The role of vitamin D as a preventive strategy in COVID-19 infections: evidence from South Asia

{ 'institution': [{'name': 'Research Square'}], 'indexed': {'date-parts': [[2024, 3, 29]], 'date-time': '2024-03-29T01:20:21Z', 'timestamp': 1711675221200}, 'posted': {'date-parts': [[2024, 3, 28]]}, 'group-title': 'In Review', 'reference-count': 30, 'publisher': 'Research Square Platform LLC', 'license': [ { 'start': { 'date-parts': [[2024, 3, 28]], 'date-time': '2024-03-28T00:00:00Z', 'timestamp': 1711584000000}, 'content-version': 'unspecified', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2024, 2, 17]]}, 'abstract': '<jats:title>Abstract</jats:title>\n' ' <jats:p>Background\n' ' Regional evidence on prevention of COVID-19 and its sequalae by vitamin D remains ' 'inconclusive and sparse.\n' 'Aim/Objective\n' ' This study aimed to determine the association between COVID-19 and Vitamin D deficiency ' 'among adults in Colombo District, Sri Lanka.\n' 'Methods\n' ' A sex-matched case-control study was conducted among 104 RT-PCR-confirmed 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 deficiency identified ' '(&lt;\u200950.0nmol/L).\n' 'Results\n' ' Cases (34.2; SD\u2009=\u200915.4nmol/L) had significantly lower 25(OH)D compared to controls ' '(39.8; SD\u2009=\u200917.8nmol/L) (p\u2009=\u20090.02) which persisted after adjustments ' '(p\u2009=\u20090.02), along with Sinhalese ethnicity (p\u2009&lt;\u20090.001). VDD was ' 'significantly more prevalent in cases (83.7% vs. 71.2%; crude odds ratio (OR)\u2009=\u2009' '2.1; 95%-CI:1.1,4.1), although not an independent COVID-19 predictor (adjusted OR\u2009=\u2009' '1.9; 95%-CI:0.6,5.7). A significantly lower 25(OH)D level was observed in moderate/severe ' 'cases (39.7; SD\u2009=\u200912.3nmol/L) vs mild (32.9; SD\u2009=\u200915.8nmol/L) (p\u2009' '=\u20090.015). Neither low serum concentrations nor deficiency showed an independent ' 'relationship with severity (p\u2009&gt;\u20090.05). Diabetes was the sole predictor of ' 'COVID-19 severity (p\u2009=\u20090.022).\n' 'Conclusions\n' ' Vitamin D has potential as a cost-effective primary, but not secondary, preventive ' 'strategy.</jats:p>', 'DOI': '10.21203/rs.3.rs-3964082/v1', 'type': 'posted-content', 'created': {'date-parts': [[2024, 3, 28]], 'date-time': '2024-03-28T18:19:17Z', 'timestamp': 1711649957000}, 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'The role of vitamin D as a preventive strategy in COVID-19 infections: evidence from South Asia', 'prefix': '10.21203', 'author': [ { 'given': 'Carukshi', 'family': 'Arambepola', 'sequence': 'first', 'affiliation': [{'name': 'University of Colombo'}]}, { 'given': 'Ruwanika', 'family': 'Seneviratne', 'sequence': 'additional', 'affiliation': [ { 'name': 'Postgraduate Institute of Medicine, University of Colombo, Sri ' 'Lanka'}]}, { 'given': 'Sumedha', 'family': 'Wijeratne', 'sequence': 'additional', 'affiliation': [{'name': 'University of Colombo'}]}, { 'given': 'Nalika', 'family': 'Gunawardena', 'sequence': 'additional', 'affiliation': [{'name': 'World Health Organization Regional Office for South-East Asia'}]}, { 'given': 'Ruwan', 'family': 'Wijayamuni', 'sequence': 'additional', 'affiliation': [{'name': 'Department of Public Health, Colombo Municipal Council'}]}, { 'given': 'Deepika', 'family': 'Attygalle', 'sequence': 'additional', 'affiliation': [{'name': 'World Bank, South Asia Region'}]}], 'member': '8761', 'reference': [ { 'key': 'ref1', 'doi-asserted-by': 'publisher', 'author': 'Holick MF', 'year': '2011', 'unstructured': 'Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, ' 'and prevention of vitamin D deficiency: An endocrine society clinical ' 'practice guideline. J Clin Endocrinol Metab, 2011;96(12):3908, ' 