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Associations between predicted vitamin D status, vitamin D intake, and risk of SARS-CoV-2 infection and Coronavirus Disease 2019 severity

Ma et al., The American Journal of Clinical Nutrition, doi:10.1093/ajcn/nqab389
Dec 2021  
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Case 23% Improvement Relative Risk Case (b) 23% Sunlight for COVID-19  Ma et al.  Prophylaxis Is sunlight beneficial for COVID-19? Retrospective 19,535 patients in the USA (May 2020 - March 2021) Fewer cases with increased sunlight exposure (p=0.00012) c19early.org Ma et al., The American J. Clinical Nu.., Dec 2021 Favorssun exposure Favorscontrol 0 0.5 1 1.5 2+
Sunlight for COVID-19
32nd treatment shown to reduce risk in December 2021
 
*, now with p = 0.000052 from 5 studies.
Lower risk for mortality, hospitalization, recovery, and cases.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 81 treatments. c19early.org
Analysis of 39,915 patients with 1,768 COVID+ cases based on surveys in the Nurses' Health Study II, showing higher UVA/UVB exposure associated with lower risk of COVID-19 cases.
Study covers sunlight and vitamin D.
risk of case, 23.0% lower, RR 0.77, p < 0.001, higher sunlight exposure 411 of 10,393 (4.0%), lower sunlight exposure 495 of 9,142 (5.4%), NNT 68, adjusted per study, odds ratio converted to relative risk, UVB, highest quartile vs. lowest quartile, model 3, table 3, multivariable.
risk of case, 23.1% lower, RR 0.77, p < 0.001, higher sunlight exposure 325 of 9,325 (3.5%), lower sunlight exposure 436 of 9,079 (4.8%), NNT 76, adjusted per study, odds ratio converted to relative risk, UVA, highest quartile vs. lowest quartile, model 3, table 3, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ma et al., 3 Dec 2021, retrospective, USA, peer-reviewed, 16 authors, study period May 2020 - March 2021. Contact: achan@mgh.harvard.edu.
This PaperSunlightAll
Associations between predicted vitamin D status, vitamin D intake, and risk of SARS-CoV-2 infection and Coronavirus Disease 2019 severity
ScD Wenjie Ma, MD Long H Nguyen, MS Yiyang Yue, ScD Ming Ding, PhD David A Drew, MD, PhD Kai Wang, PhD Jordi Merino, ScD Janet W Rich-Edwards, MD, ScD Qi Sun, MD, DrPH Carlos A Camargo Jr, MD, ScD Edward Giovannucci, MD, DrPH Walter Willett, MD, DrPH Joann E Manson, MD, ScD Mingyang Song, PhD Shilpa N Bhupathiraju, MD, MPH Andrew T Chan
doi:10.1093/ajcn/nqab389/6448988
Background: Vitamin D may have a role in immune responses to viral infections. However, data on the association between vitamin D and SARS-CoV-2 infection and Coronavirus Disease 2019 (COVID-19) severity have been limited and inconsistent. Objective: We examined the associations of predicted vitamin D status and intake with risk of SARS-CoV-2 infection and COVID-19 severity. Design: We used data from periodic surveys (May 2020 to March 2021) within the Nurses' Health Study II. Among 39,315 participants, 1,768 reported a positive test for SARS-CoV-2 infection. Usual vitamin D intake from foods and supplements were measured using a semi-quantitative, pre-pandemic food frequency questionnaire in 2015. Predicted 25-hydroxyvitamin D [25(OH)D] levels were calculated based on a previously validated model including dietary and supplementary vitamin D intake, ultraviolet-B (UVB), and other behavioral predictors of vitamin D status. Results: Higher predicted 25(OH)D levels, but not vitamin D intake, were associated with a lower risk of SARS-CoV-2 infection. Comparing participants in the highest quintile of predicted 25(OH)D levels to the lowest, the multivariable-adjusted odds ratio was 0.76 (95% CI: 0.58, 0.99; P-trend=0.04). Participants in the highest quartile of UVB (OR: 0.76; 95% CI: 0.66, 0.87; P-trend=0.002) and UVA (OR: 0.76; 95% CI: 0.66, 0.88; P-trend<0.001) also had lower risk of SARS-CoV-2 infection compared
93 Logistic regression models were used in the analysis. The number of participants included in the analysis was 39,315, and the number of participants who reported a positive SARS-CoV-2 infection was 1,768. Model 1 was adjusted for age, white race, smoking pack-years (0, 0.1-10.0, 10.1-20.0, >20.0), and the Alternate Healthy Eating Index (quintiles). Vitamin D intakes from foods and supplements were mutually adjusted. Model 2 was further adjusted for body mass index (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35.0 kg/m 2 ), physical activity (quintiles), and alcohol intake (0, 0.1-5.0, 5.1-10.0, >10 g/d). Model 3 was further adjusted for being a frontline healthcare worker, chronic comorbidities including hypertension, hypercholesterolemia, diabetes, heart disease, cancer, and asthma, and 2010 census tract median income (quintiles). P-trend was evaluated using the median value in each category as a continuous variable. Abbreviations: 25(OH)D, 25-hydroxyvitamin D. .001 Logistic regression models were used in the analysis. The number of participants included in the analysis was 39,315, and the number of participants who reported a positive SARS-CoV-2 infection was 1,768. Model 1 was adjusted for age, white race, smoking pack-years (0, 0.1-10.0, 10.1-20.0, >20.0), and the Alternate Healthy Eating Index (quintiles). Model 2 was further adjusted for body mass index (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35.0 kg/m 2 ), physical activity..
