Vitamin D deficiency during the COVID-19 pandemic and war in Ukraine

Abstract

Background. Data from numerous studies indicate a significant prevalence of vitamin D deficiency in Ukraine and the world. In recent years, the Ukrainian medical community has faced two important challenges — the COVID-19 pandemic and the russian aggression, which significantly affected the organization and availability of medical care. Despite the previous epidemiological studies in Ukraine devoted to the vitamin D status, there are no data during the past 5 years that became the background for this research. The purpose was to analyze the vitamin D status in the adult population of Ukraine during the COVID-19 pandemic and russian aggression. Materials and methods. Data of the serum level of 25-hydroxyvitamin D (25(OH)D) in 5029 adults aged 20–99 years, who for various reasons applied for its measurement, were retrospectively analyzed. The analysis was performed depending on the year and month of observation, the age and gender of the subjects, and the 25(OH)D level. Results. The mean serum level of 25(OH)D in the total group was 33.2 [24.1–43.8] ng/ml. The assessment of the number of 25(OH)D tests for 2018–2022 did not reveal any signi­ficant differences in 2018 and 2019 but established a significant decrease during the russian aggression in Ukraine in 2022 (by 55.7 %) compared to 2018, as well as indices during the COVID-19 pandemic (by 21.6 % compared to 2020, by 23.5 % in 2021). During the observation period, it was established a decrease in the vitamin D deficiency proportion from 20.6 % in 2018 to 9.3 % in 2022, and an increase in the proportion of subjects with suboptimal (from 6.6 to 11.4 %, respectively) and high serum concentrations of 25(OH)D (from 2.2 to 12.7 %). Conclusions. Our results indicate a grown serum 25(OH)D level during 2020–2022 in the adult population of Ukraine compared to the indices of previous years and a decreased share of vitamin D deficiency in the Ukrainian population. In addition, a decrease in the number of 25(OH)D level tests was established, especially during the period of the russian aggression, which should be taken into account during the planning measures to optimize the vitamin D status in the adult population of Ukraine.

Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults

“…During 2011–2022, some national and regional epidemiological studies concerning vitamin D status were performed in Ukraine, involving subjects of different ages, sexes, and places of residence [ 26 , 27 , 28 , 29 , 30 , 31 ]. In the first national study (1575 persons aged 20–89 years) [ 26 ], VDD was detected in 81.8%, vitamin D insufficiency (VDI) in 13.6%, and normal 25(OH)D levels in 4.6% of the subjects.…”

“…A decreased proportion of VDI (27%) and VDD (20%) was also established. During the COVID-19 pandemic [ 31 ] serum 25(OH)D levels in the Ukrainian population were higher (annual index in 2020—36.8 ng/mL, in 2021—35.0 ng/mL) compared to the previously published studies and to the level in 2018 (30.2 ng/mL) [ 28 ]. All Ukrainian studies have shown a dependence of 25(OH)D levels on age, with the minimum levels in older age groups, and seasonal fluctuations of 25(OH)D levels with the maximum levels in early fall and late summer and the lowest levels in early spring and late winter.…”

“…Vitamin D supplementation using various doses depending on the body mass, season, and food preferences may be recommended if the above is limited or impossible. Epidemiological studies conducted in Ukraine on seasonal fluctuations in 25(OH)D levels [ 25 , 27 , 28 , 31 ] have shown that lower vitamin D levels were observed in late autumn, winter, and spring. To reduce the VDD, it may be important to prescribe prophylactic doses from October to April.…”

Diagnosis, prevention and treatment of vitamin D deficiency in adults: Ukrainian experts consensus statement

“…Протягом останніх десятиріч в Україні проведена низка епідеміологічних досліджень щодо статусу вітаміну D [31][32][33][34][35][36]. Перше епідеміологічне дослідження (2011) [31] Інше епідеміологічне дослідження із залученням 3460 осіб віком 1-92 роки з патологією кістковом'язової системи [32], опубліковане у 2017 році, виявило вищі показники забезпеченості вітаміном D порівняно з попереднім дослідженням (середній рівень 25(ОН)D становив 26,2 нг/мл) зі зменшенням частки ДВД (37,3 %) і НВД (30,6 %).…”

“…(2020 рік: 36,8 нг/мл; 2021 рік: 35,0 нг/мл) як порівняно з показниками опублікованих раніше досліджень, так і з рівнем 25(OH)D у 2018 році (30,2 нг/мл) [35]. Середньорічний рівень 25(OH)D у 2022 році (36,0 нг/мл) [36] вірогідно не відрізнявся від значень попередніх двох років, проте встановлено вірогідне зменшення кількості тестувань рівня 25(OH)D, що, очевидно, пов'язано з російським вторгненням в Україну та низкою обмежень як у діагностиці ДВД, так і в належній його саплементації.…”