A critical update on the role of mild and serious vitamin D deficiency prevalence and the COVID-19 epidemic in Europe
Dimitra Rafailia Bakaloudi, Ph.D Michail Chourdakis
Nutrition, doi:10.1016/j.nut.2021.111441
Objectives: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic, affecting nearly 180 million people worldwide as of June 22, 2021. Previous studies have examined the association between the mean vitamin D (Vit D) concentration of each country and COVID-19 infection and mortality rate in European countries. The aim of the present study was to critically evaluate the relationship between prevalence of mild and severe Vit D deficiency in each country and COVID-19 infection, recovery, and mortality using updated data and a different methodological approach. Methods: Information on Vit D concentration or deficiency for each country was retrieved through a literature search. COVID-19 infections and mortalities per million people and total recoveries, as of June 22, 2021, were obtained. The associations between Vit D deficiency and COVID-19 infection, recovery, and mortality were explored using correlation coefficients and scatterplots. Results: Non-significant correlations were observed between both number of COVID-19 infections (r = 0.363, P = 0.116) and number of recoveries (r = 0.388, P = 0.091) and the prevalence of mild Vit D deficiency (<50 nmol/L). Similarly, non-significant correlations were observed between both infections (r = 0.215, P = 0.392) and recoveries (r = 0.242, P = 0.332) and the prevalence of severe Vit D deficiency (<30 nmol/L). Significant correlations were found between COVID-19 mortality and prevalence of both mild Vit D deficiency (r = 0.634, P = 0.003) and severe Vit D deficiency (r = 0.538, P = 0.021). Conclusions: The prevalence of neither mild nor severe Vit D deficiency was associated with the number of COVID-19 infections in European countries. Thus, it is an important parameter to consider when implementing preventive measures to face COVID-19.
Supplementary materials Supplementary material associated with this article can be found in the online version at doi:10.1016/j.nut.2021.111441.
References
Adebayo, Itkonen, Lilja, Lundqvist, Laatikainen, Prevalence and determinants of vitamin D deficiency and insufficiency among three immigrant groups in Finland: evidence from a population-based study using standardised 25-hydroxyvitamin D data, Public Health Nutr
Ali, Role of vitamin D in preventing of COVID-19 infection, progression and severity, J Infect Public Health
Annweiler, Beaudenon, Gautier, Simon, Dub Ee et al., COvid-19 and high-dose VITamin D supplementation TRIAL in high-risk older patients (COVIT-TRIAL): study protocol for a randomized controlled trial, Trials
Arteh, Narra, Nair, Prevalence of vitamin D deficiency in chronic liver disease, Dig Dis Sci
Aspell, Laird, Healy, Shannon, Lawlor et al., The prevalence and determinants of vitamin D status in community-dwelling older adults: results from the English Longitudinal Study of Ageing (ELSA), Nutrients
Bahrami, Sadeghnia, Tabatabaeizadeh, Bahrami-Taghanaki, Behboodi et al., Genetic and epigenetic factors influencing vitamin D status, J Cell Physiol
Bakaloudi, Halloran, Rippin, Oikonomidou, Dardavesis et al., Intake and adequacy of the vegan diet: a systematic review of the evidence, Clin Nutr
Bergman, The link between vitamin D and COVID-19: distinguishing facts from fiction, J Intern Med
Borissova, Shinkov, Vlahov, Dakovska, Todorov et al., Vitamin D status in Bulgaria-winter data, Arch Osteoporos
Brodin, Why is COVID-19 so mild in children?, Acta Paediatr
Carpagnano, Lecce, Quaranta, Zito, Buonamico et al., Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19, J Endocrinol Invest
Cashman, Kiely, Kinsella, Durazo-Arvizu, Tian et al., Evaluation of Vitamin D Standardization Program protocols for standardizing serum 25-hydroxyvitamin D data: a case study of the program's potential for national nutrition and health surveys, Am J Clin Nutr
Cereda, Bogliolo, Lobascio, Barichella, Zecchinelli et al., Vitamin D supplementation and outcomes in coronavirus disease 2019 (COVID-19) patients from the outbreak area of Lombardy. Italy, Nutrition
Chaudhry, Dranitsaris, Mubashir, Bartoszko, Riazi, A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes, EClinicalMedicine
Cherrie, Clemens, Colandrea, Feng, Webb et al., Ultraviolet A radiation and COVID-19 deaths in the USA with replication studies in England and Italy
Clark, Jit, Warren-Gash, Guthrie, Wang et al., Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study, Lancet Glob Health
Coli C Bari C, Keser, Bituh, Rumbak, Samarin et al., Vitamin D status and prevalence of inadequacy in Croatian population
Cui, Xu, Li, Qiao, Han et al., Vitamin D receptor activation regulates microglia polarization and oxidative stress in spontaneously hypertensive rats and angiotensin II-exposed microglial cells: role of renin-angiotensin system, Redox Biol
