Ethnicity as a risk factor for vitamin D deficiency and undesirable COVID‐19 outcomes

Akbari, Amir Reza; Khan, Maaz; Adeboye, William; Lee, Lawrence Hin Hai; Chowdhury, Sabbir

doi:10.1002/rmv.2291

Cited by 7 publications

(7 citation statements)

References 4 publications

(8 reference statements)

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“…Low serum 25(OH)D concentration at hospital admission predicts the severity and deaths from COVID-19 [ 44 , 45 , 47 , 48 , 49 , 50 ]. Low pre-pandemic vitamin D status is dose-dependently and inversely associated with higher risks of contracting COVID-19 and its severity [ 44 , 45 ].…”

Section: Vitamin D and Immune Functionsmentioning

confidence: 99%

Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections—Sepsis and COVID-19

Wimalawansa¹

2022

Nutrients

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Vitamin D deficiency is a global public health problem, a pandemic that commonly affects the elderly and those with comorbidities such as obesity, diabetes, hypertension, respiratory disorders, recurrent infections, immune deficiency, and malignancies, as well as ethnic minorities living in temperate countries. The same groups were worst affected by COVID-19. Since vitamin D deficiency weakens the immune system, it increases the risk of infections, complications, and deaths, such as from sepsis and COVID-19. Deficiency can be remedied cost-effectively through targeted food fortification, supplementation, and/or daily safe sun exposure. Its endocrine functions are limited to mineral metabolism, musculoskeletal systems, specific cell membrane interactions, and parathyroid gland functions. Except for the rapid, endocrine, and cell membrane-based non-genomic functions, all other biological and physiological activities of vitamin D depend on the adequate intracellular synthesis of 1,25(OH)2D (calcitriol) in peripheral target cells via the genome. Calcitriol mediates autocrine (intracrine) and paracrine signalling in immune cells, which provides broader, protective immune functions crucial to overcoming infections. The synthesis of 1,25(OH)2D (calcitriol) in peripheral target cells is dependent on diffusion and endocytosis of D3 and 25(OH)D from the circulation into them, which requires maintenance of serum 25(OH)D concentration above 50 ng/mL. Therefore, in acute infections such as sepsis and respiratory infections like COVID-19, it is necessary to rapidly provide its precursors, D3 and 25(OH)D, through the circulation to generate adequate intracellular calcitriol. Immune defence is one of the crucial non-hormonal functions of vitamin D. A single oral (bolus) dose or divided upfront loading doses between 100,000 and 500,000 IU, using 50,000 IU vitamin D3 increase the serum 25(OH)D concentrations to a therapeutic level of above 50 ng/mL that lasts between two to three months. This takes three to five days to raise serum 25(OH)D. In contrast, a single oral dose of calcifediol (0.014 mg/kg body weight) can generate the needed 25(OH)D concentration within four hours. Considering both D3 and 25(OH)D enter immune cells for generating calcitriol, using the combination of D3 (medium-term) and calcifediol (immediate) is cost-effective and leads to the best clinical outcome. To maximise protection against infections, particularly to reduce COVID-19-associated complications and deaths, healthcare workers should advise patients on safe sun exposure, adequate vitamin D supplementation and balanced diets containing zinc, magnesium, and other micronutrients to support the immune system. Meanwhile, governments, the World Health Organisation, the Centers for Disease Control, and governments should consider similar recommendations to physicians and the public, change the outdated vitamin D and other micronutrient recommendations directed to their population, and organise targetted food fortification programs for the vulnerable groups. This article discusses a rational approach to maintaining a sustained serum 25(OH)D concentration above 50 ng/mL, necessary to attain a robust immune system for overcoming infections. Such would cost-effectively improve the population’s health and reduce healthcare costs. It also describes three cost-effective, straightforward protocols for achieving and sustaining therapeutic serum 25(OH)D concentrations above 50 ng/mL (>125 nmol/L) to keep the population healthy, reduce absenteeism, improve productivity, and lower healthcare costs.

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Section: Vitamin D and Immune Functionsmentioning

confidence: 99%

Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections—Sepsis and COVID-19

Wimalawansa¹

2022

Nutrients

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“…Low serum 25(OH)D concentration on hospital admission could predict the need for intensive care use and correlate with higher COVID-related complications and deaths. 61,79,[115][116][117] In contrast, higher serum 25(OH)D concentrations lessen the severity of SARS-CoV-2 infections and reduce deaths by several folds (Figure 7). 118 Not only does vitamin D improve immune functions, 119 but it also substantially reduces the risk of viral and bacterial infections 118,120,121 and the risk of complications and deaths from COVID-19.…”

Section: Vitamin D Signaling Positively Modulates the Immune Systemmentioning

confidence: 99%

Overcoming Infections Including COVID-19, by Maintaining Circulating 25(OH)D Concentrations Above 50 ng/mL

