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Devulapalli CS. Vitamin D supplements reduce risk of viral upper respiratory infections in children with lower concentrations. Acta Paediatr 2025; 114:816-822. [PMID: 39727150 DOI: 10.1111/apa.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 11/28/2024] [Accepted: 12/19/2024] [Indexed: 12/28/2024]
Abstract
AIM Vitamin D is crucial for the immune system, as it enhances pathogen-fighting cells and reduces inflammation. We reviewed serum 25-hydroxyvitamin D (25(OH)D) concentrations in children with viral upper respiratory tract infections (URTIs) and the impact of vitamin D supplements on those infections. METHODS A mini literature review was conducted from 1 January 2000 to 30 April 2024. It used PubMed, Google Scholar, Cochrane and Scopus and focused on children aged 0-18 years. RESULTS The review comprised 12 studies: seven randomised controlled trials, two prospective studies, two case-control studies and one cross-sectional study. The findings included lower 25(OH)D concentrations in children more susceptible to URTIs and significantly lower levels in those with recurrent infections. One study found reduced 25(OH)D concentrations and immunoglobulin G levels in children with URTIs. Of the nine studies that examined vitamin D supplements, five reported benefits for children with URTIs, one only showed short-term effects and three found no significant reductions. Two reported that taking 2000 IU a day did not reduce URTIs any more than 400 IU and high-dose supplements may be unnecessary. CONCLUSION Children with viral URTIs often had lower vitamin D concentrations and supplements frequently helped to reduce the risk of these infections.
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Jolliffe DA, Camargo CA, Sluyter JD, Aglipay M, Aloia JF, Bergman P, Bischoff-Ferrari HA, Borzutzky A, Bubes VY, Damsgaard CT, Ducharme FM, Dubnov-Raz G, Esposito S, Ganmaa D, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Manaseki-Holland S, Manson JE, Mauger DT, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Kumar GT, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of stratified aggregate data. Lancet Diabetes Endocrinol 2025; 13:307-320. [PMID: 39993397 PMCID: PMC12056739 DOI: 10.1016/s2213-8587(24)00348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/11/2024] [Accepted: 11/11/2024] [Indexed: 02/26/2025]
Abstract
BACKGROUND A 2021 meta-analysis of 37 randomised controlled trials (RCTs) of vitamin D supplementation for prevention of acute respiratory infections (ARIs) revealed a statistically significant protective effect of the intervention (odds ratio [OR] 0·92 [95% CI 0·86 to 0·99]). Since then, six eligible RCTs have been completed, including one large trial (n=15 804). We aimed to re-examine the link between vitamin D supplementation and prevention of ARIs. METHODS Updated systematic review and meta-analysis of data from RCTs of vitamin D for ARI prevention using a random effects model. Subgroup analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration, dosing regimen, or age. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov between May 1, 2020 (end-date of search of our previous meta-analysis) and April 30, 2024. No language restrictions were imposed. Double-blind RCTs supplementing vitamin D for any duration, with placebo or lower-dose vitamin D control, were eligible if approved by a Research Ethics Committee and if ARI incidence was collected prospectively and pre-specified as an efficacy outcome. Aggregate data, stratified by baseline 25(OH)D concentration and age, were obtained from study authors. The study was registered with PROSPERO (no. CRD42024527191). FINDINGS We identified six new RCTs (19 337 participants). Data were obtained for 16 085 (83·2%) participants in three new RCTs and combined with data from 48 488 participants in 43 RCTs identified in our previous meta-analysis. For the primary comparison of any vitamin D versus placebo, the intervention did not statistically significantly affect overall ARI risk (OR 0·94 [95% CI 0·88-1·00], p=0·057; 40 studies; 61 589 participants; I2=26·4%). Pre-specified subgroup analysis did not reveal evidence of effect modification by age, baseline vitamin D status, dosing frequency, or dose size. Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (OR 0·96 [95% CI 0·90-1·04]; 38 studies; I2=0·0%). A funnel plot showed left-sided asymmetry (p=0·0020, Egger's test). INTERPRETATION This updated meta-analysis yielded a similar point estimate for the overall effect of vitamin D supplementation on ARI risk to that obtained previously, but the 95% CI for this effect estimate now includes 1·00, indicating no statistically significant protection. FUNDING None.
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Affiliation(s)
- David A Jolliffe
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Centre for Applied Respiratory Research Innovation and Implementation, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mary Aglipay
- Department of Pediatrics, St Michael's Hospital, Toronto, ON, Canada
| | - John F Aloia
- Bone Mineral Research Center, Winthrop University Hospital, Mineola, NY, USA
| | - Peter Bergman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vadim Y Bubes
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Francine M Ducharme
- Departments of Paediatrics and of Social and Preventive Medicine, University of Montréal, Canada
| | - Gal Dubnov-Raz
- Exercise, Lifestyle and Nutrition Clinic, Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | - Susanna Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Clare Gilham
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Inbal Golan-Tripto
- Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Emma C Goodall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Cameron C Grant
- Department of Paediatrics: Child & Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher J Griffiths
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Centre for Applied Respiratory Research Innovation and Implementation, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | | | - Ilkka Laaksi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; The Centre For Military Medicine, Finland
| | - Margaret T Lee
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY, USA
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Paweł Majak
- Department of Pediatric Pulmonology, Medical University of Lodz, Korczak Pediatric Center, Lodz, Poland
| | - Semira Manaseki-Holland
- Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - David T Mauger
- Department of Statistics, The Pennsylvania State University, Hershey, PA, USA
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | | | - Rachel E Neale
- Trivedi School of Biosciences, Ashoka University, Sonepat, Haryana, India
| | - Hai Pham
- Population Health Department, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Christine Rake
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jenni Rosendahl
- Children's Hospital, Pediatric Research Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dheeraj Shah
- Department of Paediatrics, University College of Medical Sciences, Delhi, India
| | - Yoshiki Shimizu
- FANCL Research Institute, FANCL Corporation, Yokohama, Japan
| | - Steve Simpson-Yap
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia; Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Geeta Trilok Kumar
- Trivedi School of Biosciences, Ashoka University, Sonepat, Haryana, India
| | | | - Adrian R Martineau
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Centre for Applied Respiratory Research Innovation and Implementation, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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Hung KC, Yu TS, Hung IY, Wu JY, Yew M, Chen IW. Impact of vitamin D deficiency on postoperative outcomes in patients with chronic kidney disease undergoing surgery: a retrospective study. Sci Rep 2025; 15:9757. [PMID: 40118908 PMCID: PMC11928554 DOI: 10.1038/s41598-025-93807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 03/10/2025] [Indexed: 03/24/2025] Open
Abstract
Although both chronic kidney disease (CKD) and vitamin D deficiency (VDD) are associated with increased surgical risk, their combined impact remains unclear. Using the TriNetX Analytics Network, we conducted a matched cohort study comparing postoperative outcomes in CKD patients with preoperative VDD (≤ 20 ng/mL) to those with normal vitamin D levels (≥ 30 ng/mL). The primary outcome was 30-day mortality; secondary outcomes included acute kidney injury (AKI), pneumonia, acute myocardial infarction (AMI), and atrial fibrillation/flutter (AF). After propensity score matching (21,033 patients per group), results showed that VDD was associated with higher 30-day mortality (Odds ratio[OR]: 2.33, 95% confidence interval [CI] 1.91-2.85, p < 0.0001), AKI (OR:1.94, 95% CI1.80-2.10, p < 0.0001), and pneumonia (OR:1.76, 95% CI 1.15-2.70, p = 0.0087), with no significant difference in AMI and AF. These associations persisted for 90 days. The impact of VDD on mortality and AKI was consistent across sex and CKD stages. Vitamin D insufficiency (21-29 ng/mL) showed attenuated but significant associations, suggesting a dose-dependent effect. In conclusion, preoperative VDD in patients with CKD is associated with increased risks of mortality, AKI, and pneumonia. These findings suggest the potential value of preoperative vitamin D screening and correction in patients with CKD.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Ting-Sian Yu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Yin Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - I-Wen Chen
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
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Wen YH, Dai RX, Yang H, Lin JL, Tao RJ, Yang L, Xu JF, Lu HW. Relation between vitamin D deficiency and Pseudomonas aeruginosa colonization in patients with bronchiectasis. BMC Pulm Med 2025; 25:77. [PMID: 39953443 PMCID: PMC11827138 DOI: 10.1186/s12890-025-03548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 02/03/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND The relationship between vitamin D deficiency and Pseudomonas aeruginosa (P. aeruginosa) colonization in bronchiectasis patients is not well understood. METHODS This study was conducted at Shanghai Pulmonary Hospital from June 2014 to May 2018. Serum 25-hydroxyvitamin D levels were measured in patients with bronchiectasis, and clinical data including sputum culture results were collected. To investigate the relationship between vitamin D levels and P. aeruginosa colonization, we conducted correlation analysis and logistic regression. Additionally, in vitro experiments with bone marrow-derived macrophages (BMDMs) infected with P. aeruginosa strain PAO1 were performed to further explore the influence of vitamin D on the bacterial infection and inflammatory response. RESULTS Among the 195 patients with bronchiectasis, 83.1% (162/195) were vitamin D deficient. A significant negative correlation was observed between serum vitamin D levels and the BSI (Bronchiectasis Severity Index) score. Patients with vitamin D deficiency showed higher rates of P. aeruginosa colonization compared to those with adequate vitamin D levels. Female gender and vitamin D deficiency were identified as risk factors for P. aeruginosa colonization in patients with bronchiectasis. Additionally, serum interleukin (IL)-1β levels were significantly elevated in the vitamin D-deficiency group. In vitro experiments, 1,25-dihydroxyvitamin D [1,25D] was shown to inhibit PAO1 phagocytosis in BMDMs and to suppress IL-1β secretion. CONCLUSIONS Vitamin D deficiency was strongly associated with an increased risk of P. aeruginosa colonization in patients with bronchiectasis. Furthermore, vitamin D demonstrated protective effects by reducing P. aeruginosa survival in cells and modulating the inflammatory dysregulation induced by the bacterium.
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Affiliation(s)
- Yu-Hua Wen
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Ruo-Xuan Dai
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Heng Yang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Jie-Lu Lin
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ru-Jia Tao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Ling Yang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Hai-Wen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
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Wimalawansa SJ. Vitamin D Deficiency Meets Hill's Criteria for Causation in SARS-CoV-2 Susceptibility, Complications, and Mortality: A Systematic Review. Nutrients 2025; 17:599. [PMID: 39940457 PMCID: PMC11820523 DOI: 10.3390/nu17030599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 01/15/2025] [Accepted: 01/17/2025] [Indexed: 02/16/2025] Open
Abstract
Clinical trials consistently demonstrate an inverse correlation between serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels and the risk of symptomatic SARS-CoV-2 disease, complications, and mortality. This systematic review (SR), guided by Bradford Hill's causality criteria, analyzed 294 peer-reviewed manuscripts published between December 2019 and November 2024, focusing on plausibility, consistency, and biological gradient. Evidence confirms that cholecalciferol (D3) and calcifediol significantly reduce symptomatic disease, complications, hospitalizations, and mortality, with optimal effects above 50 ng/mL. While vitamin D requires 3-4 days to act, calcifediol shows effects within 24 h. Among 329 trials, only 11 (3%) showed no benefit due to flawed designs. At USD 2/patient, D3 supplementation is far cheaper than hospitalization costs and more effective than standard interventions. This SR establishes a strong inverse relationship between 25(OH)D levels and SARS-CoV-2 vulnerability, meeting Hill's criteria. Vitamin D3 and calcifediol reduce infections, complications, hospitalizations, and deaths by ~50%, outperforming all patented, FDA-approved COVID-19 therapies. With over 300 trials confirming these findings, waiting for further studies is unnecessary before incorporating them into clinical protocols. Health agencies and scientific societies must recognize the significance of these results and incorporate D3 and calcifediol for prophylaxis and early treatment protocols of SARS-CoV-2 and similar viral infections. Promoting safe sun exposure and adequate vitamin D3 supplementation within communities to maintain 25(OH)D levels above 40 ng/mL (therapeutic range: 40-80 ng/mL) strengthens immune systems, reduces hospitalizations and deaths, and significantly lowers healthcare costs. When serum 25(OH)D levels exceed 70 ng/mL, taking vitamin K2 (100 µg/day or 800 µg/week) alongside vitamin D helps direct any excess calcium to bones. The recommended vitamin D dosage (approximately 70 IU/kg of body weight for a non-obese adult) to maintain 25(OH)D levels between 50-100 ng/mL is safe and cost-effective for disease prevention, ensuring optimal health outcomes.