Daneshkhah, Agrawal, Eshein, Subramanian, Roy et al., Evidence for possible association of vitamin D status with cytokine storm and unregulated inflammation in COVID-19 patients, Aging Clin Exp Res
Dimakopoulos, Magriplis, Mitsopoulou, Karageorgou, Bakogianni et al., Association of serum vitamin D status with dietary intake and sun exposure in adults, Clin Nutr ESPEN
Duarte, Carvalheiro, Rodrigues, Dias, Marques et al., Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study, Arch Osteoporos
Díaz, Opez, Paz-Graniel, Alonso-Sanz, Es Baldero et al., Vitamin D deficiency in primary health care users at risk in Spain, Nutr Hosp
El Din, Fayed, Nokeety, Abdulazim, Salem, Vitamin-D deficiency is encountered in almost all Egyptian stage 3À5 chronic kidney disease patients in spite of the sunny weather, Saudi J Kidney Dis Transpl
Elmadfa, Meyer, Wottawa, Wagner, Hasenegger, Vitamin D intake and status in Austria and its effects on some health indicators, Austin J Nutr Metab
Fedele, Francesco, Riso, Collo, Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: an overview, Nutrition
Giuliani, Barbieri, Pierro, Rossi, Widmann et al., LC-MS/MS based 25(OH)D status in a large Southern European outpatient cohort: gender-and age-specific differences, Eur J Nutr
Gorman, Weller, Investigating the potential for ultraviolet light to modulate morbidity and mortality from COVID-19: a narrative review and update, Front Cardiovasc Med
Gupta, Vashi, Trukova, Lis, Lammersfeld, Prevalence of serum vitamin D deficiency and insufficiency in cancer: review of the epidemiological literature, Exp Ther Med
Hoge, Donneau, Streel, Kolh, Chapelle et al., Vitamin D deficiency is common among adults in Wallonia (Belgium, 51°30 0 North): findings from the Nutrition, Environment and Cardio-Vascular Health study, Nutr Res
Holick, Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease, Am J Clin Nutr
Hribar, Hristov, Gregori C M, Blaznik, Zaletel et al., Nutrihealth study: seasonal variation in vitamin D status among the Slovenian adult and elderly population, Nutrients
Ilie, Stefanescu, Smith, The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality, Aging Clin Exp Res
Isaia, Di Emoz, Maluta, Fountoulakis, Ceccon et al., Does solar ultraviolet radiation play a role in COVID-19 infection and deaths? an environmental ecological study in Italy, Sci Total Environ
Jayawardena, Sooriyaarachchi, Chourdakis, Jeewandara, Ranasinghe, Enhancing immunity in viral infections, with special emphasis on COVID-19: a review, Diabetes Metab Syndr
Karonova, Andreeva, Nikitina, Belyaeva, Mokhova et al., Prevalence of vitamin D deficiency in the north-west region of Russia: a crosssectional study, J Steroid Biochem Mol Biol
Kasapidou, Oikonomidou, Chourdakis, Vitamin D status among Mediterranean regions, Hippokratia
Kazemi, Mohammadi, Aghababaee, Golzarand, Clark et al., Association of vitamin D status with SARS-CoV-2 infection or COVID-19 severity: a systematic review and meta-analysis
Kuster, Pfister, Burkard, Zhou, Twerenbold et al., SARS-CoV2: should inhibitors of the reninÀangiotensin system be withdrawn in patients with COVID-19?, Eur Heart J
Li, Li, Prevalence and influencing factors of vitamin D deficiency in chronic kidney disease: a cross-sectional study, Int J Clin Pharmacol Ther
Li, Qiao, Uskokovic, Xiang, Zheng et al., Vitamin D: a negative endocrine regulator of the reninÀangiotensin system and blood pressure, J Steroid Biochem Mol Biol
Li, Zeng, Cao, Liu, Ping et al., Angiotensin-converting enzyme 2 prevents lipopolysaccharide-induced rat acute lung injury via suppressing the ERK1/2 and NF-kB signaling pathways, Sci Rep
Lips, Cashman, Lamberg-Allardt, Bischoff-Ferrari, Obermayer-Pietsch et al., Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society, Eur J Endocrinol
Martineau, Jolliffe, Hooper, Greenberg, Aloia et al., Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ
Mathieu, Badenhoop, Vitamin D and type 1 diabetes mellitus: state of the art, Trends Endocrinol Metab
Meltzer, Best, Zhang, Vokes, Arora et al., Association of vitamin D levels, race/ethnicity, and clinical characteristics with COVID-19 test results, JAMA Netw Open
Mendes, Darling, Hart, Morse, Murphy et al., Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: a need for multidisciplinary action?, J Steroid Biochem Mol Biol
Mishal, Effects of different dress styles on vitamin D levels in healthy young Jordanian women, Osteoporos Int
Murdaca, Pioggia, Negrini, Vitamin D and COVID-19: an update on evidence and potential therapeutic implications, Clin Mol Allergy
Neale, Khan, Lucas, Waterhouse, Whiteman et al., The effect of sunscreen on vitamin D: a review, Br J Dermatol
Niculescu, Capatina, Dusceac, Caragheorgheopol, Ghemigian et al., Seasonal variation of serum vitamin D levels in Romania, Arch Osteoporos
Parohan, Yaghoubi, Seraji, Javanbakht, Sarraf et al., Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies, Aging Male
Petrenya, Lamberg-Allardt, Melhus, Broderstad, Brustad, Vitamin D status in a multi-ethnic population of northern Norway: the SAMINOR 2 Clinical Survey, Public Health Nutr
