Exploring the association between vitamin D status and Corona Virus-19 infection in a cohort of adults aged 50 years and older
Clinical Nutrition https://doi.org/10.1016/j.nutos.2025.05.007
Carol L. Wagner, MD1 wagnercl at musc.edu ∙ John E. Baatz, PhD2 ∙ Myla Ebeling, RA1 ∙ Danforth A. Newton, PhD2 ∙ Judith R. Shary, MS1 ∙ Mathew Gregoski, PhD3 ∙ Mark T. Wagner, PhD4 ∙ David Zava, PhD5 ∙ Carole Baggerly, BA6,# ∙ Sonya Ketchens, BS7 ∙ Jeffrey Korte, PhD3 ∙ Bruce W. Hollis, PhD1
Objective
Evaluate the association between vitamin D (vitD) status and Corona Virus-19 (COVID-19) infection in adults aged 50 years and older.
Design
Adults ≥50 undergoing COVID-19 testing from July 2020 to December 2021, without prior vaccination, consented to blood analysis. SARS-CoV-2 PCR confirmed current COVID-19 infection. VitD status was assessed via 25(OH)D concentration (LCMS/MS, ZRT Labs, Portland, OR). Sociodemographic data were collected at enrollment. Statistical analyses (SAS 9.4) examined associations between sociodemographics, COVID-19, and vitD status. Multivariate logistic regression analyzed factors linked to COVID-19 or vitD status.
Results
Of 131 participants, 46.6% were ≥65 years old, 71.0% married, 19.9% Black American, 36.6% male, 38.9% Medicaid/Medicare/self-pay, and 42.8% BMI≥30. VitD status and Black American (p=0.0001) significantly associated with COVID-19 infection (p=0.0001). Black American (p=0.0003), males (p=0.003), and BMI (p=0.007) were inversely associated with 25(OH)D concentration. In a multiple logistic regression model predicting COVID-19 infection, only vitamin D status remained significant after controlling for certain sociodemographic and clinical factors (p<0.0001, OR 0.92, 95% CI 0.89-0.95).
Of the 44 COVID-positive participants, 35 (79.6%) were hospitalized and 19 (43.2%) were admitted to the Intensive Care Unit (ICU).
- Hospitalization due to COVID-19 was associated with age ≥65 years old (p=0.02; OR 12.0, 95% CI 1.34-106.79), male (p=0.02, OR 10.7, 95% CI 1.20-94.73),
- and 25(OH)D <40 ng/mL (p=0.0006, OR 42.5, 95% CI 3.90-461.01).
In multivariate analysis, the association between vitamin D status and the risk of COVID-related hospitalization
remained significant and inversely associated (p=0.03, OR 0.88, 95% CI 0.78-0.99).
In unadjusted analysis, COVID pneumonia was associated with male sex (p=0.049; OR 4.6, 95% CI 1.06-20.16 ) and 25(OH)D <40 ng/mL (p=0.006, OR 18.8, 95% CI 1.9-184.10).
Participants with COVID infection and 25(OH)D <20 ng/mL were 2.1 times more likely to be admitted to ICU/death (p=0.03).
In unadjusted analysis, ICU admission and/or death were linked to age ≥65 years (p=0.0002, OR 16.9, 95% CI 3.63-78.56), Medicaid/Medicare/self-pay insurance status (p=0.004, OR 0.1, 0.04-0.56), and 25(OH)D <20 (p=0.03, OR 3.9, 1.09-13.66) and <40 ng/mL (p=0.03); however, only age ≥65 remained significant in multivariate analysis (p=0.04, OR 6.7, CI 1.05-43.0).
Conclusions
Lower 25(OH)D concentration was a significant predictor and/or contributor to COVID-19 infection, suggesting the importance of maintaining adequate vitamin D status in reducing infection risk and mitigating severe outcomes.
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