Serum Vitamin D Levels Are Associated With Increased COVID-19 Severity and Mortality Independent of Whole-Body and Visceral Adiposity.

Pablo Esteban Vanegas-Cedillo,Roopa Mehta,Diana Hernández-Juárez,Neftali Eduardo Antonio-Villa,Jorge Carlos Valladares-García,Omar Yaxmehen Bello-Chavolla,José Sifuentes-Osornio,Alfredo Ponce De Leon,Monica Chapa-Ibarguengoitia,Natalia Ramírez-Pedraza,Arsenio Vargas-Vázquez,Carolina Isabel Pérez Carrión,Carlos A Aguilar-Salinas,María Isabel Jasso-Ávila,Bethsabel Rodríguez Encinas

doi:10.3389/fnut.2022.813485

Abstract

IntroductionCoronavirus disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with susceptibility to infectious disease. In this study, the association between COVID-19 outcomes and vitamin D levels in patients attending a COVID-19 reference center in Mexico City are examined.MethodsConsecutive patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation and follow-up, laboratory measurements and a thoracic computerized tomography, including the measurement of epicardial fat thickness. Low vitamin D was defined as levels <20 ng/ml (<50nmol/L) and deficient Vitamin D as a level ≤12 ng/ml (<30 nmol/L).ResultsOf the 551 patients included, low vitamin D levels were present in 45.6% and deficient levels in 10.9%. Deficient Vitamin D levels were associated with mortality (HR 2.11, 95%CI 1.24–3.58, p = 0.006) but not with critical COVID-19, adjusted for age, sex, body-mass index and epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 mortality conferred by low vitamin D levels was partly mediated by its effect on D-dimer and cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by low vitamin D levels was independent of BMI and epicardial fat.ConclusionVitamin D deficiency (≤12 ng/ml or <30 nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.

Highlights

Coronavirus disease (COVID-19) is a global pandemic
Overall, pooled evidence suggests that high Vitamin D levels have been associated with reduced risk of adverse COVID-19 outcomes, which may suggest a beneficial role for Vitamin D in COVID-19 [18]
We aimed to identify determinants of Vitamin D levels in COVID19 patients and develop causal-mediation models to propose mechanisms by which Vitamin D may lead to increased COVID19 mortality

Summary

Introduction

Coronavirus disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with susceptibility to infectious disease. Vitamin D is a steroid hormone involved in essential physiological roles including preserving bone integrity, immunomodulation by stimulating innate immunity and tempering adaptive immunity, infectious disease prevention and cardiovascular health [13, 14]. It acts on the renin angiotensin aldosterone (RAAS) system, inhibiting the angiotensin converting enzyme [ACE [7]]. Low levels of vitamin D have been associated with increased susceptibility to infectious disease, respiratory tract infections. Overall, pooled evidence suggests that high Vitamin D levels have been associated with reduced risk of adverse COVID-19 outcomes, which may suggest a beneficial role for Vitamin D in COVID-19 [18]. Evidence from randomized controlled trials have not shown benefit from Vitamin D supplementation in COVID-19 or other infections due to the high heterogeneity across studies and its systematic use requires further evaluation [19, 20]

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