Pharmacetics Magazine – Hospitalized patients with COVID-19 who had adequate levels of vitamin D showed a significant reduction in severe outcome and a lower risk of death compared with insufficient levels, new research shows.
“This study provides direct evidence that vitamin D adequacy can reduce complications including cytokine storms and eventual death from COVID-19,” said senior author Michael F. Holick, MD, PhD, of Boston University School of Medicine, Massachusetts, in a press release. statement from the institution.
The study examined hospitalized patients with severe COVID-19 in Iran, and Holick worked with lead researcher Zhila Maghbooli, MD, of the Tehran University of Medical Sciences, and colleagues, on the study published in PLoS One.
These findings follow another recently published study, in which Holick and his team found that people with adequate levels of vitamin D in the United States had a 54% reduced risk of contracting COVID-19.
Although this latest study adds to a large amount of data on the potential role of vitamin D in COVID-19, many questions and caveats remain, comments E. Michael Lewiecki, MD.
“This study adds to the accumulation of data showing an association between higher serum vitamin D levels and better outcomes in patients infected with COVID-19,” he said as quoted by Medscape Medical News.
“There is a possible biological benefit of vitamin D, as it is known to regulate innate and adaptive immunity in a way that can reduce viral load in patients exposed to SARS-CoV-2 and reduce the severity and consequences of cytokine storms.” He continued.
“However, it is important to recognize that the associations reported in observational studies do not necessarily imply a causal relationship,” warns Lewiecki, from the University of New Mexico School of Medicine in Albuquerque.
“Perhaps higher vitamin D is a marker of better health and a lower underlying risk of complications from COVID-19.” He explained.
The prevalence of low vitamin D in sun-sufficient Iran
In a recent study published in PLoS One, which involved 235 patients hospitalized for COVID-19 infection in Tehran, Iran, as of May 1, 2020, most of the patients (67.2%) had insufficient levels of vitamin D, defined as serum 25-hydroxyvitamin D [ 25 (OH) D] levels <30 ng / mL.
“Iran is a sunny country but the prevalence of vitamin D deficiency is high especially in the elderly who present with more severe clinical manifestations after exposure to SARS-CoV-2,” wrote Maghbooli and colleagues.
The mean age of those enrolled was 58.7 years, and 37.4% were 65 years or older.
Overall, 74% of patients had severe COVID-19 infection, which was determined according to Centers for Disease Control and Prevention criteria.
Those with adequate vitamin D levels (≥ 30 ng / mL) had a significantly lower prevalence of severe disease (63.6%) than those with insufficient levels (77.2%; P = 0.02).
And those with adequate levels had significantly lower levels of unconsciousness than those with insufficient levels of vitamin D (1.3% vs 8.2%; P = 0.03); the same was true for hypoxia (19.4% vs 39.2%; P = 0.004).
Among the patients, 66% had a history of chronic conditions; 36.6% had a history of diabetes, 44.4% hypertension, 1.3% immunological disorders, 1.3% chronic obstructive pulmonary disease, 22.1% heart problems, 0.9% malignancy, 5.5% pulmonary disorders, 4,3% asthma, and 3% rheumatological disorders.
However, after adjusting for factors including age, sex, body mass index (BMI), smoking, and a history of chronic medical conditions, vitamin D adequacy was still significantly associated with a reduction in the severity of COVID-19 disease (P = 0.01), so did lowering BMI (P = .02).
Do you need vitamin D supplements?
Patients with vitamin D deficiency also had significantly higher levels of the inflammatory marker C-reactive protein (P = .01) and lower lymphocyte levels (P = .03).
These data add to evidence that vitamin D has the potential to reduce the severity of the detrimental cytokine storms in COVID-19, the authors speculate.
“Indeed, the anti-inflammatory role of 1,25 (OH) 2D may explain the protective role of vitamin D against hyperimmune reactions and cytokine storms in a subgroup of patients with severe COVID-19,” they wrote.
Furthermore, vitamin D is known to modulate the renin-angiotensin pathway and decrease angiotensin converting enzyme 2, which has been implicated in COVID-19, note the authors.
But Maghbooli and his colleagues admit their study has many limitations.
“It is recommended that further studies, including randomized controlled trials, should be designed to evaluate the role of vitamin D status on the risk of developing COVID-19 infection and reducing complications and death in those infected with the virus,” they concluded.
However, most experts have repeatedly stated that randomized controlled trials are needed to draw reasonable conclusions on this issue.
“I expected a higher level of evidence from prospective randomized trials to determine if there really was a causal link,” Lewiecki told Medscape Medical News.
“Meanwhile, since vitamin D supplements are inexpensive and generally very safe, it makes sense to follow current public health guidelines to ensure adequate vitamin D and consider supplementing COVID-19 patients with vitamin D 1000-2000 IU / day,” he advised.
Maghbooli and colleagues recommend “vitamin D supplementation, according to guidelines recommended by the Endocrine Society to achieve a blood level of 25 (OH) D of at least 30 ng / mL, for children and adults to potentially reduce the risk of contracting the infection and for all COVID patients. -19 especially those hospitalized. “
Source:
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
More Evidence That Vitamin D Sufficiency Equals Less Severe COVID-19 https://www.medscape.com/viewarticle/938303
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