Endocrine Practice https://doi.org/10.1016/j.eprac.2021.03.006
Nipith Charoenngam MD 12 Arash Shirvani MD, PhD1 Michael F.Holick MD1
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Vitamin D is known not only for its importance for bone health, but also for its biologic activities on other many other organ systems. This is due to the presence of the vitamin D receptor (VDR) in various types of cells and tissues, including the skin, skeletal muscle, adipose tissue, endocrine pancreas, immune cells and blood vessels. Experimental studies have shown that vitamin D exerts several actions that are thought to be protective against COVID-19 infectivity and severity. These include the immunomodulatory effects on the innate and adaptive immune systems, the regulatory effects on renin-angiotensin-aldosterone-system in the kidneys and the lungs, and the protective effects against endothelial dysfunction and thrombosis. Prior to the COVID-19 pandemic, studies have shown that vitamin D supplementation is beneficial in protecting against risk of acquiring acute respiratory viral infection and may improve outcomes in sepsis and critically ill patients. There are a growing number of data connecting COVID-19 infectivity and severity with vitamin D status, suggesting a potential benefit of vitamin D supplementation for primary prevention or as an adjunctive treatment of COVID-19.
Although the results from most ongoing randomized clinical trials aiming to prove the benefit of vitamin D supplementation for these purposes are still pending, there is no downside to increasing vitamin D intake and having sensible sunlight exposure to maintain serum 25-hydroxyvitamin D at least 30 ng/mL (75 nmol/L) and preferably at 40 – 60 ng/mL (100 – 150 nmol/L) to minimize the risk of COVID-19 infection and its severity.