenient adjuvant therapy for these two worldwide public health problems alike. Source: Pubmed Abstract
- Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank
Raisi-Estabragh Z, McCracken C, Bethell MS, Cooper J, Cooper C, Caulfield MJ, Munroe PB, Harvey NC, Petersen SE
Publisher: J Public Health (Oxf)
Abstract: ... There was over-representation of men and BAME (Black, Asian and Minority Ethnic) ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25-hydroxyvitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations...In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25-hydroxyvitamin D levels or socio-economic factors...
- Role of vitamin D in preventing of COVID-19 infection, progression and severity
Author: Ali N
Publisher: J Infect Public Health.
Abstract: ... this study determined the correlation of vitamin D levels with COVID-19 cases and deaths in 20 European countries as of 20 May 2020. A significant negative correlation (p=0.033) has been observed between mean vitamin D levels and COVID-19 cases per one million population in European countries... Some retrospective studies demonstrated a correlation between vitamin D status and COVID-19 severity and mortality, while other studies did not find the correlation when confounding variables are adjusted.
Source: Free PMC article.
- COVID-19 Fatalities, Latitude, Sunlight, and Vitamin D
Author: Whittemore PB
Publisher: Am J Infect Control.
Abstract: A highly significant, positive correlation was found between lower death rates and a country's proximity to the equator (Pearson r = .40 p<.0001, two-tailed t-test). The R squared of .16 means that 16% of the variation in death rates among nations is accounted for by the latitude of the country. Evidence is presented suggesting a direct correlation between sunlight exposure and reduced mortality... Further research is needed to confirm the correlation between latitude and COVID-19 fatalities, and to determine the optimum amounts of safe sunlight exposure and/or vitamin D oral supplementation to reduce COVID-19 fatalities in populations that are at high risk for vitamin D deficiency...
Source: Free PMC article Free PMC article.
- Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients
Author: Mendy A, Apewokin S, Wells AA, Morrow AL
Publisher: Version 2. medRxiv.
Abstract: ...the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared to non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, COPD, chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with both hospitalization and disease severity...
Source: Free PMC article
- Perspective: Vitamin D deficiency and COVID-19 severity - plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2, and thrombosis (R1)
Author: Rhodes JM, Subramanian S, Laird E, Griffin G, Kenny RA
Publisher: J Intern Med.
Abstract: Substantial evidence supports a link between vitamin D deficiency and COVID-19 severity but it is all indirect. Community-based placebo-controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID-19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25-hydroxyvitamin D levels. Meanwhile vitamin D supplementation should be strongly advised for people likely to be deficient.
- Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths Authors: Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP Publisher: Nutrients Date: 2020-04-02... Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D ... concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25-hydroxyVitamin D concentration... To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25-hydroxyVitamin D concentrations, followed by 5000 IU/d. The goal should be to raise 25-hydroxyVitamin D concentrations above
5. Is there a relationship between vitamin D levels of people who are severely affected and their outcomes e.g death, length of stay in hospital, etc.?
Commentary: If there is a relationship, then it becomes worthwhile to understand whether outcomes are improved with higher Vitamin D levels and reduced with lower levels. If outcomes are improved with higher levels, then the impact of the disease can be reduced.
Answer to Question: Several studies of patients with COVID-19 have shown that better outcomes are associated with higher Vitamin D levels.
- Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) Author: Mark Alipio Publisher: SSRN Date: 2020-04-09: Last revised: 2020-05-07 Abstract Excerpt: ...A retrospective multicentre study of 212 cases with laboratory-confirmed infection of SARS-CoV-2 was conducted... Of the 212 cases of COVID-19, majority had ordinary clinical outcome...... Serum 25-hydroxyVitamin D level was lowest in critical cases, but highest in mild cases. Serum 25-hydroxyvitamin D were statistically significant among clinical outcomes. Majority had insufficient Vitamin D status, most of them were not severe. Vitamin D status is significantly associated with clinical outcomes... (F)or each standard deviation increase in serum 25-hydroxyvitamin D, the odds of having a mild clinical outcome rather than a severe outcome were approximately 7.94 times ... while interestingly, the odds of having a mild clinical outcome rather than a critical outcome were approximately 19.61 times.... The results suggest that an increase in serum 25-hydroxyVitamin D level in the body could either improve clinical outcomes or mitigate worst (severe to critical) outcomes, while a decrease in serum 25-hydroxyvitamin D level in the body could worsen clinical outcomes of COVID-2019 patients... Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-19... Source: Abstract and Full Report
- Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study Authors: Prabowo Raharusun, Sadiah Priambada, Cahni Budiarti, Erdie Agung, Cipta Budi Publisher: SSRN Date: 2020-04-26 Posted: 2020-04-30 Revised: 2020-05-06 Abstract Extract: This is a retrospective cohort study which included two cohorts (active and expired) of 780 cases with laboratory-confirmed infection of SARS-CoV-2 in Indonesia. ...[O]lder and male cases with pre-existing condition and below normal Vitamin D levels were associated with increasing odds of death. When controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality outcome of cases. Source: Abstract and Full Report
- 25-Hydroxyvitamin D Concentrations Are Lower in Patients with Positive PCR for SARS-CoV-2
Authors: D'Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, Keller F, Cantù M
Whatever: ... we retrospectively investigated the 25-hydroxyvitamin D ... concentrations in plasma obtained from a cohort of patients from Switzerland. In this cohort, significantly lower 25-hydroxyVitamin D levels (p = 0.004) were found in PCRa type of antigen test for the virus-positive for SARS-CoV-2 (median value27.75 nmol/L 11.1 ng/mL) patients compared with negative patients (61.5 nmol/L24.6 ng/mL); this was also confirmed by stratifying patients according to age >70 years. On the basis of this preliminary observation, vitamin D supplementation might be a useful measure to reduce the risk of infection... Source: Pubmed Abstract Source: Full Report Access
6. Do those with "adequate" levels of vitamin D in their blood are less likely to become infected than those who have lower levels?
Commentary: This question gets at the question whether "adequate" levels of Vitamin D in the blood can protect against getting COVID-19. Answering the question requires an understanding of who is infected and who is not. It also requires an understanding of "adequate" levels of Vitamin D in the blood.
Answer to Question: Although the question is difficult to answer, one study tried to address the question by comparing health records and Vitamin D levels in a large group, to determine whether Vitamin D levels were related to health records of confirmed COVID-19 cases.
- Vitamin D Concentrations and COVID-19 Infection in UK Biobank Authors: Claire E Hastie, Daniel F Mackay, Frederick Ho, Carlos A Celis-Morales, Srinivasa Vittal Katikireddi, Claire L Niedzwiedz, Bhautesh D Jani, Paul Welsh, Frances S Mair, Stuart R Gray, Catherine A O'Donnell, Jason Mr Gill, Naveed Sattar, Jill P Pell Publisher: Diabetes and Metaboli Syndrome Date: 2020-05-07 Abstract Excerpt: ... Complete data were available for 348,598 UK Biobank participants. Of these, 449 had confirmed COVID-19 infection. Vitamin D was associated with COVID-19 infection univariably (OR = 0.99; 95% CI 0.99-0.999; p = 0.013), but not after adjustment for confounders (OR = 1.00; 95% CI = 0.998-1.01; p = 0.208). Ethnicity was associated with COVID-19 infection univariably (blacks versus whites OR = 5.32, 95% CI = 3.68-7.70, p-value <0.001; South Asians versus whites OR = 2.65, 95% CI = 1.65-4.25, p-value<0.001). Adjustment for 25-hydroxyVitamin D concentration made little difference to the magnitude of the association... Our findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection. Source: Pubmed Abstract Source: Abstract and Full Report
7. As a treatment for COVID-19, have double blind placebo controlled clinical trials been undertaken?
Commentary: If so, what did they find? If not, when are they due?
Answer to Question: At the time of this report, there were two clinical trials involving Vitamin D supplementation and COVID-19. One trial was looking at older patients with severe forms of the disease, while the other trial was looking at non-severe patients in the 40 to 70 age group.The clinical trials were not looking at whether "adequate levels" of Vitamin D before acquiring COVID-19 reduced the risks of getting of the disease or reduced the impact of the disease. There are difficulties in designing such as study because ethics prevents a typical clinical trial in which one group is given a Vitamin D supplement, another group is given a placebo, both groups are exposed to the disease, and outcomes are compared.
