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Review
. 2022 Dec:22:100319.
doi: 10.1016/j.phanu.2022.100319. Epub 2022 Oct 14.

Vitamin D status can affect COVID-19 outcomes also in pediatric population

Michele Miraglia Del Giudice  1 , Cristiana Indolfi  1 , Giulio Dinardo  1 , Fabio Decimo  1 , Alberto Decimo  2 , Angela Klain  1
Affiliations
Review

Vitamin D status can affect COVID-19 outcomes also in pediatric population

Michele Miraglia Del Giudice et al. PharmaNutrition. 2022 Dec.

Abstract

Background: vitamin D influences the immune system and the inflammatory response. It is known that vitamin D supplementation reduces the risk of acute respiratory tract infection. In the last two years, many researchers have investigated vitamin D's role in the pathophysiology of COVID-19 disease.

Results: the findings obtained from clinical trials and systematic reviews highlight that most patients with COVID-19 have decreased vitamin D levels and low levels of vitamin D increase the risk of severe disease. This evidence seems to be also confirmed in the pediatric population.

Conclusions: further studies (systematic review and meta-analysis) conducted on children are needed to confirm that vitamin D affects COVID-19 outcomes and to determine the effectiveness of supplementation and the appropriate dose, duration and mode of administration.

Keywords: , IFN-γ, reduce interferon-gamma; , RAS, renin-angiotensin system; ACE2, angiotensin-converting enzyme 2; CI, confidence interval; COVID-19; Children; DAMPs, damage-associated molecular patterns; DCs, dendritic cells; HR, Hazard Risk; ICU, intensive care unit; IL, interleukin; IgE, immunoglobulin E; Immunity; MD, mean difference; NK, natural killer; OR, odds ratio; PAMPs, pathogen-associated molecular patterns; PRRs, pattern recognition receptors; RCTs, randomized control trials; RR, risk ratio; SARS-CoV-2 infection; TLRs, Toll-like receptors; TNF-α, tumor necrosis factor-α; Treg cells, CD, regulatory T cellcluster of differentiation; VDRs, vitamin D receptors; Vitamin D.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Graphical abstract
Fig. 1
Fig. 1
Comparison of the immune response induced by vitamin D administration and SARS-CoV-2 infection. Vitamin D increases the production of Toll-like receptors (TLRs), IL-10 (anti-inflammatory cytokine) and Treg cells (regulatory T cell), while the release of Th1 and Th17 inducing cytokines, interleukin (IL)− 12 and IL-23, is inhibited. In the COVID-19 pathogenesis, pattern recognition receptors (PRRs), which include TLRs, are used by innate immune cells to recognize the pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) found on virus particles. This mechanism triggers local inflammation and the release of cytokines and chemokines such as IFN- γ (interferon-gamma), IL-6, MCP1, and IP-10. IFN- γ, tumor necrosis factor (TNF), and IL-2 chemokines are expressed on SARS-CoV-2-specific CD4 + T cells, which promote the activation of the Th1 immune response and cell-mediated immunity.
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