Rabenberg, Scheidt-Nave, Busch, Rieckmann, Hintzpeter et al., Vitamin D status among adults in Germany-results from the German Health Interview and Examination Survey for Adults (DEGS1), BMC Public Health
Rhodes, Subramanian, Laird, Griffin, Kenny, Perspective: vitamin D deficiency and COVID-19 severity-plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis, J Intern Med
Sakem, Nock, Stanga, Medina, Nydegger et al., Serum concentrations of 25-hydroxyvitamin D and immunoglobulins in an older Swiss cohort: results of the Senior Labor Study, BMC Med
Schramm, Lahner, J€ Ockel K-H, Erbel, F€ et al., Recall Study Group. Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohortsa note of caution, Endocrine
Shchubelka, Vitamin D status in adults and children in Transcarpathia, Ukraine in 2019, BMC Nutr
Singh, Kaur, Singh, Revisiting the role of vitamin D levels in the prevention of COVID-19 infection and mortality in European countries post infections peak, Aging Clin Exp Res
Snijder, Van Dam, Visser, Deeg, Dekker et al., Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women, J Clin Endocrinol Metab
Sokolovic, Alimanovic-Alagic, Dzananovic, Cavaljuga, Beslic et al., Vitamin D status in Bosnia and Herzegovina: the crosssectional epidemiological analysis, Osteoporos Int
Souberbielle, Massart, Brailly-Tabard, Cavalier, Chanson, Prevalence and determinants of vitamin D deficiency in healthy French adults: the VARI-ETE study, Endocrine
Stafford, Covid-19: why Germany's case fatality rate seems so low, BMJ
Szeto, Zucker, Lasota, Rubin, Walker et al., Vitamin D status and COVID-19 clinical outcomes in hospitalized patients, Endocr Res
S€ Oderstr€ Om, Rosenblad, Adolfsson, Bergkvist, Malnutrition is associated with increased mortality in older adults regardless of the cause of death, Br J Nutr
The, Diabetes, Endocrinology, Vitamin D and COVID-19: why the controversy?, Lancet Diabetes Endocrinol
Theodoratou, Tzoulaki, Zgaga, Ioannidis, Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials, BMJ
Van Schoor, Lips, Worldwide vitamin D status
Wacker, Holick, Vitamin D-effects on skeletal and extraskeletal health and the need for supplementation, Nutrients
Webb, Kift, Durkin, 'brien, Vail et al., The role of sunlight exposure in determining the vitamin D status of the U.K. white adult population, Br J Dermatol
Worldometer, COVID-19 Coronavirus Pandemic
Zheng, Peng, Xu, Zhao, Liu et al., Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis, J Infect
Zhu, Wei, Niu, The novel coronavirus outbreak in Wuhan. China, Glob Health Res Policy
{ 'indexed': {'date-parts': [[2022, 2, 9]], 'date-time': '2022-02-09T16:30:40Z', 'timestamp': 1644424240345},
'reference-count': 74,
'publisher': 'Elsevier BV',
'license': [ { 'start': { 'date-parts': [[2022, 1, 1]],
'date-time': '2022-01-01T00:00:00Z',
'timestamp': 1640995200000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'}],
'content-domain': { 'domain': [ 'clinicalkey.jp', 'clinicalkey.com', 'clinicalkey.es', 'clinicalkey.com.au',
'clinicalkey.fr', 'elsevier.com', 'sciencedirect.com'],
'crossmark-restriction': True},
'short-container-title': ['Nutrition'],
'published-print': {'date-parts': [[2022, 1]]},
'DOI': '10.1016/j.nut.2021.111441',
'type': 'journal-article',
'created': {'date-parts': [[2021, 7, 30]], 'date-time': '2021-07-30T03:07:54Z', 'timestamp': 1627614474000},
'page': '111441',
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 3,
'title': [ 'A critical update on the role of mild and serious vitamin D deficiency prevalence and the '
'COVID-19 epidemic in Europe'],
'prefix': '10.1016',
'volume': '93',
'author': [ {'given': 'Dimitra Rafailia', 'family': 'Bakaloudi', 'sequence': 'first', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-9490-8356',
'authenticated-orcid': False,
'given': 'Michail',
'family': 'Chourdakis',
'sequence': 'additional',
'affiliation': []}],
'member': '78',
'reference': [ { 'key': '10.1016/j.nut.2021.111441_bib0001',
'unstructured': 'Worldometer, COVID-19 Coronavirus Pandemic 2020. Available at: '
'https://www.worldometers.info/coronavirus/coronavirus-cases/. Accessed '
'June 23rd, 2021.'},
{ 'key': '10.1016/j.nut.2021.111441_bib0002',
'doi-asserted-by': 'crossref',
'first-page': '6',
'DOI': '10.1186/s41256-020-00135-6',
'article-title': 'The novel coronavirus outbreak in Wuhan',
'volume': '5',
'author': 'Zhu',
'year': '2020',
'journal-title': 'China. Glob Health Res Policy'},
{ 'key': '10.1016/j.nut.2021.111441_bib0003',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.eclinm.2020.100464',
'article-title': 'A country level analysis measuring the impact of government actions, '
'country preparedness and socioeconomic factors on COVID-19 mortality '
'and related health outcomes',
'volume': '25',
'author': 'Chaudhry',
'year': '2020',
'journal-title': 'EClinicalMedicine'},
{ 'key': '10.1016/j.nut.2021.111441_bib0004',
'article-title': 'Obesity, malnutrition, and trace element deficiency in the coronavirus '
'disease (COVID-19) pandemic: an overview',
'volume': '81',
'author': 'Fedele',
'year': '2020',
