Dermatologists are perfectly mindful that pores and skin pigmentation impacts cutaneous vitamin D synthesis, making vitamin D deficiency a lot more prevalent among the folks with pores and skin of shade. Now the COVID-19 pandemic will increase the require to give due thing to consider to that link, in accordance to Pearl E. Grimes, MD.
Soon soon after COVID-19 case figures begun to fast increase throughout the world, scientists started to hypothesize and investigate danger components for infection and even worse outcomes. Success displaying associations with vitamin D deficiency appeared early and ongoing to mature.
In an article printed in July 2020, Grimes and colleagues were the to start with to recommend that lower vitamin D position could be amid the variables conveying the larger load of COVID-19 between folks of colour.1 Noting the will need for even more exploration to corroborate their speculation, the authors named on medical professionals to be mindful of the better prevalence of vitamin D deficiency in individuals with pores and skin of shade and address the challenge as a probable way to solve the disparities in COVID-19 hazards affecting minority populations.
Nine months afterwards, facts in an accumulating entire body of literature strengthens this get in touch with to action, explained Grimes, director of The Grimes Heart for Medical and Aesthetic Dermatology and founder and director of Vitiligo and Pigmentation Institute of Southern California in Los Angeles. “As we shift this agenda forward, we want a cohesive effort wherever all doctors are chatting to their clients about the worth of possessing a healthy degree of vitamin D,” she advised Dermatology Times®. “Physicians need to go on to emphasize the worth of vaccination, recurrent handwashing, carrying masks, and social distancing as strategies for defending towards COVID-19 infection. Having said that, the accessible evidence implies that acquiring a healthier degree of vitamin D is also significant for decreasing the hazard. Additionally, facts also guidance the thought that for persons who produce COVID-19, obtaining a wholesome vitamin D degree will increase the chance of getting a better outcome.”
Examining the proof on the associations between vitamin D status and COVID-19 infection and results, Grimes cited a meta-analysis posted on line in March 2021. Aggregating literature posted by means of November 26, 2020, the authors determined 39 reports conference the standards for inclusion in their systematic overview.2
Success of the meta-evaluation confirmed connected vitamin D deficiency with improved threats of COVID-19, as properly as increased composite severity and increased mortality from the condition. The results have been replicated in an additional meta-evaluation published afterwards in the month that reviewed 43 printed scientific tests applying a literature search cutoff date of January 31, 2021.3
The relationship among vitamin D position and COVID-19 infection as it exclusively applies to race and ethnicity was the topic of another examine carried out at the University of Chicago, with success posted on the internet in March 2020.4 The results further corroborate research demonstrating an association in between vitamin D deficiency (<20 ng/mL) and COVID-19 infection.
However, the study was primarily designed to investigate potential racial differences in COVID-19 risk among persons with vitamin D levels of 30 to less than 40 ng/mL, which some experts consider sufficient.
The investigators found that among Black people, the risk of testing positive for COVID-19 rose significantly, by 2.64-fold, among those with a vitamin D level of 30 to less than 40 ng/mL compared with those who had a level of at least 40 ng/mL. COVID-19 positivity rates among White people did not differ significantly when comparing the subgroup with a vitamin D level of 30 to less than 40 ng/mL and their counterparts with a higher level. The authors concluded that their findings support the idea that vitamin D supplementation could lead to COVID-19 infection rates.
Accounting for the Risk
As reviewed in the numerous published papers, including the article by Grimes, an association between vitamin D status and COVID-19 risk and outcomes is grounded on solid biologic plausibility. First, vitamin D signaling plays a key role in maintaining healthy innate and adaptive immune responses. In addition, and of particular relevance, vitamin D has been shown to mediate the induction of key antimicrobial peptides in the respiratory epithelium and inhibit production of proinflammatory cytokines that are upregulated in the COVID-19 cytokine storm.
“Two other recent meta-analyses published in the years preceding the COVID-19 pandemic linked vitamin D with risk of respiratory tract infections,” Grimes observed. “One found an increased risk of community-acquired pneumonia in persons with vitamin D levels less than 20 ng/mL, and another reported vitamin D supplementation protected against acute respiratory tract infection.”
