Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

Impact of vitamin D on COVID-19 and other viral diseases

This editorial aims to elucidate the intricate relationship between vitamin D and viral pathogenesis. It explores the anticipated role of vitamin D as a modulator in the immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other viral pathogens. The editorial comments are based on the review article by Engin et al. The potential role of vitamin D in modulating immune responses has been highlighted by several studies, suggesting that it may influence both the risk and severity of infections. Vitamin D receptors are present in immunocompetent cells, which indicates that vitamin D can potentially modulate innate and adaptive immune responses. This context is relevant in the pathophysiology of coronavirus disease 2019 (COVID-19), where the immune response to the virus can significantly impact the disease progression and outcome. The immunomodulatory effects of vitamin D can protect against SARS-CoV-2 infection by enhancing innate and adaptive immune responses. It also maintains the integrity of the body's physical barriers and modulates inflammatory responses, thereby preventing entry and replication of the virus. Many studies have suggested that adequate vitamin D levels help alleviate morbidity and mortality associated with COVID-19. Furthermore, vitamin D supplementation has been linked with a lower risk of severe disease and mortality in COVID-19 patients, particularly in those with a deficiency during seasons with less sunlight exposure.

Mediated relationship between Vitamin D deficiency and reduced pulmonary function by copper in Taiwanese young adults

BACKGROUND

Vitamin D deficiency is prevalent worldwide and associated with worse outcomes in various lung diseases. This study examines the association between vitamin D deficiency and pulmonary function in healthy young adults.

METHODS

This prospective cohort study (2017-2019) explored the impact of vitamin D deficiency on pulmonary function in a community-based young adult population. Pulmonary function was assessed via spirometry, with serum 25-hydroxyvitamin D [25(OH)D] and urinary copper levels quantified. Multivariate regression was used to estimate the relationship between vitamin D levels and lung function, with mediation analysis evaluating copper's role.

RESULTS

The study included 1034 participants, average age 33.45 years, 41.93 % male. The median 25(OH)D level was 19.20 ng/mL (Interquartile Range: 13.48-24.90 ng/mL). Over half (54.74 %) had 25(OH)D levels below 20 ng/mL. Higher 25(OH)D levels were associated with better forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁). Trends suggested subgroup differences, but these were not statistically significant, indicating a consistent effect of 25(OH)D on pulmonary function across groups. SEM analysis suggested urinary copper as a mediator between 25(OH)D levels and FVC.

CONCLUSION

Vitamin D deficiency is significantly associated with reduced pulmonary function in young adults in Taiwan.

The role of cathelicidins in neutrophil biology

Despite their relatively short lifespan, neutrophils are tasked with counteracting pathogens through various functions, including phagocytosis, production of reactive oxygen species, neutrophil extracellular traps (NETs), and host defense peptides. Regarding the latter, small cationic cathelicidins present a conundrum in neutrophil function. Although primarily recognized as microbicides with an ability to provoke pores in microbial cell walls, the ability of cathelicidin to modulate key neutrophil functions is also of great importance, including the release of chemoattractants, cytokines, and reactive oxygen species, plus prolonging neutrophil lifespan. Cumulative evidence indicates a less recognized role of cathelicidin as an "immunomodulator"; however, this term is not always explicit, and its relevance in neutrophil responses during infection and inflammation is seldom discussed. This review compiles and discusses studies of how neutrophils use cathelicidin to respond to infections, while also acknowledging immunomodulatory aspects of cathelicidin through potential crosstalk between sources of the peptide.

Exploring Micronutrient Dynamics in COVID-19 Severity and Mortality: Unraveling the Roles of Vitamin D, Calcium, Phosphorus, Magnesium and ALP

The COVID-19 pandemic has underscored the critical importance of understanding the intricate relationship between micronutrient levels and disease outcomes. This study explores the impact of Vitamin D, calcium, phosphorus, magnesium, and alkaline phosphatase (ALP) on COVID-19 severity and mortality. The study involves 200 participants (100 COVID-19 patients, 100 controls), we meticulously analyzed micronutrient dynamics. Calcium, phosphorus, magnesium and ALP was measured spectrophotometrically. Vitamin D was measured using Chemiluminescent method. The study reveals that diminished levels of calcium, phosphorus, magnesium, and with elevated ALP, are significantly associated with COVID-19 cases. Whereas the Vitamin D levels in severe group was increased when compared to mild cases but decreased than control group. Disease severity correlated with declining calcium (r = - 0.35, p < 0.01), phosphorus (r = - 0.26, p < 0.05), and magnesium (r = - 0.21, p < 0.05), and increased ALP (r = 0.42, p < 0.001). Post-discharge, calcium (p < 0.05) and phosphorus (p < 0.01) showed positive trends, while ALP (p < 0.001) decreased. Notably, calcium (OR = 0.63, p < 0.05) and ALP (OR = 1.87, p < 0.001) emerged as significant predictors of disease severity. The findings not only illuminate potential therapeutic avenues but also emphasize the need to optimize nutrient levels, including magnesium, for COVID-19 prevention and management. Given the complexities of these relationships, further rigorous exploration, including well-designed trials and understanding underlying mechanisms, is imperative to unravel the dynamics of these nutrient interactions in the context of COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12291-024-01225-9.

Role of vitamin D in COVID-19 and other viral infections

Vitamin D is a steroid hormone that is naturally produced in the body or obtained through dietary sources, primarily under the influence of UVB radiation. This essential nutrient has a vital role in numerous physiological processes, encompassing immune function, cell growth, differentiation, insulin regulation, and cardiovascular well-being, along with its pivotal role in sustaining the delicate equilibrium of calcium and phosphate concentrations in the body. Moreover, vitamin D reinforces mucosal defense and bolsters the immune system through immunomodulation, making it a critical component of overall health. Numerous studies have unveiled the profound connection between vitamin D and the predisposition to respiratory tract infections, including well-known viruses such as influenza and the novel severe acute respiratory syndrome coronavirus 2. Vitamin D deficiency has been consistently linked to increased severity of coronavirus disease 2019 (COVID-19) and a heightened risk of mortality among afflicted individuals. Retrospective observational studies have further substantiated these findings, indicating that levels of vitamin D are linked with both the occurrence and severity of COVID-19 cases. Vitamin D has its influence on viral infections through a multitude of mechanisms, such as promoting the release of antimicrobial peptides and fine-tuning the responses of the immune system. Additionally, vitamin D is intertwined with the intricate network of the renin-angiotensin system, suggesting a potential impact on the development of complications related to COVID-19. While further clinical trials and extensive research are warranted, the existing body of evidence strongly hints at the possible use of vitamin D as a valuable tool in the prophylaxis and management of COVID-19 and other viral infectious diseases.

Severe COVID-19 infection: An institutional review and literature overview

BACKGROUND

Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes.

METHODS

A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality.

RESULTS

Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%.

CONCLUSION

Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.

Changes in vitamin D status among adults from the COVID-19 pandemic to post-pandemic normality

Introduction

The COVID-19 pandemic has prompted widespread lockdown measures globally, significantly impacting daily activities and outdoor exposure. This study investigates the effect of the pandemic on vitamin D levels and the prevalence of vitamin D deficiency in the adult population, with a focus on gender-specific differences.

Methods

A total of 1525 adults from Henan Provincial People's Hospital were included. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using the Elecsys® Vitamin D total kit on the Roche Cobas® 8000 analyzer. The Clinical Application Consensus on Vitamin D and Its Analogs defined deficiency as 25(OH)D levels below 20 ng/ml. Statistical analysis was performed using SPSS 23.0 and GraphPad Prism 8 software.

