Vitamin D and immunity were discussed in the context of COVID-19. There is emerging evidence that vitamin D status may be associated with COVID-19 incidence and severity, however available studies have limitations and cannot prove causation. Maintaining adequate vitamin D through diet and sunlight is recommended for the general population, while more research is still needed, including randomized controlled trials, to fully understand any relationship between vitamin D supplementation and COVID-19 prevention or treatment. In the meantime, identifying and treating vitamin D deficiency is suggested, regardless of links to respiratory infection.
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Current State of Evidence: Vitamin D and Immunity During the COVID-19 Pandemic
1. GLOBAL FORUM2020
3 R D S A V I N G L I V E S S U S T A I N A B L Y:
SUSTAINABLE PRODUCTION IN THE HEALTH
SECTOR GLOBAL FORUM|2020 RIYADH
Dr. Maha Al Turki
Current State of Evidence:
Vitamin D and Immunity
During Covide-19
2. OUTLINE OF THE PRESENTATION
• Introduction
• Vitamin D and Respiratory Viral Infections
• Vitamin D on and Covid-19t treatment and
prevention
• Summary
3. GLOBAL FORUM 2020
INTRODUCTION
No medicine or vaccine
Global pandemic
Immune system is the
best defense
Improvement of immunity
through nutrition
4. IMMUNONUTRITION
• An optimal nutritional status guarantees the
main modulating processes of inflammatory and
oxidative stress, both connected to the immune
system.
• Adequate and balanced supply nutrients
essential to set an appropriate immune response
• Nutritional status may play an important part in
different severe infections, especially in COVID-
19.
GLOBAL FORUM 2020
5. MICRONUTRIENTS & IMMUNE
FUNCTION
Nutrients that are critical for the growth and function of immune cells:
• Vitamin C
• Vitamin D
• Zinc
• Selenium
• Iron
• Protein (including the amino acid glutamine)
6. VITAMIN D
• Essential nutrient that humans obtain through
exposure to sunlight, through diet (e.g. oily fish, and
in fortified grain and dairy products) and dietary
supplements
Potential mechanism
• Plays a vital and complex role in immune system
function and regulation
• It could prevent the cytokine storm and subsequent
acute respiratory distress syndrome that is commonly
the cause of death in COVID-19 patient
GLOBAL FORUM 2020
7. Vitamin D in the Prevention or Treatment
of Viral Respiratory Infections
GLOBAL FORUM 2020
1930
8. Bergman P et al. 2013
11 RCTs (5660 participants) found
that Vitamin D decreased the risk
of respiratory tract infections
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2013
2017
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Vitamin D &Viral Respiratory Infections
11 RCTs (5660 participants) found that Vitamin D
supplements decreased the risk of respiratory
tract infections
Bergman P et al. Vitamin D and respiratory tract infections: a systematic review and meta-
analysis of randomized controlled trials. PLoS ONE. 2013;8:e65835
25 RCTs (11321 participants) Vitamin D
decreased the risk of acute respiratory tract
infection, effects greater in those with low
starting status
Martineau AR et al. Vitamin D supplementation to prevent acute respiratory tract infections:
systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583.
9. Bergman P et al. 2013
11 RCTs (5660 participants) found
that Vitamin D decreased the risk
of respiratory tract infections
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2019
2019
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Vitamin D &Viral Respiratory Infections.
24 studies found that Serum vitamin D was
inversely associated with risk and severity of
acute respiratory tract infections
Pham H et al. Acute respiratory tract infection and 25-hydroxyvitamin D concentration: a
systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16:3020
8 observational studies (20966 participants)
found that participants with vitamin D deficiency
had increased risk of community-acquired
pneumonia
Zhou YF et al. The association between vitamin D deficiency and community-acquired pneumonia: a
meta-analysis of observational studies. Medicine 2019;98:17252
10. GLOBAL FORUM 2020
WHY CONSIDER VITAMIN D IN COVID-19
Risk Factors for
COVID-19
Risk Factors for
Vitamin D Deficiency
11. The association between Vitamin D and COVID-19
morbidity and mortality
The role of vitamin D supplement in the
prevention and treatment of COVID-19
12. VITAMIN D VS. COVID-19
GLOBAL FORUM 2020
April
April
(Lau FH et al., 2020)
May
(D’Avolio A et al., 2020)(Grant WB et al.2020)
High rates of vitamin D deficiency in people with
Covid-19
Vitamin D supplement could play a significant role in
reducing the risk of COVID-19 and its potential outcomes
After adjustment for sociodemographic & comorbidity
variables, vitamin D correlated with disease incidence
(Meltzer et al., 2020)
13. VITAMIN D VS. COVID-19
GLOBAL FORUM 2020
Sep
Jun
(Hastie C.E. et al. 2020) (Raisi-Estabragh Z. et al. 2020)
Oct
(Merzon et al., 2020)
2 Large Biobank studies: vitamin D deficiency was
not related to the incidence of COVID-19
Low plasma 25(OH) vitamin D level is associated with
increased risk of COVID‐19 infection in 14000 individual
(Meltzer et al., 2020)
A significant negative correlation between mean vitamin D
levels and COVID-19 cases in 20 European countries but not
with COVID-19 deaths
14. • There is an emerging evidence in the literature of the association of
vitamin D status and both the incidence and severity of COVID-19.
