Mainstream media was flooded this week with reports to guess what role it, if any. Vitamin D It may help reduce the severity of COVID-19 infections.
Observational data comparing results from different countries suggest an inverse relationship between vitamin D levels and the severity of COVID-19 responses and mortality, further suggesting the effect of vitamin D on the immune response to infection. I am.
However, other studies have questioned such associations, including the association between vitamin D levels and differences in COVID-19 severity by ethnic group.
Also, some researchers and clinicians believe that people need to be tested during this outbreak to see if they have adequate vitamin D levels, especially in front-line healthcare workers. However, most doctors state the best way to ensure that people get adequate levels of vitamin D during COVID-19. Only take supplements at the currently recommended levels.
This is especially important given the fact that many people spend more time than they usually do indoors during “lockdown” scenarios.
Clifford Rosen, MD, a senior scientist at the Scarborough Institute in Maine Medical Center, has been studying vitamin D for 25 years.
“There is certainly no randomized controlled trial, and that is the gold standard,” he said Medscape Medical News, “Observation data is so confusing that it’s difficult to know.”
He says that it’s important to get enough vitamin D, both from diet and from supplements, especially for those at highest risk of COVID-19. Yet, there is currently lacking firm data to support the role of vitamin D in the prevention of COVID-19 or as a “treatment” of any kind for infectious diseases.
Dr. Rose Ankeny, MD, a professor of geriatrics at Trinity College in Dublin, Ireland, recently co-authored an article detailing the inverse correlation between vitamin D levels in Europe and COVID-19 mortality.
“There’s no point in saying this is normal, but the possibility is [vitamin D] -The hanging fruit-is a contributing factor and we can now do something about it, “she said. Medscape Medical News..
Kenny urges the Irish Government to formally change their recommendations. “We updated the guidelines to the Irish Government as an urgent matter, [vitamin D] She said that Northern Ireland, part of the UK, has not yet made this recommendation.
On the other hand, Harpreet S. Bajaj MD, MPH, an endocrinologist at Mount Sinai Hospital in Toronto, Canada, said: “Vitamin D may have one of three potential roles in the risk of COVID-19 and / or its severity. A marker, or a causative factor.”
Similar to Rosen and Kenny, Bajaj states that there is a great need for randomized controlled trials (RCTs) to see if there is a specific role for vitamin D.
“Until then, in addition to following COVID-19 preventive guidance and evolving guidelines for COVID-19 treatment, we must follow established public health recommendations for vitamin D supplementation.”
What is the role of vitamin D fortification?
To Their study Irish Medical Magazine, Despite sunny days in Europe, Kenny and colleagues report that the incidence of vitamin D deficiency is high in Spain and northern Italy, and that COVID-19 has the highest infection and mortality rates in the world.
However, these countries do not formally fortify foods or recommend vitamin D supplementation.
Conversely, in northern Norway, Finland, and Sweden, higher levels of vitamin D were the result of general nutritional and formal fortification of foods, despite low UVB sun exposure. .. COVID-19 infection and mortality were also low in these Nordic countries.
Overall, the correlation between low vitamin D levels and COVID-19 mortality was statistically significant (P = .046), the investigator reports.
“Optimizing the vitamin D status to the recommendations of national and international public health agencies will certainly bring potential benefits to COVID-19,” they conclude.
“I’m not saying there are no confounders. This may be true, but this is [finding] Evidence needs to be mixed. “
Mr Kenny also said that COVID-19 mortality was relatively low in countries in the Southern Hemisphere, but explained that the virus may later have spread to these countries.
Rosen also questions this issue.
“Yes, vitamin D supplementation [Nordic countries], Their COVID-19 is better controlled, but here there is no causality. There is another step to actually prove this. Other factors may also be affecting. “
“Look at Brazil, it’s on the equator, but the disease is ruining the country. Now I just don’t believe it.”
Does vitamin D play a role in immune regulation?
One theory currently in circulation is that if vitamin D plays any role in regulating the response to COVID-19, it may be due to a slowing of the immune system response to the virus.
so Recent Preprint Survey, Dr. Ali Daneshka, and colleagues at Northwestern University, Chicago, Illinois, examined data from hospitals in China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, United Kingdom, and the United States.
Specifically, the risk of severe COVID-19 cases in patients with severe vitamin D deficiency was 17.3%, while the equivalent figure in patients with normal vitamin D levels was 14.6% (a decrease of 15.6%).
“This potential effect may be due to the ability of vitamin D to suppress the adaptive immune system and regulate cytokine levels, thereby reducing the risk of developing severe COVID-19.” The researchers say.
Similarly, Joan E. Manson, MD, head of preventive medicine at Brigham and Women’s Hospital in Boston, Massachusetts, said in a recent Medscape commentary: Observational study of three hospitals in South AsiaThe prevalence of vitamin D deficiency was much higher in patients with severe COVID-19 disease than in those with mild disease.