Wimalawansa¹

2022

PLMI

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The elderly and those with underlying chronic diseases (i.e., comorbidities) such as pulmonary, cardiovascular, metabolic, and renal diseases, increase their susceptibility to sepsis, including COVID-19. The SARS-CoV-2 virus damages pulmonary cells, causing acute respiratory distress syndrome (ARDS) and hypoxia. It further damages endothelial cells, altering clotting mechanisums causing intravascular hemolysis, microvascular thrombosis, and micro-embolization, contributing to the risk of death. Approximately 75% of the immune system functions of humans depend on vitamin D and the availability of sufficient amounts of vitamin D metabolites [vitamin D and 25(OH)D] concentrations to enter immune cells from the bloodstream. Such concentrations are achievable through sun exposure, targeted food fortification programs, and adequate daily or weekly vitamin D supplements. That would allow for generating 1,25(OH) 2 D (non-hormonal form of calcitriol) intracellularly in peripheral target cells like immune cells. This enables immune cells' physiological functions, including intracrine/autocrine and paracrine signaling processes. This initiates and maintains robust immune functions, such as forming antibodies and antimicrobial peptides, suppressing inflammation, and increasing the expression of anti-inflammatory and antioxidant genes, thus, strengthening immune functions. The opposite occurs in hypovitaminosis D, increasing vulnerability to infections and dying from it. Therefore, governments should make the population sufficient with immunoceuticals-micronutrients, especially vitamin D, and other micronutrients: the most cost-effective intervention to keep the population healthy. The cost of such interventions are minuscule compared to the expenses related to increased hospitalizations and premature deaths. Supposed such a program was implemented in mid-2020 as the author proposed, we estimated that 50% of hospitalizations (and the associated healthcare costs) and a third of deaths from COVID could have been prevented. Described herein are cost-effective strategies using vitamin D to achieve and sustain serum D 3 and 25(OH)D concentrations crucial for maintaining a robust immune system, improving general health, minimizing disease severities and deaths, and reducing healthcare costs.

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“…Vitamin D deficiency is a global problem that affects healthy and sick people ( 1 ). Race is a significant risk factor for vitamin D deficiency ( 2 ). The overall prevalence rate of vitamin D deficiency in the U.S. population was 41.6%, with the highest rate among African Americans (82.1%), followed by Hispanics (69.2%), and lowest among non-Hispanic Whites (30.9%) ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…The participation of 25(OH)D in the endocrine, autocrine, and paracrine pathways seems to be crucial for reducing the risk of cancer development, autoimmune diseases (e.g., multiple sclerosis, type 1 diabetes, and bronchial asthma), cardiovascular diseases, strokes, type 2 diabetes, and neurocognitive disorders (13,15). 25(OH)D also reduced the incidence of recurrent infections (2,16).…”

Section: Introductionmentioning

confidence: 99%

Association of serum vitamin D concentration with the final course of hospitalization in patients with COVID-19

Konikowska,

Kiliś-Pstrusińska,

Matera-Witkiewicz

et al. 2023

Front. Immunol.

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BackgroundVitamin D deficiency is a substantial public health problem. The present study evaluated the association between vitamin D concentration and hospitalization and mortality risk in patients with coronavirus disease 19 (COVID-19).MethodsThis study used the COronavirus in LOwer Silesia (COLOS) dataset collected between February 2020 and June 2021. The medical records of 474 patients with confirmed severe acute respiratory syndrome 2 (SARS-CoV-2) infection, and whose vitamin D concentration was measured, were analyzed.ResultsWe determined a significant difference in vitamin D concentration between discharged patients and those who died during hospitalization (p = 0.0096). We also found an effect of vitamin D concentration on the risk of death in patients hospitalized due to COVID-19. As vitamin D concentration increased, the odds ratio (OR) for death slightly decreased (OR = 0.978; 95% confidence interval [CI] = 0.540-0.669). The vitamin D concentration cutoff point was 15.40 ng/ml. In addition, patients with COVID-19 and serum 25-hydroxyvitamin D (25(OH)D) concentrations < 30 ng/ml had a lower survival rate than those with serum 25(OH)D ≥ 30 ng/ml (log-rank test p = 0.0018). Moreover, a Cox regression model showed that patients with an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 and higher vitamin D concentrations had a 2.8% reduced risk of mortality (hazard ratio HR = 0.972; CI = 0.95-0,99; p = 0.0097).ConclusionsThe results indicate an association between 25(OH)D levels in patients with COVID-19 and the final course of hospitalization and risk of death.

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Ethnicity as a risk factor for vitamin D deficiency and undesirable COVID‐19 outcomes

Abstract: Dear Editor, We found the article 'Vitamin D supplementation and COVID-19 outcomes: A systematic review, meta-analysis and meta-regression', by Timotius Ivan Hariyanto et al. 1 to be of great interest. Timotius

Cited by 7 publications

References 4 publications

Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections—Sepsis and COVID-19

Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections—Sepsis and COVID-19

Overcoming Infections Including COVID-19, by Maintaining Circulating 25(OH)D Concentrations Above 50 ng/mL

Association of serum vitamin D concentration with the final course of hospitalization in patients with COVID-19

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