As she aims to raise health care providers’ awareness that vitamin D status may be an important modifiable risk factor for COVID-19, especially in patients with skin of color, Grimes also is taking the message directly to the public, encouraging patients to have a dialogue with their physicians about vitamin D. To accomplish this, Grimes collaborated with producer and director Felicia D. Henderson to produce an informational YouTube video, The Colors of COVID: Saving Lives and the Benefits of D-Z-C.
The 13-minute film features Henry W. Lim, MD, chairman and C.S. Livingood chair of the Department of Dermatology at Henry Ford Health System in Detroit, Michigan, alongside other medical and nutrition experts (Jonathan Sackier, MB R. Swamy Venuturupalli, MD and Lee Bell, BCHN) and Black celebrity activists (Tyler Perry, Angela Bassett, Nicole Ari Parker, and Jenifer Lewis). It concludes with this appeal: “Please consult your health care professional to ascertain what supplementation is right for you.”
The Bigger Picture
Hopefully, concern about contracting COVID-19 will lessen in the future. However, the need to recognize and address low vitamin D status in patients with skin of color will continue to be a priority, according to Grimes. “Clinicians need to be aware of evidence showing that vitamin D insufficiency is a risk factor for many serious diseases, including diabetes, hypertension, cardiovascular disease, autoimmune diseases, and various cancers that occur at disproportionately high rates in skin of color populations,” she said.
Grimes acknowledged that there are conflicting data about the benefit of vitamin D supplementation for reducing disease risks and improving health outcomes. In particular, skeptics cite results from the Vitamin D and Omega-3 Trial (VITAL NCT01169259), a nationwide, randomized, placebo-controlled trial of healthy adults that found supplementation with vitamin D3 2000 IU per day did not lower the risk of invasive cancers or major cardiovascular events.5 “However, when you dive into the details of the published article, you see that the study [results] found a possible benefit for decreasing the incidence of cancer among Black participants,” she said.
While awaiting results from prospective studies that may help define the benefits of different dosing strategies, physicians should encourage patients with skin of color to take a daily vitamin D supplement, Grimes said. “The Institute of Medicine–recommended dietary allowance for vitamin D is 600 to 800 IU per day for adults, and the recommendation is based on bone health. Given the very high incidence of vitamin D deficiency in African Americans not taking supplements, higher doses are needed to achieve healthy levels.
“I think physicians can feel comfortable recommending to their adult patients that they take 1000 to 2000 IU of a vitamin D3 supplement each day,” she continued. “According to the National Academy of Medicine, most people can safely take up to 4000 IU per day without significant risk of hypercalcemia. I encourage health care providers to read the literature to develop their own knowledge base on this topic.”
1. Grimes PE, Elbuluk N, Alexis AF. The relevance of vitamin D supplementation for people of color in the era of COVID-19. J Drugs Dermatol. 202019(7):782-783. doi:10.36849/JDD.2021.5414
2. Kazemi A, Mohammadi V, Aghababaee SK, Golzarand M, Clark CCT, Babajafari S. Association of vitamin D status with SARS-CoV-2 infection or COVID-19 severity: a systematic review and meta-analysis. Adv Nutr. Published online March 5, 2021. doi:10.1093/advances/nmab012
3. Petrelli F, Luciani A, Perego G, Dognini G, Colombelli PL, Ghidini A. Therapeutic and prognostic role of vitamin D for COVID-19 infection: a systematic review and meta-analysis of 43 observational studies. J Steroid Biochem Mol Biol. Published online March 5, 2021.
4. Meltzer DO, Best TJ, Zhang H, et al. Association of vitamin D levels, race/ethnicity, and clinical characteristics with COVID-19 test results. JAMA Netw Open. 20214(3):e214117. doi:10.1016/j.jsbmb.2021.105883
5. Manson JE, Cook NR, Lee IM, et al VITAL Research Group. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019380(1):33-44. doi:10.1056/NEJMoa1809944