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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