Results

The overall 25(OH)D levels increased from 18.14 ng/ml [IQR: 13.78, 23.68] in 2022 to 19.15 ng/ml [IQR: 14.88, 25.01] in 2023 (p=0.004). Males exhibited significant improvement in 25(OH)D levels from 18.01 ng/ml [IQR: 14.10, 23.53] in 2022 to 20.49 ng/ml [IQR: 16.11, 26.01] in 2023 (p<0.001). The prevalence of vitamin D deficiency decreased from 62% in 2022 to 54.9% in 2023 (p=0.009), with a notable reduction in males (64.1% in 2022 to 47.2% in 2023). Among 168 individuals tested in both years, 25(OH)D levels increased from 20.73 ± 9.37 ng/ml in 2022 to 22.28 ± 8.59 ng/ml in 2023 (p=0.012), and the deficiency rate decreased from 58.3% in 2022 to 47.0% in 2023 (p=0.038). The 40-49 age group showed significant improvement in 25(OH)D levels from 16.10 ng/ml [IQR: 12.41, 21.18] in 2022 to 18.28 ng/ml [IQR: 13.91, 23.86] in 2023 (p=0.005), with a reduction in deficiency rate from 72.8% to 59.9% (p=0.02). Furthermore, in February, March, and April, 2022, 25(OH)D levels were significantly lower compared to 2023 (p<0.001, p=0.002, p<0.001, respectively), accompanied by a higher prevalence of vitamin D deficiency (p<0.001, p=0.015, p<0.001, respectively).

Discussion

This study demonstrates that the COVID-19 pandemic significantly impacted vitamin D levels, leading to an increased prevalence of deficiency, particularly among males. These findings highlight the critical importance of maintaining sufficient outdoor activities to ensure adequate vitamin D levels. The data underscore the need for public health strategies to address potential deficiencies during prolonged periods of limited outdoor exposure.

Serum 25-hydroxyvitamin D levels and health outcomes of hospitalization owing to COVID-19: a retrospective cross-sectional study

OBJECTIVE

We investigated the role of serum 25(OH)D (25-hydroxyvitamin D) in COVID-related health outcomes.

METHODS

We conducted a retrospective cross-sectional study using data of the National Center of Disease Control and Public Health, Georgia. We extracted patient data including length of hospital stay, transfer to the intensive care unit, requirement for oxygen therapy, treatment with glucocorticoids, and symptoms. After obtaining written informed consent, 384 individuals were enrolled. We divided participants into three groups according to 25(OH)D levels: group 1 = 25(OH)D <12 ng/mL (n = 83), group 2 = 25(OH)D 12-20 ng/mL (n = 141), and group 3 = 25(OH)D >20 ng/mL (n = 160).

RESULTS

The odds ratio (OR) for hospitalization in group 1 versus group 2 was 8.7 (95% confidence interval [CI] 3.6-21.3) and 5.6 for group 1 versus 3 (95% CI 2.7-11.9). Regarding oxygen therapy, OR = 28.41 for group 1 versus 2 (95% CI 3.7-220.5) and OR = 5.2 for group 1 versus 3 (95% CI 1.9-14.1). Regarding treatment with glucocorticoids, OR = 3.7 for group 1 versus 2 (95% CI 1.1-12.5) and OR = 8.4 for group 1 versus 3 (95% CI 1.8-40.7).

CONCLUSION

COVID-19-related morbidity was associated with decreased serum 25(OH)D levels. Future studies should investigate the potential role of vitamin D sufficiency in preventing SARS-CoV-2 infection and mortality.

Integrated Transcriptomic Analysis Reveals Reciprocal Interactions between SARS-CoV-2 Infection and Multi-Organ Dysfunction, Especially the Correlation of Renal Failure and COVID-19

The COVID-19 pandemic, which is caused by the SARS-CoV-2 virus, has resulted in extensive health challenges globally. While SARS-CoV-2 primarily targets the respiratory system, clinical studies have revealed that it could also affect multiple organs, including the heart, kidneys, liver, and brain, leading to severe complications. To unravel the intricate molecular interactions between the virus and host tissues, we performed an integrated transcriptomic analysis to investigate the effects of SARS-CoV-2 on various organs, with a particular focus on the relationship between renal failure and COVID-19. A comparative analysis showed that SARS-CoV-2 triggers a systemic immune response in the brain, heart, and kidney tissues, characterized by significant upregulation of cytokine and chemokine secretion, along with enhanced migration of lymphocytes and leukocytes. A weighted gene co-expression network analysis demonstrated that SARS-CoV-2 could also induce tissue-specific transcriptional profiling. More importantly, single-cell sequencing revealed that COVID-19 patients with renal failure exhibited lower metabolic activity in lung epithelial and B cells, with reduced ligand-receptor interactions, especially CD226 and ICAM, suggesting a compromised immune response. A trajectory analysis revealed that COVID-19 patients with renal failure exhibited less mature alveolar type 1 cells. Furthermore, these patients showed potential fibrosis in the hearts, liver, and lung increased extracellular matrix remodeling activities. However, there was no significant metabolic dysregulation in the liver of COVID-19 patients with renal failure. Candidate drugs prediction by Drug Signatures database and LINCS L1000 Antibody Perturbations Database underscored the importance of considering multi-organ effects in COVID-19 management and highlight potential therapeutic strategies, including targeting viral entry and replication, controlling tissue fibrosis, and alleviating inflammation.

Factors associated with vitamin D deficiency in health care workers exposed to SARS-CoV-2: a cross-sectional study

Introduction

Globally, up to 76.6% of the population may be affected by vitamin D (VD) deficiency, which has been linked to increased morbidity and mortality from COVID-19. This underscores the importance of further research into VD supplementation, particularly for health care workers, who are at higher risk due to indoor work environments and dietary challenges associated with shift schedules.

Objective

This study aimed to identify factors associated with VD deficiency in Mexican health care workers exposed to SARS-CoV-2.

Materials and methods

We conducted a cross-sectional study from June 2020 to January 2021 among frontline health care workers treating hospitalized COVID-19 patients. Blood samples were collected to measure 25-hydroxy VD levels via radioimmunoassay. We also assessed previous COVID-19 infection and comorbidities that could influence VD levels.

Results

The study included 468 health care workers. The median serum VD concentration was 16.6 ng/mL. VD deficiency was found in 69.4% (n = 325) of participants, while only 5.1% (n = 24) had normal levels. Those with type 2 diabetes (13.3 ng/mL vs. 17.1 ng/mL) or obesity (15.7 ng/mL vs. 17.1 ng/mL) had significantly lower VD levels than their counterparts (p < 0.001 and p = 0.049, respectively). No significant differences were found among participants with high blood pressure. Multivariate analysis revealed that type 2 diabetes was independently associated with VD deficiency.

Conclusion

There is a high prevalence of VD deficiency among health care workers, which is potentially linked to both personal health factors and occupational conditions.

Vitamin D Status and Cardiovascular Disease in College Athletes After SARS-CoV-2 Infection

OBJECTIVE

To evaluate the association between vitamin D status and CV disease after COVID-19 in college athletes.

DESIGN

Retrospective cohort study.

SETTING

National College Athletic Association Division-I college athletes from a single academic institution.

PATIENTS

A total of 157 athletes (60 female; median age: 20 years) from 9 sports with a positive SARS-CoV-2 test, cardiac magnetic resonance imaging (CMR), and vitamin D level.

INDEPENDENT VARIABLES

Serum 25-hydroxyvitamin D level (primary); age, sex (regression models).

MAIN OUTCOMES MEASURES

Differences in age, sex, race, ethnicity, myocarditis, pericarditis, and CMR metrics by vitamin D status were analyzed. Regression models were used to assess the relationship between vitamin D status and CMR metrics accounting for age and sex.

RESULTS

Low vitamin D (LVD) was found in 33 (21.0%) of athletes, particularly Black males (P < 0.001). Athletes with LVD had higher biventricular and lower mid-ventricular extracellular volumes, but these differences were not significant when corrected for age and sex. Athletes with LVD had higher left ventricle (LV) mass (P < 0.001) and LV mass index (P = 0.001) independent of age and sex. Differences in global circumferential strain were noted but are likely clinically insignificant. Vitamin D status did not associate with myocarditis and pericarditis (P = 0.544).

CONCLUSIONS

LVD is common in athletes, particularly in Black males. Although athletes with LVD had higher LV mass, cardiac function and tissue characterization did not differ by vitamin D status. Future studies are needed to determine if the differences in LV mass and LV mass index by vitamin D status are clinically significant. This study suggests that vitamin D status does not impact the development of myocarditis or pericarditis after COVID-19 infection.

Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review

BACKGROUND

COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition.

METHODS

This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria.

RESULTS

Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D.

CONCLUSION

This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.

