Ensuring satisfactory vitamin D status in the general population is particularly important in the context of Covid-19, and numerous clinical studies on the impact of vitamin D on COVID-19 infection have been initiated across the world. To date, only 14 clinical studies on the subject have been completed (including 2 in Europe: 1 in Spain and 1 in France, clinicaltrial).
The first reports show that the circulating concentration of 25 (OH) D is lower in infected adults than in others. In an ecological study, inverse correlations were found in 46 countries between vitamin D deficiency in the general population and the incidence of Covid-19. Specifically, the existence of vitamin D insufficiency appears to precede the incidental occurrence of Covid-19, and not the other way around. Despite the lack of solid intervention data at this time, preliminary results from the Koronastudien.no study, showing in Norway that regular consumers of cod liver oil are less likely to be infected with SARS-CoV -2, suggest that vitamin D supplementation could help prevent Covid-19.
The few published intervention studies appear to support a beneficial effect of vitamin D supplementation in reducing the severity of symptoms in adults with Covid-19, but the number of studies remains too small.
A recent Mendelian observational study suggests that vitamin D does not prevent severe forms of Covid-19. An article published in the Journal of American Medicine Association also criticizes the craze around vitamin D. A 2017 review carried out by the World Health Organization (WHO) on vitamin D and respiratory infections was a reminder of how much the level of evidence was weak and studies heterogeneous, making conclusions difficult. A recent article published in Nutrition Reviews evokes a plausible utility in people who are really deficient (less than 10 nanograms per milliliters) and those at high risk of going through the intensive care unit if they contract Covid-19 (which generally represent the same sub- groups). Taken together, these data constitute an unconvincing body of evidence to support claims to supplement the general population with prevention purposes.
It seems that the recommendation to ensure, for the purpose of primary prevention of COVID-19, that the blood values of 25 (OH) D are aligned with those proposed by the Haute Autorité de Santé – 20 ng / mL for the general population – or the Group for Research and Information on Osteoporosis (GRIO) -30 ng / mL for the elderly- may be justified in view of the meta-analyzes relating to the prevention of acute respiratory infections (in the absence of the specific context of COVID-19). On condition, as these meta-analyzes indicate, to favor, in the event of a proven deficit (less than 20 ng / mL), daily or, possibly, weekly supplementation (Vidal.fr).
- Opinion of the European countries:
Our British neighbors have made the decision to use vitamin D. Indeed, the governments of the United Kingdom (England, Scotland and Ireland) have for their part planned to provide vitamin D as a preventive measure to several million fragile people, to elderly hospitalized people, based in particular on the good results observed in Andalusia.
The Irish strongly encourage the recommendation of vitamin D supplementation to prevent infection, due to their inherent deficiency in the country’s low sunshine. In their report, The Irish Government recommends that all elderly people, hospital patients, nursing home residents and other vulnerable groups urgently receive a supplement of 20 to 50 μg / d of vitamin D to improve their resistance to Covid-19, and that this advice be quickly extended to the general adult population.
Belgium concludes in its report: “neither zinc nor vitamin D are the panacea in the treatment of Covid-19. The use of very high amounts of vitamin D for therapeutic purposes in patients with Covid-19 and to prevent very severe forms of the disease, cannot currently be recommended. “ Italy, Spain and Germany have looked into and interested in the subject, however they consider the current evidence insufficient to make a recommendation for the general population and fear possible risks associated with potential vitamin D overdoses.
In France, the Academy of Medicine also recommends vitamin D supplementation (Press release from the Academy of Medicine, May 22, 2020).
- Need for a consensus on the reference values for Vitamin D:
Disagreements remain on the interpretation of blood levels of 25 (OH) D (25-hydroxyvitamin D, the usually dosed form). Without entering into the scientific debate on this subject, we will simply recall the values that are commonly used in practice in France:
- in the general population, a blood concentration of 25 (OH) D greater than 20 ng / mL (50 nmol / L) is considered “sufficient”,
- in the population at risk of age-related osteoporosis, a disease or a chronic treatment, this reference blood level should, according to the recommendations of the GRIO , be greater than 30 ng / mL (75 nmol / L).
In terms of toxicity, it is estimated that the risk of adverse effects (hypercalcemia, kidney stones, for example) appears when blood levels persistently exceed 50-60 ng / mL According to the National Agency for Food, Environmental and Occupational Health Safety (ANSES), the daily intake of vitamin D should be 15 micrograms (600 IU) per day for an adult . In 2017, the INCA 3 study showed that, among French people aged 18 to 79, the average daily intake is rather around 3.1 micrograms (124 IU) per day.
