The CardBoard
Possible link btw Vitamin D deficiency & COVID-19? - Printable Version

+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Possible link btw Vitamin D deficiency & COVID-19? (/thread-19631.html)


Possible link btw Vitamin D deficiency & COVID-19? - 2006alum - 05-04-2020

[tweet]https://twitter.com/mattwridley/status/1257288617019482113?s=20[/tweet]
Would be interesting to see if this is confirmed by others. Interestingly, Vitamin D deficiency is strongly correlated with both darker skin color and heavier body weight, which could theoretically also help to explain why there seems to be differential outcomes for people of color and the obese:

Quote:Results: Darker skin colors and heavier body weights are independently and significantly associated with poorer vitamin D status. We report graphically the probability of vitamin D deficiency by body weight and skin color at vitamin D targets of 20 and 30 ng/mL.

Conclusion: The effects of skin color and body weight on vitamin D status are large both statistically and clinically. Knowledge of these effects may facilitate diagnosis of vitamin D deficiency.


RE: Possible link btw Vitamin D deficiency & COVID-19? - dabigv13 - 05-04-2020

Vitamin D deficiency is correlated with obesity. But I think the obesity is more likely to be the factor affecting outcomes for covid patients than the vitamin D deficiency. 

Vitamin D deficiency has been linked with all sorts of poor health states but teasing out difference between causation and correlation is tricky.

RE: Possible link btw Vitamin D deficiency & COVID-19? - M T - 05-04-2020

I reported similar results from New Orleans a couple of days ago:
(05-02-2020, 12:34 PM)M T Wrote:  While we're talking about things that may be protective,
this preprint report talks about the frequency of Vitamin D Insufficiency (VDI) in a small set of COVID patients.
Vitamin D Insufficiency is Prevalent in Severe COVID-19
Quote:Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI.

Absolutely agree with dabigv13's concern about distinguishing causation and correlation.

RE: Possible link btw Vitamin D deficiency & COVID-19? - BostonCard - 05-04-2020

Vitamin D studies have been all over the map.  About 5 - 10 years ago, it was fashionable to link vitamin D deficiency to all sorts of conditions (one of which was asthma, which I was studying).  My sense is that most of the vitamin D supplementation studies wound up being negative, though I'll admit that I'm not as up on the literature as I once was.  But I will start out being a bit skeptical. Then again, vitamin D supplementation is cheap and safe.

BC

RE: Possible link btw Vitamin D deficiency & COVID-19? - 2006alum - 05-04-2020

(05-04-2020, 06:28 PM)dabigv13 Wrote:  Vitamin D deficiency is correlated with obesity. But I think the obesity is more likely to be the factor affecting outcomes for covid patients than the vitamin D deficiency. 

Vitamin D deficiency has been linked with all sorts of poor health states but teasing out difference between causation and correlation is tricky.
Almost certainly true. But boy is Vitamin D deficiency easier and faster to "cure" than obesity, should it have any sort of independent effect, which this study seems to claim (assuming obesity was treated as a "comorbidity" - I couldn't seem to find the specific graph that shows the independent effect):
[tweet]https://twitter.com/PhonicsMom/status/1257436691742285826?s=20[/tweet]

RE: Possible link btw Vitamin D deficiency & COVID-19? - BostonCard - 05-04-2020

This article: https://www.nejm.org/doi/full/10.1056/NEJMoa1911124?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed is a bit of why I am skeptical.



Vitamin D insufficiency has been theorized to make critical illness worse, and in fact, the article notes that "Observational data and initial clinical trial data indicate that vitamin D deficiency is common among critically ill patients and constitutes a potentially modifiable risk factor associated with longer lengths of stay in the hospital and intensive care unit (ICU), lung and other organ injury, prolonged mechanical ventilation, and death.8-14"



(note that is 7 references on vitamin D insufficiency and critical care illness)



So, it was theorized that if you give critically ill patients with vitamin D insufficiency supplemental vitamin D, they might do better.  Unfortunately, "Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."