Unraveling the Catalytic Mechanism of β-Cyclodextrin in the Vitamin D Formation

Previous experimental studies have shown that the isomerization reaction of previtamin D3 (PreD3) to vitamin D3 (VitD3) is accelerated 40-fold when it takes place within a β-cyclodextrin dimer, in comparison to the reaction occurring in conventional isotropic solutions. In this study, we employ quantum mechanics-based molecular dynamics (MD) simulations and statistical multistructural variational transition state theory to unveil the origin of this acceleration. We find that the conformational landscape in the PreD3 isomerization is highly dependent on whether the system is encapsulated. In isotropic media, the triene moiety of the PreD3 exhibits a rich torsional flexibility. However, when encapsulated, such a flexibility is limited to a more confined conformational space. In both scenarios, our calculated rate constants are in close agreement with experimental results and allow us to identify the PreD3 flexibility restriction as the primary catalytic factor. These findings enhance our understanding of VitD3 isomerization and underscore the significance of MD and environmental factors in biochemical modeling.

Comparing vitamin D receptor gene polymorphisms in rs11568820, rs7970314, rs4334089 between COVID-19 patients with mild and severe symptoms: a case control study

The associations of vitamin D receptor (VDR)- single nucleotide polymorphisms (SNPs) with the symptoms of COVID-19 may vary between patients with different severities of COVID-19. Therefore, in the present study, we aim to compare VDR polymorphisms in severe and mild COVID-19 patients. In this study, a total number of 85 hospitalized patients and 91 mild/moderate patients with COVID-19 were recruited. SNPs in VDR genes were determined using ARMS and then confirmed by sanger sequencing. The mean (SD) age of participants in hospitalized and non-hospitalized group was 59.0 (12.4) and 47.8 (14.8) years, respectively. Almost 46% of participants in hospitalized and 48% of participant in non-hospitalized group were male. The frequency of TT genotype of SNP rs11568820 was significantly lower in hospitalized than non-hospitalized group (3.5% vs. 17.6%; P = 0.018). However, there was no significant differences between genotypes of SNPs rs7970314 and rs4334089 and also alleles frequencies in all SNPs of two groups. The genotype of rs11568820 SNP had an inverse association with hospitalization of patients with COVID-19 after adjustment for comorbidities [OR 0.18, 95% CI 0.04, 0.88; P = 0.034]. While, there was no relationship between genotypes of SNPs rs7970314 and rs4334089 and hospitalization. The TT genotype of rs11568820 plays protective role in sever COVID-19 and hospitalization. Further studies with a large sample size which consider various confounding factors are warranted to confirm our results.

Calcium and vitamin D homoeostasis in male fertility

Calcium and vitamin D have well-established roles in maintaining calcium balance and bone health. Decades of research in human subjects and animals have revealed that calcium and vitamin D also have effects on many other organs including male reproductive organs. The presence of calcium-sensing receptor, vitamin D receptor, vitamin D activating and inactivating enzymes and calcium channels in the testes, male reproductive tract and human spermatozoa suggests that vitamin D and calcium may modify male reproductive function. Functional animal models have shown that vitamin D deficiency in male rodents leads to a decrease in successful mating and fewer pregnancies, often caused by impaired sperm motility and poor sperm morphology. Human studies have to a lesser extent validated these findings; however, newer studies suggest a positive effect of vitamin D supplementation on semen quality in cases with vitamin D deficiency, which highlights the need for initiatives to prevent vitamin D deficiency. Calcium channels in male reproductive organs and spermatozoa contribute to the regulation of sperm motility and capacitation, both essential for successful fertilisation, which supports a need to avoid calcium deficiency. Studies have demonstrated that vitamin D, as a regulator of calcium homoeostasis, influences calcium influx in the testis and spermatozoa. Emerging evidence suggests a potential link between vitamin D deficiency and male infertility, although further investigation is needed to establish a definitive causal relationship. Understanding the interplay between vitamin D, calcium and male reproductive health may open new avenues for improving fertility outcomes in men.

The role of vitamin D in outcomes of critical care in COVID-19 patients: evidence from an umbrella meta-analysis of interventional and observational studies

OBJECTIVES

Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with severe acute respiratory syndrome coronavirus-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients.

DESIGN

Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase.

SETTINGS

Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated.

PARTICIPANTS

Adult patients suffering from COVID-19 were studied.

RESULTS

Overall, 13 meta-analyses summarising data from 4 randomised controlled trial and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES = 0·42; 95 % CI: 0·10, 0·75, P < 0·001; I2 = 20·4 %, P = 0·285) and observational studies (ES = 1·99; 95 % CI: 1·37, 2·62, P < 0·001; I2 = 00·0 %, P = 0·944). Also, vitamin D deficiency increased the risk of infection and disease severity among patients.

CONCLUSION

Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to intensive care unit and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.

COVID-19 and Comorbidities: What Has Been Unveiled by Metabolomics?

The COVID-19 pandemic has brought about diverse impacts on the global population. Individuals with comorbidities were more susceptible to the severe symptoms caused by the virus. Within the crisis scenario, metabolomics represents a potential area of science capable of providing relevant information for understanding the metabolic pathways associated with the intricate interaction between the viral disease and previous comorbidities. This work aims to provide a comprehensive description of the scientific production pertaining to metabolomics within the specific context of COVID-19 and comorbidities, while highlighting promising areas for exploration by those interested in the subject. In this review, we highlighted the studies of metabolomics that indicated a variety of metabolites associated with comorbidities and COVID-19. Furthermore, we observed that the understanding of the metabolic processes involved between comorbidities and COVID-19 is limited due to the urgent need to report disease outcomes in individuals with comorbidities. The overlap of two or more comorbidities associated with the severity of COVID-19 hinders the comprehension of the significance of each condition. Most identified studies are observational, with a restricted number of patients, due to challenges in sample collection amidst the emergent situation.

Precision nutrition to reset virus-induced human metabolic reprogramming and dysregulation (HMRD) in long-COVID

SARS-CoV-2, the etiological agent of COVID-19, is devoid of any metabolic capacity; therefore, it is critical for the viral pathogen to hijack host cellular metabolic machinery for its replication and propagation. This single-stranded RNA virus with a 29.9 kb genome encodes 14 open reading frames (ORFs) and initiates a plethora of virus-host protein-protein interactions in the human body. These extensive viral protein interactions with host-specific cellular targets could trigger severe human metabolic reprogramming/dysregulation (HMRD), a rewiring of sugar-, amino acid-, lipid-, and nucleotide-metabolism(s), as well as altered or impaired bioenergetics, immune dysfunction, and redox imbalance in the body. In the infectious process, the viral pathogen hijacks two major human receptors, angiotensin-converting enzyme (ACE)-2 and/or neuropilin (NRP)-1, for initial adhesion to cell surface; then utilizes two major host proteases, TMPRSS2 and/or furin, to gain cellular entry; and finally employs an endosomal enzyme, cathepsin L (CTSL) for fusogenic release of its viral genome. The virus-induced HMRD results in 5 possible infectious outcomes: asymptomatic, mild, moderate, severe to fatal episodes; while the symptomatic acute COVID-19 condition could manifest into 3 clinical phases: (i) hypoxia and hypoxemia (Warburg effect), (ii) hyperferritinemia ('cytokine storm'), and (iii) thrombocytosis (coagulopathy). The mean incubation period for COVID-19 onset was estimated to be 5.1 days, and most cases develop symptoms after 14 days. The mean viral clearance times were 24, 30, and 39 days for acute, severe, and ICU-admitted COVID-19 patients, respectively. However, about 25-70% of virus-free COVID-19 survivors continue to sustain virus-induced HMRD and exhibit a wide range of symptoms that are persistent, exacerbated, or new 'onset' clinical incidents, collectively termed as post-acute sequelae of COVID-19 (PASC) or long COVID. PASC patients experience several debilitating clinical condition(s) with >200 different and overlapping symptoms that may last for weeks to months. Chronic PASC is a cumulative outcome of at least 10 different HMRD-related pathophysiological mechanisms involving both virus-derived virulence factors and a multitude of innate host responses. Based on HMRD and virus-free clinical impairments of different human organs/systems, PASC patients can be categorized into 4 different clusters or sub-phenotypes: sub-phenotype-1 (33.8%) with cardiac and renal manifestations; sub-phenotype-2 (32.8%) with respiratory, sleep and anxiety disorders; sub-phenotype-3 (23.4%) with skeleto-muscular and nervous disorders; and sub-phenotype-4 (10.1%) with digestive and pulmonary dysfunctions. This narrative review elucidates the effects of viral hijack on host cellular machinery during SARS-CoV-2 infection, ensuing detrimental effect(s) of virus-induced HMRD on human metabolism, consequential symptomatic clinical implications, and damage to multiple organ systems; as well as chronic pathophysiological sequelae in virus-free PASC patients. We have also provided a few evidence-based, human randomized controlled trial (RCT)-tested, precision nutrients to reset HMRD for health recovery of PASC patients.

