14 lines of evidence to support the critical role of Vitamin D in COVID 19 - Subhasree Ray

COVID 19 is defining the global health crisis of our time and one of the major threats posed to the world since world war two. Worldwide, scientists are racing for a safe vaccine or medicine. Amid these hustles, nutrition, one of the most crucial aspects in COVID recovery and prevention is overlooked.

Specific micronutrients (Vitamins and Minerals) are potential antioxidant and play a vital role in boosting immunity as well as keep the pathogens at bay. Vitamin D, among these micronutrients, found be of utmost importance during COVID 19 as researchers’ uncovered prevalence of Vitamin D deficiency in people who succumbed to death.

Observational studies on mortality and severity in COVID 19 patients also revealed that the pandemic is affecting people who are either overweight, obese, living with diabetes, hypertension, malnourished, and immune suppressants. Vitamin D deficiency is associated with all these conditions, directly or indirectly. 

Global Literature: Vitamin D and COVID 19:

[1] Latest trial from Spain with 76 COVID 19 patients found that calcifediol (the active form of Vit-D) reduced ICU admission & mortality in 50 patients treated w/calcifediol. only 1 among these 50 needed ICU admission in comparison to 13/26 w/out intervention.

Reference: J Ster Biochem & Mol Biol (Oct 2020)
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

[2] A cohort study reported that only 17.6% of patients required oxygen who received Vit-D, magnesium & B12 combination in comparison with 61.5% who didn't receive this combination.

Reference: Nutrition (8 Sept 2020)
A cohort study to evaluate the effect of combination Vitamin D, Magnesium and Vitamin B12 (DMB) on progression to severe outcome in older COVID-19 patients.

[3] A multivariate analysis showed that persons who are likely to have deficient vitamin D levels at the time of COVID-19 testing were at substantially higher risk of testing positive for COVID-19 than were persons who were likely to have sufficient levels.

Reference: JAMA Network Open (3 Sept 2020)
Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results

[4] A study from Iran found significant alterations in vitamin D and ACE levels as well as NLR (neutrophil to lymphocyte ratio) in the patients’ group. The contribution of those factors with the prognosis and severity of the disease has been shown.

Reference: Virus Research (Nov 2020)
Association of vitamin D with the modulation of the disease severity in COVID-19

[5] In 70 patients, researchers observed more Vitamin D deficiency among COVID positive patients and concluded worse morbidity outcomes may be seen in older adults with vitamin D deficiency and COVID-19.

Reference: BMJ, Aug 2020
Vitamin D status and outcomes for hospitalised older patients with COVID-19

[6] A retrospective, observational study with 42 patients revealed that after 10 days of hospitalization, severe vitamin D deficiency patients had a 50% mortality probability, while those with vitamin D ≥10 had a 5% mortality risk.

Reference: ResearchSquare, July 2020
Vitamin D deciency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19

[7] A hospital data of 235 patients from Iran showed Vitamin D sufficiency reduced risk for morbidity and mortality in COVID-19 patients.

Reference: SSRN, 14 July 2020
Vitamin D Sufficiency Reduced Risk for Morbidity and Mortality in COVID-19 Patients

[8] A Mexican study with 172 COVID 19 patients demonstrated patients with vitamin D serum levels below 8 ng/mL had a 3.68 higher risk of dying from COVID-19.

Reference: Medigraphic, April 2020
Deficiency of vitamin D is a risk factor of mortality in patients with COVID-19

[9] A retrospective analysis in hospitalized COVID 19 patients found that patients requiring ITU admission were more frequently vitamin D deficient than those managed on medical wards, despite being significantly younger.

Reference: MedRxiv, June 2020
Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalised with COVID-19 are associated with greater disease severity: results of a local audit of practice.

[10] A study from Belgium with 186 patients concluded vitamin D deficiency is a prevalent risk factor for severe COVID-19. Vitamin D supplementation might be inexpensive and safe mitigation for the SARS-CoV-2 pandemic.

Reference: MedRxiv, May 2020
Vitamin D deficiency as risk factor for severe COVID-19: a convergence of two pandemics

[11] Swiss study with 107 COVID 19 patients found significantly lower 25(OH)D levels in PCR-positive for SARS-CoV-2 compared with negative patients (24.6 ng/mL)

Reference: Nutrients, May 2020
25-Hydroxyvitamin D Concentrations Are Lower in Patients with Positive PCR for SARS-CoV-2

[12] Among 4,314 patients from Chicago tested for COVID-19 those with pre-existing Vitamin D deficiency were more likely to test positive for the disease in comparison to those who were having a sufficient level of Vitamin D.

Reference: MedRxiv, May 2020
Association of Vitamin D Deficiency and Treatment with COVID-19 Incidence

[13] A population-based study among 4.6 million members of Clalit Health Services (CHS) in Israel showed a strong association between vitamin D deficiency and Covid-19 occurrence. Vitamin D tests performed between 2010 and 2019.

Reference: MedRxiv, Sept 2020
The link between vitamin D deficiency and Covid-19 in a large population

[14] Israeli study in 7807 COVID 19 patients demonstrated an association between the low plasma 25(OH)D level and increased likelihood of COVID‐19 infection and of hospitalization due to the SARS‐CoV‐2 virus

Reference: Febs Press, July 2020
Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study

 

Conclusion:

An optimum level of vitamin D has a crucial function beyond bone health and curing rickets. The discovery of VDRs and Vitamin D associated enzymes in a variety of cells including cells of the innate and adaptive immune system was crucial in appreciating its role as a potent immunomodulator. Immune cells are not only a target for Vitamin D but are also able to activate the hormone locally, thus postulating for an autocrine and paracrine role for the active Vitamin D. Inadequate amounts of Vitamin D could be linked to defective functioning of the associated autocrine and paracrine circuits eventually leading to various immune abnormalities. Large clinical trials are recommended to assess the role of vitamin D in COVID 19 disease severity and mortality. State and National Govt. are encouraged to prioritize a thorough screening of vitamin D status in population followed by initiating mass prophylaxis to fight this deadly pandemic. 

 

Author Bio:

Subhasree Ray
A clinical and public health nutritionist with 8 years of experience in the field of nutrition and dietetics. Her research work (PhD) is on Ketogenic diet and refectory epilepsy. She is the recipient of ‘Young Researcher Award’ in General Pediatrics 2018, Abu Dhabi, UAE, 12-13 December 2018 and Women Leadership Award in Healthcare from World Health & Wellness Congress 2019, ABP News, 14-15 February 2019. She has authored 17 research article so far and spoke at many international and national conferences. 

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