Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials

Jolliffe, David A.; Camargo, Carlos A.; Sluyter, John; Aglipay, Mary; Aloia, John F.; Ganmaa, Davaasambuu; Bergman, Peter; Bischoff‐Ferrari, Heike A.; Borzutzky, Arturo; Damsgaard, Camilla T.; Dubnov‐Raz, Gal; Esposito, Susanna; Gilham, Clare; Ginde, Adit A.; Golan‐Tripto, Inbal; Goodall, Emma C; Grant, Cameron; Griffiths, Christopher J.; Hibbs, Anna Maria; Janssens, Wim; Khadilkar, Anuradha; Laaksi, Ilkka; Lee, Margaret T.; Loeb, Mark; Maguire, Jonathon L.; Majak, Paweł; Mauger, David T.; Manaseki‐Holland, Semira; Murdoch, David R.; Nakashima, Akitoshi; Neale, Rachel E.; Pham, Hai; Rake, Christine; Rees, Judy R.; Rosendahl, Jenni; Scragg, Robert; Shah, Dheeraj; Shimizu, Yoshiki; Simpson‐Yap, Steve; Kumar, Geeta Trilok; Urashima, Mitsuyoshi; Martineau, Adrian R.

doi:10.1016/s2213-8587(21)00051-6

Cited by 382 publications

(366 citation statements)

References 58 publications

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“…Epidemiologic data suggest that the risk of infectious diseases is higher when 25-hydroxyvitamin D [25(OH) D] levels are < 20 ng/mL (50 nmol/L) and risk decreases with higher concentrations [124]. In RCTs vitamin D supplementation of 10-25 µg (400-1000units) a day had a small protective effect against acute respiratory infections [125,126]. COVID-19 severity and mortality rates are higher in older adults, African Americans, patients with diabetes, chronic lung disease, and CVD-all groups with low vitamin D levels.…”

Section: Vitamin Dmentioning

confidence: 99%

“…COVID-19 severity and mortality rates are higher in older adults, African Americans, patients with diabetes, chronic lung disease, and CVD-all groups with low vitamin D levels. Ecological studies suggest that high latitudes and winter season-risk factors for low vitamin D-are associated with higher mortality rates in COVID-19 [125,126]. Consequently, the fact that risk for vitamin D deficiency overlaps with factors associated with mortality from COVID-19 has stimulated studies on the role of vitamin D in COVID-19, especially from a therapy viewpoint.…”

Section: Vitamin Dmentioning

confidence: 99%

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Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

et al. 2021

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Purpose In the pathogenesis of severe COVID-19 complications, derangements of renin–angiotensin–aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

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Section: Vitamin Dmentioning

confidence: 99%

Section: Vitamin Dmentioning

confidence: 99%

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

et al. 2021

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“…Based on these findings, a possible protective role of vitamin D treatment in patients with COVID-19 was suggested but, to date, only a few peer-reviewed observational studies and small randomized open-label clinical trials of uncertain quality have been performed, and they had conflicting results. However, it is conceivable that effectively tackling hypovitaminosis D in populations at high risk of COVID-19 (for example, patients who are older, have diabetes mellitus or have obesity) might have an important role in reducing the risk of COVID-19, as well as other acute respiratory infections 9 .…”

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confidence: 99%

The emerging osteo-metabolic phenotype of COVID-19: clinical and pathophysiological aspects

2021

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“…The role of vitamin D in acute respiratory infections has been examined in multiple studies, including a number of clinical trials. A recent meta-analysis of stratified aggregate data from 48,488 participants in 43 RCTs testing the effect of vitamin D on the risk of incident acute respiratory infections in adults and children demonstrated a modest protective effect from vitamin D supplementation (OR 0.92, 95% CI 0.86 to 0.99) [ 21 ]. There was significant variation in baseline 25(OH)D status of participants and in supplementation regimens.…”

Section: Search Strategymentioning

confidence: 99%

Vitamin D and coronavirus disease 2019 (COVID-19): rapid evidence review

et al. 2021

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Background The rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has re-ignited interest in the possible role of vitamin D in modulation of host responses to respiratory pathogens. Indeed, vitamin D supplementation has been proposed as a potential preventative or therapeutic strategy. Recommendations for any intervention, particularly in the context of a potentially fatal pandemic infection, should be strictly based on clinically informed appraisal of the evidence base. In this narrative review, we examine current evidence relating to vitamin D and COVID-19 and consider the most appropriate practical recommendations. Observations Although there are a growing number of studies investigating the links between vitamin D and COVID-19, they are mostly small and observational with high risk of bias, residual confounding, and reverse causality. Extrapolation of molecular actions of 1,25(OH)2-vitamin D to an effect of increased 25(OH)-vitamin D as a result of vitamin D supplementation is generally unfounded, as is the automatic conclusion of causal mechanisms from observational studies linking low 25(OH)-vitamin D to incident disease. Efficacy is ideally demonstrated in the context of adequately powered randomised intervention studies, although such approaches may not always be feasible. Conclusions At present, evidence to support vitamin D supplementation for the prevention or treatment of COVID-19 is inconclusive. In the absence of any further compelling data, adherence to existing national guidance on vitamin D supplementation to prevent vitamin D deficiency, predicated principally on maintaining musculoskeletal health, appears appropriate.

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Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials

Cited by 382 publications

References 58 publications

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

The emerging osteo-metabolic phenotype of COVID-19: clinical and pathophysiological aspects

Vitamin D and coronavirus disease 2019 (COVID-19): rapid evidence review

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