The role of vitamin D as a preventive strategy in COVID-19 infections: evidence from South Asia
Carukshi Arambepola, Ruwanika Seneviratne, Sumedha Wijeratne, Nalika Gunawardena, Ruwan Wijayamuni, Deepika Attygalle
doi:10.21203/rs.3.rs-3964082/v1
Background Regional evidence on prevention of COVID-19 and its sequalae by vitamin D remains inconclusive and sparse.
Aim/Objective This study aimed to determine the association between COVID-19 and Vitamin D de ciency among adults in Colombo District, Sri Lanka.
Methods A sex-matched case-control study was conducted among 104 RT-PCR-con rmed COVID-19 patients and 104 RT-PCR negative adults recruited from community. Non-fasting blood samples were analysed for serum 25(OH)D using chemiluminescence assay and vitamin D de ciency identi ed (< 50.0nmol/L).
Results Cases (34.2; SD = 15.4nmol/L) had signi cantly lower 25(OH)D compared to controls (39.8; SD = 17.8nmol/L) (p = 0.02) which persisted after adjustments (p = 0.02), along with Sinhalese ethnicity (p < 0.001). VDD was signi cantly more prevalent in cases (83.7% vs. 71.2%; crude odds ratio (OR) = 2.1; 95%-CI:1.1,4.1), although not an independent COVID-19 predictor (adjusted OR = 1.9; 95%-CI:0.6,5.7). A signi cantly lower 25(OH)D level was observed in moderate/severe cases (39.7; SD = 12.3nmol/L) vs mild (32.9; SD = 15.8nmol/L) (p = 0.015). Neither low serum concentrations nor de ciency showed an independent relationship with severity (p > 0.05). Diabetes was the sole predictor of COVID-19 severity (p = 0.022).
Conclusions Vitamin D has potential as a cost-effective primary, but not secondary, preventive strategy.
References
Alguwaihes, Sabico, Hasanato, Severe vitamin D de ciency is not related to SARS-CoV-2 infection but may increase mortality risk in hospitalized adults: a retrospective case-control study in an Arab Gulf country, Aging Clin Exp Res,
doi:10.1007/s40520-021-01831-0Amaratunga, Fernando, Haigh, Jayasinghe, The COVID-19 outbreak in Sri Lanka: A synoptic analysis focusing on trends, impacts, risks and science-policy interaction processes, Prog Disaster Sci,
doi:10.1016/j.pdisas.2020.100133Amer, Alotaibi, 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, J Transl Med,
doi:10.1186/s12967-021-02838-xAranow, Vitamin D and the Immune System, Nih.gov
D'antiga, Coronaviruses and immunosuppressed patients: The facts during the third epidemic, Liver Transpl,
doi:10.1002/lt.25756Greiller, Martineau, Modulation of the immune response to respiratory viruses by vitamin D, Nutrients,
doi:10.3390/nu7064240Haugen, Chandyo, Ulak, 25-hydroxy-vitamin D concentration is not affected by severe or non-severe pneumonia, or in ammation, in young children, Nutrients,
doi:10.3390/nu9010052Hernández, Nan, Fernandez-Ayala, Vitamin D status in hospitalized patients with SARS-CoV-2 infection, J Clin Endocrinol Metab,
doi:10.1210/clinem/dgaa733Holick, Binkley, Bischoff-Ferrari, Evaluation, treatment, and prevention of vitamin D de ciency: An endocrine society clinical practice guideline, J Clin Endocrinol Metab,
doi:10.1210/jcem.96.12Ilie, Stefanescu, Smith, The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality, Aging Clin Exp Res,
doi:10.1007/s40520-020-01570-8Kaplan, Pesce, Clinical Chemistry: Theory, Analysis, Correlation
Kiyumi, Kalra, Davies, Kalhan, The impact of vitamin d de ciency on the severity of symptoms and mortality rate among adult patients with COVID-19: A systematic review and metaanalysis, Indian J Endocrinol Metab,
doi:10.4103/ijem.ijem_115_21Lim, Bae, Kwon, Nauck, COVID-19 and diabetes mellitus: from pathophysiology to clinical management, Nat Rev Endocrinol,
doi:10.1038/s41574-020-00435-4Luo, Liao, Shen, Li, Cheng, Vitamin D de ciency is associated with COVID-19 incidence and disease severity in Chinese people, J Nutr,
doi:10.1093/jn/nxaa332Martineau, Jolliffe, Greenberg, Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis, Health Technol Assess,
doi:10.3310/hta23020Meltzer, Best, Zhang, Vokes, Arora et al., Association of vitamin D de ciency and treatment with COVID-19 incidence, bioRxiv,
doi:10.1101/2020.05.08.20095893Merzon, Tworowski, Gorohovski, Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study, FEBS J,
doi:10.1111/febs.15495Nimavat, Singh, Singh, Singh, Sinha, Vitamin D de ciency and COVID-19: A case-control study at a tertiary care hospital in India, Ann Med Surg (Lond),
doi:10.1016/j.amsu.2021.102661Nimitphong, Holick, Vitamin D status and sun exposure in southeast Asia, Dermatoendocrinol,
doi:10.4161/derm.24054Pereira, Damascena, Azevedo, De Almeida Oliveira, Da et al., Vitamin D de ciency aggravates COVID-19: systematic review and meta-analysis, Crit Rev Food Sci Nutr,
doi:10.1080/10408398.2020.1841090Petrilli, Jones, Yang, Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study, BMJ,
doi:10.1136/bmj.m1966Schlesselman, Case Control Studies: Design, Conduct, Analysis
Svensson, Hofmann, Häbel, Jernberg, Nordberg, Association between cardiometabolic disease and severe COVID-19: a nationwide case-control study of patients requiring invasive mechanical ventilation, BMJ Open,
doi:10.1136/bmjopen-2020-044486Talebi, Nejad, Yaseri, Hadadi, Association of vitamin D status with the severity and mortality of community-acquired pneumonia in Iran during 2016-2017: A prospective cohort study, Reports of Biochemistry & Molecular Biology
