COVID-19: the older adult and the importance of vitamin D sufficiency

Abstract

In December 2019, in Wuhan, China, the novel coronavirus ‘severe acute respiratory syndrome 2’ (SARS-CoV-2) was discovered as the cause of a pneumonia-like illness and subsequently named coronavirus disease 2019 (COVID-19). COVID-19 spread and is now a global pandemic. With few exceptions, countries in the Northern hemisphere have higher mortality rates from COVID-19. This may be due to an increased prevalence of older people in Northern Europe at higher risk of having cardio-pulmonary and metabolic comorbidities as well as hypovitaminosis D. With increasing age, immunosenescence and ‘inflammaging’ lead to impaired and maladaptive immune responses to SARS-CoV-2 infections, contributing to the enhanced prevalence of severe COVID-19 in older patients. The association of ageing with increased vitamin D deficiency, which is associated with cardiovascular risk factors and disease and worse prognosis in COVID-19 infection, is discussed. Considerable experimental evidence demonstrates the immuno-modulatory properties of vitamin D, in particular, its role in regulating and suppressing the inflammatory cytokine response to viral respiratory infections links the importance of vitamin D sufficiency as a potential protective factor in COVID-19. There is an urgent need for prospective randomised studies to examine whether hypovitaminosis D correlates with severity of COVID-19 disease and the actual benefit of repletion. Moreover, given what has been described as a ‘pandemic of vitamin D deficiency’, especially in Europe, and in the context of the SARS-CoV-2 contagion, the authors support the call for public health doctors and physicians, with support from Governments, to prioritise and strengthen recommendations on vitamin D intake and supplementation.

Low Serum 25-hydroxyvitamin D (Vitamin D) Level Is Associated With Susceptibility to COVID-19, Severity, and Mortality: A Systematic Review and Meta-Analysis

“…Thus, elderly patients with low serum 25-OHD are more susceptible to COVID-19 compared to non-elderly patients with low serum 25-OHD. Older adults may experience immunosenescence and inflammaging which may affect immune responses against infection, thus contributing to susceptibility ( 23 , 24 ). Elderly population produces 75% less cutaneous vitamin D3 than young adults and is thus more prone to lower serum 25-OHD level ( 25 ).…”

COVID-19-Omics Report: From Individual Omics Approaches to Precision Medicine

“…Although metabolic profiling has not entered clinical practice, in the future, it may provide a means to better diagnose and classify COVID-19 susceptibility and predict severity. For example, individuals who were diagnosed with preexisting metabolome conditions, such as chronic vitamin D deficiency, particularly adults 65 years and older, were recommended to increase their vitamin D consumption to prevent severe forms of COVID-19 (e.g., those accompanied by increased intravascular coagulation) [85,86]. Dietary supplementations with other vitamins, nutraceuticals, and micronutrient minerals were also recommended for the general population, particularly for individuals with known deficiencies [87].…”

Nurse Practitioner–Led Vitamin D Screening and Supplementation Program in Rural Primary Care

“…23 An observed correlation between vitamin D levels and the incidence and severity of COVID-19 symptoms has also been identified. 3,[24][25][26] Specifically, vitamin D sufficiency is associated with a lower incidence of respiratory cytokine storm, often seen in severe COVID-19 cases. [27][28][29] In a Spanish caseecontrol study, 82% of hospitalized patients had vitamin D levels <20 ng/mL.…”

“…1 Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level <30 ng/mL and is associated with preventable adverse health sequelae. 2 Unfortunately, vitamin D deficiency is the most common micronutrient deficiency globally, 3 and approximately 1 billion individuals worldwide are vitamin D deficient. 4 Deficient vitamin D levels are associated with chronic illnesses involving the musculoskeletal, respiratory, cardiovascular, and immune systems and affect people over age 65 at a disproportionate rate.…”