Vitamin D for COVID-19
8th treatment shown to reduce risk in
October 2020, now with p < 0.0000000001 from 138 studies, recognized in 18 countries.
No treatment is 100% effective.
Protocols combine treatments.
Prospective observational study of 94 postcritical COVID-19 patients showing that higher vitamin D levels were associated with fewer complications, shorter hospital and ICU stays, and improved morphofunctional recovery. Vitamin D deficiency correlated with longer hospitalizations, extended ICU stays, increased sarcopenic obesity prevalence, and elevated C-reactive protein (CRP).
Simón-Frapolli et al., 30 Dec 2024, prospective, Spain, peer-reviewed, mean age 62.0, 16 authors, study period April 2020 - June 2022.
Contact: jgarciaalmeida@gmail.com (corresponding author), victorsimonfrapolli.med@gmail.com, angel.lmont@gmail.com, martag1996@gmail.com, isabelmaria.cornejo@gmail.com, fjtinahones@uma.es, rociofernandeznutricion@gmail.com, isabel.mva13@gmail.com, anamsgar25@gmail.com, pimart7@yahoo.es, pilarnuevoortega@gmail.com, careinart@yahoo.es, mae404@hotmail.com, adelareha@gmail.com, belen.gonzalez.j@gmail.com, elma.avanesi.sspa@juntadeandalucia.es.
Relationship Between Vitamin D Levels with In-Hospital Complications and Morphofunctional Recovery in a Cohort of Patients After Severe COVID-19 Across Different Obesity Phenotypes
Nutrients, doi:10.3390/nu17010110
Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity of COVID-19 is still insufficient due to the lack of primary robust trial-based data and heterogeneous study designs. the principal aims of our study were to determine the impact of vitamin D deficiency or insufficiency on complications during intensive care unit (icu) stay, as well as its role in muscle mass and strength improvement as well as morphofunctional recovery during a multispecialty 6-month follow-up program based on adapted nutritional support and specific physical rehabilitation. as a secondary objective, we compared the association mentioned above between patients with sarcopenic obesity and non-sarcopenic obesity. methods: this prospective observational study included 94 outpatients postcritical COVID-19. two weeks after hospital discharge, patients were divided into sufficient (≥30 ng/mL), insufficient (20.01-29.99 ng/mL), or deficient (≤20 ng/mL) vitamin D levels. the differences in inhospital complications and morphofunctional parameters including phase angle (PhA), body cell mass (BCM), handgrip strength (HGS), timed get-up-and-go (UAG), 6 min walk test (6MWT), and proinflammatory biochemical variables were analyzed. Incremental (∆) changes in these parameters were also analyzed at the end of follow-up according to vitamin D levels and the presence vs. absence of sarcopenic obesity. A multivariate linear regression analysis was performed to detect possible confounding factors in the impact analysis of vitamin D changes on functional recovery in patients with obesity. Results: A total of 36.2% of patients exhibited vitamin D deficiency, 29.8% vitamin D insufficiency,
to maintain these benefits. Furthermore, mechanistic studies examining the underlying processes through which vitamin D influences inflammation, muscle mass, and strength could provide deeper insights into how this micronutrient contributes to recovery in patients after critical COVID-19.
Conclusions Vitamin D level deficiency was associated with more complications and requiring aggressive therapies during ICU admission and with the improvement in clinical and morphofunctional outcomes in patients postcritical COVID-19, particularly those with sarcopenic obesity, partly due to a higher degree of inflammation as a result of a longer hospital stay. Therefore, it would be appropriate to measure vitamin D levels and to treat for them, if necessary, during the recovery from post-ICU syndrome after severe COVID-19 disease. While our findings are partly consistent with the existing literature, addressing limitations through larger, controlled studies and prolonged monitoring could yield more definitive insights.
Supplementary Materials: The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/nu17010110/s1 . Table S1 . Changes (∆) in morphofunctional parameters at six months. Table S2 . Morphofunctional parameters at 6 months, according to vitamin D levels. Informed Consent Statement: Informed consent was obtained from all subjects involved in this study.
Conflicts of Interest: The authors declare no conflicts of interest.
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DOI record:
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"abstract": "<jats:p>Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity of COVID-19 is still insufficient due to the lack of primary robust trial-based data and heterogeneous study designs. the principal aims of our study were to determine the impact of vitamin D deficiency or insufficiency on complications during intensive care unit (icu) stay, as well as its role in muscle mass and strength improvement as well as morphofunctional recovery during a multispecialty 6-month follow-up program based on adapted nutritional support and specific physical rehabilitation. as a secondary objective, we compared the association mentioned above between patients with sarcopenic obesity and non- sarcopenic obesity. methods: this prospective observational study included 94 outpatients postcritical COVID-19. two weeks after hospital discharge, patients were divided into sufficient (≥30 ng/mL), insufficient (20.01–29.99 ng/mL), or deficient (≤20 ng/mL) vitamin D levels. the differences in in-hospital complications and morphofunctional parameters including phase angle (PhA), body cell mass (BCM), handgrip strength (HGS), timed get-up-and-go (UAG), 6 min walk test (6MWT), and proinflammatory biochemical variables were analyzed. Incremental (Δ) changes in these parameters were also analyzed at the end of follow-up according to vitamin D levels and the presence vs. absence of sarcopenic obesity. A multivariate linear regression analysis was performed to detect possible confounding factors in the impact analysis of vitamin D changes on functional recovery in patients with obesity. Results: A total of 36.2% of patients exhibited vitamin D deficiency, 29.8% vitamin D insufficiency, and only 32.9% showed sufficient levels at hospital discharge. A total of 46.8% of patients had obesity, and 36.1% had sarcopenic obesity. Vitamin D deficiency was associated with longer hospital stays (p = 0.04), longer ICU stays (p = 0.04), more days of invasive mechanical ventilation (IMV) (p = 0.04), lower skeletal muscle mass/weight (SMM/w) (p = 0.04) and skeletal muscle index (SMI) (p = 0.047), higher fat mass percentage (FM%) (p = 0.04), C-reactive-protein (CRP) (p = 0.04), and glycated hemoglobin (HbA1c) (p = 0.03), and better performance in R-HGS (p = 0.04), UAG (p = 0.03), and 6MWT (p = 0.034) when compared with those with normal vitamin D levels. At six months, Δvitamin D significantly correlated with ΔHbA1c (p = 0.002) and CRP (p = 0.049). Patients with normal vitamin D values showed better recovery of ΔSMI (p = 0.046), ΔSMM/w (p = 0.04), ΔR-HGS (p = 0.04), and ΔUAG (p = 0.04) compared to those with abnormal vitamin D levels, and these improvements in ΔR-HGS and ΔUAG were greater in the subgroup of sarcopenic obesity compared than in nonsarcopenic obesity (p = 0.04 and p = 0.04, respectively). Multivariate regression analysis detected that these results were also attributable to a longer hospital stay and lower ΔCRP in the subgroup of patients with sarcopenic obesity. Conclusions: Vitamin D deficiency was associated with longer hospital stays, longer VMI requirement, worse muscle health, and a higher degree of systemic inflammation. Furthermore, normal vitamin D levels at the end of the follow-up were associated with better morphofunctional recovery in postcritical COVID-19, particularly in patients with sarcopenic obesity partly due to a higher degree of inflammation as a result of a longer hospital stay.</jats:p>",
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