'journal-title': 'Nutrition'},
{ 'key': '10.1016/j.nut.2021.111441_bib0005',
'doi-asserted-by': 'crossref',
'first-page': 'e1003',
'DOI': '10.1016/S2214-109X(20)30264-3',
'article-title': 'Global, regional, and national estimates of the population at increased '
'risk of severe COVID-19 due to underlying health conditions in 2020: a '
'modelling study',
'volume': '8',
'author': 'Clark',
'year': '2020',
'journal-title': 'Lancet Glob Health'},
{ 'key': '10.1016/j.nut.2021.111441_bib0006',
'doi-asserted-by': 'crossref',
'first-page': '532',
'DOI': '10.1017/S0007114517000435',
'article-title': 'Malnutrition is associated with increased mortality in older adults '
'regardless of the cause of death',
'volume': '117',
'author': 'Söderström',
'year': '2017',
'journal-title': 'Br J Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0007',
'doi-asserted-by': 'crossref',
'first-page': '367',
'DOI': '10.1016/j.dsx.2020.04.015',
'article-title': 'Enhancing immunity in viral infections, with special emphasis on '
'COVID-19: a review',
'volume': '14',
'author': 'Jayawardena',
'year': '2020',
'journal-title': 'Diabetes Metab Syndr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0008',
'doi-asserted-by': 'crossref',
'first-page': '111',
'DOI': '10.3390/nu5010111',
'article-title': 'Vitamin D—effects on skeletal and extraskeletal health and the need for '
'supplementation',
'volume': '5',
'author': 'Wacker',
'year': '2013',
'journal-title': 'Nutrients'},
{ 'key': '10.1016/j.nut.2021.111441_bib0009',
'doi-asserted-by': 'crossref',
'first-page': 'i6583',
'DOI': '10.1136/bmj.i6583',
'article-title': 'Vitamin D supplementation to prevent acute respiratory tract '
'infections: systematic review and meta-analysis of individual '
'participant data',
'volume': '356',
'author': 'Martineau',
'year': '2017',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.nut.2021.111441_bib0010',
'doi-asserted-by': 'crossref',
'first-page': '1373',
'DOI': '10.1016/j.jiph.2020.06.021',
'article-title': 'Role of vitamin D in preventing of COVID-19 infection, progression and '
'severity',
'volume': '13',
'author': 'Ali',
'year': '2020',
'journal-title': 'J Infect Public Health'},
{ 'key': '10.1016/j.nut.2021.111441_bib0011',
'doi-asserted-by': 'crossref',
'first-page': '131',
'DOI': '10.1111/joim.13158',
'article-title': 'The link between vitamin D and COVID-19: distinguishing facts from '
'fiction',
'volume': '289',
'author': 'Bergman',
'year': '2021',
'journal-title': 'J Intern Med'},
{ 'key': '10.1016/j.nut.2021.111441_bib0012',
'doi-asserted-by': 'crossref',
'first-page': '23',
'DOI': '10.1186/s12948-020-00139-0',
'article-title': 'Vitamin D and COVID-19: an update on evidence and potential therapeutic '
'implications',
'volume': '18',
'author': 'Murdaca',
'year': '2020',
'journal-title': 'Clin Mol Allergy'},
{ 'key': '10.1016/j.nut.2021.111441_bib0013',
'article-title': 'Vitamin D supplementation and outcomes in coronavirus disease 2019 '
'(COVID-19) patients from the outbreak area of Lombardy',
'volume': '82',
'author': 'Cereda',
'year': '2021',
'journal-title': 'Italy. Nutrition'},
{ 'key': '10.1016/j.nut.2021.111441_bib0014',
'doi-asserted-by': 'crossref',
'DOI': '10.1001/jamanetworkopen.2021.4117',
'article-title': 'Association of vitamin D levels, race/ethnicity, and clinical '
'characteristics with COVID-19 test results',
'volume': '4',
'author': 'Meltzer',
'year': '2021',
'journal-title': 'JAMA Netw Open'},
{ 'key': '10.1016/j.nut.2021.111441_bib0015',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.redox.2019.101295',
'article-title': 'Vitamin D receptor activation regulates microglia polarization and '
'oxidative stress in spontaneously hypertensive rats and angiotensin '
'II-exposed microglial cells: role of renin-angiotensin system',
'volume': '26',
'author': 'Cui',
'year': '2019',
'journal-title': 'Redox Biol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0016',
'doi-asserted-by': 'crossref',
'first-page': '27911',
'DOI': '10.1038/srep27911',
'article-title': 'Angiotensin-converting enzyme 2 prevents lipopolysaccharide-induced rat '
'acute lung injury via suppressing the ERK1/2 and NF-κB signaling '
'pathways',
'volume': '6',
'author': 'Li',
'year': '2016',
'journal-title': 'Sci Rep'},
{ 'key': '10.1016/j.nut.2021.111441_bib0017',
'doi-asserted-by': 'crossref',
'first-page': '97',
'DOI': '10.1111/joim.13149',
'article-title': 'Perspective: vitamin D deficiency and COVID-19 severity—plausibly '
'linked by latitude, ethnicity, impacts on cytokines, ACE2 and '
'thrombosis',
'volume': '289',
'author': 'Rhodes',
'year': '2021',
'journal-title': 'J Intern Med'},
{ 'key': '10.1016/j.nut.2021.111441_bib0018',
'doi-asserted-by': 'crossref',
'first-page': '387',
'DOI': '10.1016/j.jsbmb.2004.03.004',
'article-title': 'Vitamin D: a negative endocrine regulator of the renin–angiotensin '
'system and blood pressure',
'volume': '89–90',
'author': 'Li',
'year': '2004',
'journal-title': 'J Steroid Biochem Mol Biol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0019',
'doi-asserted-by': 'crossref',
