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.

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

18. GLOBAL FORUM2020
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