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Vitamin D status of Arab Gulf residents screened for SARS-CoV-2 and its association with COVID-19 infection: a multi-centre case–control study

Al-Daghri et al., Journal of Translational Medicine, doi:10.1186/s12967-021-02838-x
Apr 2021  
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Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,800+ studies for 98 treatments. c19early.org
Case control study with 220 adults showing significantly lower vitamin D levels in PCR+ patients.
Al-Daghri et al., 26 Apr 2021, peer-reviewed, 13 authors.
This PaperVitamin DAll
Vitamin D status of Arab Gulf residents screened for SARS-CoV-2 and its association with COVID-19 infection: a multi-centre case–control study
Nasser M Al-Daghri, Osama E Amer, Naif H Alotaibi, Dara A Aldisi, Mushira A Enani, Eman Sheshah, Naji J Aljohani, Naemah Alshingetti, Suliman Y Alomar, Hanan Alfawaz, Syed D Hussain, Abdullah M Alnaami, Shaun Sabico
Journal of Translational Medicine, doi:10.1186/s12967-021-02838-x
Objectives: Vitamin D status in patients with COVID-19 is an on-going controversial issue. This study aims to determine differences in the serum 25(OH)D concentrations of Arab Gulf adult residents screened for SARS-CoV-2 and its association with risk of COVID-19 infection together with other comorbidities. Methods: In this multi-center, case-control study, a total of 220 male and female adults presenting with none to mild symptoms were screened for COVID-19 (n = 138 RT-PCR-confirmed SARS-CoV-2 positive and 82 negative controls). Medical history was noted. Anthropometrics were measured and non-fasting blood samples were collected for the assessment of glucose, lipids, inflammatory markers and serum 25(OH)D concentrations. Results: Serum 25(OH)D levels were significantly lower in the SARS-CoV-2 positive group compared to the negative group after adjustment for age and BMI (52.8 nmol/l ± 11.0 versus 64.5 nmol/l ± 11.1; p = 0.009). Being elderly (> 60 years) [Odds ratio 6 (95% Confidence Interval, CI 2-18; p = 0.001) as well as having type 2 diabetes (T2D) [6] [7] [8] [9] [10] [11] [12] [13] [14] ; p < 0.001)] and low HDL cholesterol (HDL-c) [6] [7] [8] [9] [10] [11] [12] [13] [14] ; p < 0.001)] were significant risk factors for COVID-19 infection independent of age, sex and obesity. Conclusions: Among Arab Gulf residents screened for SARS-CoV-2, serum 25(OH) D levels were observed to be lower in those who tested positive than negative individuals, but it was the presence of old age, diabetes mellitus and low-HDL-c that were significantly associated with risk of COVID-19 infection. Large population-based randomized controlled trials should be conducted to assess the protective effects of vitamin D supplementation against COVID-19.