'first-page': '1801',
'DOI': '10.1093/eurheartj/ehaa235',
'article-title': 'SARS-CoV2: should inhibitors of the renin–angiotensin system be '
'withdrawn in patients with COVID-19?',
'volume': '41',
'author': 'Kuster',
'year': '2020',
'journal-title': 'Eur Heart J'},
{ 'key': '10.1016/j.nut.2021.111441_bib0020',
'doi-asserted-by': 'crossref',
'first-page': '765',
'DOI': '10.1007/s40618-020-01370-x',
'article-title': 'Vitamin D deficiency as a predictor of poor prognosis in patients with '
'acute respiratory failure due to COVID-19',
'volume': '44',
'author': 'Carpagnano',
'year': '2021',
'journal-title': 'J Endocrinol Invest'},
{ 'key': '10.1016/j.nut.2021.111441_bib0021',
'doi-asserted-by': 'crossref',
'first-page': '2141',
'DOI': '10.1007/s40520-020-01677-y',
'article-title': 'Evidence for possible association of vitamin D status with cytokine '
'storm and unregulated inflammation in COVID-19 patients',
'volume': '32',
'author': 'Daneshkhah',
'year': '2020',
'journal-title': 'Aging Clin Exp Res'},
{ 'key': '10.1016/j.nut.2021.111441_bib0022',
'doi-asserted-by': 'crossref',
'first-page': '1609',
'DOI': '10.1007/s40520-020-01619-8',
'article-title': 'Revisiting the role of vitamin D levels in the prevention of COVID-19 '
'infection and mortality in European countries post infections peak',
'volume': '32',
'author': 'Singh',
'year': '2020',
'journal-title': 'Aging Clin Exp Res'},
{ 'key': '10.1016/j.nut.2021.111441_bib0023',
'doi-asserted-by': 'crossref',
'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',
'year': '2020',
'journal-title': 'Aging Clin Exp Res'},
{ 'key': '10.1016/j.nut.2021.111441_bib0024',
'unstructured': 'ISO 3166 Country Codes. The International Standard for country codes and '
'codes for their subdivisions: International Organization for '
'Standardization. 2021 Available at: '
'https://www.iso.org/iso-3166-country-codes.html. Accessed June 23rd, '
'2021'},
{ 'key': '10.1016/j.nut.2021.111441_bib0025',
'first-page': '1050',
'article-title': 'Vitamin D intake and status in Austria and its effects on some health '
'indicators',
'volume': '4',
'author': 'Elmadfa',
'year': '2017',
'journal-title': 'Austin J Nutr Metab'},
{ 'key': '10.1016/j.nut.2021.111441_bib0026',
'doi-asserted-by': 'crossref',
'first-page': '716',
'DOI': '10.1016/j.nutres.2015.06.005',
'article-title': 'Vitamin D deficiency is common among adults in Wallonia (Belgium, '
'51°30′ North): findings from the Nutrition, Environment and '
'Cardio-Vascular Health study',
'volume': '35',
'author': 'Hoge',
'year': '2015',
'journal-title': 'Nutr Res'},
{ 'key': '10.1016/j.nut.2021.111441_bib0027',
'doi-asserted-by': 'crossref',
'first-page': '1021',
'DOI': '10.1007/s00198-016-3831-0',
'article-title': 'Vitamin D status in Bosnia and Herzegovina: the cross-sectional '
'epidemiological analysis',
'volume': '28',
'author': 'Sokolovic',
'year': '2017',
'journal-title': 'Osteoporos Int'},
{ 'key': '10.1016/j.nut.2021.111441_bib0028',
'doi-asserted-by': 'crossref',
'first-page': '133',
'DOI': '10.1007/s11657-013-0133-4',
'article-title': 'Vitamin D status in Bulgaria—winter data',
'volume': '8',
'author': 'Borissova',
'year': '2013',
'journal-title': 'Arch Osteoporos'},
{ 'key': '10.1016/j.nut.2021.111441_bib0029',
'series-title': 'Book of Abstracts of 4th International Congress of Nutritionists Zadar, '
'Hrvatska',
'first-page': '97',
'article-title': 'Vitamin D status and prevalence of inadequacy in Croatian population',
'author': 'Colić Barić',
'year': '2016'},
{ 'key': '10.1016/j.nut.2021.111441_bib0030',
'doi-asserted-by': 'crossref',
'first-page': '1254',
'DOI': '10.1017/S1368980019004312',
'article-title': 'Prevalence and determinants of vitamin D deficiency and insufficiency '
'among three immigrant groups in Finland: evidence from a '
'population-based study using standardised 25-hydroxyvitamin D data',
'volume': '23',
'author': 'Adebayo',
'year': '2020',
'journal-title': 'Public Health Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0031',
'doi-asserted-by': 'crossref',
'first-page': '543',
'DOI': '10.1007/s12020-016-0960-3',
'article-title': 'Prevalence and determinants of vitamin D deficiency in healthy French '
'adults: the VARIETE study',
'volume': '53',
'author': 'Souberbielle',
'year': '2016',
'journal-title': 'Endocrine'},
{ 'key': '10.1016/j.nut.2021.111441_bib0032',
'doi-asserted-by': 'crossref',
'first-page': '641',
'DOI': '10.1186/s12889-015-2016-7',
'article-title': 'Vitamin D status among adults in Germany—results from the German Health '
'Interview and Examination Survey for Adults (DEGS1)',
'volume': '15',
'author': 'Rabenberg',
'year': '2015',
'journal-title': 'BMC Public Health'},
{ 'key': '10.1016/j.nut.2021.111441_bib0033',
'doi-asserted-by': 'crossref',
'first-page': '23',
'DOI': '10.1016/j.clnesp.2019.09.008',
'article-title': 'Association of serum vitamin D status with dietary intake and sun '
'exposure in adults',
'volume': '34',
'author': 'Dimakopoulos',
'year': '2019',
'journal-title': 'Clin Nutr ESPEN'},
{ 'key': '10.1016/j.nut.2021.111441_bib0034',