Immunomodulatory Effects of Vitamin D and Zinc on Viral Infection

Several nutrients are crucial in enhancing the immune system and preserving the structural integrity of bodily tissue barriers. Vitamin D (VD) and zinc (Zn) have received considerable interest due to their immunomodulatory properties and ability to enhance the body's immune defenses. Due to their antiviral, anti-inflammatory, antioxidative, and immunomodulatory properties, the two nutritional powerhouses VD and Zn are crucial for innate and adaptive immunity. As observed with COVID-19, deficiencies in these micronutrients impair immune responses, increasing susceptibility to viral infections and severe disease. Ensuring an adequate intake of VD and Zn emerges as a promising strategy for fortifying the immune system. Ongoing clinical trials are actively investigating their potential therapeutic advantages. Beyond the immediate context of the pandemic, these micronutrients offer valuable tools for enhancing immunity and overall well-being, especially in the face of future viral threats. This analysis emphasizes the enduring significance of VD and Zn as both treatment and preventive measures against potential viral challenges beyond the current health crisis. The overview delves into the immunomodulatory potential of VD and Zn in combating viral infections, with particular attention to their effects on animals. It provides a comprehensive summary of current research findings regarding their individual and synergistic impacts on immune function, underlining their potential in treating and preventing viral infections. Overall, this overview underscores the need for further research to understand how VD and Zn can modulate the immune response in combatting viral diseases in animals.

Vitamin D and immune system

The active metabolite of vitamin D 1,25(OH)2D is well known for its role in regulating calcium-phosphate homeostasis of the human body. However, the immunomodulating activity of 1,25(OH)2D has been known for many years. There are numerous reports correlating low vitamin D levels in blood serum with the onset of autoimmune diseases and with the severe course of acute infections. In this chapter, we address the role of 1,25(OH)2D in these diseases, and we discuss the possible mechanisms of action of 1,25(OH)2D in immune cells.

Vitamin D and viral infections: Infectious diseases, autoimmune diseases, and cancers

Viruses can cause many human diseases. Three types of human diseases caused by viruses are discussed in this chapter: infectious diseases, autoimmune diseases, and cancers. The infectious diseases included in this chapter include three respiratory tract diseases: influenza, COVID-19, and respiratory syncytial virus. In addition, the mosquito-borne dengue virus diseases are discussed. Vitamin D can reduce risk, severity, and mortality of the respiratory tract diseases and possibly for dengue virus. Many autoimmune diseases are initiated by the body's reaction to a viral infection. The protective role of vitamin D in Epstein-Barr virus-related diseases such as multiple sclerosis is discussed. There are a few cancers linked to viral infections. Such cancers include cervical cancer, head and neck cancers, Hodgkin's and non-Hodgkin's lymphoma, and liver cancer. Vitamin D plays an important role in reducing risk of cancer incidence and mortality, although not as strongly for viral-linked cancers as for other types of cancer.

Essential contribution of the JAK/STAT pathway to carcinogenesis, lytic infection of herpesviruses and pathogenesis of COVID‑19 (Review)

The intracellular pathway of Janus kinase/signal transducer and activator of transcription (JAK/STAT) and modification of nucleosome histone marks regulate the expression of proinflammatory mediators, playing an essential role in carcinogenesis, antiviral immunity and the interaction of host proteins with Herpesviral particles. The pathway has also been suggested to play a vital role in the clinical course of the acute infection caused by severe acute respiratory syndrome coronavirus type 2 (SARS‑CoV‑2; known as coronavirus infection‑2019), a novel human coronavirus initially identified in the central Chinese city Wuhan towards the end of 2019, which evolved into a pandemic affecting nearly two million people worldwide. The infection mainly manifests as fever, cough, myalgia and pulmonary involvement, while it also attacks multiple viscera, such as the liver. The pathogenesis is characterized by a cytokine storm, with an overproduction of proinflammatory mediators. Innate and adaptive host immunity against the viral pathogen is exerted by various effectors and is regulated by different signaling pathways notably the JAK/STAT. The elucidation of the underlying mechanism of the regulation of mediating factors expressed in the viral infection would assist diagnosis and antiviral targeting therapy, which will help overcome the infection caused by SARS‑CoV‑2.

Association between vitamin D deficiency and post-acute outcomes of SARS-CoV-2 infection

OBJECTIVES

This study aimed to investigate the association between vitamin D deficiency (VDD) and post-acute outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

METHODS

This retrospective study used the TriNetX research network to identify COVID-19 patients between January 1 and November 30, 2022. Patients were matched using propensity score matching (PSM) and divided into VDD (< 20 ng/mL) and control (≥ 20 ng/mL) groups. The primary outcome was a composite of post-COVID-19 condition (identified by ICD-10 code), all-cause emergency department (ED) visits, hospitalization, and death during the follow-up period (90-180 days) after the diagnosis of COVID-19.

RESULTS

From an initial recruitment of 42,674 non-hospitalized patients with COVID-19 and known 25(OH)D status, a VDD group of 8300 was identified and propensity matched with 8300 controls. During the follow-up period, the VDD group had a higher risk of the primary outcome than did the control group [hazard ratio (HR) = 1.122; 95% confidence interval (CI) = 1.041-1.210]. The VDD group also had a higher risk of all-cause ED visits (HR = 1.114; 95% CI = 1.012-1.226), all-cause hospitalization (HR = 1.230; 95% CI = 1.105-1.369), and all-cause death (HR = 1.748; 95% CI = 1.047-2.290) but not post-COVID-19 condition (HR = 0.980; 95% CI = 0.630-1.523), individually.

CONCLUSION

Among the COVID-19 patients, VDD might be associated with a higher risk of all-cause ED visits, hospitalization, and death during the post-acute phase.

Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer

Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.

UV index-based model for predicting synthesis of (pre-)vitamin D3 in the mediterranean basin

The importance of solar radiation for the body's ability to synthesize Vitamin D3 is well documented, yet the precise amount of sun exposure required to avoid Vitamin D insufficiency is less clear. To address this knowledge gap, this study sought to utilize the sun in a suitable period at the optimum dose by utilizing numerical simulations to determine the amount of Vitamin D3 synthesis in the skin according to season, time of day, and geographical location in Turkey. The study was carried out in three stages; in the first stage, daily, monthly, and annual values were determined in cases where the solar zenith angle has the active UV-B wavelength. The second stage determined the level of Vitamin D that can be synthesized in all skin types at 25% solar radiation exposure. In the third stage, the sun exposure time required for 1000 International Units (IU) for all skin types was calculated. According to the analysis, the yearly period of active synthesis of D3 on Earth lasts from the beginning of March to the third week of October. During the day, it is between 10:00 and 16:00. For 1000 IU/day, the average annual estimated times (minutes) are 5.05 for Type I, 6.3 for Type II, 7.6 for Type III, 11.35 for Type IV, 15.15 for Type V, and 25.25 for Type VI. The results of this paper will impact awareness for academic-medical users.

The association between vitamin D deficiency and the clinical outcomes of hospitalized COVID-19 patients

Background

Vitamin D deficiency is an emerging public health problem that affects more than one billion people worldwide. Vitamin D has been shown to be effective in preventing and reducing the severity of viral respiratory diseases, including influenza. However, the role of vitamin D in COVID-19 infection remains controversial. This study aimed to analyze the association of vitamin D deficiency on the clinical outcome of hospitalized COVID-19 patients.

Methods

A prospective cohort study was conducted among hospitalized COVID-19 patients at two COVID-19 referral hospitals in Indonesia from October 2021 until February 2022.