'https://doi.org/10.1210/jcem.96.12.zeg3908a. Erratum for J Clin ' 'Endocrinol Metab, 2011;95(7);3352–3359, ' 'https://doi.org/10.1210/jc.2010-0437.', 'DOI': '10.1210/jcem.96.12.zeg3908a'}, { 'key': 'ref2', 'article-title': 'Vitamin D and the Immune System', 'author': 'Aranow C', 'unstructured': 'Aranow C. Vitamin D and the Immune System. Nih gov. ' 'https://doi.org/10.231/JIM.0b013e31821b8755.', 'journal-title': 'Nih gov'}, { 'key': 'ref3', 'doi-asserted-by': 'publisher', 'first-page': '4240', 'author': 'Greiller CL', 'unstructured': 'Greiller CL, Martineau AR, Nutrients. 7(6), 4240–70. ' 'https://doi.org/10.3390/nu7064240.', 'DOI': '10.3390/nu7064240'}, { 'issue': '5', 'key': 'ref4', 'doi-asserted-by': 'publisher', 'first-page': '1308', 'DOI': '10.1080/10408398.2020.1841090', 'article-title': 'Vitamin D deficiency aggravates COVID-19: systematic review and ' 'meta-analysis', 'volume': '62', 'author': 'Pereira M', 'year': '2022', 'unstructured': 'Pereira M, Dantas Damascena A, Galvão Azevedo LM, de Almeida Oliveira T, ' 'da Mota Santana J. Vitamin D deficiency aggravates COVID-19: systematic ' 'review and meta-analysis. Crit Rev Food Sci Nutr. 2022;62(5):1308–16. ' 'https://doi.org/10.1080/10408398.2020.1841090.', 'journal-title': 'Crit Rev Food Sci Nutr'}, { 'issue': '4', 'key': 'ref5', 'doi-asserted-by': 'publisher', 'first-page': '561', 'DOI': '10.1016/j.dsx.2020.04.050', 'article-title': 'Vitamin D concentrations and COVID-19 infection in UK Biobank', 'volume': '14', 'author': 'Hastie CE', 'year': '2020', 'unstructured': 'Hastie CE, Mackay DF, Ho F, et al. Vitamin D concentrations and COVID-19 ' 'infection in UK Biobank. Diabetes Metab Syndr. 2020;14(4):561–5. ' 'https://doi.org/10.1016/j.dsx.2020.04.050.', 'journal-title': 'Diabetes Metab Syndr'}, { 'issue': '3', 'key': 'ref6', 'doi-asserted-by': 'publisher', 'first-page': 'e1343', 'DOI': '10.1210/clinem/dgaa733', 'article-title': 'Vitamin D status in hospitalized patients with SARS-CoV-2 infection', 'volume': '106', 'author': 'Hernández JL', 'year': '2021', 'unstructured': 'Hernández JL, Nan D, Fernandez-Ayala M, et al. Vitamin D status in ' 'hospitalized patients with SARS-CoV-2 infection. J Clin Endocrinol ' 'Metab. 2021;106(3):e1343–53. https://doi.org/10.1210/clinem/dgaa733.', 'journal-title': 'J Clin Endocrinol Metab'}, { 'issue': '4', 'key': 'ref7', 'doi-asserted-by': 'publisher', 'first-page': '261', 'DOI': '10.4103/ijem.ijem_115_21', 'article-title': 'The impact of vitamin d deficiency on the severity of symptoms and ' 'mortality rate among adult patients with COVID-19: A systematic review ' 'and meta-analysis', 'volume': '25', 'author': 'Al Kiyumi M', 'year': '2021', 'unstructured': 'Al Kiyumi M, Kalra S, Davies JS, Kalhan A. The impact of vitamin d ' 'deficiency on the severity of symptoms and mortality rate among adult ' 'patients with COVID-19: A systematic review and meta-analysis. Indian J ' 'Endocrinol Metab. 2021;25(4):261. ' 'https://doi.org/10.4103/ijem.ijem_115_21.', 'journal-title': 'Indian J Endocrinol Metab'}, { 'issue': '100051', 'key': 'ref8', 'doi-asserted-by': 'publisher', 'first-page': '100051', 'DOI': '10.1016/j.medidd.2020.100051', 'article-title': 'COVID-19 Susceptibility: Is there any Correlation?', 'volume': '7', 'author': 'Razdan K', 'year': '2020', 'unstructured': 'Razdan K, Singh K, Singh D, Vitamin D, Levels. COVID-19 Susceptibility: ' 'Is there any Correlation? Med Drug Discov. 