Evidensen for forholdet mellem Vitamin D og COVID-19

København, den 20.7.2020

(redigeret den 15.8.2020)

Til ære for de af jer som gerne vil se nærmere på den videnskabelige evidens for at man kun bliver alvorligt syg af COVID-19 hvis man har D vitamin mangel kommer her resumeer/abstracts/konklusioner af de 3 mest relevante videnskabelige artikler som der henvises til (direkte eller indirekte) i den oprindelige tekst HOW WE CAN FIX THIS PANDEMIC IN A MONTH fra Orthomolecular News.

Her kommer abstractet til den første artikel. Artiklen kan downloades fra ssrn.com (Elsevier):

Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19)

Abstract

The rapid spread of COVID-19 in many areas of the world calls for preventive health measures. Although basic guidelines on infection control are suggested, treatment has remained the best choice to avert mortality. However, for the time being, there are no known vaccines for the disease. In this paper, a multinomial logistic regression was used to predict clinical outcomes of patients infected with COVID-19 based on 25-hydroxyvitamin D [25(OH)D] levels, the barometer for Vitamin D status. A retrospective multicentre study of 212 cases with laboratory-confirmed infection of SARS-CoV-2 was conducted. Data pertaining to clinical features and serum 25(OH)D levels were extracted from the medical records. For statistical analysis, Mann-Whitney U and χ² tests were used to compare differences in the clinical outcomes. Multinomial logistic regression was used to explore the association between serum 25(OH)D level and clinical outcomes of the cases. Frequency and percentage were used for categorical variables. Mean was used for continuous variables. A p-value below 0.01 was considered statistically significant. Of the 212 cases of COVID-19, majority had ordinary clinical outcome. Mean serum 25(OH)D level was 23.8 ng/ml. Serum 25(OH)D level was lowest in critical cases, but highest in mild cases. Serum 25(OH)D levels were statistically significant among clinical outcomes. Majority had insufficient Vitamin D status, most of them were not severe. Vitamin D status is significantly associated with clinical outcomes. A multinomial logistic regression analysis reported that for each standard deviation increase in serum 25(OH)D, the odds of having a mild clinical outcome rather than a severe outcome were approximately 7.94 times (OR=0.126, p<0.001) while interestingly, the odds of having a mild clinical outcome rather than a critical outcome were approximately 19.61 times (OR=0.051, p<0.001). The results suggest that an increase in serum 25(OH)D level in the body could either improve clinical outcomes or mitigate worst (severe to critical) outcomes, while a decrease in serum 25(OH)D level in the body could worsen clinical outcomes of COVID-2019 patients. In conclusion, this study provides substantial information to clinicians and health policy-makers. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-19. Further research should conduct randomized controlled trials and large population studies to evaluate this recommendation.

Den anden artikel ‘burde’ findes her:

Raharusuna P, Priambada S, Budiarti C, et al. Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study. April 26, 2020; Available at SSRN: https://ssrn.com/abstract=3585561, doi:10.2139/ssrn.3585561. [CrossRef

Men der er den blevet slettet (censur?). Man kan dog finde og downloade et ‘preprint’ her:

Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study

KEY FINDINGS:

• Majority of the COVID-19 cases with insufficient and deficient Vitamin D status died.

• The odds of death was higher in older and male cases with pre-existing condition and below normal Vitamin D levels.

• When controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality.

• Randomized controlled trials are warranted to investigate the role of vitamin D supplementation on COVID-19 outcomes and to establish the underlying mechanisms.

ABSTRACT

This is a retrospective cohort study which included two cohorts (active and expired) of 780 cases with laboratory-confirmed infection of SARS-CoV-2 in Indonesia. Age, sex, co-morbidity, Vitamin D status, and disease outcome (mortality) were extracted from electronic medical records. The aim was to determine patterns of mortality and associated factors, with a special focus on Vitamin D status. Results revealed that majority of the death cases were male and older and had pre-existing condition and below normal Vitamin D serum level. Univariate analysis revealed that older and male cases with pre-existing condition and below normal Vitamin D levels were associated with increasing odds of death. When controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality outcome of cases.

Jeg fandt desuden en artikel fra NFS Journal på ca. 14 A4 sider + en liste med 196 referencer(!) Den kan downloades fra ncbi.nlm.nih.gov (Elsevier). Den har tilsyneladende intet abstract. Men her kommer konklusionen:

Vitamin D deficiency and co-morbidities in COVID-19 patients – A fatal relationship?

3. Conclusion

An inadequate supply of vitamin D has a variety of skeletal and non-skeletal effects. There is ample evidence that various non-communicable diseases (hypertension, diabetes, CVD, metabolic syndrome) are associated with low vitamin D plasma levels. These comorbidities, together with the often concomitant vitamin D deficiency, increase the risk of severe COVID-19 events. Much more attention should be paid to the importance of vitamin D status for the development and course of the disease. Particularly in the methods used to control the pandemic (lockdown), the skin’s natural vitamin D synthesis is reduced when people have few opportunities to be exposed to the sun. The short half-lives of the vitamin therefore make an increasing vitamin D deficiency more likely. Specific dietary advice, moderate supplementation or fortified foods can help prevent this deficiency. In the event of hospitalisation, the status should be urgently reviewed and, if possible, improved.

In the meantime, 8 studies have started to test the effect of supplementing vitamin D in different dosages (up to 200,000 IU) on the course of the COVID-19 disease. The aim is to clarify whether supplementation with vitamin D in different dosages has an influence on the course of the disease or, in particular, on the immune response, or whether it can prevent the development of ARDS or thromboses [¹⁹³].

Kærlig hilsen

Henrik Rosenø, M.Sc (civilingeniør)

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