Results

The median serum 25(OH)D level in 191 hospitalized COVID-19 patients was 13.6 [IQR=10.98] ng/mL. The serum 25(OH)D levels were significantly lower among COVID-19 patients with vitamin D deficiency who had cardiovascular disease (p-value=0.04), the use of a ventilator (p-value=0.004), more severe COVID-19 cases (p-value=0.047), and mortality (p-value=0.002). Furthermore, serum 25(OH)D levels were significantly different between patients with mild and severe COVID-19 cases (p-value=0.019). Serum 25(OH)D levels in moderate and severe COVID-19 cases were significantly different (p-value=0.031). Lower serum 25(OH)D levels were significantly associated with an increased number of comorbidities (p-value=0.03), the severity of COVID-19 (p-value=0.002), and the use of mechanical ventilation (p-value=0.032). Mortality was found in 7.3% of patients with deficient vitamin D levels. However, patients with either sufficient or insufficient vitamin D levels did not develop mortality.

Conclusions

COVID-19 patients with vitamin D deficiency were significantly associated with having cardiovascular disease, mortality, more severe COVID-19 cases, and the used of mechanical ventilation. Lower serum 25(OH)D levels were associated with an increased number of comorbidities, COVID-19 severity, and the use of mechanical-ventilation. Thus, we suggest hospitalized COVID-19 patients to reach a sufficient vitamin D status to improve the clinical outcome of the disease.

Immunomodulatory effect of vitamin D supplementation on Behçet's disease patients: effect on nitric oxide and Th17/Treg cytokines production

INTRODUCTION

In the last decade, an immuno-modulatory effect of vitamin D supplementation have emerged as a potential therapeutic approach for some inflammatory and autoimmune diseases. As previously reported, vitamin D deficiency was strongly linked to several diseases as Behçet's disease (BD). BD is a chronic systemic inflammatory disorder with autoimmunity, genetic and environmental factors involvement. The aim of our current study is to set up a new therapeutic strategy in BD, combining conventional therapy and vitamin D supplementation.

MATERIALS AND METHODS

Blood samples were collected from active and inactive BD patients and healthy controls (HC) to evaluate 25(OH) vitamin D levels using an electrochemiluminescence method. All deficient and insufficient vitamin D BD patients' were supplemented with vitamin D3 (CHOLECALCIFEROL, 200 000 UI/1 ml). In this context, NO, IL-17A and IL-10 levels were evaluated in patients and HC in vivo and ex vivo using Griess and ELISA methods respectively.

RESULTS

Before supplementation, we noted with interest that BD patients had vitamin D deficiency, associated with elevated in vivo and ex vivo NO and IL-17A levels compared to HC. Conversely, low IL-10 levels were observed in the same BD patients in comparison to HC. Interestingly, restored vitamin D status in supplemented BD patients was related to the decreased NO levels. In the same way, the IL-10/IL-17A ratio was improved.

CONCLUSIONS

Collectively, our data suggest that vitamin D supplementation in combination with conventional treatments has a beneficial effect and could constitute a good therapeutic candidate for alleviating inflammatory responses during Behçet disease.

Prognostic Factors for Predicting Post-COVID-19 Condition in Patients With COVID-19 in an Outpatient Setting

BACKGROUND

Although data on post-coronavirus disease 2019 (COVID-19) conditions are extensive, the prognostic factors affecting symptom duration in non-hospitalized patients with COVID-19 are currently not well known. We aimed to investigate the various prognostic factors affecting symptom duration among outpatients with COVID-19.

METHODS

Data were analyzed from 257 patients who were diagnosed with mild COVID-19 and visited the 'post-COVID-19 outpatient clinic' between April and December 2022 after a mandatory isolation period. The symptom duration was measured from diagnosis to symptom resolution. Laboratory and pulmonary function test results from their first visit were collected.

RESULTS

The mean age of patients was 55.7 years, and the median symptom duration was 57 days. The development of post-COVID-19 conditions (> 12 weeks) were significantly correlated with not using antiviral drugs, leukocytosis (white blood cell > 10,000/µL), lower 25(OH)D3 levels, forced vital capacity (FVC) < 90% predicted, and presence of dyspnea and anxiety/depression. Additionally, in multivariable Cox regression analysis, not using antiviral drugs, lower 25(OH)D3 levels, and having dyspnea were poor prognostic factors for longer symptom duration. Particularly, vitamin D deficiency (< 20 ng/mL) and not using antivirals during the acute phase were independent poor prognostic factors for both post-COVID-19 condition and longer symptom duration.

CONCLUSION

The non-use of antivirals, lower 25(OH)D3 levels, leukocytosis, FVC < 90% predicted, and the presence of dyspnea and anxiety/depression symptoms could be useful prognostic factors for predicting post-COVID-19 condition in outpatients with COVID-19. We suggest that the use of antiviral agents during the acute phase and vitamin D supplements might help reduce COVID-19 symptom duration.

Association of air pollution and weather conditions during infection course with COVID-19 case fatality rate in the United Kingdom

Although the relationship between the environmental factors, such as weather conditions and air pollution, and COVID-19 case fatality rate (CFR) has been found, the impacts of these factors to which infected cases are exposed at different infectious stages (e.g., virus exposure time, incubation period, and at or after symptom onset) are still unknown. Understanding this link can help reduce mortality rates. During the first wave of COVID-19 in the United Kingdom (UK), the CFR varied widely between and among the four countries of the UK, allowing such differential impacts to be assessed. We developed a generalized linear mixed-effect model combined with distributed lag nonlinear models to estimate the odds ratio of the weather factors (i.e., temperature, sunlight, relative humidity, and rainfall) and air pollution (i.e., ozone, [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text]) using data between March 26, 2020 and September 15, 2020 in the UK. After retrospectively time adjusted CFR was estimated using back-projection technique, the stepwise model selection method was used to choose the best model based on Akaike information criteria and the closeness between the predicted and observed values of CFR. The risk of death reached its maximum level when the low temperature (6 °C) occurred 1 day before (OR 1.59; 95% CI 1.52-1.63), prolonged sunlight duration (11-14 h) 3 days after (OR 1.24; 95% CI 1.18-1.30) and increased [Formula: see text] (19 μg/m3) 1 day after the onset of symptom (OR 1.12; 95% CI 1.09-1.16). After reopening, many COVID-19 cases will be identified after their symptoms appear. The findings highlight the importance of designing different preventive measures against severe illness or death considering the time before and after symptom onset.

The association between interest of nutritional supplements and COVID-19 pandemic - evidence from Google Trends

BACKGROUND

Due to the spread of the coronavirus disease 2019 (COVID-19) pandemic in 2020, the interest of nutritional supplements has emerged. Limited data are available on how the COVID-19 pandemic affects the search interest in nutritional supplements in Taiwan and worldwide. The study aims to investigate changes in public search interest of nutritional supplements pre- and during the COVID-19 pandemic.

METHODS

Our World in Data dataset was used to collect both global and local (Taiwan) number of COVID-19 newly confirmed cases and deaths. Google Trends search query was being used to obtain relative search volumes (RSVs) covering a timeframe between 2019 to 2022. Spearman's rank-order correlation coefficients were used to measure relationships between confirmed new cases and deaths and RSVs of nutritional supplements. Multivariate analysis was conducted to examine the effect of domestic and global new cases and deaths on the RSVs of nutritional supplements.

RESULTS

The mean RSVs for nutritional supplements were higher during the COVID-19 pandemic period (between 2020 to 2022) compared to the pre-pandemic period (year of 2019) for both Taiwan and worldwide. In terms of seasonal variations, except for vitamin D, the mean RSVs of probiotics, vitamin B complex, and vitamin C in winter were significantly lower compared to other seasons in Taiwan. The RSVs of nutritional supplements were not only affected by domestic cases and deaths but also by global new cases and deaths.

CONCLUSIONS

The interests in nutritional supplements had substantially increased in response to the COVID-19 pandemic. The RSVs of nutritional supplements in Taiwan were not only influenced by global and domestic pandemic severity but also by seasons.

Novel antioxidant protein target therapy to counter the prevalence and severity of SARS-CoV-2

Background

This review analyzed the magnitude of the COVID-19 pandemic globally and in India and the measures to counter its effect using natural and innate immune booster molecules. The study focuses on two phases: the first focuses on the magnitude, and the second on the effect of antioxidants (natural compounds) on SARS-CoV-2.