Now, to be fair, critical care illness is a very heterogeneous disease, and the participants in the trial were in the ICU for a variety of reasons: pneumonia, shock, sepsis, acute respiratory failure, aspiration, lung contusion, pancreatitis and smoke inhalation.  It is possible that vitamin D helps a subset of those patients but not others.  That being said, if you look at the survival curve, although not significant, the patients who got placebo actually did better than those who got vitamin D.


[Image: nejmoa1911124_f2.jpeg]

There are lots of other considerations, of course, including the timing (maybe you have to give it before someone goes into the ICU), or maybe you  need to give more than one dose.  Still, I'll remain skeptical until I see evidence that vitamin D repletion will actually help.


BC

RE: Possible link btw Vitamin D deficiency & COVID-19? - 2006alum - 05-04-2020

Oh, my thought was not that this could improve outcomes once admitted to the ICU; my thought was just that it might be a cheap way to (even if mildly) reduce the hospitalization rate until there's a vaccine. I'm assuming with supplementation someone who's D-deficient can get up to normal levels within a month or two?

And put it this way: as someone who's long been mildly vitamin D deficient and very haphazard about taking the recommended supplement, I will definitely be diligent about it going forward, since there was really no excuse for the deficiency in the first place.

RE: Possible link btw Vitamin D deficiency & COVID-19? - magnus - 05-04-2020

Seattle is known for constantly battling Vitamin D deficiency given the long winter nights.   Check the hospitalization rates there for a correlation.

RE: Possible link btw Vitamin D deficiency & COVID-19? - 82 Card - 05-04-2020

(05-04-2020, 06:45 PM)BostonCard Wrote:  Then again, vitamin D supplementation is cheap and safe.

Most people here probably know this but just in case: Unless a doctor has recommended higher dosage, I would be reluctant to take much more than 800 IU for a long period of time. The effects of Viramin D toxicity can be nasty (see https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108). A lot of the Vitamin D  tablets in the store are much higher dose. Calcium Citrate, Magnizium & Zinc tablets typically have more modest doses of D included. There are some people that regularly need much higher dosage. That needs to be done under doctor's supervision. If you've been getting a lot of sun, probably should skip the D supplement (unless doc says otherwise).

RE: Possible link btw Vitamin D deficiency & COVID-19? - stupac2 - 05-05-2020

(05-04-2020, 08:24 PM)82 Card Wrote:  If you've been getting a lot of sun, probably should skip the D supplement  (unless doc says otherwise).

I was going to say, isn't it the case that some time outside is plenty for people with light skin? I thought I read half an hour a day was plenty but that's a hazy memory.

RE: Possible link btw Vitamin D deficiency & COVID-19? - burger - 05-05-2020

(05-05-2020, 06:47 AM)stupac2 Wrote:  
(05-04-2020, 08:24 PM)82 Card Wrote:  If you've been getting a lot of sun, probably should skip the D supplement  (unless doc says otherwise).

I was going to say, isn't it the case that some time outside is plenty for people with light skin? I thought I read half an hour a day was plenty but that's a hazy memory.

I think it's even less.  But...if you live north of central CA or so, in winter the sun is not strong enough to make Vitamin D.  The UV index has to be >3, according to this site: http://blogs.oregonstate.edu/linuspaulinginstitute/2016/01/25/sunlight-vitamin-d-winter/

So, if you're anywhere outside the southern tier of the US, as in this map, you may not be getting enough D from the sun alone in winter.

[Image: january_map.jpg?w=604&ssl=1]

RE: Possible link btw Vitamin D deficiency & COVID-19? - oldalum - 05-05-2020

Vit D deficiency has been linked to everything under the sun (pun intended). The cutoff for "deficiency" is arbitrary and there is insufficient evidence that Vit D supplementation in asymptomatic "deficient" individuals detected by screening with blood tests has improved outcomes: see the USPSTF statement on this for a sober appraisal. I remember reading that more than 40% of the U.S. population is Vit. D "deficient" by the numbers, so it's no surprise that it's prevalent in patients with COVID-19. The correlation might be due to the people who are seriously ill with COVID-19 having pre-existing comorbidities that kept them from being outdoors as much as needed. People who are obese might have their Vit. D sequestered in fat cells. As far as I'm concerned, this is a nothing burger until proven otherwise. There are going to be tons of spurious correlations related to COVID-19. But if you're so inclined, no harm to taking it in an appropriate low dose.