- Vitamin D on Prevention and Treatment of COVID-19 (COVITD-19) Author/Sponsor: Manuel Castillo Garzón/Universidad de Granada Publisher: ClinicalTrials.gov Date: First Posted: 2020-04-03 Update Posted 2020-04-07 Brief Summary: Study Type: Interventional (Clinical Trial)...Estimated Enrollment: 200 participants... Ages Eligible for Study: 40 Years to 70 Years...Inclusion Criteria: Non-severe symptomatic patients who present cough, fever, nasal congestion, gastrointestinal symptoms, fatigue, anosmia, ageusia or alternative signs of respiratory infections... Allocation: Randomized...Primary Purpose: Treatment ...Official Title: Effect of Vitamin D Administration on Prevention and Treatment of Mild Forms of Suspected Covid-19...The intervention group will receive a single dose of 25000 UI of vitamin D supplement in addition to prescription of NSAIDs, ACE2 inhibitor, ARB or thiazolidinediones, according to clinician criteria, based on the current recommendations...Active Comparator: Usual care... Estimated Study Start Date: April 10, 2020...Estimated Primary Completion Date: June 30, 2020...Estimated Study Completion Date: June 30, 2020...ADD Clinical Trial Data Source: Study Details
- Covid-19 and Vitamin D Supplementation: a Multicenter Randomized Controlled Trial of High Dose Versus Standard Dose Vitamin D3 in High-risk COVID-19 Patients (CoVitTrial) Author/Sponsor: University Hospital, Angers; Collaborator: Mylan Laboratories Publisher: ClinicalTrials.gov Date: Update Posted 2020-05-06 Brief Summary:...We hypothesize that high-dose vitamin D supplementation improves the prognosis of older patients diagnosed with COVID-19 compared to a standard dose of vitamin D...260 participants...Inclusion Criteria: Age = 70 years old...Infection with COVID-19 diagnosed with RT-PCR SARS-CoV-2 or withCT-scan of the chest suggesting viral pneumonia of peripheral predominance in a clinically relevant context...Diagnosed within the preceding 3 days...Actual Study Start Date: April 15, 2020...Estimated Primary Completion Date: July 2020...Estimated Study Completion Date: July 2020... Source: Study Details
8. What is a "sufficient" level of vitamin D in the blood for preventing, or reducing the impact, of respiratory diseases in general, and COVID-19 in particular?
Commentary: When one has a blood test for Vitamin D, the normal or sufficiency range defined by blood testing labs appears to be 76 to 250 nanomoles per litre, with deficiency defined as less than 25, insufficiency defined as 25 to 75, and toxicity defined as greater than 250. Some medical organizations suggest 120 nanomoles per litre is optimal. The Mayo Clinic in 2018 defined the normal range for healthy adults as 50 to 125 nanomoles per litre. These numbers were developed before the COVID-19 pandemic, and are presumably set to optimize health in general, rather than health specific to respiratory track infections or COVID-19
Answer to Question: The answer to the question is controversial. The subject has not been conclusively studied, and there is no scientific or medical consensus on the matter. For example, government agencies have not carried out the usual extensive process needed to determine the Recommended Dietary Allowaince (RDA). In this situation, one is left with expert opinions. The best opinion comes from the authors of an authoritative review in 2017 that concluded that blood levels of Vitamin D improve outcomes from respiratory track infections. This opinion was that blood levels should be in the 100 to 150 nanomoles per litre range.
Note that there is a Recommended Dietary Allowance related to Vitamin D, but that amount was determined with regard to conditions other than respiratory tract infections.
