Vitamin D status of Arab Gulf residents screened for SARS-CoV-2 and its association with COVID-19 infection: a multi-centre case–control study

Abstract

Objectives Vitamin D status in patients with COVID-19 is an on-going controversial issue. This study aims to determine differences in the serum 25(OH)D concentrations of Arab Gulf adult residents screened for SARS-CoV-2 and its association with risk of COVID-19 infection together with other comorbidities. Methods In this multi-center, case–control study, a total of 220 male and female adults presenting with none to mild symptoms were screened for COVID-19 (n = 138 RT-PCR-confirmed SARS-CoV-2 positive and 82 negative controls). Medical history was noted. Anthropometrics were measured and non-fasting blood samples were collected for the assessment of glucose, lipids, inflammatory markers and serum 25(OH)D concentrations. Results Serum 25(OH)D levels were significantly lower in the SARS-CoV-2 positive group compared to the negative group after adjustment for age and BMI (52.8 nmol/l ± 11.0 versus 64.5 nmol/l ± 11.1; p = 0.009). Being elderly (> 60 years) [Odds ratio 6 (95% Confidence Interval, CI 2–18; p = 0.001) as well as having type 2 diabetes (T2D) [OR 6 (95% CI 3–14); p < 0.001)] and low HDL cholesterol (HDL-c) [OR 6 (95% CI 3–14); p < 0.001)] were significant risk factors for COVID-19 infection independent of age, sex and obesity. Conclusions Among Arab Gulf residents screened for SARS-CoV-2, serum 25(OH) D levels were observed to be lower in those who tested positive than negative individuals, but it was the presence of old age, diabetes mellitus and low-HDL-c that were significantly associated with risk of COVID-19 infection. Large population-based randomized controlled trials should be conducted to assess the protective effects of vitamin D supplementation against COVID-19.

Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial

“…To the best of our knowledge, the present study is the first clinical trial for vitamin D and COVID-19 conducted in the Middle East, a region with one of the highest prevalences of vitamin D deficiency in the world, especially in Saudi Arabia (SA) [ 13 , 16 , 20 ], which consequently, is one of the hardest hit by COVID-19 within the Gulf Cooperation Council (GCC) countries [ 1 ]. The goal of the present randomized clinical trial is primarily to determine whether a short-term 5000 IU vitamin D3 supplementation can reduce recovery times of COVID-19 symptoms among mostly in-patients with mild-moderate symptoms.…”

“…Among the well-established theories of this association is the biophysical and structural evidence that SARS-CoV-2’s point of cellular entry is the angiotensin converting enzyme 2 (ACE2) receptor protein, which is found in abundance on the surfaces of respiratory cells and is the same point of entry observed in SARS-CoV-1 [ 14 ]. Vitamin D heightens the expression of the ACE2 receptor protein, which balances the pathways that are known to be disrupted by coronaviruses, ACE/ACE2 and angiotensin II (ANG)/ANG 1-7 [ 15 , 16 ]. Another interesting theory is that vitamin D is a negative acute phase reactant in most acute and chronic inflammatory conditions [ 17 ], which also explains why vitamin D deficiency is common in states that harbor low-grade systemic inflammation such as diabetes, hypertension, heart disease, and aging [ 18 ].…”

“…As it has already been documented that severe vitamin D deficiency is a predictor of mortality among SA residents [ 13 , 20 ] and that the vitamin D status of confirmed SARS-CoV-2 positive patients are significantly lower than those who tested negative [ 16 ], it is the appropriate strategy to move the field forward by conducting intervention trials. To fill this gap, the present randomized, open-label clinical trial aims to determine the beneficial effects of a 2-week, daily 5000 IU versus standard therapy (1000 IU) vitamin D3 supplementation on the recovery times of symptoms among patients having mild to moderate COVID-19 with sub-optimal vitamin D status being treated in tertiary care hospitals in Riyadh, Saudi Arabia.…”

Vitamin D Metabolites and Clinical Outcome in Hospitalized COVID-19 Patients

“…For example, in a retrospective case–control study of 216 COVID-19 patients and 197 controls, Hernández et al did not find any relationship between serum 25(OH)D and the severity of the disease [ 40 ]. Additionally, the risk of Sars-CoV2 infection is not consistently related to the 25(OH)D serum concentration [ 41 ]. For example, Al-Daghri et al analyzed 138 patients with RT-PCR-confirmed Sars-CoV2 infection and 82 negative controls [ 41 ].…”

“…Additionally, the risk of Sars-CoV2 infection is not consistently related to the 25(OH)D serum concentration [ 41 ]. For example, Al-Daghri et al analyzed 138 patients with RT-PCR-confirmed Sars-CoV2 infection and 82 negative controls [ 41 ]. Although Sars-CoV2 patients had lower 25(OH)D concentrations than non-infected controls, Al-Daghri et al could not show a higher risk of Sars-CoV2 infection in individuals with low 25(OH)D concentrations [ 41 ].…”