Insufficient Levels of Vitamin D and Zinc May Increase Severity of Symptoms in Adults Infected with COVID-19

by | Dec 9, 2021 | 2021, COVID-19, Vitamin D - Infections & Immunity, Zinc

Written by Taylor Woosley, Staff Writer. Study results show that infected participants with deficient levels of vitamin D and zinc experience higher severity of general and pulmonary symptoms of COVID-19 compared to participants with adequate vitamin D and zinc serum levels.

Covid-19 - maskCoronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an infectious disease resulting in symptoms including fatigue, fever, headache, loss of taste and smell, shortness of breath, coughing, and pneumonia 1. People with severe symptoms may experience excessive activation of the immune system with progressive inflammation and a cytokine storm from overactivated cells, particularly in the airways 2. Previous studies have shown the importance of specific micronutrients to combat the severity of symptoms relating to COVID-19, with an emphasis on vitamin D and zinc 3. Vitamin D deficiency is prevalent worldwide and is associated with an increased risk in infectious diseases 4. Vitamin D acts as a mediator in the immune system and can stimulate the production of antimicrobial peptides that combat various microorganisms, including bacteria, viruses, and fungi 5. Additionally, zinc deficiency is common worldwide, with over 2 billion people having insufficient zinc levels 6. The micronutrient zinc plays a crucial role in the maintenance and development of immune cells, along with its role in maintaining adequate levels of natural killer cells which aid in defending against viral infections 7.

In this cross-sectional and descriptive-analytical study, researchers compared outpatients infected with COVID-19 to potentially non-infected study participants through comparisons of baseline comorbidities, demographics such as education and BMI, and serum concentrations of zinc and vitamin D observed on the second and seventh day of the disease. For those who tested positive for COVID-19, confirmed using reverse transcription-polymerase chain reaction (RT-PCR) testing, these participants were further evaluated from day 1 to day 28 to analyze the effect of vitamin D and zinc status on the disease symptom progression. Vitamin D levels were determined through blood tests to measure the total concentration of 25-hydroxyvitamin D (25(OH)D) after 8 hours of fasting. Zinc levels were evaluated with a fully automated analyzer following a direct colorimetric method to calculate zinc levels in the serum samples.

A total of 106 participants (53 infected and 53 non-infected) completed the follow-up and analysis for the study. Of the 53 infected, 68% of them were male (mean age=41 years). The non-infected participants were 72% male (mean age=40 years). Participants were further matched for comparison based on age and sex. The results were as follows:

  • Respiratory rates (RR) were significantly higher in infected participants compared to non-infected participants (p=0.001).
  • Oxygen saturation (SpO2), a measurement to determine blood oxygen levels, was lower among infected participants compared to non-infected participants (p=0.03).
  • Infected patients (101±18µg/dL) showed a significantly lower serum concentration of zinc compared to non-infected participants (114 ± 13 µg/dL) (p=0.013).
  • Patients with sufficient (odds ratio (OR), 0.19; p ≤ 0.001) and insufficient (OR, 0.3; p = 0.007) vitamin D serum levels at the second and seventh days of disease had a decreased odds ratio of general disease symptoms compared to patient with deficient vitamin D levels.
  • Participants with adequate vitamin D levels were less likely to experience general symptoms and pulmonary symptoms than patients with vitamin D deficiency with ORs of 0.10 (95% CI, 0.04–0.24; p ≤ 0.001) and 0.27 (95% CI, 0.07–0.99; p = 0.05), respectively.

In conclusion, these results suggest that vitamin D status may play a role in the severity of COVID-19 and the progression of symptoms throughout the disease’s course. The findings show that severe vitamin D deficiency is associated with the progression of general and pulmonary symptoms. Although zinc is important for immune function due to its immunomodulating abilities, more research needs to be done to further understand its potential therapeutic use for combatting symptoms of COVID-19. The research does suggest the potential importance of vitamin D ((25(OH)D)) and zinc supplementation to offset the severity of COVID-19 symptoms in people with inadequate zinc and vitamin D serum levels. Limitations of the study include the small sample size, a lack of a proper nutritional assessment to better understand if other nutrient deficiencies played a role in the severity of symptoms, and the possibility of recall bias due to data of clinical symptoms being self-reported.

Source: Golabi, Sahar, Maryam Adelipour, Sara Mobarak, Maghsud Piri, Maryam Seyedtabib, Reza Bagheri, Katsuhiko Suzuki, Damoon Ashtary-Larky, Fatemeh Maghsoudi, and Mahshid Naghashpour. “The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study.” Nutrients 13, no. 10 (2021): 3368.

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Click here to read the full text study.

Posted December 9, 2021.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Han HJ, Nwagwu C, Anyim O, Ekweremadu C, Kim S. COVID-19 and cancer: From basic mechanisms to vaccine development using nanotechnology. Int Immunopharmacol. Jan 2021;90:107247. doi:10.1016/j.intimp.2020.107247
  2. Alexander J, Tinkov A, Strand TA, Alehagen U, Skalny A, Aaseth J. Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19. Nutrients. Aug 7 2020;12(8)doi:10.3390/nu12082358
  3. Elham AS, Azam K, Azam J, Mostafa L, Nasrin B, Marzieh N. Serum vitamin D, calcium, and zinc levels in patients with COVID-19. Clin Nutr ESPEN. Jun 2021;43:276-282. doi:10.1016/j.clnesp.2021.03.040
  4. Merker M, Amsler A, Pereira R, et al. Vitamin D deficiency is highly prevalent in malnourished inpatients and associated with higher mortality: A prospective cohort study. Medicine (Baltimore). Nov 2019;98(48):e18113. doi:10.1097/md.0000000000018113
  5. Bae M, Kim H. Mini-Review on the Roles of Vitamin C, Vitamin D, and Selenium in the Immune System against COVID-19. Molecules. Nov 16 2020;25(22)doi:10.3390/molecules25225346
  6. Joachimiak MP. Zinc against COVID-19? Symptom surveillance and deficiency risk groups. PLoS Negl Trop Dis. Jan 2021;15(1):e0008895. doi:10.1371/journal.pntd.0008895
  7. Lordan R, Rando HM, Greene CS. Dietary Supplements and Nutraceuticals under Investigation for COVID-19 Prevention and Treatment. mSystems. May 4 2021;6(3)doi:10.1128/mSystems.00122-21