As observed for the blood reference values, the definition of vitamin D deficiency or insufficiency is not completely consensual. According to the recommendations of the High Authority of Health (HAS), in the general population, we speak of severe deficiency for a blood level below 5 ng / mL (12.5 nmol / L), of moderate deficiency for a level between 5 and 10 ng / mL (12.5-25 nmol / L), and a deficit for a level between 10 and 20 ng / mL (25-50 nmol / L).
ANSES recently updated the reference values of Vitamin D in French adults and plans to communicate the various reference values for specific populations during the year.
Français
Focus on … vitamin D and COVID 19 in Europe
The first reports show that the circulating concentration of 25 (OH) D is lower in infected adults than in others. In an ecological study, inverse correlations were found in 46 countries between vitamin D deficiency in the general population and the incidence of Covid-19. Specifically, the existence of vitamin D insufficiency appears to precede the incidental occurrence of Covid-19, and not the other way around. Despite the lack of solid intervention data at this time, preliminary results from the Koronastudien.no study, showing in Norway that regular consumers of cod liver oil are less likely to be infected with SARS-CoV -2, suggest that vitamin D supplementation could help prevent Covid-19.
The few published intervention studies appear to support a beneficial effect of vitamin D supplementation in reducing the severity of symptoms in adults with Covid-19, but the number of studies remains too small.
A recent Mendelian observational study suggests that vitamin D does not prevent severe forms of Covid-19. An article published in the Journal of American Medicine Association also criticizes the craze around vitamin D. A 2017 review carried out by the World Health Organization (WHO) on vitamin D and respiratory infections was a reminder of how much the level of evidence was weak and studies heterogeneous, making conclusions difficult. A recent article published in Nutrition Reviews evokes a plausible utility in people who are really deficient (less than 10 nanograms per milliliters) and those at high risk of going through the intensive care unit if they contract Covid-19 (which generally represent the same sub- groups). Taken together, these data constitute an unconvincing body of evidence to support claims to supplement the general population with prevention purposes.
It seems that the recommendation to ensure, for the purpose of primary prevention of COVID-19, that the blood values of 25 (OH) D are aligned with those proposed by the Haute Autorité de Santé – 20 ng / mL for the general population – or the Group for Research and Information on Osteoporosis (GRIO) -30 ng / mL for the elderly- may be justified in view of the meta-analyzes relating to the prevention of acute respiratory infections (in the absence of the specific context of COVID-19). On condition, as these meta-analyzes indicate, to favor, in the event of a proven deficit (less than 20 ng / mL), daily or, possibly, weekly supplementation (Vidal.fr).
Our British neighbors have made the decision to use vitamin D. Indeed, the governments of the United Kingdom (England, Scotland and Ireland) have for their part planned to provide vitamin D as a preventive measure to several million fragile people, to elderly hospitalized people, based in particular on the good results observed in Andalusia.
The Irish strongly encourage the recommendation of vitamin D supplementation to prevent infection, due to their inherent deficiency in the country’s low sunshine. In their report, The Irish Government recommends that all elderly people, hospital patients, nursing home residents and other vulnerable groups urgently receive a supplement of 20 to 50 μg / d of vitamin D to improve their resistance to Covid-19, and that this advice be quickly extended to the general adult population.
Belgium concludes in its report: “neither zinc nor vitamin D are the panacea in the treatment of Covid-19. The use of very high amounts of vitamin D for therapeutic purposes in patients with Covid-19 and to prevent very severe forms of the disease, cannot currently be recommended. “ Italy, Spain and Germany have looked into and interested in the subject, however they consider the current evidence insufficient to make a recommendation for the general population and fear possible risks associated with potential vitamin D overdoses.
In France, the Academy of Medicine also recommends vitamin D supplementation (Press release from the Academy of Medicine, May 22, 2020).
In terms of toxicity, it is estimated that the risk of adverse effects (hypercalcemia, kidney stones, for example) appears when blood levels persistently exceed 50-60 ng / mL According to the National Agency for Food, Environmental and Occupational Health Safety (ANSES), the daily intake of vitamin D should be 15 micrograms (600 IU) per day for an adult . In 2017, the INCA 3 study showed that, among French people aged 18 to 79, the average daily intake is rather around 3.1 micrograms (124 IU) per day.
Orchidali peut vous accompagner dans la préparation et la rédaction de dossiers règlementaires.
Tags: