Serum Vitamin D Levels Are Associated With Increased COVID-19 Severity and Mortality Independent of Whole-Body and Visceral Adiposity
Pablo Esteban Vanegas-Cedillo, Omar Yaxmehen Bello-Chavolla, Natalia Ramírez-Pedraza, Bethsabel Rodríguez Encinas, Carolina Isabel Pérez Carrión, María Isabel Jasso-Ávila, Jorge Carlos Valladares-García, Diana Hernández-Juárez, Arsenio Vargas-Vázquez, Neftali Eduardo Antonio-Villa, Monica Chapa-Ibarguengoitia, Alfredo Ponce De Leon, José Sifuentes-Osornio, Carlos A Aguilar-Salinas, Roopa Mehta
Frontiers in Nutrition, doi:10.3389/fnut.2022.813485
Conclusion: Vitamin D deficiency (≤12 ng/ml or <30 nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.
DATA AVAILABILITY STATEMENT The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found at: https://github.com/ oyaxbell/covid_metabolism.
ETHICS STATEMENT The studies involving human participants were reviewed and approved by Research and Ethics Committee of the INCMNZ (Ref 3383). Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
AUTHOR CONTRIBUTIONS RM, OB-C, and CA-S: research idea and study design. RM, PV-C, NR-P, MJ-Á, CP, BR, JV-G, and CA-S: data acquisition. OB-C, RM, CA-S, NA-V, and AV-V: data analysis/interpretation. OB-C and NA-V: statistical analysis. RM, OB-C, NA-V, AV-V, and CA-S: manuscript drafting. RM, CA-S, AP, and JS-O: supervision or mentorship. All authors contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.
Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's Note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated..
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'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>INTRODUCTION</jats:title><jats:p>Coronavirus '
'disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with '
'susceptibility to infectious disease. In this study, the association between COVID-19 '
'outcomes and vitamin D levels in patients attending a COVID-19 reference center in Mexico '
'City are '
'examined.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Consecutive '
'patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation '
'and follow-up, laboratory measurements and a thoracic computerized tomography, including the '
'measurement of epicardial fat thickness. Low vitamin D was defined as levels <20ng/mL '
'(<50nmol/L) and deficient Vitamin D as a level ≤12ng/mL '
'(<30nmol/L)</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of the '
'551 patients included, low vitamin D levels were present in 45.6% and deficient levels in '
'10.9%. Deficient Vitamin D levels were associated with mortality (HR 2.11, 95%CI 1.24-3.58, '
'p=0.006) but not with critical COVID-19, adjusted for age, sex, body-mass index and '
'epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 '
'mortality conferred by low vitamin D levels was partly mediated by its effect on D-dimer and '
'cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by '
'low vitamin D levels was independent of BMI and epicardial '
'fat.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p>Vitamin D '
'deficiency (≤12ng/mL or <30nmol/L), is independently associated with COVID-19 mortality '
'after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to '
'a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 '
'outcomes.</jats:p></jats:sec>',
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