Association Between Vitamin D Levels and COVID-19 Infection in Children: A Case-Control Study

Abstract

Objective: Coronavirus disease 2019 (COVID-19) infection is seen in all age groups, and its symptoms are very variable. The course of the disease can be asymptomatic or mortal. In pediatric patients, vitamin D is thought to be protective against (COVID-19) with its immunomodulator, antiviral, anti-inflammatory, and epithelial integrity properties. Our aim is to investigate the relationship between (COVID-19) infection and vitamin D level. Materials and Methods: We included (COVID-19) patients between 1 month and 18 years of age and healthy control groups. We compared epidemiological, clinical, laboratory, and imaging findings in patients. Results: One hundred forty-nine patients were evaluated in our study. Seventy-three (49%) of them were (COVID-19)-positive patients and 76 (51%) of them were healthy control group. The mean 25(OH)-D vitamin level was 15.80 ng/mL (5‐41.56) in (COVID-19) patients and 21.51 ng/mL (5-69.80) in the control group. Vitamin D level was shown to be statistically significantly lower in coronavirus disease 2019 patients ( P < .001). It was observed that myalgia was more common in patients with low 25(OH)-D levels ( P < .048). Conclusion: Our study is one of the rare studies examining the relationship between (COVID-19) and 25(OH)-D vitamins in the pediatric age group. Children with (COVID-19) have a lower 25(OH)-D vitamin level than the control group.

Role of Vitamin D and Vitamin D Polymorphisms in COVID-19 Risk and Severity in Children: A Systematic Review

“…Several studies classified patients according to their serum 25(OH)D level of sufficiency, and variations were noted between the values defined as sufficient, insufficient, and deficient. Studies included in our systematic review determine vitamin D deficiency as levels of serum 25(OH)D less than 20 ng/mL (<50 nmol/L) [16][17][18], less than 12 ng/mL (<30 nmol/L) [9], or between 5 and 15 ng/mL [19], mild deficiency as of 21-30 ng/mL [20], and mild to moderate deficiency as of 10-24 ng/mL [21]. Two studies defined severe vitamin D deficiency as 25(OH)D levels below 10 ng/ml [21,22], and one study as less than 5 ng/mL [19].…”

“…Studies included in our systematic review determine vitamin D deficiency as levels of serum 25(OH)D less than 20 ng/mL (<50 nmol/L) [ 16 - 18 ], less than 12 ng/mL (<30 nmol/L) [ 9 ], or between 5 and 15 ng/mL [ 19 ], mild deficiency as of 21-30 ng/mL [ 20 ], and mild to moderate deficiency as of 10-24 ng/mL [ 21 ]. Two studies defined severe vitamin D deficiency as 25(OH)D levels below 10 ng/ml [ 21 , 22 ], and one study as less than 5 ng/mL [ 19 ]. Those with 25(OH)D levels of 21-29 ng/mL (52.5 and 72.5 nmol/l) [ 16 , 17 ] or 12-20 ng/mL (30-50 nmol/L) [ 9 , 23 ] were defined as vitamin D insufficient, and those with levels above 30 ng/ml (75 nmol/L) were considered to have normal levels [ 16 , 17 ].…”

“…A total of 16 studies provided data on the correlation between serum 25(OH)D levels and COVID-19 severity in terms of the severity of clinical symptoms, hospital length of stay, and mortality in hospitalized patients aged one month to 18 years [ 5 , 6 , 9 - 11 , 13 - 17 , 19 - 21 , 24 , 27 , 29 ]. One population-based study, conducted during the first wave of the COVID-19 pandemic, assessed the likelihood of hospitalization in children over two months of age and adults [ 14 ].…”

“…Another study found no difference in COVID‐19-diagnosed children and adolescents regarding vitamin D levels and disease clinical course and severity [ 16 ]. Bayrak et al found no significant difference between COVID-19 patients with normal and low 25(OH)D levels when compared in terms of clinical severity (asymptomatic, mild, and moderate clinical course) [ 19 ].…”

“…Nine studies examined the association of vitamin D levels with inflammatory and other laboratory biomarkers in COVID-19 [ 5 , 9 , 16 , 17 , 19 , 20 , 23 , 24 , 26 ]. Two studies noted a negative correlation between serum concentrations of vitamin D with C-reactive protein (CRP) and fibrinogen levels [ 5 , 23 ].…”