Vitamin D, a tale of two studies

Vitamin D Supplements for Prevention of Covid-19 or other Acute Respiratory Infections: a Phase 3 Randomized Controlled Trial (CORONAVIT)

December 2020 to June 2021

Randomly assigned 6200 U.K. adults

postal finger-prick 25-hydroxyvitamin D (25[OH]D) test

provision of a 6-month supply of vitamin D

to those with blood 25(OH)D concentration less than 75 nmol/L

3,200 IU/day, n = 1,356

800 IU/day, n = 1,334

No offer of testing or supplementation, n = 3,100

Outcomes

Proportion of participants experiencing at least one swab test- or doctor-confirmed acute respiratory infection (ARI) of any cause

Incidence of swab test-confirmed Covid-19

RESULTS

2,690 (86.8%) had 25(OH)D less than 75 nmol/L

Experienced at least one ARI of any cause

Higher dose group

76 (5.0%)

Lower dose group

87 (5.7%)

No offer group

136 (4.6%)

OR

higher-dose vs. no-offer, 1.09

lower-dose vs. no-offer, 1.26

Diagnosed with covid

Higher dose group

45 (3.0%)

Lower dose group

55 (3.6%)

No offer group

78 (2.6%)

CONCLUSIONS

Implementation of a test-and-treat approach to correcting sub-optimal vitamin D status in the U.K. population was safe and effective in boosting 25(OH)D concentrations of adults with baseline concentrations less than 75 nmol/L.

However, this was not associated with protection against all-cause ARI or Covid-19.

Incidence of hospitalization for ARI was low, and we therefore lacked power to detect an effect of the intervention on severity of Covid-19 and other ARIs.

Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness

Objective

Examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2

Participants

April 7th, 2020 and February 4th, 2021

Galilee Medical Center (GMC) in Nahariya, Israel

Positive polymerase chain reaction (PCR) tests

Historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test.

Design

Patients admitted with COVID-19 were categorized according to disease severity and level of 25(OH)D.

deficient, insufficient, adequate, high-normal

Isolated influence of the sinusoidal pattern 25(OH)D changes

Results

Of 1,176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection

In patients with the severe or critical disease

87.4% had lower vitamin D levels, less than 20 ng/mL

In patients with mild or moderate disease

34.3% had lower vitamin D levels, less than 20 ng/mL

p less than 0.001

Patients with Vit D less than 20ng/ml versus patients with more than 40 ng/ml

Patients with lower vitamin D levels were 14 times more likely to have severe or critical disease

p less than 0.001

Conclusions

Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.