Methods

The magnitude of the prevalence, mortality, and comorbidities was acquired from the World Health Organization (WHO) report, media, a report from the Ministry of Health and Family Welfare (MoHFW), newspapers, and the National Centre of Disease Control (NCDC). Research articles from PubMed as well as other sites/journals and databases were accessed to gather literature on the effect of antioxidants.

Results

In the elderly and any chronic diseases, the declined level of antioxidant molecules enhanced the reactive oxygen species, which in turn deprived the immune system.

Conclusion

Innate antioxidant proteins like sirtuin and sestrin play a vital role in enhancing immunity. Herbal products and holistic approaches can also be alternative solutions for everyday life to boost the immune system by improving the redox balance in COVID-19 attack. This review analyzed the counteractive effect of alternative therapy to boost the immune system against the magnitude of the COVID-19 pandemic.

Severe vitamin D deficiency increases the risk of severe cutaneous adverse reactions

Vitamin D deficiency has been reported to be associated with allergic diseases and dermatological disorders. We investigated the role of vitamin D in drug-induced non-immediate hypersensitivity reactions by measuring serum vitamin D levels in 60 patients diagnosed with non-immediate drug hypersensitivity reactions and in 60 patients who tolerated the same medication without any allergic reactions. The results showed that serum vitamin D levels were significantly lower in patients with severe cutaneous adverse reactions (SCARs) (13.56 ± 6.23 ng/mL) compared to patients with mild reactions (17.50 ± 7.49 ng/mL) and the drug-tolerant control group (17.42 ± 7.28 ng/mL), with p values of 0.031 and 0.015, respectively. The proportion of severe vitamin D deficiency (< 10 ng/mL) was much higher in SCAR patients compared to drug-tolerant subjects (36.7% vs. 11.7%, p value = 0.005). After adjusting for age, gender, region of residence, and concurrent illnesses, patients with severe vitamin D deficiency had significantly increased in-hospital mortality (odds ratio 16.04; 95% CI, 1.25-206.12, p value = 0.03). In conclusion, the risk of developing SCARs and in-hospital mortality was increased in patients with severe vitamin D deficiency. Further investigations should be conducted to elucidate the role of vitamin D in the development of SCARs.

Adjunctive use of oral MAF is associated with no disease progression or mortality in hospitalized patients with COVID-19 pneumonia: The single-arm COral-MAF1 prospective trial

Based on a growing body of evidence that a dysregulated innate immune response mediated by monocytes/macrophages plays a key role in the pathogenesis of COVID-19, a clinical trial was conducted to investigate the therapeutic potential and safety of oral macrophage activating factor (MAF) plus standard of care (SoC) in the treatment of hospitalized patients with COVID-19 pneumonia. Ninety-seven hospitalized patients with confirmed COVID-19 pneumonia were treated with oral MAF and a vitamin D3 supplement, in combination with SoC, in a single-arm, open label, multicentre, phase II clinical trial. The primary outcome measure was a reduction in an intensive care unit transfer rate below 13% after MAF administration. At the end of the study, an additional propensity score matching (PSM) analysis was performed to compare the MAF group with a control group treated with SoC alone. Out of 97 patients treated with MAF, none needed care in the ICU and/or intubation with mechanical ventilation or died during hospitalization. Oxygen therapy was discontinued after a median of nine days of MAF treatment. The median length of viral shedding and hospital stay was 14 days and 18 days, respectively. After PSM, statistically significant differences were found in all of the in-hospital outcomes between the two groups. No mild to serious adverse events were recorded during the study. Notwithstanding the limitations of a single-arm study, which prevented definitive conclusions, a 21-day course of MAF treatment plus SoC was found to be safe and promising in the treatment of hospitalized adult patients with COVID-19 pneumonia. Further research will be needed to confirm these preliminary findings.

Prevalence and predictors of vitamin D deficiency in Lebanon: 2016-2022, before and during the COVID-19 outbreak

BACKGROUND

Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years.

METHODS

Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved.

RESULTS

Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables).

CONCLUSION

Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

Mechanistic Insight into the role of Vitamin D and Zinc in Modulating Immunity Against COVID-19: A View from an Immunological Standpoint

The pathophysiology of coronavirus disease-19 (COVID-19) is characterized by worsened inflammation because of weakened immunity, causing the infiltration of immune cells, followed by necrosis. Consequently, these pathophysiological changes may lead to a life-threatening decline in perfusion due to hyperplasia of the lungs, instigating severe pneumonia, and causing fatalities. Additionally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause mortality due to viral septic shock, resulting from unrestrained and backfiring immune reactions to the pathogen. Sepsis can cause premature organ failure in COVID-19 patients, as well. Notably, vitamin D and its derivatives and minerals, such as zinc and magnesium, have been reported to improve the immune system against respiratory illnesses. This comprehensive review aims to provide updated mechanistic details of vitamin D and zinc as immunomodulators. Additionally, this review also focuses on their role in respiratory illnesses, while specifically delineating the plausibility of employing them as a preventive and therapeutic agent against current and future pandemics from an immunological perspective. Furthermore, this comprehensive review will attract the attention of health professionals, nutritionists, pharmaceuticals, and scientific communities, as it encourages the use of such micronutrients for therapeutic purposes, as well as promoting their health benefits for a healthy lifestyle and wellbeing.

The impact of vitamin D, vitamin C, and zinc supplements on immune status among Jordanian adults during COVID-19: cross-sectional study findings

BACKGROUND AND AIMS

Nutritional status is essential for the maintenance of the immune system, with malnutrition suppressing immunity. The aims of the current study were to assess the immune status of a group of Jordanian adults and to evaluate the association between vitamin C, vitamin D, and zinc consumption and the Immune Status during the COVID-19 pandemic.

METHODS

A total of 615 adults Jordanian participants were enrolled in this study, an online- based cross sectional survey was used as a tool for this study. Data was collected by distributing the questionnaire form link through social media platforms. The association between ISQ score and the supplement intake pattern (daily, weekly, monthly and rarely) was assessed using multinomial logistic regression analysis, described as Odds ratio and 95% CI.

RESULTS

Data have indicated that the majority of the participants did not take Vitamin D supplements during the pandemic (46.3%). Also, there was a significant association between the frequency of Vitamin D supplement intake and ISQ (r = 12.777; P < 0.05). Data showed that the majority of participants used vitamin C supplementation (49.4%). Also, there was a significant association between the frequency of Vitamin C supplement intake and ISQ (r = 12.797; P < 0.05). Data also have indicated that the majority of the participants did not increase their consumption of Zinc during the COVID-19 pandemic (55.6%).

CONCLUSIONS

The findings of this study suggest a significant association between the frequency of Vitamin D, and vitamin C supplement intake and ISQ. Nutritional status is essential for the maintenance of the immune system, with malnutrition suppressing immunity.

Unmasking an Allosteric Binding Site of the Papain-like Protease in SARS-CoV-2: Molecular Dynamics Simulations of Corticosteroids

To date, mechanistic insights into many clinical drugs against COVID-19 remain unexplored. Dexamethasone, a corticosteroid, is one of them. While treating the entire corticosteroid database, including vitamins D2 and D3, with cutting-edge computational techniques, several intriguing results are unfolded. From the top-notch candidates, dexamethasone is likely to inhibit the viral main protease (Mpro), with vitamin D3 exhibiting multitarget [Mpro, papain-like protease (PLpro), and nucleocapsid protein (N-pro)] roles and ciclesonide's dynamic flipping disinterring a cryptic allosteric site in the PLpro enzyme. The results rationalize why these drugs improve the health of COVID-19 patients. Understanding an enzyme's secret binding site is essential to understanding how the enzyme works and how to inhibit its function. Ciclesonide's allosteric inhibition could not only jeopardize PLpro's catalytic role in polyprotein processing but also make it less vulnerable to the host body's defense machinery. Hotspot residues in the identified allosteric site could be considered for effective therapeutic designs against PLpro.

