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Vitamin D and SARS-CoV-2 Infection: SERVE Study (SARS-CoV-2 Exposure and the Role of Vitamin D among Hospital Employees)

Liu et al., The Journal of Nutrition, doi:10.1016/j.tjnut.2023.03.001
Mar 2023  
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Prospective study of 250 healthcare workers in the USA. The results are unclear - Figure 3 shows ~40% lower incidence with vitamin D supplementation, while the text indicates OR 1.18.
Authors collected symptom information, stating that "55% were symptomatic; the most common symptoms were cough, sore throat, and loss of taste or smell. Nine participants (16%) sought medical care...", but provide no information on symptoms per group for vitamin D supplementation. It is unclear what the definition of infection is - based on the antibody tests only, or also including self-reported cases? The meaning of increased antibodies is also not clear - vitamin D may improve antibody production.
Authors state "Despite a lack of evidence, a recent study found that nearly 70% of health care workers reported recommending vitamin D supplements...", however there is extensive evidence. There are currently 116 studies showing 36% [30‑41%] lower risk, including 28 RCTs showing 29% [18‑39%] lower risk.
Authors perform multivariable analysis for serum levels, but do not provide the results other than indicating they did not reach statistical significance. Similarly, they note no significant association between levels and symptoms, without providing any details. Authors do not provide multivariable analysis for supplement use. Authors make no comment on symptom prevalence for supplement use. Discussion is biased, for example referencing only 4 of the 25 RCTs at the time, strongly biased towards those reporting lower efficacy. No baseline information per group is provided.
38% of patients were lost to followup. We could not find any prospective registration or protocol. Funding was disclosed from Novartis and Radius Pharmaceuticals (whose lead product abaloparatide is an osteoporosis treatment).
Liu et al., 5 Mar 2023, prospective, USA, peer-reviewed, survey, mean age 40.0, 15 authors, dosage 2,250IU daily, average dose.
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Vitamin D and SARS-CoV-2 Infection: SERVE Study (SARS-CoV-2 Exposure and the Role of Vitamin D among Hospital Employees)
Yi Liu, Shannon Clare, Gia D’erasmo, Alison Heilbronner, Alexander Dash, Alexandra Krez, Caroline Zaworski, Katherine Haseltine, Alana Serota, Andy Miller, M.S Keila Veiga, Marvin Sandoval, Theresa T Lu, Donald J Mcmahon, Jeri W Nieves, MD Emily Margaret Stein
The Journal of Nutrition, doi:10.1016/j.tjnut.2023.03.001
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
reflection of the high infectivity of this viral strain but also may have related to waning antibody levels from the time since vaccination. While it is conceivable that our sample size was too small to detect a relationship between 25OHD and infection risk, the observed rate of infection we observed was greater than we predicted in our a priori power calculation, suggesting the null finding of our study was unlikely to be due to a small sample size. Although we investigated several cut-points for 25OHD, it is conceivable that there is a non-linear relationship between serum 25OHD and incident infection which we were not able to detect in our analyses. We did not find that use of vitamin D supplements lowered the risk of incident SARS-CoV-2 infection. Nor did we find a relationship between dosage of supplements and incident infection. In our study, about half of the participants took vitamin D supplements at baseline. Our findings are consistent with those of a recent meta-analysis that included one randomized controlled trial and three cohort studies in which vitamin D supplementation did not significantly reduce the risk of COVID-19 (45) . In a study from the UK Biobank, use of vitamin D supplements was associated with a 34% lower risk of COVID-19. As only individuals who had clinical COVID-19 tests were included, those findings may not have reflected relationships with asymptomatic disease in the general population. Further, the information about vitamin D supplement use..
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