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Affiliation(s)
- Sunil J Wimalawansa
- Endocrinology and Human Nutrition, CardioMetabolic & Endocrine Institute, North Brunswick, NJ 08902, USA
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Fatima M, Butt I, MohammadEbrahimi S, Kiani B, Gruebner O. Spatiotemporal clusters of acute respiratory infections associated with socioeconomic, meteorological, and air pollution factors in South Punjab, Pakistan. BMC Public Health 2025; 25:469. [PMID: 39910401 PMCID: PMC11800423 DOI: 10.1186/s12889-025-21741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 01/31/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND In Pakistan, acute respiratory infections (ARI) continue to be a major public health problem. However, there is still a lack of scholarly work regarding different environmental and socioeconomic influencing factors and how they interact with respiratory infections. Furthermore, we do not know much about geographic variation in this context. Therefore, our study examines the ecological-level spatial and temporal patterns of acute respiratory infection incidence (ARI) and their geographic relationship with selected socio-economic, meteorological, and air pollution factors in Pakistan. METHODS We applied the spatiotemporal scan statistics to examine the purely temporal, spatial, and spatiotemporal clusters of ARI in South Punjab, Pakistan for five years (2016-2020). Generalized Linear Model (GLM) and geographically weighted regression (GWR) were also applied to model the linear and non-linear spatial relationships between selected variables and ARI. RESULTS Our results indicate that in the central and northern regions of Pakistan, two spatial clusters of ARI were present, accounting for 28.5% of the total cases. A spatiotemporal cluster with a relative risk of 1.57 was discovered in the northeastern area. The results obtained from the season-based GLM highlighted the significance of climatic factors (temperature, fog, dust storms) and air pollutants (NO2) in influencing ARI incidence, while socio-economic variables (rural population, literacy) had limited impact. In addition, GWR revealed that the relationships between predictors and ARI incidence varied across locations, emphasizing the importance of considering local settings. Season-based non-stationary GLM revealed a multifaceted interaction among socio-economic, meteorological, and air pollution factors. CONCLUSIONS Our study provides evidence about environmental and socio-economic factors significantly associated with ARI incidence. In addition, this study provides the first baseline of ARI cases in Pakistan to plan for intervention and adaptation strategies and may be replicated in other regions of comparable settings worldwide.
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Affiliation(s)
- Munazza Fatima
- Department of Geography, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Ibtisam Butt
- Institute of Geography, University of The Punjab, Lahore, Pakistan
| | - Shahab MohammadEbrahimi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal (ESPUM), Montreal, QC, Canada
| | - Behzad Kiani
- Centre for Clinical Research, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Oliver Gruebner
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Zhou L, Han C, Zhou Y. The Role of Severe Vitamin D Deficiency in Predicting the Risk of Severe Exacerbation in Patients With Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2025; 20:171-179. [PMID: 39867990 PMCID: PMC11766290 DOI: 10.2147/copd.s489650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 12/28/2024] [Indexed: 01/28/2025] Open
Abstract
Background This study aims to investigate the association between vitamin D levels and the risk of severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods We conducted a prospective observational study with 636 COPD patients admitted for exacerbations between January 2021 and December 2022. Patients were categorized based on serum 25-hydroxyvitamin D levels: severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20-30 ng/mL), or sufficiency (>30 ng/mL). Severe exacerbation was defined when the patient visits an emergency room or is hospitalized due to COPD exacerbation. Multivariate Cox regression was used to evaluate the risk associated with vitamin D deficiency. Results Over an 18-month follow-up, 178 (28.0%) patients experienced at least one severe exacerbation. The severe deficiency group had the highest exacerbation rate (40.6%), followed by deficiency (27.8%), insufficiency (22.5%), and sufficiency (18.1%) groups (P<0.01). Multivariate Cox regression analysis showed that severe vitamin D deficiency was significantly associated with an increased risk of severe exacerbations (HR=2.74, 95% CI: 1.55-4.84; P<0.01) compared to vitamin D sufficiency. Conclusion Severe vitamin D deficiency is a significant predictor of severe COPD exacerbations, highlighting the importance of routine vitamin D assessment and supplementation in COPD management.
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Affiliation(s)
- Li Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, People’s Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People’s Republic of China
| | - Cunqiao Han
- Department of Emergency Medicine, Shangjinnanfu Hospital, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yue Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, People’s Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People’s Republic of China
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Bournot AR, Darling AL, Givens ID, Lovegrove JA, Lanham-New SA, Hart KH. Effect of vitamin D status and vitamin D supplementation on immune function and prevention of acute respiratory tract infections in dark-skinned individuals: a systematic review and meta-analysis. Public Health Nutr 2024; 27:e224. [PMID: 39465641 PMCID: PMC11645122 DOI: 10.1017/s1368980024001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/14/2024] [Accepted: 08/21/2024] [Indexed: 10/29/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the evidence for a potential relationship between vitamin D status and vitamin D supplementation on immune function biomarkers and prevention of acute respiratory tract infections (ARTI) in dark-skinned individuals. DESIGN Six databases were searched (inception to December 2021) for randomised controlled trials (RCT) and observational studies. A narrative synthesis and random-effects meta-analysis were used to synthesise the findings. SETTING Not applicable. PARTICIPANTS Ethnic groups other than white, with or without a white comparator. RESULTS After duplicates were removed, 2077 articles were identified for screening. A total of eighteen studies (n 36 707), including seven RCT and 11 observational studies, met the inclusion criteria, and three RCT (n 5778) provided sufficient data of high enough quality to be included in a meta-analysis. An inverse association between vitamin D status and at least one inflammatory biomarker in black adults was found in three studies, and vitamin D status was inversely associated with ARTI incidence in black and Indigenous groups in two studies. There was no significant effect of vitamin D supplementation on differences in ARTI incidence in ethnic minority groups (OR, 1·40; 95 % CI: 0·70, 2·79; P = 0·34), nor African American (OR, 1·77; 95 % CI: 0·51, 6·19; P = 0·37) or Asian/Pacific (OR, 1·08; 95 % CI: 0·77, 2·68; P = 0·66) subgroups. CONCLUSIONS There is a lack of conclusive evidence supporting an association between vitamin D status and immune function or ARTI incidence in dark-skinned individuals. Further RCT in diverse ethnic populations are urgently needed.
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Affiliation(s)
- Abigail R Bournot
- Department of Nutrition, Food & Exercise Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Andrea L Darling
- Department of Nutrition, Food & Exercise Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ian D Givens
- Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | - Julie A Lovegrove
- Institute for Food, Nutrition and Health, University of Reading, Reading, UK
- Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK
| | - Susan A Lanham-New
- Department of Nutrition, Food & Exercise Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Kathryn H Hart
- Department of Nutrition, Food & Exercise Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Wimalawansa SJ. Unveiling the Interplay-Vitamin D and ACE-2 Molecular Interactions in Mitigating Complications and Deaths from SARS-CoV-2. BIOLOGY 2024; 13:831. [PMID: 39452140 PMCID: PMC11504239 DOI: 10.3390/biology13100831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 10/26/2024]
Abstract
The interaction of the SARS-CoV-2 spike protein with membrane-bound angiotensin-converting enzyme-2 (ACE-2) receptors in epithelial cells facilitates viral entry into human cells. Despite this, ACE-2 exerts significant protective effects against coronaviruses by neutralizing viruses in circulation and mitigating inflammation. While SARS-CoV-2 reduces ACE-2 expression, vitamin D increases it, counteracting the virus's harmful effects. Vitamin D's beneficial actions are mediated through complex molecular mechanisms involving innate and adaptive immune systems. Meanwhile, vitamin D status [25(OH)D concentration] is inversely correlated with severity, complications, and mortality rates from COVID-19. This study explores mechanisms through which vitamin D inhibits SARS-CoV-2 replication, including the suppression of transcription enzymes, reduced inflammation and oxidative stress, and increased expression of neutralizing antibodies and antimicrobial peptides. Both hypovitaminosis D and SARS-CoV-2 elevate renin levels, the rate-limiting step in the renin-angiotensin-aldosterone system (RAS); it increases ACE-1 but reduces ACE-2 expression. This imbalance leads to elevated levels of the pro-inflammatory, pro-coagulatory, and vasoconstricting peptide angiotensin-II (Ang-II), leading to widespread inflammation. It also causes increased membrane permeability, allowing fluid and viruses to infiltrate soft tissues, lungs, and the vascular system. In contrast, sufficient vitamin D levels suppress renin expression, reducing RAS activity, lowering ACE-1, and increasing ACE-2 levels. ACE-2 cleaves Ang-II to generate Ang(1-7), a vasodilatory, anti-inflammatory, and anti-thrombotic peptide that mitigates oxidative stress and counteracts the harmful effects of SARS-CoV-2. Excess ACE-2 molecules spill into the bloodstream as soluble receptors, neutralizing and facilitating the destruction of the virus. These combined mechanisms reduce viral replication, load, and spread. Hence, vitamin D facilitates rapid recovery and minimizes transmission to others. Overall, vitamin D enhances the immune response and counteracts the pathological effects of SARS-CoV-2. Additionally, data suggests that widely used anti-hypertensive agents-angiotensin receptor blockers and ACE inhibitors-may lessen the adverse impacts of SARS-CoV-2, although they are less potent than vitamin D.
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Laaksi A, Kyröläinen H, Pihlajamäki H, Vaara JP, Luukkaala T, Laaksi I. Effects of Vitamin D Supplementation and Baseline Vitamin D Status on Acute Respiratory Infections and Cathelicidin: A Randomized Controlled Trial. Open Forum Infect Dis 2024; 11:ofae482. [PMID: 39301110 PMCID: PMC11412237 DOI: 10.1093/ofid/ofae482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/23/2024] [Indexed: 09/22/2024] Open
Abstract
Background Vitamin D supplementation may lower the risk of acute respiratory infection (ARI), and the effects may be mediated through the induction of cathelicidin production. Objective To study the effect of vitamin D supplementation on ARI and cathelicidin concentration in a randomized controlled trial (RCT) and to study the associations between baseline serum 25 hydroxyvitamin D (25(OH)D) and ARIs and cathelicidin concentrations in a 14-week follow-up study. Methods In the RCT study, the participants were randomized into 2 groups to receive either 20 µg of vitamin D3 or an identical placebo daily. Blood samples were obtained 3 times, at the beginning (study week 0), mid-term (study week 6), and at the end of the study period (study week 14). The follow-up study had 412 voluntary young men from 2 different locations and seasons (January and July). The primary outcomes were the number of ARIs diagnosed and the number of days off because of ARI. Results In the RCT, vitamin D supplementation had no effect on ARI or days off because of ARI. However, regardless of the group, vitamin D insufficiency (<50 nmol/L) was associated with increased ARI. In the 14-week follow-up study, insufficient serum 25(OH)D at baseline was also associated with increased risk of ARI (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7) and also days-off duty (OR, 2.3; 95% CI, 1.3-4.0) and was inversely associated with cathelicidin concentration (OR, 0.49; 95% CI, .24-.99). Conclusions Sufficient serum 25(OH)D may be preventive against acute respiratory infection and the preventive effect could be mediated through the induction of cathelicidin production. Clinical Trial Registry number: NCT05014048. https://clinicaltrials.gov/study/NCT05014048?term=NCT05014048&rank=1.
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Affiliation(s)
- Akseli Laaksi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Heikki Kyröläinen
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Harri Pihlajamäki
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jani P Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ilkka Laaksi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Centre for Military Medicine, Finnish Defence Forces, Riihimäki, Finland
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Wang CH, Porta L, Yang TK, Wang YH, Wu TH, Qian F, Han YY, Sheng WH, Chen SC, Lee CC, Chang SC. Optimal methods of vitamin D supplementation to prevent acute respiratory infections: a systematic review, dose-response and pairwise meta-analysis of randomized controlled trials. Nutr J 2024; 23:92. [PMID: 39143549 PMCID: PMC11323636 DOI: 10.1186/s12937-024-00990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Vitamin D supplementation may prevent acute respiratory infections (ARIs). This study aimed to identify the optimal methods of vitamin D supplementation. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov registry were searched from database inception through July 13, 2023. Randomized-controlled trials (RCTs) were included. Data were pooled using random-effects model. The primary outcome was the proportion of participants with one or more ARIs. RESULTS The analysis included 43 RCTs with 49320 participants. Forty RCTs were considered to be at low risk for bias. The main pairwise meta-analysis indicated there were no significant preventive effects of vitamin D supplementation against ARIs (risk ratio [RR]: 0.99, 95% confidence interval [CI]: 0.97 to 1.01, I2 = 49.6%). The subgroup dose-response meta-analysis indicated that the optimal vitamin D supplementation doses ranged between 400-1200 IU/day for both summer-sparing and winter-dominant subgroups. The subgroup pairwise meta-analysis also revealed significant preventive effects of vitamin D supplementation in subgroups of daily dosing (RR: 0.92, 95% CI: 0.85 to 0.99, I2 = 55.7%, number needed to treat [NNT]: 36), trials duration < 4 months (RR: 0.81, 95% CI: 0.67 to 0.97, I2 = 48.8%, NNT: 16), summer-sparing seasons (RR: 0.85, 95% CI: 0.74 to 0.98, I2 = 55.8%, NNT: 26), and winter-dominant seasons (RR: 0.79, 95% CI: 0.71 to 0.89, I2 = 9.7%, NNT: 10). CONCLUSION Vitamin D supplementation may slightly prevent ARIs when taken daily at doses between 400 and 1200 IU/d during spring, autumn, or winter, which should be further examined in future clinical trials.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, Zhongzheng Dist, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City 100, Taiwan, ROC
| | - Lorenzo Porta
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Department of Emergency Medicine, Università Degli Studi Di Milano Bicocca, Milan, Italy
| | - Ting-Kai Yang
- Department of Emergency Medicine, Zhongzheng Dist, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City 100, Taiwan, ROC
| | - Yu-Hsiang Wang
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsung-Hung Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Frank Qian
- Sections of Cardiovascular Medicine, Department of Medicine, Boston University, Avedisian School of Medicine, Chobanian &, Boston, MA, USA
| | - Yin-Yi Han
- Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, Zhongzheng Dist, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City 100, Taiwan, ROC
| | - Chien-Chang Lee
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Emergency Medicine, Zhongzheng Dist, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City 100, Taiwan, ROC.
