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Am J Clin Nutr
. 2021 Dec 3;nqab389.
doi: 10.1093/ajcn/nqab389. Online ahead of print.
Associations between predicted vitamin D status, vitamin D intake, and risk of SARS-CoV-2 infection and Coronavirus Disease 2019 severity
Wenjie Ma 1 2 , Long H Nguyen 1 2 , Yiyang Yue 3 , Ming Ding 3 , David A Drew 1 2 , Kai Wang 4 , Jordi Merino 5 6 7 , Janet W Rich-Edwards 4 8 , Qi Sun 3 4 8 , Carlos A Camargo 4 9 10 , Edward Giovannucci 3 4 9 , Walter Willett 3 4 9 , JoAnn E Manson 4 11 , Mingyang Song 1 2 3 4 , Shilpa N Bhupathiraju 3 9 , Andrew T Chan 1 2 4 9
Affiliations
- PMID: 34864844
- DOI: 10.1093/ajcn/nqab389
Abstract
Background: Vitamin D may have a role in immune responses to viral infections. However, data on the association between vitamin D and SARS-CoV-2 infection and Coronavirus Disease 2019 (COVID-19) severity have been limited and inconsistent.
Objective: We examined the associations of predicted vitamin D status and intake with risk of SARS-CoV-2 infection and COVID-19 severity.
Design: We used data from periodic surveys (May 2020 to March 2021) within the Nurses' Health Study II. Among 39,315 participants, 1,768 reported a positive test for SARS-CoV-2 infection. Usual vitamin D intake from foods and supplements were measured using a semi-quantitative, pre-pandemic food frequency questionnaire in 2015. Predicted 25-hydroxyvitamin D [25(OH)D] levels were calculated based on a previously validated model including dietary and supplementary vitamin D intake, ultraviolet-B (UVB), and other behavioral predictors of vitamin D status.
Results: Higher predicted 25(OH)D levels, but not vitamin D intake, were associated with a lower risk of SARS-CoV-2 infection. Comparing participants in the highest quintile of predicted 25(OH)D levels to the lowest, the multivariable-adjusted odds ratio was 0.76 (95% CI: 0.58, 0.99; P-trend = 0.04). Participants in the highest quartile of UVB (OR: 0.76; 95% CI: 0.66, 0.87; P-trend = 0.002) and UVA (OR: 0.76; 95% CI: 0.66, 0.88; P-trend<0.001) also had lower risk of SARS-CoV-2 infection compared to the lowest. High intake of vitamin D from supplements (≥400 IU/d) was associated with a lower risk of hospitalization (OR: 0.51; 95% CI: 0.29, 0.91; P-trend = 0.04).
Conclusions: Our study provides suggestive evidence on the association between higher predicted circulating 25(OH)D levels and a lower risk of SARS-CoV-2 infection. Greater intake of vitamin D supplements was associated with a lower risk of hospitalization. Our data also support an association between exposure to UVB or UVA, independent of vitamin D, and SARS-CoV-2 infection, so results for predicted 25(OH)D need to be interpreted cautiously.
Keywords: COVID-19; Robertson-Berger meter; SARS-CoV-2; UVA; Vitamin D; diet; infection; severity; solar UVB; supplement.