that low levels of vitamin D patients do much worse than high levels of vitamin D patients.

Vitamin D deficiency prevalence and cardiovascular risk in Israel

https://pubmed.ncbi.nlm.nih.gov/20955219/

N = 34,874

Vit D levels, women, 22.7 ng mL

Vit D levels, men, 23.2 ng mL

Prevalence of vitamin D deficiency or insufficiency

(vitamin D levels less than 30 ng mL)

Women, 77·5%,

Men, 79·2%

Only little variation when stratified by age

Prevalence of deficiency in Israel, similar to less sunny regions

Two groups

Group with vitamin D less than 15 ng mL

Group with vitamin D levels more than 30 ng mL

less than 0·031 age-adjusted odds ratios for the presence of,

Hypertension

Diabetes mellitus

Dyslipidemia

Obesity

Peripheral vascular disease

Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness

https://journals.plos.org/plos....one/article?id=10.13

https://www.webmd.com/lung/new....s/20220208/vitamin-d

Potential correlation, low vitamin D and increased risk of infection with SARS-CoV-2,

and poorer clinical outcomes

This study examines

Any relationship exists between,

pre-infection serum 25-hydroxyvitamin D (25(OH)D) level,

With disease severity and mortality due to SARS-CoV-2.

April 7th, 2020 and February 4th, 2021

Positive polymerase chain reaction tests for SARS-CoV-2,

searched for historical 25(OH)D levels measured 14 to 730 days prior

Design

Patients admitted were categorized,

disease severity and level of 25(OH)D

Deficient, less than 20 ng/mL (n = 133)

Insufficient, 20 to 30 ng/mL (n = 36)

Adequate, 30 to less than 40 ng/mL (n = 30)

High-normal, 40 ng/mL or greater (n = 40)

Accounted for changes throughout the year

Results

1,176 patients admitted

253 had records of a 25(OH)D level prior to infection

A lower vitamin D status was more common in patients with the severe or critical disease

In patients with severe or critical disease

87.4% had less than 20 ng/mL

In patients with mild or moderate disease

34.3% had Less than 20 ng/mL

P less than 0.001

Patients with vitamin D deficiency (less than 20 ng/mL)

14 times more likely to have severe or critical disease,

Odds ratio 14 (95% confidence interval 4 to 51) p less than 0.001

Mortality, patients with sufficient vitamin D levels

2.3%

Mortality, patients with deficient vitamin D levels

25.6% mortality rate (p less than 0.001)

Conclusions

Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

Low vitamin D status has been associated with a range of autoimmune, cardiovascular, and infectious diseases

Essential immunologic mediator

Inhibitory effects on pro-inflammatory cytokines,

TNF-alpha and IL-6

Epidemiological risk factors for vitamin D deficiency

Darker skin pigmentation

Low sun exposure

Skin-covering clothes

Sun creams

Diet low in fish and dairy products

An association between low 25-hydroxyvitamin D (25(OH)D) levels and an increased risk of acquiring influenza and respiratory viruses

Meta-analyses of randomized controlled trials, 2007 and 2020

Vitamin D supplementation reduced the risk of acute respiratory infection as compared with placebos

Factors associated with poorer COVID-19 prognoses

Geographic location in northern countries

Older age

Black and minority ethnic groups

Obesity

Preexisting conditions, diabetes and hypertension

these risk factors are also independently associated with vitamin D deficiency

Difficult to ascertain a definitive causative effect of baseline vitamin D status on a clinical presentation during active COVID-19 infection

A cosinor model, to account for the cycles of serum vitamin D values across the seasons

Vitamin D levels below less than 20 ng/mL

Israeli Arabs 64.3%

Israeli non-Arabs 35.7%