Vitamin D deficiency in British South Asians, a persistent but avoidable problem associated with many health risks (including rickets, T2DM, CVD, COVID-19 and pregnancy complications): the case for correcting this deficiency

Abstract

High vitamin D deficiency rates, with rickets and osteomalacia, have been common in south Asians (SAs) arriving in Britain since the 1950s with preventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease), recent trials and non-linear Mendelian randomisation studies having shown deficiency to be causal for both disorders. Ethnic minority, obesity, diabetes and social deprivation are recognised COVID-19 risk factors but vitamin D deficiency isn’t, despite convincing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitamin D deficiency in COVID-19 risk prediction but both factors lower serum 25(OH)D specifically. Social deprivation inadequately explains increased ethnic-minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using ‘education’, ‘assimilation’ and ‘diet’ as ‘proxies’ for ethnic differences and increasing pressures to assimilate. Meanwhile, English rickets was abolished from ~1940 by free ‘welfare foods’ (meat, milk, eggs, cod-liver-oil), for all pregnant/nursing mothers and young children (<5 years old). Cod-liver-oil was withdrawn from antenatal clinics from 1994 (for excessive vitamin A teratogenicity), without alternative provision. The take-up of 2006 ‘Healthy-Start’ scheme food-vouchers for low-income families with young children (<3 years old) has been poor, being inaccessible and poorly publicized. COVID-19 pandemic advice for UK adults in ‘lockdown’ was ‘400 IU vitamin D/day’, inadequate for correcting the deficiency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA people in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. Not providing vitamin D for preventing SA rickets and osteomalacia continues to be unacceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any other factor worsening ethnic minority health in Britain

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“…On the other hand, as proposed by Caccialanza et al, 49 efforts towards ensuring safe efficacious vitamin D serum levels and methods of delivery that ensure optimal vitamin D serum levels 50 and that are forthcoming among vulnerable groups and individuals, may yet have a favorable impact on reducing COVID-19 risk as well the predisposition of many youth and adults with chronic health challenges acquiring severe forms of COVID-19, with its possible highly disabling long term musculoskeletal, neurological and neuropsychiatric complications. Vitamin D may also serve as anti-inflammatory or immune-system modulating role that may well attenuate the harmful consequences of COVID-19, 51 which are emerging, even if deemed possibly non significant by some, 50 but not all. For example, findings by D'Avolio et al, 52 obtained from a cohort of patients in Switzerland did tend to suggest vitamin D may be one potentially important adjunct to consider in the realm of efforts to mitigate the onset and severity of COVID-19 infections and its variants.…”

“…Alternately, the presence of a sustained vvitamin D deficit may predispose vulnerable as well as healthy individuals to lung infections 26 and higher mortality rates than those deemed vitamin D sufficient, 53 plus a generally worse COVID-19 infection outcome even if this is only associated with obesity, ethnicity, and social deprivation explanatory factors. 50 Many reasons for being vitamin D deficient exist including low physical activity levels, 54 hence along with other vitamins, Catalano et al , 55 propose vitamins D as a possible alternative preventive and therapeutic means of support for fostering the health of COVID-19 disease outcomes in both adults as well as children, as well as for averting a COVID-19 infection and its possible severe outcomes in the event they acquire the disease. 56 As such, and although further well designed studies are warranted, available evidence suggests that efforts to maintain an optimal serum vitamin D status in the case of the COVID-19 patient may significantly reduce the risk of acute respiratory distress syndrome as well as its severity, with possible beneficial effects on the need for mechanical ventilation and/or intensive care unit admission.…”

Can vitamin D positively impact one or more postacute-COVID-19 syndrome musculoskeletal and cognitive complications?

“…On the other hand, as proposed by Caccialanza et al, 49 efforts towards ensuring safe efficacious vitamin D serum levels and methods of delivery that ensure optimal vitamin D serum levels 50 and that are forthcoming among vulnerable groups and individuals, may yet have a favorable impact on reducing COVID-19 risk as well the predisposition of many youth and adults with chronic health challenges acquiring severe forms of COVID-19, with its possible highly disabling long term musculoskeletal, neurological and neuropsychiatric complications. Vitamin D may also serve as anti-inflammatory or immune-system modulating role that may well attenuate the harmful consequences of COVID-19, 51 which are emerging, even if deemed possibly non significant by some, 50 but not all. For example, findings by D'Avolio et al, 52 obtained from a cohort of patients in Switzerland did tend to suggest vitamin D may be one potentially important adjunct to consider in the realm of efforts to mitigate the onset and severity of COVID-19 infections and its variants.…”

“…Alternately, the presence of a sustained vvitamin D deficit may predispose vulnerable as well as healthy individuals to lung infections 26 and higher mortality rates than those deemed vitamin D sufficient, 53 plus a generally worse COVID-19 infection outcome even if this is only associated with obesity, ethnicity, and social deprivation explanatory factors. 50 Many reasons for being vitamin D deficient exist including low physical activity levels, 54 hence along with other vitamins, Catalano et al , 55 propose vitamins D as a possible alternative preventive and therapeutic means of support for fostering the health of COVID-19 disease outcomes in both adults as well as children, as well as for averting a COVID-19 infection and its possible severe outcomes in the event they acquire the disease. 56 As such, and although further well designed studies are warranted, available evidence suggests that efforts to maintain an optimal serum vitamin D status in the case of the COVID-19 patient may significantly reduce the risk of acute respiratory distress syndrome as well as its severity, with possible beneficial effects on the need for mechanical ventilation and/or intensive care unit admission.…”

Overcoming Infections Including COVID-19, by Maintaining Circulating 25(OH)D Concentrations Above 50 ng/mL

“…16 Evidence suggests that those with low circulating 25(OH)D have a higher risk of acquiring post-COVID syndrome. 14,18 Progress in Managing COVID-19…”