- Department of Information Management, Ministry of Health and Welfare, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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12
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Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, Lips P, Mitchell DM, Murad MH, Powers S, Rao SD, Scragg R, Tayek JA, Valent AM, Walsh JME, McCartney CR. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2024; 109:1907-1947. [PMID: 38828931 DOI: 10.1210/clinem/dgae290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Numerous studies demonstrate associations between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and a variety of common disorders, including musculoskeletal, metabolic, cardiovascular, malignant, autoimmune, and infectious diseases. Although a causal link between serum 25(OH)D concentrations and many disorders has not been clearly established, these associations have led to widespread supplementation with vitamin D and increased laboratory testing for 25(OH)D in the general population. The benefit-risk ratio of this increase in vitamin D use is not clear, and the optimal vitamin D intake and the role of testing for 25(OH)D for disease prevention remain uncertain. OBJECTIVE To develop clinical guidelines for the use of vitamin D (cholecalciferol [vitamin D3] or ergocalciferol [vitamin D2]) to lower the risk of disease in individuals without established indications for vitamin D treatment or 25(OH)D testing. METHODS A multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, identified and prioritized 14 clinically relevant questions related to the use of vitamin D and 25(OH)D testing to lower the risk of disease. The panel prioritized randomized placebo-controlled trials in general populations (without an established indication for vitamin D treatment or 25[OH]D testing), evaluating the effects of empiric vitamin D administration throughout the lifespan, as well as in select conditions (pregnancy and prediabetes). The panel defined "empiric supplementation" as vitamin D intake that (a) exceeds the Dietary Reference Intakes (DRI) and (b) is implemented without testing for 25(OH)D. Systematic reviews queried electronic databases for publications related to these 14 clinical questions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and guide recommendations. The approach incorporated perspectives from a patient representative and considered patient values, costs and resources required, acceptability and feasibility, and impact on health equity of the proposed recommendations. The process to develop this clinical guideline did not use a risk assessment framework and was not designed to replace current DRI for vitamin D. RESULTS The panel suggests empiric vitamin D supplementation for children and adolescents aged 1 to 18 years to prevent nutritional rickets and because of its potential to lower the risk of respiratory tract infections; for those aged 75 years and older because of its potential to lower the risk of mortality; for those who are pregnant because of its potential to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality; and for those with high-risk prediabetes because of its potential to reduce progression to diabetes. Because the vitamin D doses in the included clinical trials varied considerably and many trial participants were allowed to continue their own vitamin D-containing supplements, the optimal doses for empiric vitamin D supplementation remain unclear for the populations considered. For nonpregnant people older than 50 years for whom vitamin D is indicated, the panel suggests supplementation via daily administration of vitamin D, rather than intermittent use of high doses. The panel suggests against empiric vitamin D supplementation above the current DRI to lower the risk of disease in healthy adults younger than 75 years. No clinical trial evidence was found to support routine screening for 25(OH)D in the general population, nor in those with obesity or dark complexion, and there was no clear evidence defining the optimal target level of 25(OH)D required for disease prevention in the populations considered; thus, the panel suggests against routine 25(OH)D testing in all populations considered. The panel judged that, in most situations, empiric vitamin D supplementation is inexpensive, feasible, acceptable to both healthy individuals and health care professionals, and has no negative effect on health equity. CONCLUSION The panel suggests empiric vitamin D for those aged 1 to 18 years and adults over 75 years of age, those who are pregnant, and those with high-risk prediabetes. Due to the scarcity of natural food sources rich in vitamin D, empiric supplementation can be achieved through a combination of fortified foods and supplements that contain vitamin D. Based on the absence of supportive clinical trial evidence, the panel suggests against routine 25(OH)D testing in the absence of established indications. These recommendations are not meant to replace the current DRIs for vitamin D, nor do they apply to people with established indications for vitamin D treatment or 25(OH)D testing. Further research is needed to determine optimal 25(OH)D levels for specific health benefits.
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Affiliation(s)
- Marie B Demay
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Daniel D Bikle
- Departments of Medicine and Dermatology, University of California San Francisco, San Francisco VA Medical Center, San Francisco, CA 94158, USA
| | - Dima L Diab
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences and INFANT Research Centre, University College Cork, Cork, T12 Y337, Ireland
| | - Marise Lazaretti-Castro
- Department of Internal Medicine, Division of Endocrinology, Universidade Federal de Sao Paulo, Sao Paulo 04220-00, Brazil
| | - Paul Lips
- Endocrine Section, Amsterdam University Medical Center, Internal Medicine, 1007 MB Amsterdam, Netherlands
| | - Deborah M Mitchell
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Shelley Powers
- Bone Health and Osteoporosis Foundation, Los Gatos, CA 95032, USA
| | - Sudhaker D Rao
- Division of Endocrinology, Diabetes and Bone & Mineral Disorders, Henry Ford Health, Detroit, MI 48202, USA
- College of Human Medicine, Michigan State University, Lansing, MI 48824, USA
| | - Robert Scragg
- School of Population Health, The University of Auckland, Auckland 1142, New Zealand
| | - John A Tayek
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA
- The Lundquist Institute, Torrance, CA 90502, USA
| | - Amy M Valent
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Judith M E Walsh
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Christopher R McCartney
- Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
- Department of Medicine, West Virginia University, Morgantown, WV 26506, USA
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13
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Jia H, Sheng F, Yan Y, Liu X, Zeng B. Vitamin D supplementation for prevention of acute respiratory infections in older adults: A systematic review and meta-analysis. PLoS One 2024; 19:e0303495. [PMID: 38787821 PMCID: PMC11125479 DOI: 10.1371/journal.pone.0303495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Acute respiratory infections (ARIs) have a substantial impact on morbidity, healthcare utilization, and functional decline among older adults. Therefore, we systematically reviewed evidence from randomized controlled trials (RCTs) to evaluate the efficacy and safety of vitamin D supplementation in preventing ARIs in older adults. METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched until 1 February 2024. RCTs evaluating the use of vitamin D supplements to protect older adults from ARIs were included. Two reviewers independently screened papers, extracted the data and assessed the risk of bias. Data were summarised as relative risks (RRs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Random effects meta-analyses were used to synthesise the results. GRADE was used to evaluate the quality of evidence. All the analysis were performed with Stata version 17. RESULTS Twelve trials (41552 participants) were included in the meta-analysis. It showed that vitamin D supplementation probably does not reduce the incidence of ARIs (RR, 0.99; 95% CI, 0.97-1.02, I2 = 0%; moderate certainty). No significant effect of vitamin D supplementation on the risk of ARI was observed for any of the subgroups defined by baseline 25(OH)D concentration, control treatments, dose frequency, study duration, and participants' condition. However, there was a possibility, although not statistically significant, that vitamin D may reduce the risk of ARI in patients with a baseline 25(OH)D concentration <50 nmol/L (OR, 0.90; 95% CI, 0.79-1.04, I2 = 14.7%). Additionally, vitamin D supplements might result in little to no difference in death due to any cause, any adverse event, hypercalcinemia, and kidney stones. CONCLUSIONS Vitamin D supplementation among older adults probably results in little to no difference in the incidence of ARIs. However, further evidence is needed, particularly for individuals with vitamin D deficiency and populations residing in low and middle income countries. TRIAL REGISTRATION This study was registered on PROSPERO (CRD42023451265).
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Affiliation(s)
- Hao Jia
- Drug Clinical Trial Institution, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China
| | - Feng Sheng
- Department of Education and Science, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China
| | - Yulan Yan
- Department of Education and Science, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China
| | - Xiaozhi Liu
- Central Laboratory, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China
- Tianjin Key Laboratory of Epigenetic for Organ Development of Preterm Infants, Tianjin Fifth Central Hospital, Tianjin, China
- High Altitude Characteristic Medical Research Institute, Huangnan Tibetan Autonomous Prefecture People’s Hospital, Huangnan Prefecture, Qinghai, China
| | - Baoqi Zeng
- Central Laboratory, Tianjin Fifth Central Hospital (Peking University Binhai Hospital), Tianjin, China
- Emergency Department of Tianjin Fifth Central Hospital, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
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Haas M, Brandl B, Schinhammer L, Skurk T. Individualized Supplementation of Immunoactive Micronutrients and Severity of Upper Respiratory Infection Symptoms-A Randomized Intervention Study. Nutrients 2024; 16:1400. [PMID: 38794638 PMCID: PMC11123851 DOI: 10.3390/nu16101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/20/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Certain micronutrients exhibit immunomodulatory effects. However, no intervention has yet investigated the effect of individualized supplementation on the severity of upper respiratory tract infections (URIs). Therefore, we investigated whether a personalized supplementation moderates the incidence and severity of URI. Selenium, zinc, and vitamin D were measured in dried blood spots from 59 healthy participants. Accordingly, a personalized supplement was provided with or without the respective micronutrients. We used WURSS-21 questionnaires to assess the disease status. The blood values converged during the intervention and micronutrients no longer differed between treated and untreated volunteers at the end of the intervention period. The incidence and severity of the illness did not significantly differ between the groups. However, when analyzing the WURSS-21 scores by the intention to treat, the initially randomized treatment arm revealed a significantly higher score than the placebo arm. Upon acute administration, individualized combinations of selenium, zinc and vitamin D do not reduce the number, or contribute to a milder course of URIs. Therefore, supplementation in acute infectious situations seems questionable. Further studies must address the habitual diet in more detail, to better understand the impact of individual micronutrient status on the prevention of URI.
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Affiliation(s)
- Melanie Haas
- ZIEL–Institute for Food and Health, Core Facility Human Studies, Technical University Munich, Gregor-Mendel-Straße 2, 85354 Freising, Germany
| | - Beate Brandl
- ZIEL–Institute for Food and Health, Core Facility Human Studies, Technical University Munich, Gregor-Mendel-Straße 2, 85354 Freising, Germany
| | - Laura Schinhammer
- ZIEL–Institute for Food and Health, Core Facility Human Studies, Technical University Munich, Gregor-Mendel-Straße 2, 85354 Freising, Germany
| | - Thomas Skurk
- ZIEL–Institute for Food and Health, Core Facility Human Studies, Technical University Munich, Gregor-Mendel-Straße 2, 85354 Freising, Germany
- School of Medicine and Health, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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Feketea G, Vassilopoulou E, Andreescu O, Berghea EC, Pop RM, Sabin O, Zdrenghea M, Bocsan IC. Vitamin D Level and Immune Modulation in Children with Recurrent Wheezing. CHILDREN (BASEL, SWITZERLAND) 2024; 11:219. [PMID: 38397331 PMCID: PMC10888088 DOI: 10.3390/children11020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION AND AIM A direct causal relationship between vitamin D (vit D) deficiency and recurrent wheezing has not been proven. The present study investigated the role of vit D in enhancing the risk of asthma or recurrent wheezing by modifying the intensity of the inflammatory process. MATERIAL AND METHOD Forty children with wheezing presenting at the emergency service and sixteen healthy control subjects were included in the study. Children with wheezing were either in the first episode (20) or with recurrent wheezing (20). Children with chronic diseases, and other conditions that present with acute wheezing or that might influence the vit D level, were excluded. Blood samples were taken at presentation and 3-6 months later, to evaluate the serum levels of total IgE, vit D, IL-10 and IL-31. Statistical analysis was performed using the SPSS 25 program, with a significance level of p < 0.05. RESULTS AND CONCLUSION The vit D level was lower in patients with recurrent wheezing compared with those with a single episode and with the control group, and this increased with time. IL-10 was significantly higher in children with wheezing than in the control group, with the highest values in those with an acute episode of wheezing. IL-31 was higher in children with recurrent wheezing than in those with a first episode only at the initial point, while at the final time point it was lower. Low levels of vit D appear to be detected more frequently in recurrent wheezing than in simple wheezing. Immune modulation, as measured by Th2 status reflected by IL-10 and IL-31 levels, appears to depend on the wheezing phenotype and on the general health status.
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Affiliation(s)
- Gavriela Feketea
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (O.S.); (I.C.B.)