“I also know that vitamin D has an immunomodulatory effect that can reduce inflammation. COVID-19 and the cytokine storm It was proven. “
Rosen said he was prepared to listen to the question of the potential role of vitamin D in immune regulation.
“I was very skeptical from the start and criticized the data out loud for doing nothing. I was surprised that it might have some effect,” he said. Medscape Medical News..
“Obviously most people don’t get this [cytokine storm] However, it is unclear why among those who do so. Maybe if you are getting enough vitamin D, it may somehow affect your response to infections in the future.
Influence of minority ethnic minorities
It is also well recognized that COVID-19 excessively affects individuals in the Black and Asian Minorities (BAME).
But recently reviewed on the issue of vitamin D in this context Investigation Using UK Biobank data, “there is no evidence to support a potential role for vitamin D levels to explain susceptibility to COVID-19 infections to explain differences across or across ethnic groups.”
“Vitamin D is unlikely to be the underlying mechanism of the higher risk observed in blacks and minority individuals, and vitamin D supplements are unlikely to provide effective intervention,” said University of Glasgow, UK. Dr. Claire Hastie and colleagues conclude.
However, this does not prevent the two endocrinologists from requesting a member of the British Indian Medical Association (BAPIO) to test their vitamin D levels.
“Black people and ethnic minorities (BAMEs) in Asia, especially front-line staff, need to check their vitamin D3 levels and get the appropriate substitutes if needed,” Weston, Weston Super Mare, UK. Dr Paragusinhar of the General Hospital said, and in a letter Medscape saw to BAPIO members, retired endocrinologist David C. Anderson...
In fact, they propose a one-time booster dose of 100,000 IU for BAME health care staff who need to raise their vitamin D levels for 2-3 months. They are Systematic review It concludes, “A single dose of Vitamin D3 over 300,000 IU is most effective in improving Vitamin D status … for up to 3 months.”
Rosen commented on this idea, and generally, a single, high-dose dose of 50,000-100,000-500,000 IU yields greater benefits than a single dose of 1000 IU daily, except for elevated blood levels. Said it will not bring. Faster and higher.
“There is really no evidence that ingesting really ultra high levels of vitamin D would outweigh normal levels,” he said. “Thus, if a health care worker suspects a vitamin D deficiency, a dose of 1000 IU per day seems reasonable. Even if you miss a dose, your blood levels are relatively stable.”
Rosen said a particular issue regarding the need for vitamin D in ethnic minorities was whether serum levels of vitamin D were low, but whether there was a clinical significance associated with this.
“The real problem is [ethnic minority individuals] These low levels have been around for thousands of years, and are otherwise physiologically adapted to this. In fact, African Americans have lower levels of vitamin D, but bones are definitely better than whites, “he noted.
Tests and government recommendations during COVID-19
of National Institutes of Health (NIH) In general, it is recommended that you take 400 IU to 800 IU of vitamin D per day, depending on your age. People over 70 need the highest daily dose. This provides blood levels sufficient to maintain bone health and normal calcium metabolism in healthy people.
However, there are no additional recommendations specific to vitamin D intake during the COVID-19 pandemic.
And Rosen points out that there is no evidence for extensive screening for vitamin D levels among the US population.
“U.S. public health guidance is pre-COVID and can be used by high-risk individuals, such as Inflammatory bowel disease Or liver or pancreatic disease. Anyway, these people are at a higher risk, possibly because of their low vitamin D, “he said.
“Skip the test and make sure you’re getting the right level of vitamin D, whether you’re using a diet or a supplement [400-800 IU] Per day]”It won’t do any harm.”
British Public Health England (PHE) Clarified their advice About vitamin D supplement in COVID-19. Dr. Alison Tedstone, PHE’s chief dietitian, said: “Many people spend a lot of time indoors, not taking all the vitamin D they need from the sun. 10 micrograms to protect bone and muscle health [400 IU] Of vitamin D. “
However, “there is insufficient evidence to support recommending vitamin D to reduce the risk of COVID-19,” she emphasized.
Bajaj is on the Advisory Board of Medscape Diabetes & Endocrinology. He has Erve (d) as a speaker or speaker bureau member of Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Merck, Novo Nordisk, Sanofi; Research grants from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi, Valeant. I am receiving. Sanofi-aventis earns over $ 250 from Amgen, AstraZeneca, Boehringer Ingelheim, Canadian Collaborative Research Network, CMS Knowledge Translation, Diabetes Canada Scientific Group, Janssen, LMC Healthcare, mdBriefCase, Medscape, Meducom, Merck, Novo Nordisk. , Valeant.
Kenny, Rosen, and Sinhal do not disclose related financial relationships.
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