Correlation between 25-hydroxyvitamin D/D3 Deficiency and COVID-19 Disease Severity in Adults from Northern Colorado

In this observational study, lower levels of vitamin D were significantly associated with severe COVID-19 disease. However, it is not clear whether vitamin D supplementation efforts would influence long–term outcomes such as developing post-acute sequelae of COVID-19 (PASC).

• 69% of the cohort had optimal levels of total 25(OH)D, 22% had insufficient levels, and 9% had deficient levels.  
• Participants with severe disease (n = 37) had significantly lower 25-hydroxyvitamin D (total 25(OH)D) when compared to adults with mild disease (p = 0.006) or no COVID-19 diagnosis (p = 0.007).  
• 44% of the cohort reported having post-acute sequalae of COVID-19 (PASC). 
• Significant differences were detected in 25-hydroxyvitamin D status by sex and BMI, however there were no correlations between 25-hydroxyvitamin D status in participants with or without PASC.  

131 adults diagnosed with COVID-19 and 18 adults without a COVID-19 diagnosis, in Northern Colorado.

• This study had a small sample size and short study duration. 
• Study duration may have been too short to accurately detect changes in plasma total 25(OH)D levels that may have occurred over time. 
• The authors noted that the analyses for total 25(OH)D levels used blood samples collected prior to widespread vaccination for COVID-19, and a stay-at-home order was implemented during the study period which may have limited outdoor activity and reduced the opportunity for participants to receive sunlight sources of vitamin D. 

We showed that plasma total 25-hydroxyvitamin D levels were lower in obese/overweight adult participants in comparison to normal weight participants and were not related to risk for developing PASC. Our findings support that lower Vitamin D levels are associated with severe disease, and we therefore put forth that supplementation of Vitamin D, with physician oversight, may reduce risk of severe COVID-19 disease for male individuals with underlying chronic diseases. In combination with vaccination, dietary supplementation of Vitamin D in obese adults remains a promising area of exploration for reducing risk and disease severity following COVID-19 infection.

• This observational cohort study evaluated body weight- and sex-related differences in plasma 25-hydroxyvitamin D and D3 levels and their relationship to COVID-19 disease severity and the development post-acute sequelae of COVID-19 infection (PASC). 
• 131 adults with COVID-19 and 18 adults without COVID-19, in Northern Colorado, were enrolled for a period of 6 months, and blood samples were collected at baseline, and approximately 1, 4, and 6 months after baseline. 
• Plasma 25-hydroxyvitamin D levels were quantified by LC-MS/MS at the initial visit and after 4 months, and participants were classified as deficient (<30 nM or <12 ng/mL), insufficient (<30–50 nM or 12–20 ng/mL), or optimal (50–75 nM or >20 ng/mL) for 25-hydroxyvitamin D status. 
• Disease severity was categorized as mild (no oxygen required), moderate (1-5L oxygen requirement), or severe (greater than 5L oxygen requirement). 
• Body mass index (BMI) was based on self-reported height and weight for non-hospitalized participants and electronic health records from hospitalized participants. 
• A symptom survey was administered at every study visit to identify PASC. Participants were defined as having PASC if experiencing at least one of the following symptoms for at least 60 days post-infection: fatigue, dyspnea, joint pain, chest pain, forgetful or absent-mindedness, confusion, or difficulty breathing. 

Baxter BA, Ryan MG, LaVergne SM, Stromberg S, Berry K, Tipton M, Natter N, Nudell N, McFann K, Dunn J, Webb TL, Armstrong M, Reisdorph N, Ryan EP. Correlation between 25-hydroxyvitamin D/D3 Deficiency and COVID-19 Disease Severity in Adults from Northern Colorado. Nutrients. 2022 Dec 7;14(24):5204. doi: 10.3390/nu14245204.