More evidence that vitamin D sufficiency is equivalent to less severe COVID-19

Hospitalized patients with COVID-19 have sufficient amounts of vitamin D that show a significant reduction in severe outcomes and insufficient levels, lower risk of death than new research shows.

Senior author Michael F. Holick, MD, PhD, senior author Michael F. of Boston University School of Medicine, Massachusetts. “This study provides direct evidence that vitamin D adequacy can reduce complications including cytokine storms and ultimately death from COVID-19,” said Holick. Press statement from your institute.

The research examined hospitalized patients with severe COVID-19 in Iran, and Holik worked on the study with Tehran University of Medical Sciences MD and researcher Zilla Magbulli, MD, and colleagues, who published in happened. one more.

The findings come on the heels of another recently published study, in which Holick and his team found that people with sufficient vitamin D levels in the United States had a 54% lower risk of becoming infected with COVID-19 .

While this latest research adds a heap of data on the possible role of vitamin D in COVID-19, e. Michael Lewicki, MD, has given many questions and answers.

“This study includes an accumulation of data that shows an association between higher serum levels of vitamin D and better outcomes in patients infected with COVID-19,” he reported Medscape medical news.

“There is biological acclaim for the benefit of vitamin D, as it is known to regulate innate and adaptive immunity in ways that may reduce viral load and cytokine in patients exposed to SARS-CoV-2. Can reduce the severity and consequences of the storm. “

“However, it is important to understand that the associations reported in observational studies do not necessarily mean that there is a causal relationship,” warns Luvecki of the University of New Mexico School of Medicine in Albuquerque.

“It may be that high vitamin D is a marker of improved health and lower baseline risk of complications of COVID-19.”

Although Iran is Sunny, Vitamin D deficiency prevalence is high

In the latest study published in one more, Which included 235 patients with COVID-19 infection in Tehran, Iran, as of May 1, 2020, most patients (67.2%) had insufficient vitamin D levels, defined as serum 25-hydroxyvitamin D went. [25(OH)D] Level <30 ng / ml.

Maghbooli and colleagues stated, “Iran is a sunny country, but the prevalence of vitamin D deficiency is particularly high among the elderly who give more severe clinical manifestations after exposure to SARS-CoV-2.”

The average age of those involved was 58.7 years, and 37.4% were 65 years or older.

Overall, 74% of the patients had severe COVID-19 infection, which was defined according to the disease control and prevention criteria.

There was a significantly lower prevalence of critical illness (63.6%) with insufficient vitamin D levels (/ 30 ng / ml), with insufficient levels (77.2%); P = .02).

And those with adequate levels had lower levels of unconsciousness than inadequate vitamin D levels (1.3% vs. 8.2%); P = .03); The same was true for hypoxia (19.4% vs. 39.2%); P = .004).

However, there were no significant differences in duration of hospital stay or ICU admission between patients with and without vitamin D sufficiency.

No patient under 40 died of COVID-19 infection, whereas 207 patients over 40 had a mortality rate of 16.3%.

Among people over 40 with adequate vitamin D levels, 9.7% died of COVID-19 infection, compared to 20% with insufficient vitamin D levels.

For those with serum 25 (OH) D levels 40 ng / ml or higher, there is a 6.3% drop in mortality.

While the optimal serum level of 25 (OH) D required for a healthy immune system remains a matter of debate, these findings offer insights, noteworthy, and coauthors notes.

“A blood level of at least 40 ng / ml may be optimal for the immunomodulatory effect of vitamin D,” they write.

In patients, 66% had a history of chronic condition; 36.6% had diabetes, 44.4% hypertension, 1.3% immune disorders, 1.3% chronic obstructive pulmonary disease, 22.1% heart disorders, 0.9% malignant disease, 5.5% lung disorders, 4.3% asthma, and 3 rheumatoid disorders.

However, after adjusting for factors including age, sex, body mass index (BMI), history of smoking and chronic medical conditions, vitamin D adequacy was still associated with decreased COVID-19 disease severity (P = .01), as BMI was low (P = .02).

Is it complementary anyway?

Patients with vitamin D insufficiency also had significantly higher levels of the inflammatory marker C-reactive protein (P = .01) and low lymphocyte levels (P = .03).

These data add that vitamin D potentially reduces the severity of cytokine storms that may be harmful in COVID-19, the authors speculate.

“In fact, the anti-inflammatory role of 1,25 (OH) 2D may explain the immune over-response and the protective role of vitamin D against cytokine storms in a subgroup of patients with severe COVID-19,” they Let’s write.

In addition, vitamin D is known to modulate the renin-angiotensin pathway and the down-regulated angiotensin converting enzyme 2, which the authors implicated in COVID-19.

But Maghboli and his colleagues acknowledge that their study has several limitations.

“It is recommended that further studies, including randomized controlled trials, be designed to evaluate the status of vitamin D in people infected with the virus at the risk of developing COVID-19 infection and reducing complications and mortality. Necessity, ”they conclude.

The division of opinion on this issue continues, as reported extensively Medscape medical newsStarting back in April and May when the Emerging Association first became clear.

Nevertheless, most experts repeatedly say that randomized controlled trials are needed to draw sound conclusions on this issue.

“I think a high level of evidence is awaited from prospective randomized trials to determine if there is indeed a causal relationship” Medscape medical news.

“In the meantime, since vitamin D supplements are inexpensive and generally very safe, to ensure vitamin D adequacy and to consider supplementation of COVID-19 patients with vitamin D 1000–2000 IU / day present. It is appropriate to follow public health guidelines, ”he recommended.

Maghbooli and coworkers, with guidelines suggested by the Endocrine Society, for children and adults receiving a blood level of at least 30 ng / ml to potentially reduce the risk of infection. D supplementation is recommended. All COVID-19 patients are specifically hospitalized. ”

Holick is reported to be an advisor to Quest Diagnostics and a bureau bureau for Abbott and Hyatt Pharmaceutical Industries. Lewicki has No relevant financial relationship stated.

one more. Published on September 25, 2020. full Text

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