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      Does Vitamin D play a role in the management of Covid-19 in Brazil?

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          The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.

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          Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors.

          In order to evaluate the prevalence, risk factors, and clinical consequences of hypovitaminosis D in elderly Italian women a multicenter study of 43 osteoporosis centers from all regions of Italy was carried out. Study population included 700 women aged 60-80 years in whom blood was taken for 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) measurements. All subjects were also questioned to assess the prevalence of several risk factors for hypovitaminosis D, osteoporotic fractures and activities of daily living (ADL). Values of 25OHD lower than 5 ng/ml were found in 27% of the women and lower than 12 ng/ml in 76%. 25OHD and PTH levels were negatively correlated ( r=-0.38, after logarithmic transformation of both variables). 25OHD levels significantly declined with advancing age and number of pregnancies and were positively correlated with educational level (years spent at school), dairy calcium intake, and days spent on holiday by the sea. In a multivariate model including all these variables, the only one that remained significant was the level of education. The lowest age-adjusted 25OH D levels were found in smokers or in women living in central Italy as compared with those living in northern or southern Italy. The mean (+/-SD) age-adjusted 25OH D values were significantly lower in women who sustained a hip fracture (7.1+/-2.2 versus 11.0+/-9.9). Women with low 25OHD levels (<12 ng/ml) had worse scores for ADL and mobility ADL (move outdoors, use stairs, walk at least 400 m, carry a heavy object). Vitamin D deficiency is extremely common among elderly Italian women. Women with lower educational level, living in central Italy, smokers or with lower intake of dairy products are at greater risk. Hypovitaminosis D is associated with worsening of the ability to perform activities of daily living and higher hip fracture prevalence. This finding should lead to an urgent population-based strategy to remedy this condition.
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            The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D From the Institute of Medicine: What Clinicians Need to Know

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              Vitamin D deficiency: a global perspective

              Vitamin D is essential for the maintenance of good health. Its sources can be skin production and diet intake. Most humans depend on sunlight exposure (UVB 290­315 nm) to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by the skin, leading to transformation of 7-dehydrocholesterol into vitamin D3 (cholecalciferol). Season, latitude, time of day, skin pigmentation, aging, sunscreen use, all influence the cutaneous production of vitamin D3. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate. The prevalence of hypovitaminosis D is considerable even in low latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis. Although severe vitamin D deficiency leading to rickets or osteomalacia is rare in Brazil, there is accumulating evidence of the frequent occurrence of subclinical vitamin D deficiency, especially in elderly people.

                Author and article information

                Rev Saude Publica
                Rev Saude Publica
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                22 May 2020
                : 54
                [I ] orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Departamento de Saúde Ambiental São Paulo SP Brasil originalUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Saúde Ambiental. São Paulo, SP, Brasil
                [II ] orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Programa de Pós-Graduação em Saúde Global e Sustentabilidade São Paulo SP Brasil originalUniversidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Saúde Global e Sustentabilidade. São Paulo, SP, Brasil
                [III ] orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Departamento de Nutrição São Paulo SP Brasil originalUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
                [IV ] orgnameUniversity of Surrey orgdiv1School of Biosciences and Medicine orgdiv2Faculty of Health and Medical Sciences Guildford Surrey United Kingdom originalUniversity of Surrey. School of Biosciences and Medicine. Faculty of Health and Medical Sciences. Department of Nutritional Sciences. Guildford, Surrey, United Kingdom
                [V ] orgnameUniversity of Wollongong orgdiv1School of Medicine orgdiv2Faculty of Science Wollongong Australia originalUniversity of Wollongong. School of Medicine. Faculty of Science. Medicine and Health. Nutrition and Dietetics. Wollongong, Australia
                Author notes
                Correspondência: Helena Ribeiro Universidade de São Paulo Faculdade de Saúde Pública Departamento de Saúde Ambiental Av. Dr. Arnaldo, 715 01246-904 São Paulo, SP, Brasil E-mail: lena@ 123456usp.br

                Authors’ Contribution: Work’s design, analysis, interpretation, and writing: HR. Manuscript draft writing: KVSS, SLO. Writing of the final manuscript: HR, KVSS, SLO, PHCR, MMM, KC, SLN. Final Approval: HR, KVSS, SLO, PHCR, MMM, KC, SLN.

                Conflict of Interest: The authors declare no conflict of interest.


                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26
                Funded by: University Global Partnership Network
                Award ID: 2017
                Funding. UGPN - University Global Partnership Network, Research Collaboration Fund (RCF 2017) Healthy Living for Healthy Ageing: a Global Focus. Award received in 2018. Capes PhD scholarship for KVSS. Capes PNPD scholarship for SLO. CNPq productivity grant 1A for HR.


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