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30 augustus 2021: zie ook dit artikel: https://kanker-actueel.nl/vitamine-d-suppletie-reguleert-postoperatieve-bloedwaarden-van-pd-l1-bij-patienten-met-spijsverteringskanker-en-verbetert-sterk-de-overall-overleving-van-patienten-met-de-hoogste-pd-l1-waarden.html

28 augustus 2021: lees ook dit artikel: https://kanker-actueel.nl/vitamine-d-tekort-komt-veel-voor-bij-patienten-besmet-met-het-coronavirus-covid-19-en-vitamine-d-tekort-geeft-veel-groter-risico-meer-dan-50-procent-op-ernstige-klachten-en-overlijden.html

28 augustus 2021: Bron: Royal Society Published:
Published:https://doi.org/10.1098/rsos.201912

Abstract

Vitamin D is a hormone that acts on many genes expressed by immune cells. Evidence linking vitamin D deficiency with COVID-19 severity is circumstantial but considerable—links with ethnicity, obesity, institutionalization; latitude and ultraviolet exposure; increased lung damage in experimental models; associations with COVID-19 severity in hospitalized patients. Vitamin D deficiency is common but readily preventable by supplementation that is very safe and cheap. A target blood level of at least 50 nmol l−1, as indicated by the US National Academy of Medicine and by the European Food Safety Authority, is supported by evidence. This would require supplementation with 800 IU/day (not 400 IU/day as currently recommended in UK) to bring most people up to target. Randomized placebo-controlled trials of vitamin D in the community are unlikely to complete until spring 2021—although we note the positive results from Spain of a randomized trial of 25-hydroxyvitamin D3 (25(OH)D3 or calcifediol) in hospitalized patients. We urge UK and other governments to recommend vitamin D supplementation at 800–1000 IU/day for all, making it clear that this is to help optimize immune health and not solely for bone and muscle health. This should be mandated for prescription in care homes, prisons and other institutions where people are likely to have been indoors for much of the summer. Adults likely to be deficient should consider taking a higher dose, e.g. 4000 IU/day for the first four weeks before reducing to 800 IU–1000 IU/day. People admitted to the hospital with COVID-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high-dose calcifediol in the RECOVERY trial. We feel this should be pursued with great urgency. Vitamin D levels in the UK will be falling from October onwards as we head into winter. There seems nothing to lose and potentially much to gain.

Section

9. Conclusion

Evidence linking vitamin D deficiency with COVID-19 severity is circumstantial but considerable—links with ethnicity, obesity, age and institutionalization; latitude association; evidence from experimental models of respiratory pathogens; preliminary reports of associations with COVID-19 severity in hospitalized patients; basic biology studies showing extensive vitamin D impacts on the immune system underlying various anti-viral and anti-inflammatory responses; vitamin D responsive genes altered in lung lymphocytes from COVID-19 patients.

Vitamin D deficiency is common; particularly, but not solely, in people living well away from the equator and can persist throughout the year in individuals who have little sunlight exposure.

Vitamin D deficiency is readily preventable by supplementation that is very safe and cheap.

The current UK definition of vitamin D deficiency (less than 25 nmol l−1) is low by international standards and evidence from parathyroid hormone status (which rises with vitamin D deficiency) as well as large population studies of all-cause mortality suggests that a target blood level of at least 50 nmol l−1, as indicated by the American Institute of Medicine and by the European Food Safety Authority, is more appropriate. This would require supplementation with 800 IU/day (not 400 IU/day as currently recommended in UK) to bring most individuals up to the normal range. Growing evidence suggests that regular daily supplementation is more effective than intermittent high-dose bolus.

Vitamin D supplementation at levels needed to avoid deficiency—e.g. 800–1000 international units (25 μg) vitamin D3/day—is extremely safe and typically costs no more than 10p per day.

Randomized placebo-controlled trials of vitamin D in the community in vitamin D-deficient individuals will be difficult to conduct and will not complete until spring 2021 at earliest—although we note the positive results from Cordoba, Spain of an open-labelled randomized trial of 25(OH)D3 (calcifediol) in hospitalized patients.

Key recommendations:

There seems nothing to lose and potentially much to gain by recommending vitamin D supplementation for all, e.g. at 800–1000 IU/day, making it clear that this is to help ensure immune health and not solely for bone and muscle health.

This should be mandated for prescription in care homes, prisons and other institutions where people are likely to have been indoors for much of the time during the summer.

People likely to be currently deficient should consider taking a higher dose, e.g. 4000 IU/day for the first four weeks before reducing to 800 IU–1000 IU/day

People admitted to hospital with COVID-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high-dose calcifediol in the RECOVERY trial.

Data accessibility

This article does not contain any additional data.

Authors' contributions

J.R. drafted the first version. All authors made substantial contributions to the conception of the report and interpretation of data, contributed to drafting the article and revising it critically for important intellectual content. All have approved the submitted version, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Competing interests

M.H. and D.T. have received speaking honoraria from Thornton Ross. No other competing interests.

Funding

We received no funding for this study.

Footnotes

Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.


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