- Pediatric Allergy Outpatient Clinic, Department of Pediatrics, “Karamandaneio” Children’s Hospital of Patra, 26331 Patras, Greece
| | - Emilia Vassilopoulou
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Oana Andreescu
- Fundamental, Prophylactic and Clinical Specialties Department, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| | - Elena Camelia Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Pediatrics, “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (O.S.); (I.C.B.)
| | - Octavia Sabin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (O.S.); (I.C.B.)
| | - Mihnea Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Babes Str., 400012 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Oncology Institute, 34-36 Republicii Str., 400015 Cluj-Napoca, Romania
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (O.S.); (I.C.B.)
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Meng J, Li X, Liu W, Xiao Y, Tang H, Wu Y, Xiong Y, Gao S. The role of vitamin D in the prevention and treatment of SARS-CoV-2 infection: A meta-analysis of randomized controlled trials. Clin Nutr 2023; 42:2198-2206. [PMID: 37802017 DOI: 10.1016/j.clnu.2023.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Vitamin D (VitD) has been shown to be important for the immune response of the respiratory system, but the preventive and therapeutic effects of vitamin D supplementation on SARS-CoV-2 infection are controversial. This study aimed to determine the role of vitamin D supplementation in the prevention and treatment of SARS-CoV-2 infection through a meta-analysis of randomized controlled trials. METHODS The databases of PubMed, Cochrane Library, Embase, Web of Science and Google Scholar were searched systematically from inception to April 17,2023 to identify trials involving a randomized comparison of vitamin D supplementation versus non-vitamin D supplementation for SARS-CoV-2 infection prevention or treatment. RESULTS We retrieved 25 eligible trials, including 8128 participants. Four trials compared the preventive effects of vitamin D supplementation on SARS-CoV-2 infection, and the results (RR 0.31; 95%CI 0.07 to 1.32) were inconclusive. Regarding the treatment of SARS-CoV-2 infection with vitamin D supplementation, it was found that vitamin D supplementation could significantly reduce the rates of ICU admission (RR 0.63; 95%CI 0.44 to 0.89) and mechanical ventilation (RR 0.58; 95%CI 0.39 to 0.84), but had no statistically significant effect on mortality. However, in subgroup analyses based on the patients' specific conditions, vitamin D supplementation significantly reduced the mortality in patients with vitamin D deficiency (RR 0.76; 95%CI 0.58 to 0.98). CONCLUSION Vitamin D supplementation may have some beneficial impact on the severity of illness caused by SARS-CoV-2, particularly in VitD deficient patients, but further studies are still needed.
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Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Xi Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yumei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yilin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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17
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Horváth L, Mirani S, Girgis MMF, Rácz S, Bácskay I, Bhattoa HP, Tóth BE. Six years' experience and trends of serum 25-hydroxy vitamin D concentration and the effect of vitamin D 3 consumption on these trends. Front Pharmacol 2023; 14:1232285. [PMID: 37521483 PMCID: PMC10374949 DOI: 10.3389/fphar.2023.1232285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction: Vitamin D (vitD) deficiency may have importance in some diseases, but there is a lack of data in our country to clarify the current situation. Our aim was to examine the basic characteristics of patients' vitD status, and the ratio of vitD deficiency and its relation to certain diseases, assess seasonality and trends, and reveal the indirect impact of the COVID-19 pandemic on vitD3 supplementation at the patient population level. Methods: Anonymized data on 25(OH)D test results were obtained from the clinical data registry of a tertiary teaching hospital covering the period between 1 January 2015 and 30 June 2021. VitD consumption (pharmacy sale) data were retrieved from the database of the National Health Insurance Fund of Hungary in order to calculate the defined daily dose (DDD)/1,000 inhabitants/day. Descriptive statistics and odds ratios with their 95% confidence intervals were calculated. The two-sample t-test and F-test were used to analyze our patients' data. Significant differences were considered if p <0.05. Results: Altogether, 45,567 samples were investigated; the mean age was 49 ± 19.1 years and 68.4% of them were female subjects. Overall, 20% of all patients had hypovitaminosis D, and just over 7% of patients had vitD deficiency. Male subjects had higher odds for hypovitaminosis or vitD deficiency (65.4 ± 28.2 nmol/L vs. 68.4 ± 28.4 nmol/L; p <0.0001). The mean 25(OH)D concentration has changed during the year, reaching a peak in September and a minimum in February. Patients with diseases of the circulatory system, genitourinary system, certain conditions originating in the perinatal period, and "sine morbo" (i.e., without a disease; such as those aged over 45 years and female teenagers) had statistically higher odds for lower 25(OH)D concentrations (p <0.00001). VitD consumption showed seasonality, being higher in autumn and winter. A slight increase started in the season of 2017/18, and two huge peaks were detected at the beginning of 2020 and 2021 in association with the COVID-19 waves. Conclusion: Our data are the first to describe data concerning vitD in our region. It reinforces the notion of vitD3 supplementation for some risk groups and also in healthy individuals. To prevent the winter decline, vitD3 supplementation should be started in September. This and the results during the COVID-19 pandemic highlight the importance of health education encouraging vitamin D3 supplementation.
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Affiliation(s)
- László Horváth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Sara Mirani
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Michael Magdy Fahmy Girgis
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Szilvia Rácz
- Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Bácskay
- Healthcare Industry Institute, University of Debrecen, Debrecen, Hungary
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla E. Tóth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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18
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Laird E, O'Halloran AM, Molloy AM, Healy M, Bourke N, Kenny RA. Vitamin D status & associations with inflammation in older adults. PLoS One 2023; 18:e0287169. [PMID: 37379302 DOI: 10.1371/journal.pone.0287169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Research studies have observed associations of vitamin D with inflammation but data in representative older adult studies is lacking. We aimed to investigate the association of C-reactive protein (CRP) with vitamin D status in a representative sample of the older Irish population. The concentrations of 25-hydroxyvitamin D (25(OH)D) and CRP was measured in 5,381 community dwelling Irish adults aged ≥50 years from the Irish Longitudinal Study on Ageing (TILDA). Demographic, health and lifestyle variables were assessed by questionnaire and categorical proportions of CRP were generated by vitamin D status and age. Multi-nominal logistic regression was used to investigate the association of 25(OH)D and CRP status. The prevalence (mean; 95% confidence interval (95% CI)) of normal CRP status (0-5 mg/dL) was 83.9% (82.6-85.0%), elevated status (5-10 mg/dL) 11.0% (9.9-12.0%) and high status (>10 mg/dL) was 5.1% (4.5-5.8%). Mean (95% CI) CRP concentrations were lower in those with normal vs. deficient 25(OH)D status (2.02 mg/dL (1.95-2.08) vs. 2.60 mg/dL (2.41-2.82); p<0.0001). In a logistic regression analysis, those with insufficient or sufficient 25(OH)D status were less likely to have a high CRP status compared to those with deficient 25(OH)D status (insufficient: coefficient (CE) -0.732, 95% CI -1.12-0.33, p<0.0001; sufficient: CE -0.599, 95% CI -0.95-0.24, p = 0.001). In conclusion older adults with deficient vitamin D status had higher levels of inflammation as measured by CRP. Given that inflammation is an important pathological driver of chronic diseases of ageing, and that emerging evidence suggests that vitamin D therapy can reduce inflammation in some disease settings, optimising vitamin D status could represent an effective low risk/low-cost pathway to modulate inflammation in community dwelling older adults.
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Affiliation(s)
- Eamon Laird
- School of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Martin Healy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig Bourke
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- The TILDA Study, School of Medicine, Trinity College Dublin, Dublin, Ireland
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19
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di Filippo L, Uygur M, Locatelli M, Nannipieri F, Frara S, Giustina A. Low vitamin D levels predict outcomes of COVID-19 in patients with both severe and non-severe disease at hospitalization. Endocrine 2023; 80:669-683. [PMID: 36854858 PMCID: PMC9974397 DOI: 10.1007/s12020-023-03331-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Low vitamin D in COVID-19 have been related to worse outcomes. However, most of the studies conducted so far were not-controlled and retrospective, including biases potentially influencing this association. We evaluated 25(OH)vitamin D levels of patients with both severe and non-severe disease at hospital-admission, and in a cohort of control subjects. Moreover, we evaluated sACE-2 levels to investigate the mechanisms underlying the association between vitamin D and COVID-19. METHODS COVID-19 patients were enrolled in a matched for age, sex and comorbidities 1:1-ratio based on the presence/or not of respiratory-distress/severe-disease at hospital-admission. Control matched subjects were enrolled from an outpatient-setting. RESULTS Seventy-three COVID-19 patients (36 severe and 37 non-severe) and 30 control subjects were included. We observed a higher vitamin D deficiency (<20 ng/mL) prevalence in COVID-19 patients than control subjects (75% vs 43%). No differences were found regarding 25(OH)vitamin D and sACE-2 levels between patients with and without severe-disease at study entry. During the disease-course, in the severe group a life-threatening disease occurred in 17 patients (47.2%), and, in the non-severe group, a worsening disease occurred in 10 (27%). 25(OH)vitamin D levels, at admission, were negatively correlated with sACE-2 levels, and were lower in patients whose disease worsened as compared to those in whom it did not, independently from the disease severity at admission. In multivariate-analysis, lower 25(OH)vitamin D resulted as an independent risk factor for disease worsening. CONCLUSIONS 25(OH)vitamin D levels at hospital-admission strongly predicted the occurrence of worsening outcomes in COVID-19 independently of the disease severity at presentation.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Melin Uygur
- Institute of Endocrine and Metabolic Sciences, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
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20
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Novakovic V, Benfield T, Jørgensen HL, Mitchell NH. Vitamin D as a prognostic biomarker in COVID-19: single-center study and meta-analyses. Scand J Clin Lab Invest 2023; 83:173-182. [PMID: 37067370 DOI: 10.1080/00365513.2023.2191333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/12/2023] [Indexed: 04/18/2023]
Abstract
Vitamin D was investigated as a prognostic biomarker in COVID-19, in relation to both disease susceptibility and outcomes in infected individuals. Patients admitted to the hospital with a confirmed COVID-19 diagnosis were included if they had a vitamin D measurement prior to hospitalization. Using age- and sex-matched controls, vitamin D levels were investigated for an association with COVID-19 related hospitalizations. Further, vitamin D levels were investigated for an association with 30-day mortality in hospitalized COVID-19 patients. Additionally, three meta-analyses were conducted, investigating the association of vitamin D with the following outcomes: Having a positive SARS-CoV-2 test, hospitalization with COVID-19, and mortality in COVID-19 patients. A total of 685 hospitalized COVID-19 patients were included in the single-center study. Compared to controls, they had higher vitamin D levels. Unadjusted analysis of these 685 cases found higher vitamin D levels associated with increased 30-day mortality. This association disappeared after adjusting for age. In the fully adjusted model, no association between vitamin D and 30-day mortality was found. The meta-analyses found significant associations between lower vitamin D and having a positive SARS-CoV-2 test, and mortality among hospital-admitted COVID-19 patients. The relationship between lower vitamin D and COVID-19 related hospital admissions trended towards being positive but was not statistically significant. Many factors seem to influence the associations between vitamin D and COVID-19 related outcomes. Consequently, we do not believe that vitamin D in and of itself is likely to be a clinically useful and widely applicable predictor for the susceptibility and severity of COVID-19 infections.
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Affiliation(s)
- Vasilije Novakovic
- Department of Clinical Biochemistry, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Løvendahl Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikki Have Mitchell
- Department of Clinical Biochemistry, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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21
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Jaun F, Boesing M, Luethi-Corridori G, Abig K, Bloch N, Giezendanner S, Grillmayr V, Haas P, Leuppi-Taegtmeyer AB, Muser J, Raess A, Schuetz P, Brändle M, Leuppi JD. Effect of Single High Dose Vitamin D Substitution in Hospitalized COVID-19 Patients with Vitamin D Deficiency on Length of Hospital Stay. Biomedicines 2023; 11:biomedicines11051277. [PMID: 37238948 DOI: 10.3390/biomedicines11051277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Vitamin D and its role in the coronavirus-19 disease (COVID-19) pandemic has been controversially discussed, with inconclusive evidence about vitamin D3 (cholecalciferol) supplementation in COVID-19 patients. Vitamin D metabolites play an important role in the initiation of the immune response and can be an easily modifiable risk factor in 25-hydroxyvitamin D3 (25(OH)D3)-deficient patients. This is a multicenter, randomized, placebo-controlled double-blind trial to compare the effect of a single high dose of vitamin D3 followed by treatment as usual (TAU) of daily vitamin D3 daily until discharge versus placebo plus TAU in hospitalized patients with COVID-19 and 25(OH)D3-deficiency on length hospital stay. We included 40 patients per group and did not observe a significant difference in the median length of hospital stay (6 days in both groups, p = 0.920). We adjusted the length of stay for COVID-19 risk factors (β = 0.44; 95% CI: -2.17-2.22), and center (β = 0.74; 95% CI: -1.25-2.73). The subgroup analysis in patients with severe 25(OH)D3-deficiency (<25 nmol/L) showed a non-significant reduction in the median length of hospital stay in the intervention group (5.5 vs. 9 days, p = 0.299). The competing risk model with death did not reveal significant differences between the group in the length of stay (HR = 0.96, 95% CI 0.62-1.48, p = 0.850). Serum 25(OH)D3 level increased significantly in the intervention group (mean change in nmol/L; intervention: +26.35 vs. control: -2.73, p < 0.001). The intervention with 140,000 IU vitamin D3 + TAU did not significantly shorten the length of hospital stay but was effective and safe for the elevation of serum 25(OH)D3 levels.
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Affiliation(s)
- Fabienne Jaun
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Paracelsus Medical University, Master Programme Public Health, Center for Public Health and Healthcare Research, 5020 Salzburg, Austria
| | - Maria Boesing
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Giorgia Luethi-Corridori
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Kristin Abig
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Nando Bloch
- Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Stéphanie Giezendanner
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | | | - Philippe Haas
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Jürgen Muser
- Central Laboratories, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
| | - Andrea Raess
- Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Philipp Schuetz
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | | | - Jörg D Leuppi
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
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22
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Mandal SK, Tare M, Deepa PR. COVID-19 infection and metabolic comorbidities: Mitigating role of nutritional sufficiency and drug - nutraceutical combinations of vitamin D. HUMAN NUTRITION & METABOLISM 2023; 31:200179. [PMID: 38620788 PMCID: PMC9762046 DOI: 10.1016/j.hnm.2022.200179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
The vulnerability of human health is amplified in recent times with global increase in non-communicable diseases (due to lifestyle changes and environmental insults) and infectious diseases (caused by newer pathogens and drug-resistance strains). Clinical management of diseases is further complicated by disease severity caused by other comorbid factors. Drug-based therapy may not be the sole approach, particularly in scenarios like the COVID-19 pandemic, where there is no specific drug against SARS-CoV-2. Nutritional interventions are significant in armouring human populations in disease prevention, and as adjunctive therapy for disease alleviation. Amidst ongoing clinical trials to determine the efficacy of Vit. D against infections and associated complications, this review examines the pleiotropic benefits of nutritional adequacy of vitamin D (Vit. D) in combating viral infections (COVID-19), its severity and complications due to co-morbidities (obesity, diabetes, stroke and Kawasaki disease), based on research findings and clinical studies. Supplements of Vit. D in combination with other nutrients, and drugs, are suggested as promising preventive-health and adjunct-treatment strategies in the clinical management of viral infections with metabolic comorbidities.
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Affiliation(s)
- Sumit Kumar Mandal
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
| | - Meghana Tare
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
| | - P R Deepa
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
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23
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Chen C, Li P, Chen J, Liu C, Wang X, Cai J, Xiang E, Gu Z, Chen P. Plasma 25(OH)D Level is Associated with the Nucleic Acid Negative Conversion Time of COVID-19 Patients: An Exploratory Study. Infect Drug Resist 2023; 16:937-947. [PMID: 36814826 PMCID: PMC9939667 DOI: 10.2147/idr.s400561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose Vitamin D, an essential nutrient and a pleiotropic steroid hormone, has been reported to be associated with the risk and severity in patients infected with Coronavirus Disease-2019 (COVID-19). The role of vitamin D in predicting clinical outcome for COVID-19 patients is unknown. Here, we aimed to determine the prognostic value of plasma 25(OH)D level in COVID-19 patients. Patients and Methods A total of 158 patients infected with novel COVID-19 Omicron variants in Shanghai were recruited in this study and were categorized into three groups by the tertile levels of plasma 25(OH)D. Plasma 25(OH)D level was determined along with routine blood tests related to liver and renal functions in newly diagnosed COVID-19 patients at admission. The nucleic acid negative conversion time of throat swab samples was evaluated as the primary clinical outcome. The prognostic value of clinical characteristics and plasma 25(OH)D level was assessed using the Kaplan-Meier plot and Cox proportional hazards regression tests. Results Higher level of plasma 25(OH)D level in COVID-19 patients was independently associated with shorter nucleic acid negative conversion time from COVID-19 infection (multivariate adjusted HR: 0.54, 95%CI: 0.35-0.82, P=0.004, tertile 2 vs 1; multivariate adjusted HR: 0.60, 95%CI: 0.39-0.90, P=0.014, tertile 3 vs 1). Conclusion Plasma 25(OH)D level may serve as an independent prognostic factor in COVID-19 patient. Our findings indicate the protective roles of vitamin D supplementation in the regiment of patients with COVID-19.
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Affiliation(s)
- Changqiang Chen
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Pu Li
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jiuming Chen
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Chunxiao Liu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaodan Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jialin Cai
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Enfei Xiang
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhidong Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China,Department of Laboratory Medicine, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine (Hainan Boao Research Hospital), Hainan, People’s Republic of China,Zhidong Gu, Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201821, People’s Republic of China, Tel +86 13801653534, Email
| | - Peizhan Chen
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China,Correspondence: Peizhan Chen, Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201821, People’s Republic of China, Tel +86 13918550745, Email
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24
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Bilezikian JP, Binkley N, De Luca HF, Fassio A, Formenti AM, Fuleihan GEH, Heijboer AC, Giustina A. Consensus and Controversial Aspects of Vitamin D and COVID-19. J Clin Endocrinol Metab 2022; 108:1034-1042. [PMID: 36477486 DOI: 10.1210/clinem/dgac719] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This work aims to review and discuss controversial topics in the field of vitamin D, SARS-CoV-2 infection, and COVID-19. PARTICIPANTS The International Conferences "Controversies in Vitamin D" are a series of workshops that started in 2017 featuring international experts and leaders in vitamin D research and clinical practice. The 5th annual conference was held in Stresa, Italy, from 15 to 18 September 2021. EVIDENCE Before the event, participants reviewed available studies on their assigned topic, drafted a related abstract, and presented their findings at the time of the conference. Relevant literature that became available since was also discussed within the panel and updated accordingly. CONSENSUS Before the event, the drafted abstracts had been merged to prepare a preliminary document. After the conference presentations, in-depth discussions in open sessions led to consensus. The document was subsequently modified according to discussions and up-to-date literature inclusion. CONCLUSIONS There is quite consistent evidence for an association between low 25 OH vitamin D (25(OH)D) levels and poor COVID-19 outcomes, despite heterogeneous publications of variable quality. However, the low vitamin D status in COVID-19 patients might also reflect reverse causality. Vitamin D supplementation might have a positive role in COVID-19 prevention. The evidence supporting a beneficial effect of vitamin D treatment in decreasing the risk of COVID-19 complications is conflicting. Conclusive statement regarding the beneficial effect of vitamin D in this context await high-quality randomized controlled trials.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Neil Binkley
- Department of Medicine, Geriatrics Faculty, Medical Sciences Center, University of Wisconsin, Madison, WI, USA
| | - Hector F De Luca
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Angelo Fassio
- Rheumatology Unit, Department of Medicine, University of Verona, Italy
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
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25
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Shamlan G, Aleanizy FS. Knowledge and behaviors of using vitamin D to boost immunity against COVID-19 pandemic: A cross-sectional study in Saudi Arabia. Medicine (Baltimore) 2022; 101:e31949. [PMID: 36482609 PMCID: PMC9726423 DOI: 10.1097/md.0000000000031949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has globally impacted all aspects of life since its emergence and spread. There is a strong biological assumption and progressing epidemiological data supporting the role of vitamin D (VD) in COVID-19 infection. This study aims to determine the knowledge about VD supplements to boost immunity against COVID-19 and if participation in specific behaviors has increased the consumption of VD supplements during social distance restriction in Saudi Arabia (SA) in May 2021. This cross-sectional study used a structured online questionnaire for 2369 SA people, including demographic characteristics and knowledge about VD supplements to boost immunity against COVID-19 showed that there was a significant association between sex and vitamin D deficiency (VDD) (P = .000), and having VDD was strongly associated with having another vitamin deficiency (P = .008). Additionally, there was a statistically significant difference between VDD and cardiovascular (P = .027) and respiratory diseases (P = .019). Almost half of the participants used VD supplements to reduce or heal their COVID-19 symptoms. The adverse association between having VDD and understanding of COVID-19 symptoms was statistically significant (P = .01). Ginger is commonly used as an alternative medicine for the treatment of VD. The administration of VD is now known to be of physiological significance for general health, and evidence suggesting the beneficial role of VD in the prevention and/or treatment of diseases, particularly infectious diseases, such as COVID-19, is increasing.
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Affiliation(s)
- Ghalia Shamlan
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Fadilah Sfouq Aleanizy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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26
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de Sire A, Lippi L, Aprile V, Calafiore D, Folli A, D’Abrosca F, Moalli S, Lucchi M, Ammendolia A, Invernizzi M. Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. J Pers Med 2022; 12:1626. [PMID: 36294765 PMCID: PMC9604650 DOI: 10.3390/jpm12101626] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56122 Pisa, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantua, Italy
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
| | - Francesco D’Abrosca
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
| | - Stefano Moalli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56122 Pisa, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Relationship between Acute Respiratory Tract Infection and the Serum 25(OH) D3 Level in Chronic Kidney Disease Patients and Its Prevention and Treatment. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2550686. [PMID: 35968238 PMCID: PMC9371885 DOI: 10.1155/2022/2550686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Observational studies and randomized controlled studies propose that vitamin D plays a significant role in preventing acute respiratory tract infection (RTI); however, results are inconsistent and the optimal serum 25-hydroxyvitamin D (25-OH-D3) concentration remains unknown. This study explores the risk factors associated with acute RTI in patients with chronic kidney disease (CKD) and analyzes its correlation with serum 25-OH-D3 levels, to provide appropriate preventive treatment measures for CKD patients complicated with acute RTI. Seventy cases of CKD patients treated in the department of nephrology of Jiangxi Provincial People’s Hospital are recruited as the research objects and divided into a control group (CKD without RTI) and an observation group (CKD with RTI), with 35 cases in each group. The laboratory indexes and serum 25-OH-D3 levels are compared between the two groups. The area under the receiver operating characteristic curve (ROC) of 25-OH-D3 in the diagnosis of CKD patients complicated with RTI is 0.892, and the standard error is 0.038. The glomerular filtration rates (GFR) are
and
in the control group and the experimental group, respectively, with no statistical significance between the two groups (
). The serum 25-OH-D3 content in the control group (
) is dramatically higher than that in the observation group (
) (
). The proportion of patients with diabetes mellitus (DM) in the control group and observation group is 25.71% and 68.57%, respectively, with a considerable difference (
). In the control group and the experimental group, the proportion of patients with oral vitamin D receptor agonists is 54.29% and 11.43%, respectively, and the difference is significant (
). Results show that the serum 25-OH-D3 level is highly correlated with the occurrence of RTI in CKD patients. In addition, it is related to patients’ age, DM, and vitamin D receptor agonists.
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Positive Effects of Vitamin D Supplementation in Patients Hospitalized for COVID-19: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2022; 14:nu14153048. [PMID: 35893907 PMCID: PMC9330587 DOI: 10.3390/nu14153048] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022] Open
Abstract
Retrospective studies showed a relationship between vitamin D status and COVID-19 severity and mortality, with an inverse relation between SARS-CoV-2 positivity and circulating calcifediol levels. The objective of this pilot study was to investigate the effect of vitamin D supplementation on the length of hospital stay and clinical improvement in patients with vitamin D deficiency hospitalized with COVID-19. The study was randomized, double blind and placebo controlled. A total of 50 subjects were enrolled and received, in addition to the best available COVID therapy, either vitamin D (25,000 IU per day over 4 consecutive days, followed by 25,000 IU per week up to 6 weeks) or placebo. The length of hospital stay decreased significantly in the vitamin D group compared to the placebo group (4 days vs. 8 days; p = 0.003). At Day 7, a significantly lower percentage of patients were still hospitalized in the vitamin D group compared to the placebo group (19% vs. 54%; p = 0.0161), and none of the patients treated with vitamin D were hospitalized after 21 days compared to 14% of the patients treated with placebo. Vitamin D significantly reduced the duration of supplemental oxygen among the patients who needed it (4 days vs. 7 days in the placebo group; p = 0.012) and significantly improved the clinical recovery of the patients, as assessed by the WHO scale (p = 0.0048). In conclusion, this study demonstrated that the clinical outcome of COVID-19 patients requiring hospitalization was improved by administration of vitamin D.
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Pham H. Analyzing the relationship between the vitamin D deficiency and COVID-19 mortality rate and modeling the time-delay interactions between body's immune healthy cells, infected cells, and virus particles with the effect of vitamin D levels. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:8975-9004. [PMID: 35942745 DOI: 10.3934/mbe.2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper presents some recent views on the aspects of vitamin D levels in relation to the COVID-19 infections and analyzes the relationship between the prevalence rates of vitamin D deficiency and COVID-19 death rates per million of various countries in Europe and Asia using the data from the PubMed database. The paper also discusses a new mathematical model of time-delay interactions between the body's immune healthy cells, infected cells, and virus particles with the effect of vitamin D levels. The model can be used to monitor the timely progression of healthy immune cells with the effects of the levels of vitamin D and probiotics supplement. It also can help to predict when the infected cells and virus particles free state can ever be reached as time progresses. The consideration of the time delay in the modeling due to effects of the infected cells or virus particles and the growth of healthy cells is also an important factor that can significantly change the outcomes of the body's immune cells as well as the infections.
