Vitamin D and COVID-19: where are we now?
Post Graduate Medicine https://doi.org/10.1080/00325481.2021.2017647
Victoria Contreras-Bolívar ORCID Icon,Beatriz García-Fontana ORCID Icon,Cristina García-Fontana ORCID Icon &Manuel Muñoz-Torres ORCID Icon
The pandemic caused by the SARS-CoV-2 virus has triggered great interest in the search for the pathophysiological mechanisms of COVID-19 and its associated hyperinflammatory state. The presence of prognostic factors such as diabetes, cardiovascular disease, hypertension, obesity, and age influence the expression of the disease’s clinical severity. Other elements, such as 25-hydroxyvitamin D (25(OH)D3) concentrations, are currently being studied. Various studies, mostly observational, have sought to demonstrate whether there is truly a relationship between 25(OH)D3 levels and the acquisition and/or severity of the disease. The objective of this study was to carry out a review of the current data that associate vitamin D status with the acquisition, evolution, and/or severity of infection by the SARS-CoV-2 virus and to assess whether prevention through vitamin D supplementation can prevent infection and/or improve the evolution once acquired. Vitamin D system has an immunomodulatory function and plays a significant role in various bacterial and viral infections. The immune function of vitamin D is explained in part by the presence of its receptor (VDR) and its activating enzyme 25-hydroxyvitamin D-1alpha-hydroxylase (CYP27B1) in immune cells. The vitamin D, VDR, and Retinoid X Receptor complex allows the transcription of genes with antimicrobial activities, such as cathelicidins and defensins. COVID-19 characteristically presents a marked hyperimmune state, with the release of proinflammatory cytokines such as IL-6, TNF-α, and IL-1β. Thus, there are biological factors linking vitamin D to the cytokine storm, which can herald some of the most severe consequences of COVID-19, such as acute respiratory distress syndrome. Hypovitaminosis D is widespread worldwide, so the prevention of COVID-19 through vitamin D supplementation is being considered as a possible therapeutic strategy easy to implement. However, more-quality studies and well-designed randomized clinical trials are needed to address this relevant question.
Vitamin D, Immune System, COVID infographic
UK Guidelines: Do not use Vitamin D to prevent nor treat COVID
5.3. Guidelines: vitamin D supplementation and COVID-19
An update was published by the National Institute for Health and Care Excellence (NICE): 'COVID-19 rapid guideline: vitamin D' that recommended vitamin D supplementation for people in confined spaces, those living in residences, with low sun exposure, or spending more time at home due to the COVID-19 pandemic [124]. The recommended dose is 400 IU/day of cholecalciferol. The recommended period is between October and March (indicated all year round for people without sun exposure during spring and summer). The objective proposed by the authors was to achieve levels of 25(OH)D3 > 10 ng/mL to maintain optimal bone health. The authors indicated that low 25(OH)D3 levels are associated with more severe COVID-19 outcomes. However, they also cautioned that vitamin D supplementation should not be administered solely for the purpose of preventing or treating COVID-19, as clinical trials are necessary to give this recommendation. The US National Academy of Medicine and the European Food Safety Authority recommend achieving 25(OH)D3 levels at least 20 ng/mL. For this purpose, it was indicated that supplementation should be done at 800 IU/day. In addition, in the case of hospital admissions, it is recommended that 25(OH)D3 levels be determined on admission [125]
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Vitamin D meta-analyses for Virus
- COVID-19 treated by Vitamin D (reduce ICU by 3X) - 22nd meta-analysis - Dec 29, 2021
- COVID-19 death increased 2X if low Vitamin D (less than 10 to less than 30 ng) – 21st meta-analysis Dec 2021
- COVID-19 risk reduced by vitamin D supplementation – umbrella review of 7 meta-analysis – Oct 2021
- COVID-19 treated by Vitamin D (example: ICU reduced by 5X) – 20th meta-analysis Oct 13, 2021
- Severe COVID-19 2.5 X more likely if low vitamin D (23 studies) – 19th meta-analysis Oct 2021
- COVID-19 mortality extrapolates to zero at 50 ng of vitamin D – 18th Meta-analysis Sept 2021
- COVID-19 death 1.6 X more likely if low vitamin D (24 studies) – 17th meta-analysis Aug 2021
- Severe COVID-19 5X more likely if low vitamin D (23 studies) – 16th meta-analysis July 2021
- Severe COVID-19 3.5 more likely if low vitamin D (30 studies) – meta-analysis July 2021
- COVID-19 patients who had supplemented with Vitamin D were 3X less likely to enter ICU – June 2021
- Low Calcium associated with severe COVID-19 – several studies
- COVID-19 mortality 3X more likely if low vitamin D (999,179 people) – meta-analysis March 29, 2021
- COVID-19 was 2.6X more severe if very low Vitamin D (43 studies) – meta-analysis March 26, 2021
- Low Vitamin D associated with 2.7X more severe COVID-19 – 12th MA March 5, 2021
- Vitamin D supplementation fights COVID-19 – 11th meta-analysis Jan 24, 2021
- 3.7 X less likely to die of COVID-19 if supplemented with Vitamin D - meta-analysis Jan 5, 2021
- Less likely to test positive for COVID-19 if higher Vitamin D – meta-analysis Jan 6, 2021
- Vitamin D reduces COVID-19 by 80 percent - anonymous meta-analysis - Jan 5, 2021
- COVID-19 1.7X more likely to be severe if low Vitamin D - meta-analysis Oct 2020
- Low Vitamin D associated 1.8X increased risk of COVID-19 death in hospital – meta-analysis Nov 4, 2020
- Acute viral respiratory infections (RTI) reduced by Vitamin D - 20 reviews - Aug 2020
- Prudent to consider that Vitamin D has a role in COVID-19 – meta-analysis – Aug 7, 2020
- Risk of enveloped virus infection is increased 50 percent if poor Vitamin D Receptor - meta-analysis Dec 2018
- Hepatitis B patients have 2 ng lower level of Vitamin D – meta-analysis June 2019
- Influenza Vaccination not benefited by lowish levels of vitamin D – meta-analysis March 2018