Low vitamin D levels and prognosis in a COVID-19 pediatric population: a systematic review

Abstract

Aim We aim to study the relationship between vitamin D level, risk and severity of COVID-19 infection in pediatric population through systematic review. Methods We searched PubMed, CINAHL, EMBASE, Cochrane Library and Google Scholar from December 2019 to June 2021 for retrieving articles studying association between vitamin D deficiency with COVID-19. Qualitative details were synthesized in evidence table and quantitative data was used for deriving pooled estimate through meta-analysis. Results After initial search of 2261 articles, eight eligible studies (two reviews) were included in the systematic review. Meta-analysis of the quantitative data (six studies) showed pooled prevalence of vitamin D deficiency as 45.91% (95% CI : 25.148-67.450). In infected pediatric patients, low levels of vitamin D increased the risk of severe disease (odds ratio - 5.5; 95% CI : 1.560- 19.515; p = 0.008). It was also found that children and adolescents having vitamin D deficiency had greater risk of COVID infection as compared to patients with normal vitamin D levels. Improvement in disease severity with vitamin D supplementation was also noted. Conclusion The systematic review showed that almost half of the pediatric COVID patients suffer from vitamin D deficiency. It is also clear that the low level of vitamin D is associated with greater risk of infection and poorer outcome in pediatrics.

Association of vitamin D status with COVID‐19 disease severity in pediatric patients: A retrospective observational study

“… 38 Improvement in the severity of COVID‐19 through supplementation with vitamin D was also stated. 38 Nearly half of the pediatric COVID‐19 patients had vitamin D deficiency. 38 These findings were similar to the results of the current study.…”

“… 38 Nearly half of the pediatric COVID‐19 patients had vitamin D deficiency. 38 These findings were similar to the results of the current study.…”

“…It was reported in a meta‐analysis and systematic review that pediatric COVID‐19 patients with vitamin D deficiency had a higher risk of COVID‐19 disease and poorer outcomes than cases with normal levels of vitamin D levels 38 . Improvement in the severity of COVID‐19 through supplementation with vitamin D was also stated 38 . Nearly half of the pediatric COVID‐19 patients had vitamin D deficiency 38 .…”

Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections?

“…However, these results derive from the analysis of only 102 cases, so larger studies are needed. The absent definition of the serum 25(OH)D cutoff level used to identify vitamin D deficiency is another limitation of this systematic review [ 172 ]. Previously, we discussed that breastfeeding may contribute to decrease the risk of contract COVID-19 in infancy.…”

Association between low serum vitamin D and increased mortality and severity due to COVID-19: reverse causality?

“…Given the appearance of 8 new variants whose virulence and coverage by current vaccines are still under study [2,3], it is important to study modifiable risk factors that may reduce the risk of developing severe or fatal forms of SARS-CoV-2 infection. One of the most studied modifiable risk factors has been vitamin D. So far, several systematic and meta-analytic studies have been published, which have concluded that there may be a cause-effect relationship between low serum 25-hydroxyvitamin D (25(OH)D3) and increased mortality and severity due to SARS-CoV-2 infection [4][5][6][7][8][9]. However, the robustness of this causeand-effect relationship is currently being questioned and it has been suggested that this premature conclusion should be taken with caution for several rea-sons [10].…”