预测维生素 D 状态、维生素 D 摄入量与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和 2019 年冠状病毒病（COVID-19）严重程度风险之间的关联。
Associations between predicted vitamin D status, vitamin D intake, and risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) severity.
机构信息
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
Am J Clin Nutr. 2022 Apr 1;115(4):1123-1133. doi: 10.1093/ajcn/nqab389.
BACKGROUND
Vitamin D may have a role in immune responses to viral infections. However, data on the association between vitamin D and severe acute respiratory syndrome coronavirus 2 (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.
METHODS
We used data from periodic surveys (May 2020 to March 2021) within the Nurses' Health Study II. Among 39,315 participants, 1768 reported a positive test for SARS-CoV-2 infection. Usual vitamin D intake from foods and supplements were measured using a semiquantitative, pre-pandemic food-frequency questionnaire in 2015. Predicted 25-hydroxyvitamin D [25(OH)D] concentration were calculated based on a previously validated model including dietary and supplementary vitamin D intake, UV-B, and other behavioral predictors of vitamin D status.
RESULTS
Higher predicted 25(OH)D concentrations, 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 concentrations with the lowest, the multivariable-adjusted OR was 0.76 (95% CI: 0.58, 0.99; P-trend = 0.04). Participants in the highest quartile of UV-B (OR: 0.76; 95% CI: 0.66, 0.87; P-trend = 0.002) and UV-A (OR: 0.76; 95% CI: 0.66, 0.88; P-trend < 0.001) also had a lower risk of SARS-CoV-2 infection compared with 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 concentrations 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 UV-B or UV-A, independently of vitamin D and SARS-CoV-2 infection, so results for predicted 25(OH)D need to be interpreted cautiously.
背景
维生素 D 可能在病毒感染的免疫反应中发挥作用。然而，关于维生素 D 与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和 2019 年冠状病毒病（COVID-19）严重程度之间的关联的数据一直有限且不一致。
目的
我们研究了预测的维生素 D 状况和摄入量与 SARS-CoV-2 感染和 COVID-19 严重程度的风险之间的关联。
方法
我们使用了护士健康研究 II 中定期调查（2020 年 5 月至 2021 年 3 月）的数据。在 39315 名参与者中，有 1768 人报告 SARS-CoV-2 感染检测呈阳性。2015 年使用半定量、大流行前食物频率问卷测量了来自食物和补充剂的维生素 D 常规摄入量。根据先前验证的模型，计算了预测的 25-羟维生素 D [25（OH）D] 浓度，该模型包括膳食和补充维生素 D 摄入量、UV-B 和其他维生素 D 状态的行为预测因子。
结果
较高的预测 25（OH）D 浓度，而不是维生素 D 摄入量，与 SARS-CoV-2 感染风险降低相关。与最低五分位数相比，将最高五分位数的预测 25（OH）D 浓度的参与者进行比较，多变量调整后的 OR 为 0.76（95%CI：0.58，0.99；P 趋势=0.04）。与最低五分位数相比，处于最高四分位数的 UV-B（OR：0.76；95%CI：0.66，0.87；P 趋势=0.002）和 UV-A（OR：0.76；95%CI：0.66，0.88；P 趋势<0.001）的参与者 SARS-CoV-2 感染风险也较低。高剂量的维生素 D 补充剂（≥400IU/d）与住院风险降低相关（OR：0.51；95%CI：0.29，0.91；P 趋势=0.04）。
结论
我们的研究提供了关于循环 25（OH）D 浓度升高与 SARS-CoV-2 感染风险降低之间关联的提示性证据。维生素 D 补充剂摄入量较高与住院风险降低相关。我们的数据还支持 UV-B 或 UV-A 暴露与维生素 D 和 SARS-CoV-2 感染独立相关，因此需要谨慎解释预测 25（OH）D 的结果。
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