Abbreviations Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s12967-021-02838-x. Additional file 1: Table S1 . Differences in 25(OH)D Levels Adjusted for Different Models with Associations to Age and BMI. Table S2 . Differences in 25(OH)D Levels in Males and Females tested for SARS-Cov-2 (Unadjusted and Adjusted for Age and BMI). Authors' contributions NMA and SS conceived and designed the experiments; NAA, DAA, MAE, ES, NJA and NA recruited participants; OEA and AMA analyzed the samples; SS and SDH analyzed the data; SYA and HA contributed reagents/materials/analysis tools; OEA drafted the paper. SS revised and edited the paper. All authors read and approved the final manuscript. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Institutional Review Board (IRB) in the College of Medicine (E-20-4803), KSUMC in Riyadh, Saudi Arabia and written informed consents were obtained from all participants prior to inclusion. Consent for publication applicable. Competing interests The authors declare no conflict of interest. The sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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This study aims to determine differences in the serum 25(OH)D ' 'concentrations of Arab Gulf adult residents screened for SARS-CoV-2 and its association with ' 'risk of COVID-19 infection together with other comorbidities.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>In this multi-center, case–control study, a total of 220 male and ' 'female adults presenting with none to mild symptoms were screened for COVID-19 (n\u2009=\u2009' '138 RT-PCR-confirmed SARS-CoV-2 positive and 82 negative controls). Medical history was ' 'noted. Anthropometrics were measured and non-fasting blood samples were collected for the ' 'assessment of glucose, lipids, inflammatory markers and serum 25(OH)D ' 'concentrations.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Serum 25(OH)D levels were significantly lower in the SARS-CoV-2 ' 'positive group compared to the negative group after adjustment for age and BMI (52.8\xa0' 'nmol/l\u2009±\u200911.0 versus 64.5\xa0nmol/l\u2009±\u200911.1; p\u2009=\u20090.009). Being ' 'elderly (&gt;\u200960\xa0years) [Odds ratio 6 (95% Confidence Interval, CI 2–18; p\u2009' '=\u20090.001) as well as having type 2 diabetes (T2D) [OR 6 (95% CI 3–14); p\u2009&lt;\u2009' '0.001)] and low HDL cholesterol (HDL-c) [OR 6 (95% CI 3–14); p\u2009&lt;\u20090.001)] were ' 'significant risk factors for COVID-19 infection independent of age, sex and ' 'obesity.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>Among Arab Gulf residents screened for SARS-CoV-2, serum 25(OH) D ' 'levels were observed to be lower in those who tested positive than negative individuals, but ' 'it was the presence of old age, diabetes mellitus and low-HDL-c that were significantly ' 'associated with risk of COVID-19 infection. 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Lancet. 2020;395(10229):1054–62.', 'journal-title': 'Lancet'}, { 'key': '2838_CR18', 'doi-asserted-by': 'publisher', 'first-page': '43', 'DOI': '10.1016/j.cytogfr.2020.05.001', 'volume': '53', 'author': 'B Dariya', 'year': '2020', 'unstructured': 'Dariya B, Nagaraju GP. Understanding novel COVID-19: its impact on organ ' 'failure and risk assessment for diabetic and cancer patients. Cytokine ' 'Growth Factor Rev. 2020;53:43–52.', 'journal-title': 'Cytokine Growth Factor Rev'}, { 'issue': '5', 'key': '2838_CR19', 'doi-asserted-by': 'publisher', 'first-page': '2127', 'DOI': '10.4049/jimmunol.1102412', 'volume': '188', 'author': 'Y Zhang', 'year': '2012', 'unstructured': 'Zhang Y, Leung DY, Richers BN, et al. Vitamin D inhibits ' 'monocyte/macrophage proinflammatory cytokine production by targeting ' 'MAPK phosphatase-1. J Immunol. 