Common foods for boosting human immunity: A review

We are frequently exposed to potentially harmful microbes of various types on a daily basis. Our immune system is an amazing collection of unique organs and cells that defends us from hazardous germs as well as certain diseases. It plays a crucial role in protecting the body against external invaders, including bacteria, viruses, and parasites. Maintaining a healthy immune system requires consuming a balanced diet that provides a variety of macro- and micronutrients. By consuming sufficient amounts of water, minerals such as zinc and magnesium, micronutrients, herbs, and foods rich in vitamins C, D, and E, and adopting a healthy lifestyle, one can enhance their health and immunity, and prevent infections. This article provides a comprehensive review of the scientific literature on common foods known for their potential to boost human immunity. The review begins by discussing the various components of the immune system and their functions. It then delves into the current understanding of how nutrition can influence immune response, highlighting the importance of a well-balanced diet in supporting optimal immune function. The article presents an extensive analysis of a range of common foods that have been studied for their immune-boosting properties. These foods include fruits, vegetables, whole grains, and animal-based foods. Each food category is explored in terms of its specific nutrients and bioactive compounds that contribute to immune support. Foods such as milk, eggs, fruits, leafy greens, and spices like onion, garlic, and turmeric contain beneficial compounds that can enhance the immune system's function, activate and inhibit immune cells, and interfere with multiple pathways that eventually lead to improved immune responses and defense. The available literature on the issue was accessed via online resources and evaluated thoroughly as a methodology for preparing this manuscript.

Dietary vitamin D: growth, physiological and health consequences in broiler production

Vitamins are needed in trace amounts in dietary formulations for poultry; however, they are critical for the health, maintenance, and performance of important body organs. Broilers have a lot of leg issues because of their rapid development and lack of exercise. Because of commercial broilers have limited access to direct sunlight, vitamin D supplementation in the feed is critical to reducing the risk of bone deformation and maximizing development. Vitamin D deficiency causes skeletal abnormalities, which may lead also to financial problems. The latest scientific findings on the source, metabolism, mechanisms of action, and functions of vitamin D in broilers are the subject of this review paper.

Vitamin D supplementation in a post-pandemic era: A narrative review

Vitamin D is a fat-soluble molecule referring to the different isoforms, ergocalciferol (D2) and cholecalciferol (D3). Its physiological functions include increasing calcium serum concentrations. 25-hydroxyvitamin D3 (25(OH)D) (Calcifediol), a non-active, circulating instant precursor is seen as a pre-hormone. Studies have shown that a deficiency in calcifediol is related to chronic conditions such as cardiovascular, musculoskeletal, immune system, neurological, and anti-neoplastic functions. Vitamin D supplementation has shown its benefit as prophylaxis and treatment during the coronavirus disease 2019 (COVID-19) pandemic and an increase in the prescribing of vitamin D supplementation has been observed. The intention of this review article is to provide guidance on the recommended dosage regimen as a prophylactic measure during COVID-19 and its use as a supplement in general. From this review article, it is clear that vitamin D has an important role to play not only in COVID-19 but also in various other health aspects of the human body.Contribution: This review article highlighted the role of vitamin D in managing vitamin D deficiency and its role as a supplement in the management of respiratory tract infections, especially COVID-19. This overview can assist physicians in optimising healthcare by optimised dosing recommendations and indications.

Bovine colostrum and its potential contributions for treatment and prevention of COVID-19

Bovine colostrum (BC) is the initial milk an animal produces after giving birth, particularly in the first few days. Numerous bioactive substances found in BC, including proteins, enzymes, growth factors, immunoglobulins, etc., are beneficial to human health. BC has a significant role to play as part of a healthy diet, with well-documented health and nutritional advantages for people. Therefore, the use of BC and its crucial derivatives in the development of functional food and pharmaceuticals for the prevention of several diseases such as gastrointestinal and respiratory system disorders is becoming increasingly popular around the world. A novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of a cluster of pneumonia cases that is called Coronavirus Disease 2019 (COVID-19) in China. After the first SARS-CoV-2 virus-related fatality was announced, the illness quickly spread throughout China and to other continents, causing a pandemic. Since then, numerous studies have been initiated to develop safe and efficient treatments. To prevent viral infection and potential lingering effects, it is important to investigate alternative treatments for COVID-19. Due to its effective bioactive profile and its immunomodulatory roles in biological processes, BC might be considered a promising approach to assist in combating people affected by the SARS-CoV-2 or prevention from the virus. BC has immunomodulatory effects because to its high concentration of bioactive components such as immunoglobulins, lactoferrin, cytokines, and growth factors, etc., which might help control immunological responses, potentially fostering a balanced immune response. Furthermore, its bioactive components have a potential cross-reactivity against SARS-CoV-2, aiding in virus neutralization and its comprehensive food profile also supplies important vitamins, minerals, and amino acids, fostering a healthy immune system. Hence, the possible contributions of BC to the management of COVID-19 were reviewed in this article based on the most recent research on the subject. Additionally, the key BC components that influence immune system modulation were evaluated. These components may serve as potential mediators or therapeutic advantages in COVID-19.

Relationship between CDX2 rs11568820 and EcoRV rs4516035 polymorphisms on the vitamin D receptor gene with susceptibility to different SARS-CoV-2 variants

Several studies have revealed that vitamin D deficiency is linked to an increased risk of developing coronavirus disease 19 (COVID-19). In individuals with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, vitamin D receptor activation is required to decrease acute respiratory distress syndrome. The purpose of this study was to examine the genotypic distribution and allelic frequencies of CDX2 rs11568820 and EcoRV rs4516035 polymorphisms in COVID-19 patients with various SARS-CoV-2 variants. For genotyping of CDX2 rs11568820 and EcoRV rs4516035 polymorphisms, we used the polymerase chain reaction-restriction fragment length polymorphism technique in 1734 and 1450 recovered and deceased patients, respectively. The results indicated the rate of COVID-19 mortality was associated with CDX2 rs11568820 AA and GA genotypes in the Delta variant and with CDX2 rs11568820 AA in the Omicron BA.5 variant, while no association was shown in the Alpha variant. Therefore, the rate of COVID-19 mortality was associated with EcoRV rs4516035 TC and CC genotypes in the Delta variant, while no association was shown in the Alpha and Omicron BA.5 variants. According to our analysis, the T-G haplotype was more common in all SARS-CoV-2 variants. The C-A haplotype was associated with COVID-19 mortality in the Delta and Omicron BA.5 variants, and the T-A haplotype was related to the Alpha variant. In conclusion, the genotype frequencies of the CDX2 rs11568820 and EcoRV rs4516035 polymorphisms between SARS-CoV-2 variants were significantly different between the deceased patients and recovered patients. However, more studies should be done to confirm the results.

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.

The effect of 1-hydroxy-vitamin D treatment in hospitalized patients with COVID-19: A retrospective study

BACKGROUND & AIMS

The efficacy of vitamin D supplementation in coronavirus disease 2019 (COVID-19) remains unclear. This study aimed to evaluate the effect of 1-hydroxy-vitamin D on the prevention of severe disease and mortality in patients hospitalized for COVID-19.

METHODS

This retrospective study included 312 patients with COVID-19 who were admitted to our hospital between April 2021 and October 2021 (primarily the Delta variant) and between July 2022 and September 2022 (primarily Omicron variant). Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at the time of admission and 1-hydroxy-vitamin D was prescribed by the treating physicians. The patients were divided into two groups: those administered 1-hydroxy-vitamin D (Vit D group) and those who were not (control group). The composite primary endpoint was the need for additional respiratory support, including high-flow oxygen therapy or invasive mechanical ventilation, and in-hospital mortality rate.

RESULTS

Of 312 patients, 122 (39%) received 1-hydroxy-vitamin D treatment. Although the median age was not significantly higher in the Vit D group than in the control group (66 vs. 58 years old, P = 0.06) and there was no significant difference in the proportion of vitamin D deficiency (defined as serum 25(OH)D level less than 20 ng/mL, 77% vs. 65%, P = 0.07), patients in the control group had a more severe baseline profile compared to the Vit D group according to the Japanese disease severity definition for COVID-19 (P = 0.01). The proportion of those requiring more respiratory support and in-hospital mortality was significantly lower in the Vit D group than in the control group (6% vs. 14%, P = 0.01 log-rank test). After propensity score matching, a statistically significant difference in the primary endpoint was observed (P = 0.03 log-rank test).

CONCLUSIONS

1-hydroxy-vitamin treatment may improve outcomes in hospitalized patients with COVID-19, reducing composite outcomes including the need for additional respiratory support and in-hospital mortality.