RE: Possible link btw Vitamin D deficiency & COVID-19? - M T - 05-05-2020

Another recent preprint  "The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients"

I recently watched this 2015 talk (part of a series by UCSD) and it caught my attention.  Overall the talk is about vitamin D related to a particular cancer.   Some of it is about the safety and effectiveness of Vitamin D supplements.  The speaker's statement was to stop looking for adverse events at doses under 10,000 units per day.  Part is about vitamin D metabolism.

RE: Possible link btw Vitamin D deficiency & COVID-19? - akiddoc - 05-05-2020

(05-05-2020, 07:53 AM)oldalum Wrote:  Vit D deficiency has been linked to everything under the sun (pun intended). The cutoff for "deficiency" is arbitrary and there is insufficient evidence that Vit D supplementation in asymptomatic "deficient" individuals detected by screening with blood tests has improved outcomes: see the USPSTF statement on this for a sober appraisal. I remember reading that more than 40% of the U.S. population is Vit. D "deficient" by the numbers, so it's no surprise that it's prevalent in patients with COVID-19. The correlation might be due to the people who are seriously ill with COVID-19 having pre-existing comorbidities that kept them from being outdoors as much as needed. People who are obese might have their Vit. D sequestered in fat cells. As far as I'm concerned, this is a nothing burger until proven otherwise. There are going to be tons of spurious correlations related to COVID-19. But if you're so inclined, no harm to taking it in an appropriate low dose.

Yes, practically every study ever done on Vitamin D supplementation has been disappointing, no matter what the condition. It "might" be beneficial as an adjunct therapy for depression. It's probably not good for you to be chronically short of it in your diet. Being short throughout your life likely leads to osteoporosis but trying to treat osteoporosis later in life with vitamin D does not seem to work. 

https://www.chop.edu/news/health-tip/vitamin-d-supplements-what-parents-should-know

The kids that we are concerned about are kids with dark skin. They do not make much vitamin D in their skin and American kids do not eat much fish or drink much milk. I usually put my teens with darker skin on 1000 IU of Vitamin D3 a day. For younger kids I use 400-600 IU. I do not do Vitamin D levels except in very unusual circumstances. We don't know what a "normal" level is.

RE: Possible link btw Vitamin D deficiency & COVID-19? - stupac2 - 05-05-2020

(05-05-2020, 04:14 PM)akiddoc Wrote:  or drink much milk

Lol tell that to my son. We actively ration what he gets and still go through 2+ gallons a week between him and my wife.

RE: Possible link btw Vitamin D deficiency & COVID-19? - akiddoc - 05-05-2020

(05-05-2020, 07:42 PM)stupac2 Wrote:  
(05-05-2020, 04:14 PM)akiddoc Wrote:  or drink much milk

Lol tell that to my son. We actively ration what he gets and still go through 2+ gallons a week between him and my wife.

Sounds like me as a kid. I drank copious amounts. Neither of my kids will touch it. My son takes 1000 IU a day. My daughter eats fish every other day.

RE: Possible link btw Vitamin D deficiency & COVID-19? - M T - 05-14-2020

Here's another study, pre-COVID-19 but on acute respiratory infections, from BMJ in 2017 about the effect of Vitamin D supplementation.



Quote:Design Systematic review and meta-analysis of individual participant data (IPD) from randomised controlled trials.



Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.



[*]Meta-analysis of IPD from 10 933 participants in 25 randomised controlled trials showed an overall protective effect of vitamin D supplementation against acute respiratory tract infection (number needed to treat (NNT)=33)
[*]Benefit was greater in those receiving daily or weekly vitamin D without additional bolus doses (NNT=20), and the protective effects against acute respiratory tract infection in this group were strongest in those with profound vitamin D deficiency at baseline (NNT=4)