However,
Available evidence has limitations
• None of these studies can prove causal relationship.
• Heterogeneity in study populations & interventions
• Different COVID-19 case definitions.
• Did not adjust for important confounders
GLOBAL FORUM 2020
Summary
15. Using vitamin D supplementation to treat or prevent COVID-
19: Evidence to date is insufficient.
Too early to recommend vitamin D supplements
More applicable to general population:
Maintaining a diet containing a balance of vitamins
Maintaining optimal Nutritional status
GLOBAL FORUM 2020
Summary
16. WHAT IS NEXT?
GLOBAL FORUM 2020
Identifying and treating patients
with vitamin D deficiency
irrespective of any association
with respiratory infection
Medical Team Policymakers Researchers
Increase the public awareness on
the important of adequate dietary
supply of vitamin D and proper
exposure to sunlight
Randomized controls trials and large
population studies are needed to
investigate effectiveness and safety
of vitamin D supplementation for
the prevention and treatment of
COVID-19/ Association between
vitamin D status and COVID-19
17. References
GLOBAL FORUM 2020
Bergman P et al. Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE.
2013;8:e65835
Martineau AR et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant
data. BMJ 2017;356:i6583.
Martineau AR et al. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess.
2019 Jan;23(2):1-44. doi: 10.3310/hta23020. PMID: 30675873; PMCID: PMC6369419.
Pham H et al. Acute respiratory tract infection and 25-hydroxyvitamin D concentration: a systematic review and meta-analysis. Int J Environ Res Public
Health. 2019;16:3020
D’Avolio A et al. 25-hydroxyvitamin d concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients. 2020; 12: 1359
Grant WB et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020 Apr
2;12(4):988
Lau FH, Majumder R, Torabi R, Saeg F, Hoffman R, Cirillo JD, et al. Vitamin D insufficiency is prevalent in severe COVID-19. MedRxiv. 2020 Apr 28
Meltzer D.O. Association of vitamin d deficiency ad treatment with COVID-19 incidence. medRxiv. 2020
Hastie C.E. et al. Vitamin d concentrations and COVID-19 infection in UK biobank. Diabetes Metab. Syndr. 2020; 14: 561-565
Raisi-Estabragh Z. et al. Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic
or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank.J. Public Health (Oxf.). 2020
Eating enough nutrients as part of a varied diet is required for the health and function of all cells
Each stage of the body’s immune response relies on the presence of many micronutrients. Examples of nutrients that have been identified as critical for the growth and function of immune cells include
Interest in a potential role for vitamin D in the prevention or treatment of respiratory infections dates back to the 1930s, when cod liver oil was investigated as a means to prevent or reduce common cold.
British researchers ran two controlled trials on cod liver oil and reported a reduction in the incidence of respiratory infections by 50% and 30% respectively.
25 RCTs (11321 participants) Vitamin D decreased the risk of acute respiratory tract infection, effects greater in those with low starting status
The striking overlap between risk factors for severe COVID-19 and vitamin D deficiency, including obesity, older age, and Black or Asian ethnic origin, has led some researchers to hypothesise that vitamin D supplementation could hold promise as a preventive or therapeutic agent for COVID-19
The striking overlap between risk factors for severe COVID-19 and vitamin D deficiency, including obesity, older age, and Black or Asian ethnic origin, has led some researchers to hypothesise that vitamin D supplementation could hold promise as a preventive or therapeutic agent for COVID-19