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Deficiency of Vitamin D is very common in Pakistan, even among healthy asymptomatic individuals [1], [2]. Recent studies have shown that the risk of contracting COVID-19 was increased to two-fold, and consequent mortality to 4-fold if the person is Vitamin D deficient [3]. Health care workers including the nursing and administration staff are at a high risk of contracting SARS-CoV2 due to increased regular exposure in a health care setting [4]. Consequently, a convergence of the COVID-19 pandemic, the deficiency of Vitamin D, and the increased exposure can render the health care workers at an additional risk to COVID-19 infection. Our objective was to determine the prevalence of vitamin D deficiency in healthy asymptomatic front-line health care workers and to analyze the change in serum level by loading oral dose of SunnyD STAT softgel capsules (200000 IU Vitamin D3). We followed single centered, cross-sectional, cohort study with subsequent randomized placebo-controlled design for supplementation and follow up. Serum level of 25-hydroxyvitamin D (25OHD) was the main outcome variable, with anthropometric data, nutritional intake, and lifestyle variables analyzed for potential association as risk factors for the outcome. Severe Vitamin D deficiency was found to be prevalent among front line health care workers in this urban hospital-based sample. Serum level of Vitamin D was found to be significantly associated with designation and presence of high blood pressure. The likelihood of increased serum Vitamin D levels was observed with increasing monthly income, higher designation, increasing age and supplementation intake. Mean increase in the serum 25(OH)D3 level after 2 doses of SunnyD STAT softgel capsule (200000 IU Vitamin D3) was 34.22 ng/ml. Public health interventions regarding Vitamin D supplementation and awareness are needed, especially amid COVID-19 pandemicDeficiency of Vitamin D is very common in Pakistan, even among healthy asymptomatic individuals [1], [2]. Recent studies have shown that the risk of contracting COVID-19 was increased to two-fold, and consequent mortality to 4-fold if the person is Vitamin D deficient [3]. Health care workers including the nursing and administration staff are at a high risk of contracting SARS-CoV2 due to increased regular exposure in a health care setting [4]. Consequently, a convergence of the COVID-19 pandemic, the deficiency of Vitamin D, and the increased exposure can render the health care workers at an additional risk to COVID-19 infection. Our objective was to determine the prevalence of vitamin D deficiency in healthy asymptomatic front-line health care workers and to analyze the change in serum level by loading oral dose of SunnyD STAT softgel capsules (200000 IU Vitamin D3). We followed single centered, cross-sectional, cohort study with subsequent randomized placebo-controlled design for supplementation and follow up. Serum level of 25-hydroxyvitamin D (25OHD) was the main outcome variable, with anthropometric data, nutritional intake, and lifestyle variables analyzed for potential association as risk factors for the outcome. Severe Vitamin D deficiency was found to be prevalent among front line health care workers in this urban hospital-based sample. Serum level of Vitamin D was found to be significantly associated with designation and presence of high blood pressure. The likelihood of increased serum Vitamin D levels was observed with increasing monthly income, higher designation, increasing age and supplementation intake. Mean increase in the serum 25(OH)D3 level after 2 doses of SunnyD STAT softgel capsule (200000 IU Vitamin D3) was 34.22 ng/ml. Public health interventions regarding Vitamin D supplementation and awareness are needed, especially amid COVID-19 pandemic.

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References

  1. Iqbal, Khalida, et al. "Relationship of sociodemographic factors with serum levels of vitamin D in a healthy population of Pakistan." Pakistan journal of pharmaceutical sciences 32.1 (2019): 29.
     Google Scholar
  2. Syed, Faiza, et al. "Vitamin D deficiency in Pakistani population: critical overview from 2008 to 2018." Nutrition & Food Science (2019).
     Google Scholar
  3. De Smet, Dieter, et al. "Serum 25 (OH) D level on hospital admission associated with COVID-19 stage and mortality." American journal of clinical pathology (2020).
     Google Scholar
  4. Cubitt, Lyndsey Jayne, et al. "Beyond PPE: a mixed qualitative–quantitative study capturing the wider issues affecting doctors’ well-being during the COVID-19 pandemic." BMJ open 11.3 (2021): e050223.
     Google Scholar
  5. Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol. 2009;158:20–5.
     Google Scholar
  6. Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients.
     Google Scholar
  7. Xu J, Yang J, Chen J, Luo Q, Zhang Q, Zhang H. Vitamin D alleviates lipopolysaccharide induced acute lung injury via regulation of the renin angiotensin system
     Google Scholar
  8. Hansdottir S, Monick MM. Vitamin D effects on lung immunity and respiratory diseases. Vitam Horm. 2011;86:217–37.
     Google Scholar
  9. Bombardini T, Picano E. Angiotensin converting enzyme 2 as the molecular bridge between epidemiologic and clinical features of COVID-19. Can J Cardiol. 2020.
     Google Scholar
  10. Rehan VK, Torday JS, Peleg S, Gennaro L, Vouros P, Padbury J, et al. 1Alpha,25-dihydroxy-3-epi-vitamin D3, a natural metabolite of 1alpha,25-dihydroxy vitamin D3: production and biological activity studies in pulmonary alveolar type II cells. Mol Genet Metab. 2002;76:46–56.