- The Vitamin D Deficiency Pandemic: Approaches for Diagnosis, Treatment and Prevention Publisher: Reviews in Endocrine and Metabolic Disorders Author: Michael F Holick Date: 2017-06 Abstract Extract: ...Vitamin D deficiency and insufficiency is a global health issue that afflicts more than one billion children and adults worldwide. The consequences of vitamin D deficiency cannot be under estimated. There has been an association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders. This review is to put into perspective the controversy surrounding the definition for vitamin D deficiency and insufficiency as well as providing guidance for how to treat and prevent vitamin D deficiency. Source: Pubmed Abstract Source: Full Report and Abstract
- Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths
Authors: Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP
Date: 2020-04-02... To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25-hydroxyVitamin D concentrations, followed by 5000 IU/d. The goal should be to raise 25-hydroxyVitamin D concentrations above 100-150 nmol/L 40-60 ng/mL. For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful... Source: Pubmed Abstract Source: Abstract
9. If one does not know one's blood levels, how is one to determine whether supplementation is warranted?
Commentary: The factors which help determine blood levels of Vitamin D are understood. Natural levels of Vitamin D are created in the skin in response to sunlight. The rule is the more sunlight, the more Vitamin D. Factors affecting the creation of Vitamin D include the latitude at which one lives, whether it is summer or winter, how much one is outdoors, how much clothing one wears, whether one uses sunscreens, one's skin colour, and one's age. Persons that are overweight may be able to create Vitamin D but not utilize it effectively in the body. In addition to natural factors, some countries supplement processed food with Vitamin D, so one's Vitamin D levels in the blood are influenced by the extent to which one consumes these supplemented foods.
Answer to Question: Blood levels of Vitamin D have been studied at the country level. These levels can be useful in determining one's blood levels of Vitamin D.
- Vitamin D blood levels of Canadians
Authors: Teresa Janz and Caryn Pearson
Publisher: Statistics Canada Date: 2013-01-10 Highlights: ...A minority of Canadians (34%) took a supplement containing vitamin D ... On average, females had a higher concentration of vitamin D in their blood than males... The youngest and oldest age groups had levels of vitamin D that were notably higher than the national average of64 nmol/L 25.6 ng/ml. The average level of vitamin D for 3- to 5-year olds was74 nmol/L 29.6 ng/ml, while the average was67 nmol/L 26.8 ng/mlfor those aged 6 to 11, and70 nmol/L 28 ng/mlfor 60- to 79-year-olds...Overall, the average blood level for females (67 nmol/L 26.8 ng/ml) was higher than males (61 nmol/L). The largest sex differences were seen among children aged 6 to 11 and adults aged 20 to 39. Among children aged 6 to 11, males had higher average blood levels of vitamin D (72 nmol/L 28.8 ng/ml) than females (63 nmol/L 25.2 ng/ml). This was the only age group where males had higher levels than females. The average vitamin D blood level for males aged 20 to 39 was55 nmol/L 22 ng/ml, while it was66 nmol/L 26.4 ng/mlfor females ...The age and sex differences in blood levels of vitamin D may, to some extent, be related to how people in these groups obtain their vitamin D. For example, people can obtain vitamin D naturally from a few foods, including egg yolks and fatty fish such as mackerel or salmon...Vitamin D supplements are recommended for people over the age of 50 given that the body's ability to produce vitamin D from sun exposure declines with age. Supplements are also recommended for breast-fed infants as a preventative measure against rickets.... Previous research shows that those who do not take vitamin D supplements have double the rate of vitamin D deficiency than those who take supplements...Adding vitamin D to cow's milk and margarine is mandatory in Canada as a preventative measure against rickets, osteomalacia, and osteoporosis...It is also added to some foods such as: goat's milk, fortified plant-based beverages (such as fortified soy beverages), and calcium-fortified orange juice ... Those who consumed milk once or more a day also had a higher average vitamin D level (68 nmol/L 27.2 ng/ml) than Canadians who consumed milk less than once a day (59 nmol/L 23.6 ng/ml). Of those who consumed milk once or more a day, 3- to 5-year-olds and 60- to 79-year-olds had the highest average vitamin D levels of all age groups ... These two groups also had high rates of supplement use...The body's ability to produce vitamin D