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Affiliation(s)
- Hoang Pham
- Department of Industrial and Systems Engineering, Rutgers University, Piscataway, New Jersey 08854, USA
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30
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Chiang WF, Hsiao PJ, Chan JS. Vitamin D for Recovery of COVID-19 in Patients With Chronic Kidney Disease. Front Nutr 2022; 9:930176. [PMID: 35782942 PMCID: PMC9240470 DOI: 10.3389/fnut.2022.930176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022] Open
Abstract
The severity of coronavirus disease 2019 (COVID-19) is determined not only by viral damage to cells but also by the immune reaction in the host. In addition to therapeutic interventions that target the viral infection, immunoregulation may be helpful in the management of COVID-19. Vitamin D exerts effects on both innate and adaptive immunity and subsequently modulates immune responses to bacteria and viruses. Patients with chronic kidney disease (CKD) frequently have vitamin D deficiency and increased susceptibility to infection, suggesting a potential role of vitamin D in this vulnerable population. In this paper, we review the alterations of the immune system, the risk of COVID-19 infections and mechanisms of vitamin D action in the pathogenesis of COVID-19 in CKD patients. Previous studies have shown that vitamin D deficiency can affect the outcomes of COVID-19. Supplementing vitamin D during treatment may be protective against COVID-19. Future studies, including randomized control trials, are warranted to determine the effect of vitamin D supplementation on the recovery from COVID-19 in CKD patients.
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Affiliation(s)
- Wen-Fang Chiang
- Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Po-Jen Hsiao
- Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Jenq-Shyong Chan
- Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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31
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Stapleton EM, Keck K, Windisch R, Stroik MR, Thurman AL, Zabner J, Thornell IM, Pezzulo AA, Klesney-Tait J, Comellas AP. Vitamin D-mediated effects on airway innate immunity in vitro. PLoS One 2022; 17:e0269647. [PMID: 35666753 PMCID: PMC9170100 DOI: 10.1371/journal.pone.0269647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Vitamin D supplementation has been suggested to enhance immunity during respiratory infection season. We tested the effect of active vitamin D (calcitriol) supplementation on key airway innate immune mechanisms in vitro. METHODS Primary human airway epithelial cells (hAECs) grown at the air liquid interface were supplemented with 10-7 M calcitriol for 24 hours (or a time course) and their antimicrobial airway surface liquid (ASL) was tested for pH, viscoscity, and antibacterial and antiviral properties. We also tested hAEC ciliary beat frequency (CBF). Next, we assessed alterations to hAEC gene expression using RNA sequencing, and based on results, we measured neutrophil migration across hAECs. RESULTS Calcitriol supplementation enhanced ASL bacterial killing of Staphylococcus aureus (p = 0.02) but did not enhance its antiviral activity against 229E-CoV. It had no effect on ASL pH or viscosity at three timepoints. Lastly, it did not affect hAEC CBF or neutrophil migration, although there was a trend of enhanced migration in the presence of a neutrophil chemokine (p = 0.09). Supplementation significantly altered hAEC gene expression, primarily of AMP-related genes including CAMP and TREM1. CONCLUSION While vitamin D supplementation did not have effects on many airway innate immune mechanisms, it may provide a useful tool to resolve respiratory bacterial infections.
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Affiliation(s)
- Emma M. Stapleton
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Kathy Keck
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Robert Windisch
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Mallory R. Stroik
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Andrew L. Thurman
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Joseph Zabner
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Ian M. Thornell
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Alejandro A. Pezzulo
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Julia Klesney-Tait
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Alejandro P. Comellas
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
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32
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Batiha GES, Al-Gareeb AI, Qusti S, Alshammari EM, Kaushik D, Verma R, Al-Kuraishy HM. Deciphering the immunoboosting potential of macro and micronutrients in COVID support therapy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:43516-43531. [PMID: 35391642 PMCID: PMC8989262 DOI: 10.1007/s11356-022-20075-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/30/2022] [Indexed: 04/16/2023]
Abstract
The immune system protects human health from the effects of pathogenic organisms; however, its activity is affected when individuals become infected. These activities require a series of molecules, substrates, and energy sources that are derived from diets. The consumed nutrients from diets help to enhance the immunity of infected individuals as it relates to COVID-19 patients. This study aims to review and highlight requirement and role of macro- and micronutrients of COVID-19 patients in enhancing their immune systems. Series of studies were found to have demonstrated the enhancing potentials of macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins, copper, zinc, iron, calcium, magnesium, and selenium) in supporting the immune system's fight against respiratory infections. Each of these nutrients performs a vital role as an antiviral defense in COVID-19 patients. Appropriate consumption or intake of dietary sources that yield these nutrients will help provide the daily requirement to support the immune system in its fight against pathogenic viruses such as COVID-19.
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Affiliation(s)
- Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad, Iraq
| | - Safaa Qusti
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eida M Alshammari
- Department of Chemistry, College of Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Deepak Kaushik
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, 124001, India.
| | - Ravinder Verma
- Department of Pharmacy, School of Medical and Allied Sciences, G.D. Goenka University, Gurugram, 122103, India
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad, Iraq
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33
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Mahwish, Saeed F, Afzaal M, Hussain M, Imran M, Nawaz T, Siddeeg A. Dietary guidelines to boost immunity during pre and post covid-19 conditions. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mahwish
- Institute of Home Sciences, University of Agriculture, Faisalabad, Pakistan
| | - Farhan Saeed
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muhammad Afzaal
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muzzamal Hussain
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muhammad Imran
- Food, nutrition and lifestyle Unit, King Fahed Medical Research Center, Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University
- Department of food science and technology, University of Narowal, Pakistan
| | - Taufiq Nawaz
- Department of Food Science and Technology, The University of Agriculture, Peshawar, Pakistan
| | - Azhari Siddeeg
- Department of Food Engineering and Technology, Faculty of Engineering and Technology, University of Gezira, Wad Medani, Sudan
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34
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Muhihi A, Fawzi WW, Aboud S, Nagu TJ, Ulenga N, Wang M, Mugusi F, Sudfeld CR. Cholecalciferol Supplementation Does Not Affect the Risk of HIV Progression, Viral Suppression, Comorbidities, Weight Loss, and Depression among Tanzanian Adults Initiating Antiretroviral Therapy: Secondary Outcomes of a Randomized Trial. J Nutr 2022; 152:1983-1990. [PMID: 35460249 PMCID: PMC9361733 DOI: 10.1093/jn/nxac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies suggest that blood concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with morbidity, viral suppression, and mortality among adults living with HIV. OBJECTIVES We evaluated the effect of cholecalciferol (vitamin D3) supplementation on the risk of HIV disease progression, HIV-1 viral suppression, comorbidities, weight change, and depression among HIV-infected individuals that were initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. METHODS We conducted a randomized, double-blind, placebo-controlled trial of vitamin D3 supplementation among 4000 HIV-infected adult men and nonpregnant women initiating ART with insufficient serum 25(OH)D concentrations (<30 ng/mL). Participants were randomly assigned to receive either weekly 50,000-IU doses for 4 wk followed by daily 2000 IU vitamin D3 until 1 y or a matching placebo regimen given in weekly followed by daily doses until 1 y. Participants were followed up at weekly visits for the first month followed by monthly visits thereafter. We conducted intent-to-treat analyses to assess the effect of vitamin D3 supplementation on the secondary trial outcomes of HIV progression or death, viral suppression, comorbidities, change in BMI, >10% weight loss, incident wasting, and depression. RESULTS During follow-up, 345 participants (17.2%) in the vitamin D3 group and 371 participants (18.6%) in the placebo group experienced HIV disease progression or death and there was no difference in risk between groups (RR: 0.91; 95% CI: 0.79, 1.06). Vitamin D3 supplementation did not affect the risk of an unsuppressed HIV-1 viral load (>1000 copies/mL) after 6 mo (RR: 1.10; 95% CI: 0.87, 1.41) and there was also no effect on change in BMI, risk of >10% weight loss, wasting, comorbidities, and depression (P values >0.05). CONCLUSIONS Vitamin D supplementation did not affect the risk of HIV progression, viral suppression, common morbidities, weight-related indicators, or depression among adults initiating ART in Tanzania.This trial was registered at clinicaltrials.gov as NCT01798680.
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Affiliation(s)
- Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini J Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Elwakeel EE, Mohamed AZ, Shaalan WM. Therapeutic effects of mesenchymal stem cells and vitamin D on Bleomycin triggered lung damage in male adult albino rats. Ultrastruct Pathol 2022; 46:237-250. [PMID: 35380506 DOI: 10.1080/01913123.2022.2059040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Bleomycin is a cancer chemotherapeutic agent that induces pulmonary fibrosis. Vitamin D plays an immunomodulation role. Bone marrow-derived mesenchymal stem cells have a strong therapeutic effect in fatal pulmonary fibrosis. The objective of this study was to evaluate the significance of vitamin D and bone marrow mesenchymal stem cells as therapeutic agents on lung injuries caused by Bleomycin in adult male rats. Thirty-five adult male albino rats were allocated into five experimental groups. The control group was the group I. The group given a single intratracheal instillation of Bleomycin was group II. The group was given vitamin D3 for 2 days before Bleomycin administration was group III. Group IV was the group that was injected by a single dose of mesenchymal stem cells (MSCs) after 4 weeks of Bleomycin injection. Group V was the withdrawal group. Histological, immunohistochemical, and ultrastructural techniques were used to process and evaluate lung tissues. The lung of group 2 was demonstrated interalveolar septal thickening by RBCs, infiltration of mononuclear cells, deposition of collagen, and marked positive alpha-smooth muscle actin immunoreactivity. Mesenchymal stem cells derived from bone marrow can diminish Bleomycin-generated fibrosis of the lungs and inflammation in rats better than vitamin D treatment.
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Affiliation(s)
- Eman E Elwakeel
- Anatomy and Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amira Z Mohamed
- Microbiology Department, Faculty of Science, Tanta University, Tanta, Egypt
| | - Walaa M Shaalan
- Zoology Department, Faculty of Science, Benha University, Benha, Egypt
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36
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Motti ML, Tafuri D, Donini L, Masucci MT, De Falco V, Mazzeo F. The Role of Nutrients in Prevention, Treatment and Post-Coronavirus Disease-2019 (COVID-19). Nutrients 2022; 14:1000. [PMID: 35267974 PMCID: PMC8912782 DOI: 10.3390/nu14051000] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 virus, infecting human cells via its spike protein, causes Coronavirus disease 2019 (COVID-19). COVID-19 is characterized by shortness of breath, fever, and pneumonia and is sometimes fatal. Unfortunately, to date, there is still no definite therapy to treat COVID-19. Therefore, the World Health Organization (WHO) approved only supportive care. During the COVID-19 pandemic, the need to maintain a correct intake of nutrients to support very weakened patients in overcoming disease arose. The literature available on nutrient intake for COVID-19 is mainly focused on prevention. However, the safe intake of micro- and/or macro-nutrients can be useful either for preventing infection and supporting the immune response during COVID-19, as well as in the post-acute phase, i.e., "long COVID", that is sometimes characterized by the onset of various long lasting and disabling symptoms. The aim of this review is to focus on the role of nutrient intake during all the different phases of the disease, including prevention, the acute phase, and finally long COVID.
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Affiliation(s)
- Maria Letizia Motti
- Department of Movement Sciences and Wellbeing, University “Parthenope”, 80133 Naples, Italy; (D.T.); (L.D.); (F.M.)
| | - Domenico Tafuri
- Department of Movement Sciences and Wellbeing, University “Parthenope”, 80133 Naples, Italy; (D.T.); (L.D.); (F.M.)
| | - Lorenzo Donini
- Department of Movement Sciences and Wellbeing, University “Parthenope”, 80133 Naples, Italy; (D.T.); (L.D.); (F.M.)
| | - Maria Teresa Masucci
- Neoplastic Progression Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | - Valentina De Falco
- Istituto di Endocrinologia e Oncologia Sperimentale del CNR, Dipartimento di Medicina Molecolare e Biotecnologie mediche, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy;
| | - Filomena Mazzeo
- Department of Movement Sciences and Wellbeing, University “Parthenope”, 80133 Naples, Italy; (D.T.); (L.D.); (F.M.)
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37
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Carr AC, Gombart AF. Multi-Level Immune Support by Vitamins C and D during the SARS-CoV-2 Pandemic. Nutrients 2022; 14:689. [PMID: 35277048 PMCID: PMC8840673 DOI: 10.3390/nu14030689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
Vitamins C and D have well-known immune supportive roles, with deficiencies in both vitamins predisposing to increased risk and severity of respiratory infections. Numerous studies have indicated that administration of these vitamins, particularly to people who are deficient, can decrease the risk and severity of respiratory infections. This has stimulated an interest in the potential efficacy of these vitamins in people with novel coronavirus (SARS-CoV-2) infection and its more severe disease (COVID-19). In this overview, we highlight the current research evidence around the multiple levels of immune support provided by vitamins C and D in the context of general respiratory infections and with a focus on the current SARS-CoV-2 pandemic. These include: prevention of infection; attenuating infection symptoms and severity; adjunctive therapy for severe disease; attenuating ongoing sequelae (long COVID); and immunisation support. Although some of these topics have not yet been investigated in great depth concerning SARS-CoV-2 and COVID-19, extensive research into the role of these vitamins in general respiratory infections has highlighted directions for future research in the current pandemic.
