Letter to the Editor Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2022; 11(2): 112-114
Published online Mar 9, 2022. doi: 10.5492/wjccm.v11.i2.112
Potential role of vitamin D in patients with diabetes, dyslipidaemia, and COVID-19
Ming-Ke Wang, Xue-Lu Yu, Li-Yun Zhou, Hong-Mei Si, Ju-Fen Hui, Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
Ji-Shun Yang, Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
ORCID number: Ming-Ke Wang (0000-0001-9918-0491); Xue-Lu Yu (0000-0002-8527-2093); Li-Yun Zhou (0000-0003-1413-8679); Hong-Mei Si (0000-0003-1175-6594); Ju-Fen Hui (0000-0001-7816-0635); Ji-Shun Yang (0000-0001-7160-706X).
Author contributions: Wang MK wrote the draft; Yu XL, Zhou LY, Si HM, and Hui JF collected the literature; Wang MK and Yang JS conceptualized the article and revised the manuscript; all authors have read and approved the final manuscript.
Supported by Major Construction Program of Military Key Disciplines during the 13th Five-Year Plan Period, No. 2020SZ21-15.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Shun Yang, MD, PhD, Director, Medical Care Center, Naval Medical Center of PLA, Naval Medical University, No. 338 Huaihai West Road, Shanghai 200052, China. jasunyang@foxmail.com
Received: October 17, 2021
Peer-review started: October 17, 2021
First decision: December 16, 2021
Revised: December 22, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 9, 2022
Processing time: 136 Days and 10.3 Hours

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 has become a worldwide public health crisis. Studies have demonstrated that diabetes and dyslipidaemia are common comorbidities and could be high-risk factors for severe COVID-19. Vitamin D, a group of fat-soluble compounds responsible for intestinal absorption of calcium, magnesium, and phosphate, has been widely used as a dietary supplement for the prevention and treatment of numerous diseases, including infectious and non-infectious diseases, due to its high cost-effectiveness; safety; tolerability; and anti-thrombotic, anti-inflammatory, antiviral, and immunomodulatory properties. In this letter to the editor, we mainly discuss the potential role of vitamin D in patients with diabetes, dyslipidaemia, and COVID-19.

Key Words: Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus-2; Vitamin D; Diabetes; Dyslipidaemia

Core Tip: Diabetes and dyslipidaemia are common comorbidities in patients with coronavirus disease 2019 (COVID-19), and these comorbidities are often associated with worse clinical outcome. In this letter to the editor, we hypothesize that vitamin D may be a prognostic factor and could be a promising preventive measure and treatment for patients with diabetes, dyslipidaemia, and COVID-19.



TO THE EDITOR

We read with great interest the recent article by Iglesias et al[1] entitled “Retrospective analysis of anti-inflammatory therapies during the first wave of coronavirus disease 2019 (COVID-19) at a community hospital”, which demonstrated the survival benefit associated with anti-inflammatory therapy with glucocorticoids and revealed that combination treatment with tocilizumab and glucocorticoids could provide the most benefit in critically ill patients with COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, monotherapy with tocilizumab as an interleukin 6 (IL-6) antagonist was not associated with an increase in survival among critically ill patients with COVID-19, which could be explained by the fact that tocilizumab non-selectively blocks both anti-inflammatory and pro-inflammatory actions of IL-6[2]. Meanwhile, vitamin D, a group of fat-soluble compounds, may have advantages over tocilizumab as an IL-6 immunomodulator by potentially reducing the pro-inflammatory effects, but avoiding the deleterious effects on the anti-inflammatory actions of IL-6 in patients with COVID-19[2]. Additionally, vitamin D could modulate the innate and adaptive immune responses, and its deficiency is associated with increased morbidity and mortality in SARS-CoV-2 infection[3]. Vitamin D status may be a potential predictor of COVID-19 outcomes, and vitamin D supplementation could be a promising therapeutic and preventive method against COVID-19, due to its high cost-effectiveness; safety; tolerability; and anti-thrombotic, anti-inflammatory, antiviral, and immunomodulatory properties[3,4].

Another published article in your journal by Gkoufa et al[5] entitled “Elderly adults with COVID-19 admitted to intensive care unit: A narrative review” found that diabetes and hypercholesterolemia were common comorbidities in older patients with COVID-19 and these comorbidities were often associated with worse clinical outcome. Previous studies also showed that vitamin D deficiency was associated with diabetes and dyslipidaemia[6,7]. Unfortunately, about 30%-50% of people in the world have vitamin D deficiency or insufficiency, and vitamin D deficiency has been a global health problem[8]. Singh et al[3] reviewed the evidence of vitamin D deficiency in patients with diabetes and COVID-19, and they proposed that diabetes increased the tendency for infection and COVID-19, vitamin D deficiency was linked to both diabetes and an increased risk of infections, including COVID-19, and vitamin D supplementation may be a safe, cheap, and simple adjuvant therapy in patients with diabetes and COVID-19. Verdoia et al[4] reviewed the mechanisms of action of vitamin D and its potential interaction with SARS-CoV-2 infection, and they reported that vitamin D plays an important protective role in the cardiovascular system, immune system, respiratory system, and glucose-lipid metabolism. Therefore, we hypothesize that vitamin D status has prognostic significance in diabetes and dyslipidaemia, and vitamin D supplementation could exert a triple preventive and therapeutic effect in patients with diabetes, dyslipidaemia, and COVID-19.

In summary, diabetes and dyslipidaemia are common comorbidities in patients with COVID-19. Patients with diabetes and dyslipidaemia are more prone to SARS-CoV-2 infection, and they have poor clinical outcomes. Vitamin D may be a potential prognostic factor and could be a promising preventive measure and treatment for patients with diabetes, dyslipidaemia, and COVID-19. Notably, hypervitaminosis D is a rare but potentially serious condition, and it should be avoided when recommending fat-soluble vitamin D supplementation in the era of COVID-19[9]. Certainly, more robust studies are still required to ascertain the prognostic significance and one-arrow three-vulture effect of vitamin D in patients with diabetes, dyslipidaemia, and COVID-19.

ACKNOWLEDGEMENTS

We thank all colleagues, the reviewers, and the editors for improving our paper.

Footnotes

Provenance and peer review: Invited article; externally peer reviewed.

Peer-review model: Single blind

Specialty type: Nutrition and dietetics

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B, B

Grade C (Good): 0

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Khan MKA, Sivanand N S-Editor: Liu JH L-Editor: Wang TQ P-Editor: Liu JH

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