2020;7(100051):100051. ' 'https://doi.org/10.1016/j.medidd.2020.100051.', 'journal-title': 'Med Drug Discov'}, { 'key': 'ref9', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmj.m', 'article-title': 'Factors associated with hospital admission and critical illness among ' '5279 people with coronavirus disease 2019 in New York City: prospective ' 'cohort study', 'author': 'Petrilli CM', 'year': '1966', 'unstructured': 'Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital ' 'admission and critical illness among 5279 people with coronavirus ' 'disease 2019 in New York City: prospective cohort study. BMJ. 1966. ' 'https://doi.org/10.1136/bmj.m.', 'journal-title': 'BMJ'}, { 'issue': '1', 'key': 'ref10', 'doi-asserted-by': 'publisher', 'first-page': '34', 'DOI': '10.4161/derm.24054', 'article-title': 'Vitamin D status and sun exposure in southeast Asia', 'volume': '5', 'author': 'Nimitphong H', 'year': '2013', 'unstructured': 'Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast ' 'Asia. Dermatoendocrinol. 2013;5(1):34–7. ' 'https://doi.org/10.4161/derm.24054.', 'journal-title': 'Dermatoendocrinol'}, { 'key': 'ref11', 'doi-asserted-by': 'publisher', 'first-page': '68', 'DOI': '10.1016/j.amsu.2021.102661', 'article-title': 'Vitamin D deficiency and COVID-19: A case-control study at a tertiary ' 'care hospital in India', 'author': 'Nimavat N', 'year': '2021', 'unstructured': 'Nimavat N, Singh S, Singh P, Singh SK, Sinha N. Vitamin D deficiency and ' 'COVID-19: A case-control study at a tertiary care hospital in India. Ann ' 'Med Surg (Lond). 2021;68. https://doi.org/10.1016/j.amsu.2021.102661.', 'journal-title': 'Ann Med Surg (Lond)'}, { 'issue': '5', 'key': 'ref12', 'doi-asserted-by': 'publisher', 'first-page': '941', 'DOI': '10.1017/s0007114507844138', 'article-title': 'Vitamin D status in Sri Lankans living in Sri Lanka and Norway', 'volume': '99', 'author': 'Meyer HE', 'year': '2008', 'unstructured': 'Meyer HE, Holvik K, Lofthus CM, Tennakoon SUB. Vitamin D status in Sri ' 'Lankans living in Sri Lanka and Norway. Br J Nutr. 2008;99(5):941–4. ' 'https://doi.org/10.1017/s0007114507844138.', 'journal-title': 'Br J Nutr'}, { 'issue': '100133', 'key': 'ref13', 'doi-asserted-by': 'publisher', 'first-page': '100133', 'DOI': '10.1016/j.pdisas.2020.100133', 'article-title': 'The COVID-19 outbreak in Sri Lanka: A synoptic analysis focusing on ' 'trends, impacts, risks and science-policy interaction processes', 'volume': '8', 'author': 'Amaratunga D', 'year': '2020', 'unstructured': 'Amaratunga D, Fernando N, Haigh R, Jayasinghe N. The COVID-19 outbreak ' 'in Sri Lanka: A synoptic analysis focusing on trends, impacts, risks and ' 'science-policy interaction processes. Prog Disaster Sci. ' '2020;8(100133):100133. https://doi.org/10.1016/j.pdisas.2020.100133.', 'journal-title': 'Prog Disaster Sci'}, { 'key': 'ref14', 'volume-title': 'Case Control Studies: Design, Conduct, Analysis', 'author': 'Schlesselman JJ', 'year': '1982', 'unstructured': 'Schlesselman JJ. Case Control Studies: Design, Conduct, Analysis. Oxford ' 'University Press; 1982.'}, { 'key': 'ref15', 'unstructured': 'Food and Drug Administration. COVID-19: Developing drugs and biological ' 'products for treatment or prevention [WWW Document]. 2021. Food and Drug ' 'Administration. fda.gov. https://www.fda.gov/media/167274/download ' '(accessed 11.9.23).'}, { 'key': 'ref16', 'volume-title': 'Clinical Chemistry: Theory, Analysis, Correlation. 2010. Mosby', 'author': 'Kaplan LA', 'unstructured': 'Kaplan LA, Pesce AJ. Clinical Chemistry: Theory, Analysis, Correlation. ' '2010. Mosby. Vol 489. Elsevier.'}, { 'issue': '17', 'key': 'ref17', 'doi-asserted-by': 'publisher', 'first-page': '3693', 'DOI': '10.1111/febs.15495', 'article-title': 'Low plasma 25(OH) vitamin D level is associated with increased risk of ' 'COVID-19 infection: an Israeli population‐based study', 'volume': '287', 'author': 'Merzon E', 'year': '2020', 'unstructured': 'Merzon E, Tworowski D, Gorohovski A, et al. 