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' 'However, data on the association between vitamin D and SARS-CoV-2 infection and Coronavirus ' 'Disease 2019 (COVID-19) severity have been limited and inconsistent.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Objective</jats:title>\n' ' <jats:p>We examined the associations of predicted vitamin D status and ' 'intake with risk of SARS-CoV-2 infection and COVID-19 severity.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Design</jats:title>\n' ' <jats:p>We used data from periodic surveys (May 2020 to March 2021) within ' 'the Nurses’ Health Study II. Among 39,315 participants, 1,768 reported a positive test for ' 'SARS-CoV-2 infection. Usual vitamin D intake from foods and supplements were measured using a ' 'semi-quantitative, pre-pandemic food frequency questionnaire in 2015. Predicted ' '25-hydroxyvitamin D [25(OH)D] levels were calculated based on a previously validated model ' 'including dietary and supplementary vitamin D intake, ultraviolet-B (UVB), and other ' 'behavioral predictors of vitamin D status.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Higher predicted 25(OH)D levels, but not vitamin D intake, were ' 'associated with a lower risk of SARS-CoV-2 infection. Comparing participants in the highest ' 'quintile of predicted 25(OH)D levels to the lowest, the multivariable-adjusted odds ratio was ' '0.76 (95% CI: 0.58, 0.99; P-trend = 0.04). Participants in the highest quartile of UVB (OR: ' '0.76; 95% CI: 0.66, 0.87; P-trend = 0.002) and UVA (OR: 0.76; 95% CI: 0.66, 0.88; ' 'P-trend&amp;lt;0.001) also had lower risk of SARS-CoV-2 infection compared to the lowest. ' 'High intake of vitamin D from supplements (≥400 IU/d) was associated with a lower risk of ' 'hospitalization (OR: 0.51; 95% CI: 0.29, 0.91; P-trend = 0.04).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>Our study provides suggestive evidence on the association between ' 'higher predicted circulating 25(OH)D levels and a lower risk of SARS-CoV-2 infection. Greater ' 'intake of vitamin D supplements was associated with a lower risk of hospitalization. Our data ' 'also support an association between exposure to UVB or UVA, independent of vitamin D, and ' 'SARS-CoV-2 infection, so results for predicted 25(OH)D need to be interpreted ' 'cautiously.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1093/ajcn/nqab389', 'type': 'journal-article', 'created': { 'date-parts': [[2021, 11, 22]], 'date-time': '2021-11-22T12:06:50Z', 'timestamp': 1637582810000}, 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': [ 'Associations between predicted vitamin D status, vitamin D intake, and risk of SARS-CoV-2 ' 'infection and Coronavirus Disease 2019 severity'], 'prefix': '10.1093', 'author': [ { 'ORCID': 'http://orcid.org/0000-0001-9894-7072', 'authenticated-orcid': False, 'given': 'Wenjie', 'family': 'Ma', 'sequence': 'first', 'affiliation': [ { 'name': 'Clinical and Translational Epidemiology Unit, Massachusetts ' 'General Hospital and Harvard Medical School, Boston, MA'}, { 'name': 'Division of Gastroenterology, Massachusetts General Hospital and ' 'Harvard Medical School, Boston, MA'}]}, { 'given': 'Long H', 'family': 'Nguyen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Clinical and Translational Epidemiology Unit, Massachusetts ' 'General Hospital and Harvard Medical School, Boston, MA'}, { 'name': 'Division of Gastroenterology, Massachusetts General Hospital and ' 'Harvard Medical School, Boston, MA'}]}, { 'ORCID': 'http://orcid.org/0000-0002-6018-2980', 'authenticated-orcid': False, 'given': 'Yiyang', 'family': 'Yue', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nutrition, Harvard T.H. 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