'doi-asserted-by': 'crossref',
'first-page': '1235',
'DOI': '10.3945/ajcn.112.057182',
'article-title': 'Evaluation of Vitamin D Standardization Program protocols for '
'standardizing serum 25-hydroxyvitamin D data: a case study of the '
"program's potential for national nutrition and health surveys",
'volume': '97',
'author': 'Cashman',
'year': '2013',
'journal-title': 'Am J Clin Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0035',
'doi-asserted-by': 'crossref',
'first-page': '2511',
'DOI': '10.1007/s00394-018-1803-1',
'article-title': 'LC-MS/MS based 25(OH)D status in a large Southern European outpatient '
'cohort: gender- and age-specific differences',
'volume': '58',
'author': 'Giuliani',
'year': '2019',
'journal-title': 'Eur J Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0036',
'doi-asserted-by': 'crossref',
'first-page': '1186',
'DOI': '10.1017/S1368980018003816',
'article-title': 'Vitamin D status in a multi-ethnic population of northern Norway: the '
'SAMINOR 2 Clinical Survey',
'volume': '23',
'author': 'Petrenya',
'year': '2020',
'journal-title': 'Public Health Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0037',
'doi-asserted-by': 'crossref',
'first-page': '36',
'DOI': '10.1007/s11657-020-0695-x',
'article-title': 'Prevalence of vitamin D deficiency and its predictors in the Portuguese '
'population: a nationwide population-based study',
'volume': '15',
'author': 'Duarte',
'year': '2020',
'journal-title': 'Arch Osteoporos'},
{ 'key': '10.1016/j.nut.2021.111441_bib0038',
'doi-asserted-by': 'crossref',
'first-page': '113',
'DOI': '10.1007/s11657-017-0407-3',
'article-title': 'Seasonal variation of serum vitamin D levels in Romania',
'volume': '12',
'author': 'Niculescu',
'year': '2017',
'journal-title': 'Arch Osteoporos'},
{ 'key': '10.1016/j.nut.2021.111441_bib0039',
'doi-asserted-by': 'crossref',
'first-page': '230',
'DOI': '10.1016/j.jsbmb.2016.03.026',
'article-title': 'Prevalence of vitamin D deficiency in the north-west region of Russia: '
'a cross-sectional study',
'volume': '164',
'author': 'Karonova',
'year': '2016',
'journal-title': 'J Steroid Biochem Mol Biol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0040',
'doi-asserted-by': 'crossref',
'first-page': '1838',
'DOI': '10.3390/nu12061838',
'article-title': 'Nutrihealth study: seasonal variation in vitamin D status among the '
'Slovenian adult and elderly population',
'volume': '12',
'author': 'Hribar',
'year': '2020',
'journal-title': 'Nutrients'},
{ 'key': '10.1016/j.nut.2021.111441_bib0041',
'doi-asserted-by': 'crossref',
'first-page': '176',
'DOI': '10.1186/1741-7015-11-176',
'article-title': 'Serum concentrations of 25-hydroxyvitamin D and immunoglobulins in an '
'older Swiss cohort: results of the Senior Labor Study',
'volume': '11',
'author': 'Sakem',
'year': '2013',
'journal-title': 'BMC Med'},
{ 'key': '10.1016/j.nut.2021.111441_bib0042',
'doi-asserted-by': 'crossref',
'first-page': '1253',
'DOI': '10.3390/nu11061253',
'article-title': 'The prevalence and determinants of vitamin D status in '
'community-dwelling older adults: results from the English Longitudinal '
'Study of Ageing (ELSA)',
'volume': '11',
'author': 'Aspell',
'year': '2019',
'journal-title': 'Nutrients'},
{ 'key': '10.1016/j.nut.2021.111441_bib0043',
'doi-asserted-by': 'crossref',
'first-page': '48',
'DOI': '10.1186/s40795-020-00380-5',
'article-title': 'Vitamin D status in adults and children in Transcarpathia, Ukraine in '
'2019',
'volume': '6',
'author': 'Shchubelka',
'year': '2020',
'journal-title': 'BMC Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0044',
'first-page': '03565',
'article-title': 'Vitamin D deficiency in primary health care users at risk in Spain',
'author': 'Díaz-López',
'year': '2021',
'journal-title': 'Nutr Hosp'},
{ 'key': '10.1016/j.nut.2021.111441_bib0045',
'doi-asserted-by': 'crossref',
'article-title': 'Association of vitamin D status with SARS-CoV-2 infection or COVID-19 '
'severity: a systematic review and meta-analysis [e-pub ahead of print]',
'author': 'Kazemi',
'year': '2021',
'journal-title': 'Adv Nutr',
'DOI': '10.1093/advances/nmab012'},
{ 'key': '10.1016/j.nut.2021.111441_bib0046',
'doi-asserted-by': 'crossref',
'first-page': '658',
'DOI': '10.1007/s12020-017-1292-7',
'article-title': 'Moebus S; on behalf of the Heinz Nixdorf Recall Study Group. Impact of '
'season and different vitamin D thresholds on prevalence of vitamin D '
'deficiency in epidemiological cohorts—a note of caution',
'volume': '56',
'author': 'Schramm',
'year': '2017',
'journal-title': 'Endocrine'},
{ 'key': '10.1016/j.nut.2021.111441_bib0047',
'doi-asserted-by': 'crossref',
'first-page': '1050',
'DOI': '10.1111/j.1365-2133.2010.09975.x',
'article-title': 'The role of sunlight exposure in determining the vitamin D status of '
'the U.K. white adult population',
'volume': '163',
'author': 'Webb',
'year': '2010',
'journal-title': 'Br J Dermatol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0048',
'doi-asserted-by': 'crossref',
'first-page': '95',