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. ' 'https://doi.org/10.1111/febs.15495.', 'journal-title': 'FEBS J'}, { 'issue': '5', 'key': 'ref18', 'doi-asserted-by': 'publisher', 'first-page': '1415', 'DOI': '10.1007/s40520-021-01831-0', 'article-title': 'Severe vitamin D deficiency 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', 'volume': '33', 'author': 'Alguwaihes AM', 'year': '2021', 'unstructured': 'Alguwaihes AM, Sabico S, Hasanato R, et al. Severe vitamin D deficiency ' '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. 2021;33(5):1415–22. ' 'https://doi.org/10.1007/s40520-021-01831-0.', 'journal-title': 'Aging Clin Exp Res'}, { 'issue': '1', 'key': 'ref19', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s12967-021-02838-x', 'article-title': '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', 'volume': '19', 'author': 'Al-Daghri NM', 'year': '2021', 'unstructured': 'Al-Daghri NM, Amer OE, Alotaibi NH, et al. 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. 2021;19(1). ' 'https://doi.org/10.1186/s12967-021-02838-x.', 'journal-title': 'J Transl Med'}, { 'issue': '1', 'key': 'ref20', 'doi-asserted-by': 'publisher', 'first-page': '98', 'DOI': '10.1093/jn/nxaa332', 'article-title': 'Vitamin D deficiency is associated with COVID-19 incidence and disease ' 'severity in Chinese people', 'volume': '151', 'author': 'Luo X', 'year': '2021', 'unstructured': 'Luo X, Liao Q, Shen Y, Li H, Cheng L. Vitamin D deficiency is associated ' 'with COVID-19 incidence and disease severity in Chinese people. J Nutr. ' '2021;151(1):98–103. 10.1093/jn/nxaa332.', 'journal-title': 'J Nutr'}, { 'key': 'ref21', 'doi-asserted-by': 'publisher', 'article-title': 'Association of vitamin D deficiency and treatment with COVID-19 ' 'incidence', 'author': 'Meltzer DO', 'unstructured': 'Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of ' 'vitamin D deficiency and treatment with COVID-19 incidence. bioRxiv. ' 'https://doi.org/10.1101/2020.05.08.20095893.', 'DOI': '10.1101/2020.05.08.20095893'}, { 'issue': '7', 'key': 'ref22', 'doi-asserted-by': 'publisher', 'first-page': '1195', 'DOI': '10.1007/s40520-020-01570-8', 'article-title': 'The role of vitamin D in the prevention of coronavirus disease 2019 ' 'infection and mortality', 'volume': '32', 'author': 'Ilie PC', 'year': '2020', 'unstructured': 'Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention ' 'of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res. ' '2020;32(7):1195–8. https://doi.org/10.1007/s40520-020-01570-8.', 'journal-title': 'Aging Clin Exp Res'}, { 'issue': '105101', 'key': 'ref23', 'doi-asserted-by': 'publisher', 'first-page': '105101', 'DOI': '10.1016/j.meegid.2021.105101', 'article-title': 'Role of multiple factors likely contributing to severity-mortality of ' 'COVID-19', 'volume': '96', 'author': 'Singh J', 'year': '2021', 'unstructured': 'Singh J, Alam A, Samal J, et al. Role of multiple factors likely ' 'contributing to severity-mortality of COVID-19. Infect Genet Evol. ' '2021;96(105101):105101. https://doi.org/10.1016/j.meegid.2021.105101.', 'journal-title': 'Infect Genet Evol'}, { 'issue': '1', 'key': 'ref24', 'doi-asserted-by': 'publisher', 'first-page': '52', 'DOI': '10.3390/nu9010052', 'article-title': '25-hydroxy-vitamin D concentration is not affected by severe or ' 'non-severe pneumonia, or inflammation, in young children', 'volume': '9', 'author': 'Haugen J', 'year': '2017', 'unstructured': 'Haugen J, Chandyo R, Ulak M, et al. 25-hydroxy-vitamin D concentration ' 'is not affected by severe or non-severe pneumonia, or inflammation, in ' 'young children. Nutrients. 