Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic
Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic
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DOI：
10.1016/j.metabol.2020.154276
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发表时间：
2020-08-01
影响因子：
9.8
通讯作者：
Fuleihan, G. El Hajj
中科院分区：
文献类型：
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作者：
Chakhtoura, M.;Napoli, N.;Fuleihan, G. El Hajj
COVID-SARS-2大流行以光速袭击并传播，在3个月内到达6大洲，改变了我们全球的社会[1]。在b6个月内，数字呈指数增长至5，159，674例和335，4186例死亡（6.5%）;大约三分之一在美国（2020年5月22日）[2]。老年人、非裔美国人、糖尿病患者、慢性肺和心血管疾病患者[3，4]以及所有维生素D水平低的人群的疾病严重程度和死亡率较高。我们应该给患者补充维生素D吗？我们研究了维生素D在COVID-19患者中的生物相容性和作用的证据，并基于严格和系统的方法提供了补充指南的框架。我们询问了系统评价数据库Epistemonikos和包括科克伦在内的四个医学数据库。阳光维生素对肌肉骨骼健康的有益作用是无可争议的。维生素D不足，即血清25-羟基维生素D [25（OH）D]在20 - 50 nmol/L（8-20 ng/mL）之间，可导致钙吸收不良、继发性甲状旁腺功能亢进、骨丢失加速、骨质疏松症和成人骨折[5]。血清25（OH）D B 20 nmol/L的缺乏会降低血清钙磷乘积，导致儿童佝偻病和成人骨软化症[5]。这两种情况都可以通过每天补充400-800 IU的维生素D来预防，前提是钙的摄入量足够。在老年人或机构受试者中，维生素D在800-2000 IU/天的剂量下与钙联合给药，可将髋部骨折的风险降低15- 30%，将其他非椎骨骨折的风险降低20%[5-7]。这些剂量在COVID前主要组织推荐的范围内。生态研究表明，高纬度（N+ 30 N）和冬季是低维生素D的风险因素，与COVID-19感染的死亡率较高相关[8，9]。存在一些例外情况，并可能由其他因素解释，如人口年龄，密度和种族，生活方式因素和社交距离措施[10]。肥胖是所有非传染性疾病的风险因素，越来越多的报告将肥胖确定为非传染性疾病的风险因素。
COVID-SARS-2 pandemic has struck and spread at light speed, reaching 6 continents within 3 months, transforming our societies globally [1]. In b6 months, numbers rose exponentially to 5,159,674 cases and 335, 4186 fatalities (6.5%); a third roughly are in the US (May 22, 2020)[2]. Disease severity and mortality rates are higher in the elderly, African Americans, patients with diabetes mellitus, chronic lung and cardiovascular diseases [3, 4], all groups with low vitamin D levels. Should we supplement patients with vitamin D? We examine the biological plausibility and evidence for a role of vitamin D in COVID-19 patients, and provide a framework for guidance on supplementation, based on a rigorous and systematic approach. We interrogated the Systematic Reviews database Epistemonikos, and four medical databases including Cochrane.The beneficial role of the sunshine vitamin on musculoskeletal health is undisputed. Vitamin D insufficiency, a serum 25-Hydroxy vitamin D [25 (OH) D] between 20 and 50 nmol/L (8–20 ng/mL), causes calcium malabsorption, secondary hyperparathyroidism, accelerated bone loss, osteoporosis and fractures in adults [5]. Deficiency, a serum 25 (OH) D b 20 nmol/L, decreases the serum calcium-phosphate product, and leads to rickets in children and osteomalacia in adults [5]. Both can be prevented with daily supplements of 400–800 IU of vitamin D, provided calcium intake is adequate. In elderly or institutionalized subjects, vitamin D at doses of 800–2000 IU/day, co-administered with calcium, reduces the risk of hip fractures by 15–30%, and of other nonvertebral fractures by 20%[5–7]. These doses are within ranges recommended by major organizations pre-COVID times. Ecological studies suggest that high latitudes (N+ 30 N), and winter season, risk factors for low vitamin D, are associated with higher mortality rates in COVID-19 infections [8, 9]. Several exceptions exist and are likely explained by other contributing factors such as population age, density and ethnicity, lifestyle factors, and social distancing measures [10]. Obesity is a risk factor to all non-communicable diseases, and an increasing number of reports identify obesity as a risk factor for