2012;188(5):2127–35.', 'journal-title': 'J Immunol'}, { 'issue': '1', 'key': '2838_CR20', 'doi-asserted-by': 'publisher', 'first-page': '3312', 'DOI': '10.1038/s41598-017-03474-6', 'volume': '7', 'author': 'Y Shi', 'year': '2017', 'unstructured': 'Shi Y, Liu T, Yao L, Xing Y, Zhao X, Fu J, Xue X. Chronic vitamin D ' 'deficiency induces lung fibrosis through activation of the ' 'renin-angiotensin system. Sci Rep. 2017;7(1):3312.', 'journal-title': 'Sci Rep'}, { 'issue': '1', 'key': '2838_CR21', 'doi-asserted-by': 'publisher', 'first-page': '32', 'DOI': '10.1016/j.anl.2020.11.006', 'volume': '48', 'author': 'N Jain', 'year': '2021', 'unstructured': 'Jain N, Varman R, Tarbox JA, Nguyen T. Biomolecular endotype factors ' 'involved in COVID-19 airway infectivity: a systematic review. Auris ' 'Nasus Larynx. 2021;48(1):32–40.', 'journal-title': 'Auris Nasus Larynx'}, { 'key': '2838_CR22', 'doi-asserted-by': 'publisher', 'first-page': '198235', 'DOI': '10.1016/j.virusres.2020.198235', 'volume': '292', 'author': 'R Kumar', 'year': '2021', 'unstructured': 'Kumar R, Rathi H, Haq A, Wimalawansa SJ, Sharma A. Putative roles of ' 'vitamin D in modulating immune response and immunopathology associated ' 'with COVID-19. Virus Res. 2021;292:198235.', 'journal-title': 'Virus Res'}, { 'key': '2838_CR23', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/13813455.2020.1826530', 'author': 'H Musavi', 'year': '2020', 'unstructured': 'Musavi H, Abazari O, Barartabar Z, Kalaki-Jouybari F, Hemmati-Dinarvand ' 'M, Esmaeili P, Mahjoub S. The benefits of Vitamin D in the COVID-19 ' 'pandemic: biochemical and immunological mechanisms. Arch Physiol ' 'Biochem. 2020. https://doi.org/10.1080/13813455.2020.1826530.', 'journal-title': 'Arch Physiol Biochem'}, { 'issue': '11', 'key': '2838_CR24', 'doi-asserted-by': 'publisher', 'first-page': '3361', 'DOI': '10.3390/nu12113361', 'volume': '12', 'author': 'J Mercola', 'year': '2020', 'unstructured': 'Mercola J, Grant WB, Wagner CL. Evidence Regarding Vitamin D and Risk of ' 'COVID-19 and Its Severity. Nutrients. 2020;12(11):3361.', 'journal-title': 'Nutrients'}, { 'issue': '17', 'key': '2838_CR25', 'doi-asserted-by': 'publisher', 'first-page': '3693', 'DOI': '10.1111/febs.15495', 'volume': '287', 'author': 'E Merzon', 'year': '2020', 'unstructured': 'Merzon E, Tworowski D, Gorohovski A, Vinker S, Golan Cohen A, Green I, ' 'Frenkel-Morgenstern M. Low plasma 25(OH) vitamin D level is associated ' 'with increased risk of COVID-19 infection: an Israeli population-based ' 'study. FEBS J. 2020;287(17):3693–702.', 'journal-title': 'FEBS J'}, { 'key': '2838_CR26', 'doi-asserted-by': 'publisher', 'first-page': '102', 'DOI': '10.1016/j.jsbmb.2016.12.017', 'volume': '175', 'author': 'NM Al-Daghri', 'year': '2018', 'unstructured': 'Al-Daghri NM. Vitamin D in Saudi Arabia: prevalence, distribution and ' 'diseases associations. J Steroid Biochem Mol Biol. 2018;175:102–7.', 'journal-title': 'J Steroid Biochem Mol Biol'}, { 'issue': '3', 'key': '2838_CR27', 'doi-asserted-by': 'publisher', 'first-page': '346', 'DOI': '10.1111/j.1365-2265.2011.04219.x', 'volume': '76', 'author': 'NM Al-Daghri', 'year': '2012', 'unstructured': 'Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, El-Kholie E, Yousef ' 'M, Al-Othman A, Al-Saleh Y, Sabico S, Kumar S, Chrousos GP. Increased ' 'vitamin D supplementation