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Affiliation(s)
- Anitra C. Carr
- Nutrition in Medicine Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand
| | - Adrian F. Gombart
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA;
- Department of Biochemistry and Biophysics, Oregon State University, Corvallis, OR 97331, USA
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Jaun F, Boesing M, Lüthi-Corridori G, Abig K, Makhdoomi A, Bloch N, Lins C, Raess A, Grillmayr V, Haas P, Schuetz P, Gabutti L, Muser J, Leuppi-Taegtmeyer AB, Giezendanner S, Brändle M, Leuppi JD. High-dose vitamin D substitution in patients with COVID-19: study protocol for a randomized, double-blind, placebo-controlled, multi-center study-VitCov Trial. Trials 2022; 23:114. [PMID: 35120577 PMCID: PMC8814790 DOI: 10.1186/s13063-022-06016-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Background The coronavirus disease 19 (COVID-19) pandemic has caused millions of deaths, and new treatments are urgently needed. Factors associated with a worse COVID-19 prognosis include old age (> 65 years), ethnicity, male sex, obesity, and people with comorbidities. Furthermore, vitamin D deficiency was reported as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. According to a recent clinical case series, vitamin D deficiency is a modifiable risk factor, which has the prospect of reducing hospital stay, intensive care, and fatal outcomes. Vitamin D has potent immunomodulatory properties, and its supplementation might improve important outcomes in critically ill and vitamin D-deficient COVID-19 patients. Despite the evidence that supports an association between vitamin D deficiency and COVID-19 severity, there is uncertainty about the direct link. Therefore, the aim of the trial is to assess if high-dose vitamin D supplementation has a therapeutic effect in vitamin D-deficient patients with COVID-19. Methods As the trial design, a randomized, placebo-controlled, double-blind, multi-center approach was chosen to compare a high single dose of vitamin D (140,000 IU) followed by treatment as usual (TAU) (VitD + TAU) with treatment as usual only (placebo + TAU) in patients with COVID-19 and vitamin D deficiency. Discussion Vitamin D substitution in patients with COVID-19 and vitamin D deficiency should be investigated for efficacy and safety. The study aim is to test the hypothesis that patients with vitamin D deficiency suffering from COVID-19 treated under standardized conditions in hospital will recover faster when additionally treated with high-dose vitamin D supplementation. Latest studies suggest that vitamin D supplementation in patients with COVID-19 is highly recommended to positively influence the course of the disease. With this randomized controlled trial, a contribution to new treatment guidelines shall be made. Trial registration ClinicalTrials.gov NCT04525820 and SNCTP 2020-01401
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Affiliation(s)
- Fabienne Jaun
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Maria Boesing
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Giorgia Lüthi-Corridori
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Kristin Abig
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Anja Makhdoomi
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Nando Bloch
- Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, CH-9001, St. Gallen, Switzerland
| | - Christina Lins
- Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, CH-9001, St. Gallen, Switzerland
| | - Andrea Raess
- Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, CH-9001, St. Gallen, Switzerland
| | - Victoria Grillmayr
- Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, CH-9001, St. Gallen, Switzerland
| | - Philippe Haas
- Science Application Concepts GmbH, Luzernerstrasse 190, CH-6402, Merlischachen, Switzerland
| | - Philipp Schuetz
- Cantonal Hospital Aarau, Tellstrasse 25, CH-5001, Aarau, Switzerland
| | - Luca Gabutti
- Regional Hospital Bellinzona, Via A. Gallino 12, CH-6500, Bellinzona, Switzerland
| | - Jürgen Muser
- Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | | | - Stéphanie Giezendanner
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Michael Brändle
- Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, CH-9001, St. Gallen, Switzerland
| | - Jörg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410, Liestal, Switzerland
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39
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Scapaticci S, Neri CR, Marseglia GL, Staiano A, Chiarelli F, Verduci E. The impact of the COVID-19 pandemic on lifestyle behaviors in children and adolescents: an international overview. Ital J Pediatr 2022; 48:22. [PMID: 35120570 PMCID: PMC8815717 DOI: 10.1186/s13052-022-01211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
The adverse effects of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are not limited to the related infectious disease. In children and adolescents, serious risks due to the coronavirus disease 2019 (COVID-19) pandemic are also related to its indirect effects. These include an unbalanced diet with an increased risk of weight excess or nutritional deficiencies, increased sedentary lifestyle, lack of schooling, social isolation, and impaired mental health.Pediatricians should be aware of the side effects of the COVID-19 pandemic on children's diet, physical mental health and advise the families according to their nutritional needs and financial resources. Moreover, the lack of a targeted therapy able to offer protection against the deleterious effects of SARS-CoV-2 infection should require a greater effort by scientific societies to find a more effective prevention strategy. In this context, much interest should be given to nutritional support, able to contrast malnutrition and to stimulate the immune system.
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Affiliation(s)
- S Scapaticci
- Department of Paediatrics, University of Chieti-Pescara, Chieti, Italy
| | - C R Neri
- Department of Paediatrics, University of Chieti-Pescara, Chieti, Italy
| | - G L Marseglia
- Department of Paediatrics, University of Pavia IRCCS San Matteo foundation, Pavia, Italy
| | - A Staiano
- Department of Paediatrics, University of Naples "Federico II", Naples, Italy
| | - F Chiarelli
- Department of Paediatrics, University of Chieti-Pescara, Chieti, Italy.
| | - E Verduci
- Department of Paediatrics, Children's Hospital "Vittore Buzzi", University of Milan, Milan, Italy
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40
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Micronutrient Deficiency as a Confounder in Ascertaining the Role of Obesity in Severe COVID-19 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031125. [PMID: 35162148 PMCID: PMC8834257 DOI: 10.3390/ijerph19031125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023]
Abstract
Food insecurity in the United States has been exacerbated due to the socioeconomic strain of the coronavirus disease 2019 (COVID-19) pandemic. Populations experiencing poverty and, as a consequence, food insecurity in the United States are disproportionately affected by obesity, which was identified early in the pandemic as a major risk factor for increased susceptibility to COVID-19 infection and mortality. Given the focus on obesity and its role in immune dysregulation, it is also important to note the role of micronutrient deficiency, another sequalae of food insecurity. Micronutrients play an important role in the ability of the immune system to mount an appropriate response. Moreover, OBESE individuals are more likely to be micronutrient deficient. This review will explore the role of micronutrients, vitamin A, vitamin D, vitamin C, and zinc in respiratory immunity and COVID-19 and how micronutrient deficiency may be a possible confounder in obesity’s association with severe outcomes. By illuminating the role of micronutrients in COVID-19, this paper expands the discussion from food insecurity and obesity to include micronutrient deficiency and how all of these interact in respiratory illnesses such as COVID-19.
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41
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Ranjbar M, Karbalaie Niya MH, Roham M, Rezaie N, Yadollahzadeh M, Farrokhpour M, Azimi M, Motamed N, Perumal D, Tameshkel FS, Dadras F, Madani NH, Ghanbari B, Faraji A, Nikkhah M, Rahmani S, Golgiri F, Emadi SY, Abbasi R, Mohseni I, Babaei MR, Eskandari R, Ataee M, Panahi M, Zamani F, Makiani MJ, Laali A. Serum level of Vitamin D is associated with COVID-19 mortality rate in hospitalized patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:112. [PMID: 35126575 PMCID: PMC8765512 DOI: 10.4103/jrms.jrms_1151_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/28/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Due to widespread of coronavirus disease 2019 (COVID-19) infection, identification of its risk factors and clinical characteristics are important. The aim of the present study was to assess Vitamin D levels in individuals with severe acute respiratory syndrome coronavirus-19 infection and to report on its potential as a predictive marker. MATERIALS AND METHODS All patients, diagnosed with COVID-19 infection from February 16 to March 21, 2020, and referred to Firoozgar Hospital, Tehran, Iran, were enrolled in this study. Vitamin D analysis was undertaken on patient serum samples using a commercial kit (Pars Azmoon Co., Tehran, Iran). SPSS v. 22 was used for statistical analysis. RESULTS Vitamin D serum concentration was analyzed in a total of 317 patients whose mean age ± standard deviation was 62.05 ± 15 years and with 62.5% being male. A significant association of Vitamin D level and death was observed. Higher levels of serum Vitamin D had protection against death (odds ratio = 0.955 [95% confidence interval = 0.923-0.988], P = 0.008). CONCLUSION As a preliminary study in the Iranian population who suffered COVID-19 disease, we identified that Vitamin D deficiency was associated with a higher death rate and intensive care unit admission.
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Affiliation(s)
- Mitra Ranjbar
- Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Roham
- Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Antimicrobial Resistant Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Rezaie
- Department of Pulmonology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Yadollahzadeh
- Department of Internal Medicine, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Farrokhpour
- Department of Internal Medicine, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Azimi
- Department of Internal Medicine, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Motamed
- Department of Social Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Dhayaneethie Perumal
- Drug Discovery, Delivery and Patient Care (DDDPC) Theme, School of Life Sciences Pharmacy and Chemistry, Kingston University, London, United Kingdom
| | | | - Farahnaz Dadras
- Department of Nephrology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Hashemi Madani
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ghanbari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Faraji
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Nikkhah
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Rahmani
- Department of Nephrology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemah Golgiri
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Yadollah Emadi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rowshanak Abbasi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Mohseni
- Department of Interventional Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Babaei
- Department of Interventional Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Eskandari
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Manizhe Ataee
- Department of Interventional Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Panahi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Jamshidi Makiani
- Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Antimicrobial Resistant Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Laali
- Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Antimicrobial Resistant Research Center, Iran University of Medical Sciences, Tehran, Iran
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Campos A, Scheveck B, Parikh J, Hernandez-Bojorge S, Terán E, Izurieta R. Effect of altitude on COVID-19 mortality in Ecuador: an ecological study. BMC Public Health 2021; 21:2079. [PMID: 34772396 PMCID: PMC8589098 DOI: 10.1186/s12889-021-12162-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/01/2021] [Indexed: 01/20/2023] Open
Abstract
Background The SARS-CoV-2/COVID-19 pandemic has claimed nearly 900,000 lives worldwide and infected more than 27 million people. Researchers worldwide are studying ways to decrease SARS-CoV-2 transmission and COVID-19 related deaths. Several studies found altitude having a negative association with both COVID-19 incidence and deaths. Ecuadorian data was used to explore the relationship between altitude and COVID-19. Methods This is an ecological study examining province-level data. To explore a relationship between altitude and COVID-19, this study utilized publicly available COVID-19 data and population statistics. ANOVA, correlation statistics, and a multivariate linear model explored the relationship between different Ecuadorian altitudes against incidence, mortality, and case-fatality rates. Population statistics attributed to COVID-19 were included in the linear model to control for confounding factors. Results Statistically significant differences were observed in the regions of Amazónica, Sierra, Costa of Ecuador for incidence, mortality, and case fatality rates, suggesting an association between altitude and SARS-CoV-2 transmission and COVID-19 disease severity (p-value ≤0.05). In univariate analysis, altitude had a negative association to mortality rate with a 1-unit change in altitude resulting in the decrease of 0.006 units in mortality rate (p-value = 0.03). The multiple linear models adjusted for population statistics showed a statistically significant negative association of altitude with mortality rate (p-value = 0.01) with a 1-unit change in altitude resulting in the decrease in mortality rate by 0.015 units. Overall, the model helped in explaining 50% (R2 = 0.4962) of the variance in mortality rate. Conclusion Altitude may have an effect on COVID-19 mortality rates. However, based on our model and R2 value, the relationship between our variables of interest and COVID-19 mortality may be nonlinear. More research is needed to understand why altitude may have a protective effect against COVID-19 mortality and how this may be applicable in a clinical setting.
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Affiliation(s)
- Adriana Campos
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S..
| | - Bridget Scheveck
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
| | - Jeegan Parikh
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
| | | | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Campus Cumbayá, Diego de Robles s/n, Quito, 170901, Quito, Ecuador
| | - Ricardo Izurieta
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
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43
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Dyussenova SB, Gordiyenko MY, Askarov MS, Tuleuova GK, Suleimenova SB, Кhussainova GS, Abisheva BI. The Role of Vitamin D in Respiratory Viral Infections and Other Infectious Diseases. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Clinical studies and meta-analyzes have shown that reduced levels of 25 (OH) D in the blood contribute to impaired immunity and stimulate excessive inflammation that adversely affects the health of children: the risk of developing bronchial asthma (BA), obstructive bronchitis, and allergic rhinitis increases. The main purpose of this review is to summarize the current literature data on the relationship between vitamin D, VRI and other infectious diseases with a clinical example.