'DOI': '10.1016/j.jsbmb.2018.12.012',
'article-title': 'Impact of high latitude, urban living and ethnicity on '
'25-hydroxyvitamin D status: a need for multidisciplinary action?',
'volume': '188',
'author': 'Mendes',
'year': '2019',
'journal-title': 'J Steroid Biochem Mol Biol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0049',
'doi-asserted-by': 'crossref',
'first-page': '931',
'DOI': '10.1007/s001980170021',
'article-title': 'Effects of different dress styles on vitamin D levels in healthy young '
'Jordanian women',
'volume': '12',
'author': 'Mishal',
'year': '2001',
'journal-title': 'Osteoporos Int'},
{ 'key': '10.1016/j.nut.2021.111441_bib0050',
'doi-asserted-by': 'crossref',
'first-page': '907',
'DOI': '10.1111/bjd.17980',
'article-title': 'The effect of sunscreen on vitamin D: a review',
'volume': '181',
'author': 'Neale',
'year': '2019',
'journal-title': 'Br J Dermatol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0051',
'doi-asserted-by': 'crossref',
'first-page': '4119',
'DOI': '10.1210/jc.2005-0216',
'article-title': 'Adiposity in relation to vitamin D status and parathyroid hormone '
'levels: a population-based study in older men and women',
'volume': '90',
'author': 'Snijder',
'year': '2005',
'journal-title': 'J Clin Endocrinol Metab'},
{ 'key': '10.1016/j.nut.2021.111441_bib0052',
'doi-asserted-by': 'crossref',
'first-page': '3503',
'DOI': '10.1016/j.clnu.2020.11.035',
'article-title': 'Intake and adequacy of the vegan diet: a systematic review of the '
'evidence',
'volume': '40',
'author': 'Bakaloudi',
'year': '2020',
'journal-title': 'Clin Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0053',
'doi-asserted-by': 'crossref',
'first-page': '595',
'DOI': '10.5414/CP203737',
'article-title': 'Prevalence and influencing factors of vitamin D deficiency in chronic '
'kidney disease: a cross-sectional study',
'volume': '58',
'author': 'Li',
'year': '2020',
'journal-title': 'Int J Clin Pharmacol Ther'},
{ 'key': '10.1016/j.nut.2021.111441_bib0054',
'doi-asserted-by': 'crossref',
'first-page': '1389',
'DOI': '10.4103/1319-2442.275483',
'article-title': 'Vitamin-D deficiency is encountered in almost all Egyptian stage 3–5 '
'chronic kidney disease patients in spite of the sunny weather',
'volume': '30',
'author': 'El Din',
'year': '2019',
'journal-title': 'Saudi J Kidney Dis Transpl'},
{ 'key': '10.1016/j.nut.2021.111441_bib0055',
'doi-asserted-by': 'crossref',
'first-page': '2624',
'DOI': '10.1007/s10620-009-1069-9',
'article-title': 'Prevalence of vitamin D deficiency in chronic liver disease',
'volume': '55',
'author': 'Arteh',
'year': '2010',
'journal-title': 'Dig Dis Sci'},
{ 'key': '10.1016/j.nut.2021.111441_bib0056',
'doi-asserted-by': 'crossref',
'first-page': '181',
'DOI': '10.3892/etm.2011.205',
'article-title': 'Prevalence of serum vitamin D deficiency and insufficiency in cancer: '
'review of the epidemiological literature',
'volume': '2',
'author': 'Gupta',
'year': '2011',
'journal-title': 'Exp Ther Med'},
{ 'key': '10.1016/j.nut.2021.111441_bib0057',
'doi-asserted-by': 'crossref',
'first-page': '4033',
'DOI': '10.1002/jcp.26216',
'article-title': 'Genetic and epigenetic factors influencing vitamin D status',
'volume': '233',
'author': 'Bahrami',
'year': '2018',
'journal-title': 'J Cell Physiol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0058',
'doi-asserted-by': 'crossref',
'first-page': '8S',
'DOI': '10.1093/ajcn/80.6.1678S',
'article-title': 'Sunlight and vitamin D for bone health and prevention of autoimmune '
'diseases, cancers, and cardiovascular disease',
'volume': '80',
'author': 'Holick',
'year': '2004',
'journal-title': 'Am J Clin Nutr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0059',
'doi-asserted-by': 'crossref',
'first-page': '261',
'DOI': '10.1016/j.tem.2005.06.004',
'article-title': 'Vitamin D and type 1 diabetes mellitus: state of the art',
'volume': '16',
'author': 'Mathieu',
'year': '2005',
'journal-title': 'Trends Endocrinol Metab'},
{ 'key': '10.1016/j.nut.2021.111441_bib0060',
'doi-asserted-by': 'crossref',
'first-page': 'e16',
'DOI': '10.1016/j.jinf.2020.04.021',
'article-title': 'Risk factors of critical & mortal COVID-19 cases: a systematic '
'literature review and meta-analysis',
'volume': '81',
'author': 'Zheng',
'year': '2020',
'journal-title': 'J Infect'},
{ 'key': '10.1016/j.nut.2021.111441_bib0061',
'doi-asserted-by': 'crossref',
'first-page': '1416',
'DOI': '10.1080/13685538.2020.1774748',
'article-title': 'Risk factors for mortality in patients with Coronavirus disease 2019 '
'(COVID-19) infection: a systematic review and meta-analysis of '
'observational studies',
'volume': '2020',
'author': 'Parohan',
'year': '2020',
'journal-title': 'Aging Male'},
{ 'key': '10.1016/j.nut.2021.111441_bib0062',
'doi-asserted-by': 'crossref',
'first-page': '363',
'DOI': '10.1111/bjd.20093',
'article-title': 'Ultraviolet A radiation and COVID-19 deaths in the USA with replication '
'studies in England and Italy [e-pub ahead of print]',
'volume': '185',
'author': 'Cherrie',
'year': '2021',