from the sun also declines with age. For example, a person aged 70 makes, on average, 25% of the vitamin D that a 20-year-old makes when exposed to the same amount of sunlight ... Children and adults who were overweight or obese generally had lower average vitamin D blood levels than those who were normal or underweight ... Vitamin D blood levels for obese adults were significantly lower than overweight and normal/underweight adults.. However, there were no notable differences between the overweight and normal/underweight adults. One exception was found in the 18 to 39 age group. For this age group, there were no significant differences in average vitamin D blood levels across any of the three BMI categories...Children aged 5 to 11 and adolescents aged 12 to 17 who were thin or normal weight had significantly higher average vitamin D levels (67 nmol/L) than those who were overweight or obese (61 nmol/L 24.4 ng/ml) ... Source: Statistics Canada Catalog no. 82-624-X
- Vitamin D Fact Sheet for Consumers Author: National Institutes of Health: Office of Dietary Supplements Publisher: National Institutes of Health Date: 2020-03-24 Report Extract: ... the best measure of one’s vitamin D status is blood levels of a form known as 25-hydroxyvitamin D...In general, levels below 30 nmol/L (12 ng/mL) are too low for bone or overall health, and levels above 125 nmol/L (50 ng/mL) are probably too high. Levels of 50 nmol/L or above (20 ng/mL or above) are sufficient for most people...By these measures, some Americans are vitamin D deficient and almost no one has levels that are too high. In general, young people have higher blood levels of 25-hydroxyvitamin D than older people and males have higher levels than females. By race, non-Hispanic blacks tend to have the lowest levels and non-Hispanic whites the highest. The majority of Americans have blood levels lower than 75 nmol/L (30 ng/mL). Certain other groups may not get enough vitamin D: Breastfed infants, because human milk is a poor source of the nutrient...Older adults, because their skin doesn’t make vitamin D when exposed to sunlight as efficiently as when they were young, and their kidneys are less able to convert vitamin D to its active form....People with dark skin, because their skin has less ability to produce vitamin D from the sun...People with disorders such as Crohn’s disease or celiac disease who don’t handle fat properly, because vitamin D needs fat to be absorbed...Obese people, because their body fat binds to some vitamin D and prevents it from getting into the blood. Source: Govermment Fact Sheet
- What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19?
Authors: Bauer SR, Kapoor A, Rath M, Thomas SA
Publisher: Cleve Clin J Med.
Study Excerpt: A number of randomized trials have evaluated the effect of vitamin D supplementation for the prevention of acute respiratory infections. In a meta-analysis, vitamin D supplementation decreased the incidence of acute respiratory infection. In subgroup analyses, the protective effect of vitamin D was greater in patients with baseline serum 25-hydroxyvitamin D concentrations <25 nmol/L (vs ≥ 25 nmol/L) and isolated to those receiving daily dosing (vs bolus dosing). In light of these data, a recent article recommended that patients at risk for COVID-19 consider starting daily vitamin D supplementation to raise serum 25-hydroxyvitamin D concentrations in order to reduce the risk for infection. While this strategy is unlikely to cause harm, it has not been specifically evaluated for prevention of COVID-19 infection and should be further studied before it is recommended to patients.
Source: Free article
- Diet Supplementation, Probiotics, and Nutraceuticals in SARS-CoV-2 Infection: A Scoping Review
Authors: Infusino F, Marazzato M, Mancone M, Fedele F, Mastroianni CM, Severino P, Ceccarelli G, Santinelli L, Cavarretta E, Marullo AGM, Miraldi F, Carnevale R, Nocella C, Biondi-Zoccai G, Pagnini C, Schiavon S, Pugliese F, Frati G, d'Ettorre G
Study Excerpt: The hypothesis that vitamin D supplementation can reduce the risk of COVID-19 incidence or mortality should be investigated through large-scale randomized trials. Currently, no data are available on the dosage, method of administration (daily or bolus), and safety in the setting of COVID-19; however, for the moment it is reasonable to focus on the identification and treatment of deficiencies in asymptomatic subjects as well as in patients affected by COVID-19. An Italian study group has proposed a nutritional protocol for patients with COVID-19, which also includes the supplementation of 25-hydroxyvitamin D in the presence of a deficit...
Source: Free article.
- Role of vitamin D in preventing of COVID-19 infection, progression and severity
Author: Ali N
Publisher: J Infect Public Health.