recommended during summer season in the gulf ' 'region: a counterintuitive seasonal effect of vitamin D levels in adult, ' 'overweight and obese Middle-Eastern residents. Clin Endocrinol. ' '2012;76(3):346–50.', 'journal-title': 'Clin Endocrinol'}, { 'key': '2838_CR28', 'doi-asserted-by': 'publisher', 'first-page': '1', 'DOI': '10.1007/s11657-016-0295-y', 'volume': '12', 'author': 'NM Al-Daghri', 'year': '2017', 'unstructured': 'Al-Daghri NM, Al-Saleh Y, Aljohani N, Sulimani R, Al-Othman AM, Alfawaz ' 'H, Fouda M, Amri F, Shahrani A, Alharbi M, et al. Vitamin D status ' 'correction in Saudi Arabia: an experts’ consensus under the auspices of ' 'the European Society for Clinical and Economic Aspects of Osteoporosis, ' 'Osteoarthritis, and Musculoskeletal Diseases (ESCEO). Arch Osteoporos. ' '2017;12:1.', 'journal-title': 'Arch Osteoporos'}, { 'key': '2838_CR29', 'unstructured': 'Saudi Center for Disease Prevention and Control (Weqaya). Laboratory ' 'Diagnosis of COVID-19 in Suspected Cases. ' 'https://covid19.cdc.gov.sa/professionals-health-workers/laboratory-diagnosis/ ' 'Accessed 4 Jan 2021'}, { 'key': '2838_CR30', 'doi-asserted-by': 'publisher', 'first-page': '35', 'DOI': '10.1007/s11657-020-0709-8', 'volume': '15', 'author': 'Y Al Saleh', 'year': '2020', 'unstructured': 'Al Saleh Y, Beshyah SA, Hussein W, Almadani A, Hassoun A, Al Mamari A, ' 'Ba-Essa E, Al-Dhafiri E, Hassanein M, Fouda MA, et al. Diagnosis and ' 'management of vitamin D deficiency in the Gulf Cooperative Council (GCC) ' 'countries: an expert consensus summary statement from the GCC vitamin D ' 'advisory board. Arch Osteoporos. 2020;15:35.', 'journal-title': 'Arch Osteoporos'}, { 'issue': '10', 'key': '2838_CR31', 'doi-asserted-by': 'publisher', 'first-page': '981', 'DOI': '10.1002/ppul.21089', 'volume': '44', 'author': 'JD McNally', 'year': '2009', 'unstructured': 'McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg ' 'AM. Vitamin D deficiency in young children with severe acute lower ' 'respiratory infection. Pediatr Pulmonol. 2009;44(10):981–8.', 'journal-title': 'Pediatr Pulmonol'}, { 'key': '2838_CR32', 'doi-asserted-by': 'publisher', 'first-page': '423', 'DOI': '10.2147/IJGM.S149049', 'volume': '10', 'author': 'M Mamani', 'year': '2017', 'unstructured': 'Mamani M, Muceli N, Ghasemi Basir HR, Vasheghani M, Poorolajal J. ' 'Association between serum concentration of 25-hydroxyvitamin D and ' 'community-acquired pneumonia: a case-control study. Int J Gen Med. ' '2017;10:423–9.', 'journal-title': 'Int J Gen Med'}, { 'key': '2838_CR33', 'doi-asserted-by': 'publisher', 'first-page': '1149', 'DOI': '10.3758/BRM.41.4.1149', 'volume': '41', 'author': 'F Faul', 'year': '2009', 'unstructured': 'Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses ' 'using G*Power 3.1: tests for correlation and regression analyses. ' 'Behavior Res Methods. 2009;41:1149–60.', 'journal-title': 'Behavior Res Methods'}, { 'key': '2838_CR34', 'doi-asserted-by': 'publisher', 'first-page': 'e8342', 'DOI': '10.1371/journal.pone.0008342', 'volume': '4', 'author': 'R Minakshi', 'year': '2009', 'unstructured': 'Minakshi R, Padhan K, Rani M, Khan N, Ahmad F, Jameel S. The SARS ' 'Coronavirus 3a protein causes endoplasmic reticulum stress and induces ' 'ligand-independent downregulation of the type 1 interferon receptor. ' 'PLoS ONE. 2009;4:e8342.', 'journal-title': 'PLoS ONE'}, { 'key': '2838_CR35', 'doi-asserted-by': 'publisher', 'first-page': 'E589', 'DOI': '10.1152/ajpendo.00138.2020', 'volume': '318', 'author': 'H Jakovac', 'year': '2020', 'unstructured': 'Jakovac H. COVID-19 and vitamin D-Is there a link and an opportunity for ' 'intervention? 