Rhodes, JM ORCID: 0000-0002-1302-260X, Subramanian, S
ORCID: 0000-0002-6483-1730, Laird, E, Griffin, G and Kenny, RA
(2020)
Perspective: Vitamin D deficiency and COVID‐19 severity – plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis.
Journal of Internal Medicine, 289 (1).
pp. 97-115.
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Abstract
Background SARS‐CoV‐2 coronavirus infection ranges from asymptomatic through to fatal COVID‐19 characterized by a ‘cytokine storm’ and lung failure. Vitamin D deficiency has been postulated as a determinant of severity. Objectives To review the evidence relevant to vitamin D and COVID‐19. Methods Narrative review. Results Regression modelling shows that more northerly countries in the Northern Hemisphere are currently (May 2020) showing relatively high COVID‐19 mortality, with an estimated 4.4% increase in mortality for each 1 degree latitude north of 28 degrees North (P = 0.031) after adjustment for age of population. This supports a role for ultraviolet B acting via vitamin D synthesis. Factors associated with worse COVID‐19 prognosis include old age, ethnicity, male sex, obesity, diabetes and hypertension and these also associate with deficiency of vitamin D or its response. Vitamin D deficiency is also linked to severity of childhood respiratory illness. Experimentally, vitamin D increases the ratio of angiotensin‐converting enzyme 2 (ACE2) to ACE, thus increasing angiotensin II hydrolysis and reducing subsequent inflammatory cytokine response to pathogens and lung injury. Conclusions Substantial evidence supports a link between vitamin D deficiency and COVID‐19 severity but it is all indirect. Community‐based placebo‐controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID‐19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25(OH) vitamin D levels. Meanwhile, vitamin D supplementation should be strongly advised for people likely to be deficient.
Item Type: | Article |
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Uncontrolled Keywords: | vitamin D, COVID-19, cytokine |
Depositing User: | Symplectic Admin |
Date Deposited: | 09 Sep 2020 10:36 |
Last Modified: | 18 Jan 2023 23:34 |
DOI: | 10.1111/joim.13149 |
Open Access URL: | http://doi.org/10.1111/joim.13149 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3100528 |