2017;9(1):52. ' 'https://doi.org/10.3390/nu9010052.', 'journal-title': 'Nutrients'}, { 'issue': '2', 'key': 'ref25', 'doi-asserted-by': 'publisher', 'first-page': '1', 'DOI': '10.3310/hta23020', 'article-title': 'Vitamin D supplementation to prevent acute respiratory infections: ' 'individual participant data meta-analysis', 'volume': '23', 'author': 'Martineau AR', 'year': '2019', 'unstructured': 'Martineau AR, Jolliffe DA, Greenberg L, et al. Vitamin D supplementation ' 'to prevent acute respiratory infections: individual participant data ' 'meta-analysis. Health Technol Assess. 2019;23(2):1–44. ' 'https://doi.org/10.3310/hta23020.', 'journal-title': 'Health Technol Assess'}, { 'issue': '1', 'key': 'ref26', 'first-page': '85', 'article-title': 'Association of vitamin D status with the severity and mortality of ' 'community-acquired pneumonia in Iran during 2016–2017: A prospective ' 'cohort study', 'volume': '8', 'author': 'Talebi F', 'year': '2019', 'unstructured': 'Talebi F, Nejad MR, Yaseri M, Hadadi A. Association of vitamin D status ' 'with the severity and mortality of community-acquired pneumonia in Iran ' 'during 2016–2017: A prospective cohort study. Rep Biochem Mol Biology. ' '2019;8(1):85.', 'journal-title': 'Rep Biochem Mol Biology'}, { 'issue': '6', 'key': 'ref27', 'doi-asserted-by': 'publisher', 'first-page': '832', 'DOI': '10.1002/lt.25756', 'article-title': 'Coronaviruses and immunosuppressed patients: The facts during the third ' 'epidemic', 'volume': '26', 'author': 'D’Antiga L', 'year': '2020', 'unstructured': 'D’Antiga L. Coronaviruses and immunosuppressed patients: The facts ' 'during the third epidemic. Liver Transpl. 2020;26(6):832–4. ' 'https://doi.org/10.1002/lt.25756.', 'journal-title': 'Liver Transpl'}, { 'issue': '2', 'key': 'ref28', 'doi-asserted-by': 'publisher', 'first-page': 'e044486', 'DOI': '10.1136/bmjopen-2020-044486', 'article-title': 'Association between cardiometabolic disease and severe COVID-19: a ' 'nationwide case–control study of patients requiring invasive mechanical ' 'ventilation', 'volume': '11', 'author': 'Svensson P', 'year': '2021', 'unstructured': 'Svensson P, Hofmann R, Häbel H, Jernberg T, Nordberg P. Association ' 'between cardiometabolic disease and severe COVID-19: a nationwide ' 'case–control study of patients requiring invasive mechanical ' 'ventilation. BMJ Open. 2021;11(2):e044486. ' 'https://doi.org/10.1136/bmjopen-2020-044486.', 'journal-title': 'BMJ Open'}, { 'issue': '1', 'key': 'ref29', 'doi-asserted-by': 'publisher', 'first-page': '11', 'DOI': '10.1038/s41574-020-00435-4', 'article-title': 'COVID-19 and diabetes mellitus: from pathophysiology to clinical ' 'management', 'volume': '17', 'author': 'Lim S', 'year': '2021', 'unstructured': 'Lim S, Bae JH, Kwon HS, Nauck MA. COVID-19 and diabetes mellitus: from ' 'pathophysiology to clinical management. Nat Rev Endocrinol. ' '2021;17(1):11–30. https://doi.org/10.1038/s41574-020-00435-4.', 'journal-title': 'Nat Rev Endocrinol'}, { 'key': 'ref30', 'author': 'Sri Lanka STEPS', 'unstructured': 'Ministry of Health, Sri Lanka STEPS. Survey 2021 Fact Sheet. Gov.lk. ' 'https://www.ncd.health.gov.lk/images/pdf/Steps-Fact-Sheet.pdf.'}], 'container-title': [], 'original-title': [], 'link': [ { 'URL': 'https://www.researchsquare.com/article/rs-3964082/v1', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.researchsquare.com/article/rs-3964082/v1.html', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 3, 28]], 'date-time': '2024-03-28T18:20:37Z', 'timestamp': 1711650037000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.researchsquare.com/article/rs-3964082/v1'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 3, 28]]}, 'references-count': 30, 'URL': 'http://dx.doi.org/10.21203/rs.3.rs-3964082/v1', 'relation': {}, 'published': {'date-parts': [[2024, 3, 28]]}, 'subtype': 'preprint'}