     Google Scholar
  11. Phokela SS, Peleg S, Moya FR, Alcorn JL. Regulation of human pulmonary surfactant protein gene expression by 1alpha,25-dihydroxyvitamin D3. Am J Physiol Lung Cell Mol Physiol. 2005;289:617–26.
     Google Scholar
  12. De Smet, Dieter, et al. "Serum 25 (OH) D level on hospital admission associated with COVID-19 stage and mortality." American journal of clinical pathology (2020).
     Google Scholar
  13. Castillo, Marta Entrenas, et al. "Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study." The Journal of steroid biochemistry and molecular biology 203 (2020): 105751.
     Google Scholar
  14. Holick MF. Vitamin D Deficiency. N Engl J Med 2007; 357: 266-81.
     Google Scholar
  15. Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 2005; 26: 662-87.
     Google Scholar
  16. Hollick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008; 87: 1080S-6S.
     Google Scholar
  17. Riaz, H., et al. "Prevalence of Vitamin D deficiency in Pakistan and implications for the future." Expert review of clinical pharmacology 9.2 (2016): 329-338.
     Google Scholar
  18. Zuberi LM, Habib A, Haque N, Jabbar A. Vitamin D deficiency in ambulatory patients. J Pak Med Assoc 2008; 58: 482-4.
     Google Scholar
  19. Baig A, Anjum P, Khani MK, Islam N, Rahman A. Pattern of serum Vitamin D in OPD patients. Pak J Surg 2007; 23: 145-9.
     Google Scholar
  20. Rab SM. Occult osteomalacia amongst health and pregnant women in Pakistan. Lancet 1976; 2: 1211-3.
     Google Scholar
  21. Atiq M, Suria A, Nizami SQ, Ahmed I. Maternal Vitamin D deficiency in Pakistan. Acta Obstet Gynaecol Scand 1998; 77, 970-3.
     Google Scholar
  22. Sahibzada AS, Khan MS, Javed M. Presentation of osteomalacia in Kohistani women. J Ayub Med Coll Abottabad 2004; 16: 63-5.
     Google Scholar
  23. van Groningen, Lenneke, et al. "Cholecalciferol loading dose guideline for vitamin D-deficient adults." European Journal of Endocrinology 162.4 (2010): 805-811. Accessed on 12th February 2021 via https://eje.bioscientifica.com/view/journals/eje/162/4/805.xml.
     Google Scholar
  24. Syed, Faiza, et al. "Vitamin D deficiency in Pakistani population: critical overview from 2008 to 2018." Nutrition & Food Science (2019): Kandhro, Farhatullah, et al. "Study of Vitamin D deficiency and contributing factors in the population of Hyderabad, Pakistan." Pakistan Journal of Pharmaceutical Sciences 32.3 (2019).
     Google Scholar
  25. Iqbal, Khalida, et al. "Relationship of sociodemographic factors with serum levels of vitamin D in a healthy population of Pakistan." Pakistan journal of pharmaceutical sciences 32.1 (2019): 29.
     Google Scholar
  26. Meltzer, David O., et al. "Association of Vitamin D Levels, Race/Ethnicity, and Clinical Characteristics With COVID-19 Test Results." JAMA network open 4.3 (2021): e214117-e214117.
     Google Scholar
  27. Wang, Li-Kai, et al. "Age, Gender and Season Are Good Predictors of Vitamin D Status Independent of Body Mass Index in Office Workers in a SubtropicalRegion." Nutrients 12.9 (2020): 2719.
     Google Scholar
  28. Al Zarooni, Amal Abdul Rahim, et al. "Prevalence of vitamin D deficiency and associated comorbidities among Abu Dhabi Emirates population." BMC research notes 12.1 (2019): 1-6.
     Google Scholar
  29. Mohn, Emily S., et al. "Evidence of drug–nutrient interactions with chronic use of commonly prescribed medications: An update." Pharmaceutics 10.1 (2018): 36.
     Google Scholar
  30. Vitamin D. Mayo Clinic. (2021). Retrieved 28 June 2021, from https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-20363792.
     Google Scholar
  31. Özdemir, Abdurrahman Avar, et al. "Vitamin D deficiency in pregnant women and their infants." Journal of clinical research in pediatric endocrinology 10.1 (2018): 44.
     Google Scholar
  32. Dharmshaktu, Pramila, et al. "Absence of vitamin D deficiency among common outdoor workers in Delhi." Clinical endocrinology 91.2 (2019): 356-362.
     Google Scholar
  33. O'sullivan, Fiona, et al. "Ambient UVB dose and sun enjoyment are important predictors of vitamin D status in an older population." The Journal of nutrition 147.5 (2017): 858-868.
     Google Scholar
  34. Jacob Schor, N. D. "Heliophobia: Fear of the Sun."
     Google Scholar
  35. Grant, William B., Harjit P. Bhattoa, and Pawel Pludowski. "Determinants of vitamin D deficiency from Sun exposure: a global perspective." Vitamin D. Academic Press, 2018. 79-90.
     Google Scholar
  36. Harkness, Laura S., and Barbara A. Cromer. "Vitamin D deficiency in adolescent females." Journal of adolescent health 37.1 (2005): 75.
     Google Scholar
  37. Mosekilde, Leif. "Vitamin D and the elderly." Clinical endocrinology 62.3 (2005): 265-281.
     Google Scholar
  38. Kweder, Hasan, and Housam Eidi. "Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status." Avicenna journal of medicine 8.4 (2018): 139.
     Google Scholar