Role of micronutrients in the modulation of immune system and platelet activating factor in patients with COVID-19; a narrative review

Background

Dietary micronutrients may play important roles in the improvement of the immune responses against SARS-CoV-2. This study aimed to assess the effect of micronutrients on platelet activating factor (PAF) and immunity with a special focus on the coronavirus disease 2019 (COVID-19).

Methods

All paper published in English on the effects of micronutrients including fat soluble vitamins, water soluble vitamins, and minerals on PAF, immunity, and COVID-19 were collected from online valid databases.

Results

Vitamin A may modulate the expression of PAF-receptor gene in patients with COVID-19. Vitamin D may modulate inflammatory response through influencing PAF pathway. Vitamin E may improve COVID-19 related heart injuries by exert anti-PAF activities. Vitamin C status may have PAF related anti-inflammatory and micro-thrombotic effects in SARS-CoV-2 patients. Furthermore, some trace elements such as copper, selenium, and iron may have key roles in strengthens immunity by inactivate PAF acetyl hydrolase.

Conclusion

This narrative review study highlighted the importance of micronutrients in the improvement of immune function through modulation of PAF in patients with COVID-19. Further longitudinal studies are warranted.

Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis

Aim

Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF).

Methods

Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used.

Results

According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue.

Conclusion

According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.

Vitamin D Knowledge, Awareness, and Attitudes of Adolescents and Adults: A Systematic Review

INTRODUCTION

The aims of this systematic review were 2-fold: (1) evaluate the effect of vitamin D educational interventions on serum 25-hydroxyvitamin D (25-OHD) concentration in adolescents (aged 10-19 years) and adults, and (2) assess the association between serum 25-OHD concentration and vitamin D knowledge, awareness of vitamin D deficiency risk, and attitudes toward behaviors associated with acquiring vitamin D.

METHODS

Medline, CINAHL, Embase, and SPORTDiscus were systematically searched for studies reporting associations between serum 25-OHD concentration and vitamin D knowledge, awareness, and attitudes. Results were summarized narratively. Effect sizes were calculated when data were available.

RESULTS

Eight studies reported experimental effects (2 randomized controlled trials, 1 cluster randomized trial, 4 quasi-experiments, 1 clinical audit), and 14 reported cross-sectional associations. Seven of 8 interventions reported no effect of educational interventions on serum 25-OHD concentration. A slight majority (53%; κ = 19) of studies reported statistically significant associations between serum 25-OHD concentration and vitamin D knowledge and attitudes.

IMPLICATIONS FOR RESEARCH AND PRACTICE

The few educational interventions employed to increase serum 25-OHD concentration lack effectiveness. Future studies may use randomized controlled trial designs, enroll those at risk for vitamin D insufficiency and underrepresented in the literature, increase the salience of the information to the target population, and include safe sun exposure recommendations.

Prediagnostic 25-Hydroxyvitamin D in Association with Cancer-specific and All-cause Mortality among Low-income, Non-Hispanic Black Americans with Colorectal Cancer

BACKGROUND

Observational studies show high prediagnosis 25-hydroxyvitamin D is associated with lower mortality after colorectal cancer diagnosis. Results from clinical trials suggest vitamin D supplementation may improve outcomes among patients with colorectal cancer. Most studies included few Black Americans, who typically have lower 25-hydroxyvitamin D. We evaluated associations between serum 25-hydroxyvitamin D and mortality after colorectal cancer diagnosis among Black American cases.

METHODS

Data arose from 218 Black Americans from the Southern Community Cohort Study diagnosed with colorectal cancer during follow-up (age 40-79 at enrollment). Prediagnostic 25-hydroxyvitamin D was measured at enrollment and categorized as deficient (<12 ng/mL), insufficient (12-19.9 ng/mL), or sufficient (≥20 ng/mL). Mortality was determined from the National Death Index. Cox proportional hazards were used to estimate HRs and 95% confidence intervals (CI) for associations between 25-hydroxyvitamin D and mortality.

RESULTS

As a continuous exposure, higher 25-hydroxyvitamin D was associated with overall mortality [HR = 0.79 (0.65-0.96) per-SD increase, Ptrend = 0.02] and colorectal cancer-specific mortality [HR = 0.83 (0.64-1.08), Ptrend = 0.16]. For overall mortality, associations were strongest among females [HR = 0.65 (0.42-0.92)], current smokers [HR = 0.61 (0.38-0.98)], and obese participants [HR = 0.47 (0.29-0.77)]. Compared with those with deficiency, participants with sufficient 25-hydroxyvitamin D had lower overall mortality after multivariable adjustment [HR: 0.61 (0.37-1.01)].

CONCLUSIONS

Prediagnosis 25-hydroxyvitamin D is inversely associated with overall and colorectal cancer-specific mortality among Black Americans with colorectal cancer. Correcting vitamin D deficiency may improve survival of these patients, particularly for obese individuals and smokers.

IMPACT

Our results support including more Black Americans in trials of vitamin D supplementations to improve colorectal cancer outcomes.

Host genetic polymorphisms involved in long-term symptoms of COVID-19

Host genetic polymorphisms are recognized as a critical determinant of diversity in clinical symptoms of Coronavirus disease 2019 (COVID-19). Accordingly, this study aimed to determine possible associations between single nucleotide polymorphisms (SNPs) in 37 candidate genes and clinical consequences of COVID-19 - especially long-term symptoms, Long COVID. A total of 260 COVID-19 patients, divided into mild (n=239) and severe (n=21) and further categorized based on the presence of Long COVID (no, n=211; yes, n=49), were recruited. Genotyping of selected polymorphisms in 37 genes responsible for viral entry, immune response, and inflammation was performed using MassARRAY system. Out of 37 SNPs, 9 including leucine zipper transcription factor like-1 (LZTFL1) rs10490770 C allele, LZTFL1 rs11385942 dupA allele, nicotinamide adenine dinucleotide synthetase-1 (NADSYN1) rs12785878 TT genotype, plexin A-4 (PLXNA4) rs1424597 AA genotype, LZTFL1 rs17713054 A allele, interleukin-10 (IL10) rs1800896 TC genotype and C allele, angiotensin converting enzyme-2 (ACE2) rs2285666 T allele, and plasmanylethanolamine desaturase-1 (PEDS1) rs6020298 GG genotype and G allele were significantly associated with an increased risk of developing Long COVID, whereas interleukin-10 receptor subunit beta (IL10RB) rs8178562 GG genotype was significantly associated with a reduced risk of Long COVID. Kaplan-Meier curve displayed that polymorphisms in the above genes were significantly associated with cumulative rate of Long COVID occurrence. Polymorphisms in LZTFL1 rs10490770, LZTFL1 rs11385942, LZTFL1 rs17713054, NADSYN1 rs12785878, PLXNA4 rs1424597, IL10 rs1800896, ACE2 rs2285666, PEDS1 rs6020298, and IL10RB rs8178562 appear to be genetic factors involved in development of Long COVID.

Dietary Supplement Use among Iranian Households during COVID-19 Epidemic Lockdown: Less Access in Those Who May Need More National Food and Nutrition Surveillance

Background

The coronavirus disease 2019 (COVID-19) pandemic elicited the general population to use various dietary supplements (DSs) and nutraceuticals as a protective means against the disease. The present study aimed to evaluate changes and certain determinants of DS intake during the COVID-19 lockdown among Iranian households.

Methods

This nationwide cross-sectional study was conducted from April 4 to April 25, 2020, during which Iran was in lockdown. To collect data, a web-based electronic self-administered questionnaire was created. The data were compared among provinces based on their food security situations.

Results

A total of 21,290 households were included in the analyses. Approximately 27% of the households were using DSs after the epidemic. The most common DSs used were vitamin D (42%) and vitamin C (20%), followed by multi-vitamin (16%), zinc (9%), omega-3 (6%), vitamin A (4%), and probiotics (3%). Logistic regression analysis revealed that DS intake was directly associated with the household income but inversely with household size and the food security status of the provinces. DS intake was positively associated with the presence of high-risk persons in the households, the education of the households' head, and the presence of a person with a history of COVID-19 within the household.

Conclusions

During epidemic lockdown, DS use was remarkably increased among the Iranian households. Apart from the debatable usefulness of DSs against COVID-19, the inverse association of DS use with a household's income and provincial food security well indicates inequity in accessibility to DS. Actions to improve the nutritional status of the under-privileged populations including targeted supplementation are strongly recommended.