'journal-title': 'Br J Dermatol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0063',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.scitotenv.2020.143757',
'article-title': 'Does solar ultraviolet radiation play a role in COVID-19 infection and '
'deaths? an environmental ecological study in Italy',
'volume': '757',
'author': 'Isaia',
'year': '2021',
'journal-title': 'Sci Total Environ'},
{ 'key': '10.1016/j.nut.2021.111441_bib0064',
'doi-asserted-by': 'crossref',
'DOI': '10.3389/fcvm.2020.616527',
'article-title': 'Investigating the potential for ultraviolet light to modulate morbidity '
'and mortality from COVID-19: a narrative review and update',
'volume': '7',
'author': 'Gorman',
'year': '2020',
'journal-title': 'Front Cardiovasc Med'},
{ 'key': '10.1016/j.nut.2021.111441_bib0065',
'first-page': '191',
'article-title': 'Vitamin D status among Mediterranean regions',
'volume': '22',
'author': 'Kasapidou',
'year': '2018',
'journal-title': 'Hippokratia'},
{ 'key': '10.1016/j.nut.2021.111441_bib0066',
'series-title': 'Vitamin D, Vol. 2: health, disease and therapeutics',
'first-page': '15',
'article-title': 'Worldwide vitamin D status',
'author': 'van Schoor',
'year': '2018'},
{ 'key': '10.1016/j.nut.2021.111441_bib0067',
'doi-asserted-by': 'crossref',
'first-page': '53',
'DOI': '10.1016/S2213-8587(21)00003-6',
'article-title': 'The Lancet Diabetes & Endocrinology. Vitamin D and COVID-19: why the '
'controversy?',
'volume': '9',
'year': '2021',
'journal-title': 'Lancet Diabetes Endocrinol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0068',
'doi-asserted-by': 'crossref',
'first-page': '66',
'DOI': '10.1080/07435800.2020.1867162',
'article-title': 'Vitamin D status and COVID-19 clinical outcomes in hospitalized '
'patients',
'volume': '46',
'author': 'Szeto',
'year': '2021',
'journal-title': 'Endocr Res'},
{ 'key': '10.1016/j.nut.2021.111441_bib0069',
'doi-asserted-by': 'crossref',
'first-page': 'g2035',
'DOI': '10.1136/bmj.g2035',
'article-title': 'Vitamin D and multiple health outcomes: umbrella review of systematic '
'reviews and meta-analyses of observational studies and randomised '
'trials',
'volume': '348',
'author': 'Theodoratou',
'year': '2014',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.nut.2021.111441_bib0070',
'unstructured': 'WHO Coronavirus (COVID-19) Dashboard. Situation by WHO Region, Country, '
'Territory & Area. Available at: https://covid19.who.int Accessed June '
'23rd, 2021'},
{ 'key': '10.1016/j.nut.2021.111441_bib0071',
'doi-asserted-by': 'crossref',
'first-page': 'm1395',
'DOI': '10.1136/bmj.m1395',
'article-title': "Covid-19: why Germany's case fatality rate seems so low",
'volume': '369',
'author': 'Stafford',
'year': '2020',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.nut.2021.111441_bib0072',
'doi-asserted-by': 'crossref',
'first-page': '1082',
'DOI': '10.1111/apa.15271',
'article-title': 'Why is COVID-19 so mild in children?',
'volume': '109',
'author': 'Brodin',
'year': '2020',
'journal-title': 'Acta Paediatr'},
{ 'key': '10.1016/j.nut.2021.111441_bib0073',
'doi-asserted-by': 'crossref',
'first-page': '23',
'DOI': '10.1530/EJE-18-0736',
'article-title': 'Current vitamin D status in European and Middle East countries and '
'strategies to prevent vitamin D deficiency: a position statement of the '
'European Calcified Tissue Society',
'volume': '180',
'author': 'Lips',
'year': '2019',
'journal-title': 'Eur J Endocrinol'},
{ 'key': '10.1016/j.nut.2021.111441_bib0074',
'doi-asserted-by': 'crossref',
'first-page': '1031',
'DOI': '10.1186/s13063-020-04928-5',
'article-title': 'COvid-19 and high-dose VITamin D supplementation TRIAL in high-risk '
'older patients (COVIT-TRIAL): study protocol for a randomized '
'controlled trial',
'volume': '21',
'author': 'Annweiler',
'year': '2020',
'journal-title': 'Trials'}],
'container-title': ['Nutrition'],
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S0899900721003038?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S0899900721003038?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2021, 12, 2]],
'date-time': '2021-12-02T14:59:55Z',
'timestamp': 1638457195000},
'score': 1,
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2022, 1]]},
'references-count': 74,
'alternative-id': ['S0899900721003038'],
'URL': 'http://dx.doi.org/10.1016/j.nut.2021.111441',
'relation': {},
'ISSN': ['0899-9007'],
'issn-type': [{'value': '0899-9007', 'type': 'print'}],
'subject': ['Nutrition and Dietetics', 'Endocrinology, Diabetes and Metabolism'],
'published': {'date-parts': [[2022, 1]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'A critical update on the role of mild and serious vitamin D deficiency '
'prevalence and the COVID-19 epidemic in Europe',
'name': 'articletitle',
'label': 'Article Title'},
{'value': 'Nutrition', 'name': 'journaltitle', 'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.nut.2021.111441',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2021 Elsevier Inc. All rights reserved.',
'name': 'copyright',
'label': 'Copyright'}],
'article-number': '111441'}
