Evidence for the Efficacy of a High Dose of Vitamin D on the Hyperinflammation State in Moderate-to-Severe COVID-19 Patients: A Randomized Clinical Trial.

Medicina (Kaunas, Lithuania). 2022;58(10)
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Vitamin D insufficiency is an example of the factors which may affect snowballed COVID-19 risk and mortality. The aim of this study was to determine whether the clinical results and prognoses of COVID-19 patients are enhanced by supplementing a high dose of vitamin D relative to the conventional low dose. This study is a randomised controlled trial of 116 patients. Participants were randomly assigned to one of the two groups i.e. 58 patients received treatment with low-dose vitamin D and 58 received treatment with high-dose vitamin D. Results show that the incidence of mechanical ventilation, intensive care unit hospitalisation, death, sepsis, and atrial fibrillation in the high-dosage vitamin D group was considerably reduced compared to the low-dosage vitamin D group. However, the need for high oxygen was significantly higher in the high-dose vitamin D group compared to the low-dose group. Additionally, there was a significant difference in the monitored parameters before and after treatment in favour of the high-dose vitamin D group, which were significantly lower in the high-dose vitamin D group compared to the low-dose group. Authors conclude that the sooner micronutrients are administered to outpatients, the better the outcome, especially before supportive or specific treatment is commenced.


Background and Objectives: Vitamin D supplementation plays a key effect in lowering cytokine storms among COVID-19 patients by influencing the activity of the renin-angiotensin system and the production of the angiotensin-2 converting enzyme. The study was conducted to explore the effect of high-dose intramuscular vitamin D in hospitalized adults infected with moderate-to-severe SARS-CoV-2 in comparison with the standard of care in the COVID-19 protocol. Materials and Methods: Two groups of patients were compared in this prospective randomized controlled trial as the vitamin D was administered orally to group 1 (alfacalcidol 1 mcg/day) and intramuscularly to group 2 (cholecalciferol 200,000 IU). One hundred and sixteen participants were recruited in total, with fifty-eight patients in each group. Following the Egyptian Ministry of Health's policy for COVID-19 management, all patients received the same treatment for a minimum of five days. Results: A significant difference was recorded in the length of hospital stay (8.6 versus 6.8 days), need for high oxygen or non-invasive mechanical ventilator (67% versus 33%), need for a mechanical ventilator (25% versus 75%), clinical improvement (45% versus 55%), the occurrence of sepsis (35% versus 65%), and in the monitored laboratory parameters in favor of high-dose vitamin D. Moreover, clinical improvement was significantly associated with the need for low/high oxygen, an invasive/non-invasive mechanical ventilator (MV/NIMV), and diabetes, while mortality was associated with the need for MV, ICU admission, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and the occurrence of secondary infection. Conclusions: Our study showed that high-dose vitamin D was considered a promising treatment in the suppression of cytokine storms among COVID-19 patients and was associated with better clinical improvement and fewer adverse outcomes compared to low-dose vitamin D.

Lifestyle medicine

Fundamental Clinical Imbalances : Immune and inflammation
Patient Centred Factors : Mediators/COVID-19
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Blood

Methodological quality

Jadad score : 3
Allocation concealment : Yes


Nutrition Evidence keywords : Vitamin D ; Inflammation