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Rev Med Virol. 2020;30(5):e2119.', 'journal-title': 'Rev Med Virol.'}, { 'issue': '6', 'key': '2838_CR40', 'doi-asserted-by': 'publisher', 'first-page': '363', 'DOI': '10.1038/s41577-020-0311-8', 'volume': '20', 'author': 'MZ Tay', 'year': '2020', 'unstructured': 'Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: ' 'immunity, inflammation and intervention. Nat Rev Immunol. ' '2020;20(6):363–74.', 'journal-title': 'Nat Rev Immunol'}, { 'issue': '2', 'key': '2838_CR41', 'doi-asserted-by': 'publisher', 'first-page': '237', 'DOI': '10.1007/s12020-020-02407-0', 'volume': '69', 'author': 'F Tramontana', 'year': '2020', 'unstructured': 'Tramontana F, Napoli N, El-Hajj Fuleihan G, Strollo R. The D-side of ' 'COVID-19: musculoskeletal benefits of vitamin D and beyond. Endocrine. ' '2020;69(2):237–40.', 'journal-title': 'Endocrine'}, { 'issue': '9', 'key': '2838_CR42', 'doi-asserted-by': 'publisher', 'first-page': '5458', 'DOI': '10.4049/jimmunol.0803217', 'volume': '183', 'author': 'LE Jeffery', 'year': '2009', 'unstructured': 'Jeffery LE, Burke F, Mura M, et al. 1,25-Dihydroxyvitamin D3 and IL-2 ' 'combine to inhibit T cell production of inflammatory cytokines and ' 'promote development of regulatory T cells expressing CTLA-4 and FoxP3. J ' 'Immunol. 2009;183(9):5458–67.', 'journal-title': 'J Immunol'}, { 'key': '2838_CR43', 'doi-asserted-by': 'publisher', 'first-page': '105', 'DOI': '10.1016/j.cca.2020.07.015', 'volume': '510', 'author': 'X Hu', 'year': '2020', 'unstructured': 'Hu X, Chen D, Wu L, He G, Ye W. Declined serum high density lipoprotein ' 'cholesterol is associated with the severity of COVID-19 infection. Clin ' 'Chim Acta. 2020;510:105–10.', 'journal-title': 'Clin Chim Acta'}, { 'issue': '8', 'key': '2838_CR44', 'doi-asserted-by': 'publisher', 'first-page': '9843', 'DOI': '10.1096/fj.202001451', 'volume': '34', 'author': 'AV Sorokin', 'year': '2020', 'unstructured': 'Sorokin AV, Karathanasis SK, Yang ZH, Freeman L, Kotani K, Remaley AT. ' 'COVID-19-Associated dyslipidemia: Implications for mechanism of impaired ' 'resolution and novel therapeutic approaches. FASEB J. ' '2020;34(8):9843–53.', 'journal-title': 'FASEB J'}, { 'key': '2838_CR45', 'doi-asserted-by': 'publisher', 'first-page': '105751', 'DOI': '10.1016/j.jsbmb.2020.105751', 'volume': '203', 'author': 'M Entrenas Castillo', 'year': '2020', 'unstructured': 'Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, Alcalá Díaz ' 'JF, López Miranda J, Bouillon R, Quesada Gomez JM. 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. J Steroid Biochem Mol ' 'Biol. 2020;203:105751.', 'journal-title': 'J Steroid Biochem Mol Biol'}, { 'issue': '11', 'key': '2838_CR46', 'doi-asserted-by': 'publisher', 'first-page': '3377', 'DOI': '10.3390/nu12113377', 'volume': '12', 'author': 'G Annweiler', 'year': '2020', 'unstructured': 'Annweiler G, Corvaisier M, Gautier J, Dubée V, Legrand E, Sacco G, ' 'Annweiler C. Vitamin D supplementation associated to better survival in ' 'hospitalized frail elderly COVID-19 patients: the GERIA-COVID ' 'quasi-experimental study. 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The sponsors had no role in the ' 'design of the study; in the collection, analyses, or interpretation of data; in ' 'the writing of the manuscript, and in the decision to publish the results.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '166'}
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