Abstract: Nutrition 79 80 (2020) 111017 Contents lists available at ScienceDirect Nutrition journal homepage: www.nutritionjrnl.com Applied nutritional investigation Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B12 in combination on progression to severe outcomes in older patients with coronavirus (COVID-19) Chuen Wen Tan M.R.C.P., F.R.C.Path a,1, Liam Pock Ho F.R.C.P.A. a,b,c,1, Shirin Kalimuddin M.B.B.S., M.R.C.P., M.P.H. d,e, Benjamin Pei Zhi Cherng M.B.B.S., M.R.C.P. d, Yii Ean Teh M.B.B.S., M.R.C.P.(UK) d, Siew Yee Thien M.R.C.P.(UK) d, Hei Man Wong M.R.C.P.(UK), M.Med(NUS) d, Paul Jie Wen Tern M.B B.Chir d, Manju Chandran M.D., F.A.C.P., F.A.C.E., F.A.M.S., C.C.D. f, Jason Wai Mun Chay M.R.C.P., F.R.C.Path(UK) b,c, Chandramouli Nagarajan F.R.C.P.(Edin), F.R.C.Path(UK) a, Rehena Sultana M.Sc. (Statistics), MBA (Systems Management) g, Jenny Guek Hong Low M.R.C.P.(UK), M.P.H.(US) d,e, Heng Joo Ng M.R.C.P.(UK), F.R.C.Path(UK) a,* a Department of Hematology, Singapore General Hospital, Singapore Department of Clinical Pathology, Singapore General Hospital, Singapore c Department of Pathology, Sengkang General Hospital, Singapore d Department of Infectious Diseases, Singapore General Hospital, Singapore e Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore f Department of Endocrinology, Singapore General Hospital, Singapore g Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore b A R T I C L E I N F O Article History: Received 24 June 2020 Received in revised form 25 August 2020 Accepted 1 September 2020 Keywords: Vitamin D Magnesium Vitamin B12 COVID-19 A B S T R A C T Objectives: The aim of this study was to determine clinical outcomes of older patients with coronavirus (COVID-19) who received a combination of vitamin D, magnesium, and vitamin B12 (DMB) compared with those who did not. We hypothesized that fewer patients administered this combination would require oxygen therapy, intensive care support, or a combination of both than those who did not. Methods: This was a cohort observational study of all consecutive hospitalized patients 50 y of age with COVID-19 in a tertiary academic hospital. Before April 6, 2020, no patients received the (DMB) combination. After this date, patients were administered 1000 IU/d oral vitamin D3, 150 mg/d oral magnesium, and 500 mcg/d oral vitamin B12 upon admission if they did not require oxygen therapy. Primary outcome was deterioration leading to any form of oxygen therapy, intensive care support, or both. Results: Between January 15 and April 15, 2020, we identified 43 consecutive patients 50 y of age with COVID-19. Seventeen patients received DMB before onset of primary outcome and 26 patients did not. Baseline demographic characteristics between the two groups were significantly different by age. In univariate analysis, age and hypertension had a significant influence on outcome. After adjusting for age or hypertension separately in a multivariate analysis, the intervention group retained protective significance. Fewer treated patients than controls required initiation of oxygen therapy during hospitalization (17.6 vs 61.5%, P = 0.006). DMB exposure was associated with odds ratios of 0.13 (95% confidence interval [CI], 0.03 0.59) and 0.20 (95% CI, 0.04 0.93) for oxygen therapy, intensive care support, or both on univariate and multivariate analyses, respectively. Conclusions: A vitamin D / magnesium / vitamin B12 combination in..