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Winter Vitamin D Update

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Vitamin D Essential role in immunomodulation Innate and adaptive immune systems Enhances innate immunity, immune peptides, anti-viral effects, disrupt viral envelopes Suppressing the excessive expression of proinflammatory cytokines Regulating the expression of ACE2 receptors Epidemiological and clinical evidence, incidence, severity and mortality Low levels Hypertension, diabetes, cancer, cardiovascular diseases Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study https://covid19.tabipacademy.com/2020/09/08/vitamin-d-reduces-risk-of-icu-admission-97/ https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub 50 patients treated with calcifediol One required admission to the ICU (2%) No deaths All discharged, without complications 26 untreated patients 13 required ICU (50 %) 2 died Calcifediol clinical trial, 1,000 patients, 15 hospitals https://sevilla.abc.es/andalucia/cordoba/sevi-coronavirus-cordoba-calcifediol-ensayo-clinico-1000-pacientes-15-hospitales-probara-eficacia-farmaco-contra-covid-202010091322_noticia.html?ref=https:%2F%2Fwww.youtube.com Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection The Journal of Clinical Endocrinology & Metabolism (Accepted, 27th October 2020) https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827 To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 Analyze the possible influence of vitamin D status on disease severity Retrospective Case-control 216 COVID-19 patients 197 population-based controls Results Vitamin D deficiency was defined as serum 25OHD levels less than 20 ng/ml (50 nmol/L) COVID patients group Mean levels 13.8 ng/ml. (34.5 nmol/L) 82.2% vitamin D deficient Community control group Mean levels 20.9 ng/ml (52.25 nmol/L) (p less than 0.0001) 47.2% vitamin D deficient Blood levels lower in men than in women Evidence of protective role of Ultraviolet-B (UVB) radiation in reducing COVID-19 deaths (Nature scientific reports, 19th October 2020) https://www.nature.com/articles/s41598-020-74825-z Ultraviolet-B (UVB) radiation, mediated by vitamin D synthesis Dataset of 152 countries over 108 days (n = 6,524) A permanent unit increase in UVI is associated with a 1.2 percentage points decline in daily growth rates of cumulative COVID-19 deaths and a 1.0 percentage points decline in the CFR daily growth rate Globally Minus 12% of cumulative COVID-19 deaths Minus 38% on CFR We find a significant negative association between UVI and COVID-19 deaths indicating evidence of the protective role of UVB in mitigating COVID-19 deaths If confirmed via clinical studies, then the possibility of mitigating COVID-19 deaths via sensible sunlight exposure or vitamin D intervention would be very attractive Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239799 Association between serum 25-hydroxyvitamin D levels and its effect on adverse clinical outcomes n = 235 Results Based on CDC criteria, among our study patients, 74% had severe COVID-19 infection and 32.8% were vitamin D sufficient. Vitamin D sufficiency 25(OH)D less than 30 ng/ml. (75 nmol/L) Reduction in clinical severity Inpatient mortality Serum levels of C-reactive protein (CRP) Increase in lymphocyte percentage Vitamin D insufficiency in southern Arizona (American Journal of Clinical Nutrition) https://academic.oup.com/ajcn/article/87/3/608/4633323 Population 26.1 ng/ml (65.25 nmol/L) Below 20 ng/ml (50 nmol/L) Blacks 55% Hispanics 37.6% Whites 22.7% Also more obesity in first two groups Adult Health Status Among Native American Families Participating in the Growing Resilience Home Garden Study (CDC August 22, 2019) https://www.cdc.gov/pcd/issues/2019/19_0021.htm Northern Arapaho and Eastern Shoshone tribes sharing the Wind River Indian Reservation (WRIR) in Wyoming reportedly die 30 years earlier than whites in the state Nearly 80% of adults had deficient vitamin D levels ( less than 20 ng/mL; n = 167) (50 nmol/L) Obesity Waist circumference, associated with higher risk of obesity-related disease Women 95% Men 80% Hypertension Diabetes EVMS CRITICAL CARE COVID-19 MANAGEMENT PROTOCOL https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf If you would like to donate to John's educational projects, please use the following link, thank you, https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=78GGHGLK5ZXAE

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