Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers

Sebastian T Lugg; William R Mackay; Aduragbemi A Faniyi; Sian E Faustini; Craig Webster; Joanne E Duffy; Martin Hewison; Adrian M Shields; Dhruv Parekh; Alex G Richter; Aaron Scott; David R Thickett

doi:10.1136/bmjresp-2022-001258

Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers

Sebastian T Lugg, William R Mackay, Aduragbemi A Faniyi, Sian E Faustini, Craig Webster, Joanne E Duffy, Martin Hewison, Adrian M Shields, Dhruv Parekh, Alex G Richter, Aaron Scott, David R Thickett^*

^*Corresponding author for this work

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Abstract

Background There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. Methods The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D 3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). Results When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m 2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). Conclusions Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.

Original language	English
Article number	e001258
Number of pages	10
Journal	BMJ Open Respiratory Research
Volume	9
Issue number	1
Early online date	27 Sept 2022
DOIs	https://doi.org/10.1136/bmjresp-2022-001258
Publication status	Published - 27 Sept 2022

Bibliographical note

Funding Information:
Research support was provided by the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. Laboratory work was done at the Clinical Immunology Service of the University of Birmingham and the Biochemistry department within the University Hospitals Birmingham NHS Foundation Trust.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

COVID-19
respiratory infection
viral infection

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

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Lugg, S. T., Mackay, W. R., Faniyi, A. A., Faustini, S. E., Webster, C., Duffy, J. E., Hewison, M., Shields, A. M., Parekh, D., Richter, A. G., Scott, A., & Thickett, D. R. (2022). Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers. BMJ Open Respiratory Research, 9(1), Article e001258. Advance online publication. https://doi.org/10.1136/bmjresp-2022-001258

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title = "Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers",

abstract = "Background There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. Methods The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D 3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). Results When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m 2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). Conclusions Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.",

keywords = "COVID-19, respiratory infection, viral infection",

author = "Lugg, {Sebastian T} and Mackay, {William R} and Faniyi, {Aduragbemi A} and Faustini, {Sian E} and Craig Webster and Duffy, {Joanne E} and Martin Hewison and Shields, {Adrian M} and Dhruv Parekh and Richter, {Alex G} and Aaron Scott and Thickett, {David R}",

note = "Funding Information: Research support was provided by the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. Laboratory work was done at the Clinical Immunology Service of the University of Birmingham and the Biochemistry department within the University Hospitals Birmingham NHS Foundation Trust. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = sep,

day = "27",

doi = "10.1136/bmjresp-2022-001258",

language = "English",

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T2 - a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers

AU - Lugg, Sebastian T

AU - Mackay, William R

AU - Faniyi, Aduragbemi A

AU - Faustini, Sian E

AU - Webster, Craig

AU - Duffy, Joanne E

AU - Hewison, Martin

AU - Shields, Adrian M

AU - Parekh, Dhruv

AU - Richter, Alex G

AU - Scott, Aaron

AU - Thickett, David R

N1 - Funding Information: Research support was provided by the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. Laboratory work was done at the Clinical Immunology Service of the University of Birmingham and the Biochemistry department within the University Hospitals Birmingham NHS Foundation Trust. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/9/27

Y1 - 2022/9/27

N2 - Background There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. Methods The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D 3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). Results When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m 2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). Conclusions Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.

AB - Background There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. Methods The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D 3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). Results When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m 2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). Conclusions Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.

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KW - respiratory infection

KW - viral infection

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ER -

Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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