Abstract: ... In the meta-analysis, vitamin D supplementation has been shown as safe and effective against acute respiratory tract infections. Thus, people who are at higher risk of vitamin D deficiency during this global pandemic should consider taking vitamin D supplements to maintain the circulating 25-hydroxyVitamin D in the optimal levels (75-125nmol/L)...
Source: Free PMC article.
- Vitamin D blood levels of Canadians Authors: Teresa Janz and Caryn Pearson
10. If supplementation is warranted, what does one need to know about dosage and other details?
Commentary: Supplementation over 4,000 international units is not recommended.
Answer to Question: Magnesium levels appear to affect Vitamin D levels in the blood, because the enzumes that synthesize and metabolize Vitamin D are magnesium dependent. There is no simple test for magnesium levels, but many North Americans are believed to be deficient in magnesium.
- Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial
Authors: Qi Dai, Xiangzhu Zhu, JoAnn E Manson, Yiqing Song, Xingnan Li, Adrian A Franke, Rebecca B Costello, Andrea Rosanoff, Hui Nian, Lei Fan, Harvey Murff, Reid M Ness, Douglas L Seidner, Chang Yu, Martha J Shrubsole
Publisher: The American Journal of Clinical Nutrition
Abstract Excerpt: Previous in vitro and in vivo studies indicate that enzymes that synthesize and metabolize vitamin D are magnesium dependent. Recent observational studies found that magnesium intake significantly interacted with vitamin D in relation to vitamin D status and risk of mortality. According to NHANES, 79% of US adults do not meet their Recommended Dietary Allowance of magnesium...The aim of this study was to test the hypothesis that magnesium supplementation differentially affects vitamin D metabolism dependent on baseline 25-hydroxyvitamin D] concentration...The relations between magnesium treatment and plasma concentrations of 25-hydroxyVitamin D3, 25-hydroxyVitaminD2, and 24,25(OH)2D3 were significantly different dependent on the baseline concentrations of 25-hydroxyVitamin D, and significant interactions persisted after Bonferroni corrections. Magnesium supplementation increased the 25-hydroxyVitamin D3 concentration when baseline 25-hydroxyVitamin D concentrations were close to 75 nmol/L30 ng/mL, but decreased it when baseline 25-hydroxyVitamin D was higher (from ~75 to 125 nmol/L30 to 50 ng/mL). Magnesium treatment significantly affected 24,25(OH)2D3 concentration when baseline 25-hydroxyVitamin D concentration was125 nmol/L50 ng/mLbut not75 nmol/L30 ng/mL. On the other hand, magnesium treatment increased 25-hydroxyVitamin D2 as baseline 25-hydroxyVitamin D increased...Our findings suggest that optimal magnesium status may be important for optimizing 25-hydroxyVitamin D status... Source: Pubmed Abstract Source: Abstract and Full Report
- Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial Authors: Qi Dai, Xiangzhu Zhu, JoAnn E Manson, Yiqing Song, Xingnan Li, Adrian A Franke, Rebecca B Costello, Andrea Rosanoff, Hui Nian, Lei Fan, Harvey Murff, Reid M Ness, Douglas L Seidner, Chang Yu, Martha J Shrubsole Publisher: The American Journal of Clinical Nutrition Date: 2018-12 Abstract Excerpt: Previous in vitro and in vivo studies indicate that enzymes that synthesize and metabolize vitamin D are magnesium dependent. Recent observational studies found that magnesium intake significantly interacted with vitamin D in relation to vitamin D status and risk of mortality. According to NHANES, 79% of US adults do not meet their Recommended Dietary Allowance of magnesium...The aim of this study was to test the hypothesis that magnesium supplementation differentially affects vitamin D metabolism dependent on baseline 25-hydroxyvitamin D] concentration...The relations between magnesium treatment and plasma concentrations of 25-hydroxyVitamin D3, 25-hydroxyVitaminD2, and 24,25(OH)2D3 were significantly different dependent on the baseline concentrations of 25-hydroxyVitamin D, and significant interactions persisted after Bonferroni corrections. Magnesium supplementation increased the 25-hydroxyVitamin D3 concentration when baseline 25-hydroxyVitamin D concentrations were close to