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Chiappini E, Santamaria F, Marseglia GL, Marchisio P, Galli L, Cutrera R, de Martino M, Antonini S, Becherucci P, Biasci P, Bortone B, Bottero S, Caldarelli V, Cardinale F, Gattinara GC, Ciarcià M, Ciofi D, D'Elios S, Di Mauro G, Doria M, Indinnimeo L, Lo Vecchio A, Macrì F, Mattina R, Miniello VL, Del Giudice MM, Morbin G, Motisi MA, Novelli A, Palamara AT, Panatta ML, Pasinato A, Peroni D, Perruccio K, Piacentini G, Pifferi M, Pignataro L, Sitzia E, Tersigni C, Torretta S, Trambusti I, Trippella G, Valentini D, Valentini S, Varricchio A, Verga MC, Vicini C, Zecca M, Villani A. Prevention of recurrent respiratory infections : Inter-society Consensus. Ital J Pediatr 2021; 47:211. [PMID: 34696778 PMCID: PMC8543868 DOI: 10.1186/s13052-021-01150-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs.Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs.
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Affiliation(s)
- Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy.
| | - Francesca Santamaria
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia IRCCS San Matteo foundation, Pavia, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Renato Cutrera
- Respiratory Unit, Academic Pediatric Department, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy
| | - Maurizio de Martino
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Antonini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Paolo Becherucci
- Family Pediatrician, Local Health Unit, Lastra a Signa, Florence, Italy
| | - Paolo Biasci
- Family Pediatrician, Local Health Unit, Livorno, Italy
| | - Barbara Bortone
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | | | - Martina Ciarcià
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Daniele Ciofi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Mattia Doria
- Family Pediatrician, Local Health Unit, Chioggia, Venice, Italy
| | - Luciana Indinnimeo
- Pediatric Department "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Andrea Lo Vecchio
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Macrì
- Department of Pediatrics "Sapienza", University of Rome, Rome, Italy
| | - Roberto Mattina
- Department of Biomedical, Surgical, and Odontoiatric Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Guido Morbin
- Family Pediatrician, Local Health Unit, Trento, Italy
| | - Marco Antonio Motisi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Andrea Novelli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Anna Teresa Palamara
- Department of Public Health and Infectious Diseases, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Panatta
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Angela Pasinato
- Family Pediatrician, Local Health Unit, Torri di Quartesolo, Vicenza, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Massimo Pifferi
- Department of Pediatrics Pulmonology and Allergology Section University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Sitzia
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Chiara Tersigni
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Trambusti
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giulia Trippella
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Diletta Valentini
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sandro Valentini
- Family Pediatrician, Local Health Unit, Colle Val d'Elsa, Siena, Italy
| | | | - Maria Carmen Verga
- Family Pediatrician, Local Health Unit Salerno, Vietri sul Mare, Salerno, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Marco Zecca
- Pediatric Hematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Villani
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Afaghi S, Esmaeili Tarki F, Sadat Rahimi F, Besharat S, Mirhaidari S, Karimi A, Alamdari NM. Prevalence and Clinical Outcomes of Vitamin D Deficiency in COVID-19 Hospitalized Patients: A Retrospective Single-Center Analysis. TOHOKU J EXP MED 2021; 255:127-134. [PMID: 34645738 DOI: 10.1620/tjem.255.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vitamin D attenuates inflammatory responses to viral respiratory infections. Hence, vitamin D deficiency may be a highly significant prognostic factor for severity and mortality in COVID-19 patients. To evaluate the complications and mortality in different vitamin D status groups in COVID-19 hospitalized patients, we conducted this retrospective study on 646 laboratory-confirmed COVID-19 patients who were hospitalized in Shahid Modarres Hospital, Tehran, Iran from 16th March 2020 until 25th February 2021. Overall, patients with vitamin D deficiency, insufficiency and sufficiency were 16.9%, 43.6% and 39.5%, respectively. The presence of comorbidity, length of hospitalization, ICU admission, and invasive mechanical ventilation requirement and overall complications were significantly more in patients with vitamin D deficiency (p-value < 0.001). 46.8% (51/109) of vitamin D deficient patients died due to the disease, whilst the mortality rate among insufficient and sufficient vitamin D groups was 29.4% (83/282) and 5.5% (14/255), respectively. In univariate analysis, age > 60 years (odds ratio (OR) = 6.1), presence of comorbidity (OR = 10.7), insufficient vitamin D status (OR = 7.2), and deficient vitamin D status (OR = 15.1) were associated with increase in COVID-19 mortality (p-value < 0.001). Finally, the multivariate analysis adjusted for age, sex, and comorbidities indicated vitamin D deficiency as an independent risk factor for mortality (OR = 3.3, p-value = 0.002). Vitamin D deficiency is a strong risk factor for mortality and severity of SARS-CoV-2 infection. Vitamin D supplementation may be able to prevent or improve the prognosis of COVID-19 during this pandemic.
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Affiliation(s)
- Siamak Afaghi
- Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Farzad Esmaeili Tarki
- Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Fatemeh Sadat Rahimi
- Critical Care and Quality Improvement Research Center, Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Sara Besharat
- Clinical Research and Development Center, Department of Radiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Shayda Mirhaidari
- Clinical Instructor of Surgery, Northeastern Ohio University (NEOMED)
| | - Anita Karimi
- Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Nasser Malekpour Alamdari
- Vascular and Laparoscopic Surgery, Clinical Research and Development Center, Shahid Modarres Hospital, Department of Surgery, Shahid Beheshti University of Medical Sciences
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van Daal MT, Folkerts G, Garssen J, Braber S. Pharmacological Modulation of Immune Responses by Nutritional Components. Pharmacol Rev 2021; 73:198-232. [PMID: 34663688 DOI: 10.1124/pharmrev.120.000063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The incidence of noncommunicable diseases (NCDs) has increased over the last few decades, and one of the major contributors to this is lifestyle, especially diet. High intake of saturated fatty acids and low intake of dietary fiber is linked to an increase in NCDs. Conversely, a low intake of saturated fatty acids and a high intake of dietary fiber seem to have a protective effect on general health. Several mechanisms have been identified that underlie this phenomenon. In this review, we focus on pharmacological receptors, including the aryl hydrocarbon receptor, binding partners of the retinoid X receptor, G-coupled protein receptors, and toll-like receptors, which can be activated by nutritional components and their metabolites. Depending on the nutritional component and the receptors involved, both proinflammatory and anti-inflammatory effects occur, leading to an altered immune response. These insights may provide opportunities for the prevention and treatment of NCDs and their inherent (sub)chronic inflammation. SIGNIFICANCE STATEMENT: This review summarizes the reported effects of nutritional components and their metabolites on the immune system through manipulation of specific (pharmacological) receptors, including the aryl hydrocarbon receptor, binding partners of the retinoid X receptor, G-coupled protein receptors, and toll-like receptors. Nutritional components, such as vitamins, fibers, and unsaturated fatty acids are able to resolve inflammation, whereas saturated fatty acids tend to exhibit proinflammatory effects. This may aid decision makers and scientists in developing strategies to decrease the incidence of noncommunicable diseases.
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Affiliation(s)
- Marthe T van Daal
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG, Utrecht, The Netherlands (M.T.v.D., G.F., J.G., S.B.); and Danone Nutricia Research, 3584 CT, Utrecht, The Netherlands (J.G.)
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG, Utrecht, The Netherlands (M.T.v.D., G.F., J.G., S.B.); and Danone Nutricia Research, 3584 CT, Utrecht, The Netherlands (J.G.)
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG, Utrecht, The Netherlands (M.T.v.D., G.F., J.G., S.B.); and Danone Nutricia Research, 3584 CT, Utrecht, The Netherlands (J.G.)
| | - Saskia Braber
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG, Utrecht, The Netherlands (M.T.v.D., G.F., J.G., S.B.); and Danone Nutricia Research, 3584 CT, Utrecht, The Netherlands (J.G.)
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Menshawey E, Menshawey R, Nabeh OA. Shedding light on vitamin D: the shared mechanistic and pathophysiological role between hypovitaminosis D and COVID-19 risk factors and complications. Inflammopharmacology 2021; 29:1017-1031. [PMID: 34185200 PMCID: PMC8239482 DOI: 10.1007/s10787-021-00835-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-COV-2) is the culprit of the Coronavirus Disease (COVID-19), which has infected approximately 173 million people and killed more than 3.73 million. At risk groups including diabetic and obese patients are more vulnerable to COVID-19-related complications and poor outcomes. Substantial evidence points to hypovitaminosis D as a risk factor for severe disease, the need for ICU, and mortality. 1,25(OH)D, a key regulator of calcium homeostasis, is believed to have various immune-regulatory roles including; promoting anti-inflammatory cytokines, down regulating pro-inflammatory cytokines, dampening entry and replication of SARS-COV-2, and the production of antimicrobial peptides. In addition, there are strong connections which suggest that dysregulated 1,25(OH)D levels play a mechanistic and pathophysiologic role in several disease processes that are shared with COVID-19 including: diabetes, obesity, acute respiratory distress syndrome (ARDS), cytokine storm, and even hypercoagulable states. With evidence continuing to grow for the case that low vitamin D status is a risk factor for COVID-19 disease and poor outcomes, there is a need now to address the public health efforts set in place to minimize infection, such as lock down orders, which may have inadvertently increased hypovitaminosis D in the general population and those already at risk (elderly, obese, and disabled). Moreover, there is a need to address the implications of this evidence and how we may apply the use of cheaply available supplementation, which has yet to overcome the near global concern of hypovitaminosis D. In our review, we exhaustively scope these shared pathophysiologic connections between COVID-19 and hypovitaminosis D.
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Affiliation(s)
- Esraa Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Rahma Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Omnia Azmy Nabeh
- Faculty of Medicine, Department of Medical Pharmacology, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
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Martínez Leo EE, Peñafiel AM, Hernández Escalante VM, Cabrera Araujo ZM. Ultra-processed diet, systemic oxidative stress, and breach of immunologic tolerance. Nutrition 2021; 91-92:111419. [PMID: 34399404 DOI: 10.1016/j.nut.2021.111419] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
In recent years, consumption of ultra-processed food around the world has been increasing. The nutritional profile of an ultra-processed diet is associated with the development of cellular alterations that lead to oxidative stress. The chronic prooxidative state leads to an environment that influences the proliferation, apoptosis, and signaling pathways of immune cells. Likewise, the decrease in the transcription factor NRF2, owing to exacerbated production of reactive oxygen species, leads to changes in immune function and response to infections. This review aims to analyze the connection between an ultra-processed diet, systemic oxidative stress, and immune tolerance, as a contribution to the scientific evidence on the impact of oxidative stress on health and the possible risk of infections-an important consideration in the association of eating pattern and the immune response.
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Affiliation(s)
- Edwin E Martínez Leo
- Research Department, University Latino, Merida, Mexico; School of Medicine, Autonomous University of Yucatan, Merida, Mexico.
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Mortaz E, Bezemer G, Alipoor SD, Varahram M, Mumby S, Folkerts G, Garssen J, Adcock IM. Nutritional Impact and Its Potential Consequences on COVID-19 Severity. Front Nutr 2021; 8:698617. [PMID: 34291074 PMCID: PMC8287001 DOI: 10.3389/fnut.2021.698617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background: During late 2019 a viral disease due to a novel coronavirus was reported in Wuhan, China, which rapidly developed into an exploding pandemic and poses a severe threat to human health all over the world. Until now (May 2021), there are insufficient treatment options for the management of this global disease and shortage of vaccines. Important aspects that help to defeat coronavirus infection seems to be having a healthy, strong, and resilient immune system. Nutrition and metabolic disorders, such as obesity and diabetes play a crucial role on the community health situation in general and especially during this new pandemic. There seems to be an enormous impact of lifestyle, metabolic disorders, and immune status on coronavirus disease 2019 (COVID-19) severity and recovery. For this reason, it is important to consider the impact of lifestyle and the consumption of well-defined healthy diets during the pandemic. Aims: In this review, we summarise recent findings on the effect of nutrition on COVID-19 susceptibility and disease severity and treatment. Understanding how specific dietary features might help to improve the public health strategies to reduce the rate and severity of COVID-19.
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Affiliation(s)
- Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gillina Bezemer
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Impact Station, Hilversum, Netherlands
| | - Shamila D. Alipoor
- Molecular Medicine Department, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Mohammad Varahram
- Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharon Mumby
- Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gert Folkerts
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Center of Excellence Immunology, Nutricia Research, Utrecht, Netherlands
| | - Ian M. Adcock
- Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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50
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James PT, Ali Z, Armitage AE, Bonell A, Cerami C, Drakesmith H, Jobe M, Jones KS, Liew Z, Moore SE, Morales-Berstein F, Nabwera HM, Nadjm B, Pasricha SR, Scheelbeek P, Silver MJ, Teh MR, Prentice AM. The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. J Nutr 2021; 151:1854-1878. [PMID: 33982105 PMCID: PMC8194602 DOI: 10.1093/jn/nxab059] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
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Affiliation(s)
- Philip T James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zakari Ali
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Bonell
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Carla Cerami
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Modou Jobe
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kerry S Jones
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie E Moore
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Fernanda Morales-Berstein
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Behzad Nadjm
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Pauline Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matt J Silver
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Megan R Teh
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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