生物与医学2020mdpi.com
维生素D不足可能解释近90%的新冠死亡
Vitamin D insufficiency may account for almost 90% of Covid-19 deaths
进阶 · 约 30 分钟读完前置知识：流行病学基础、观察性研究与混杂因素、维生素D生理基础
导读
这篇论文探讨维生素D不足与COVID-19死亡率之间的关系，并提出维生素D不足可能解释近90%的COVID-19死亡。需要强调，这属于观察性/相关性证据，评论指出无法排除整体健康状况等混杂因素。
HN 关注点：维生素D补充是否能防COVID，以及“近九成死亡”这类强表述是否只是相关性或生态学推断。
HN 评论精选
这几条评论里：质疑 1 补充 1 亲历 2
亲历亲历：全家补D3并晒太阳，N=1未感染，强调剂量安全和日照吸收差异。
当第三篇支持性预印本在4月底发布时，我开始给年迈的母亲补充D3；5月更多论文出来后，我又让全家开始补。查过剂量，除非长期超大剂量，否则很难过量，不良反应/相互作用也少见。我们按年龄/体重每天补约5000–10000 IU（含复合维生素中的量；IU不等于mg），并尽量每天晒20–30分钟太阳。N=1，但迄今家里没人感染COVID-19，甚至没有流感样症状，尽管有过可能暴露。上个月验血D3为89（检测正常范围约30–100）。研究显示膳食补充有效，但一些专家认为阳光生成的D可能以不同方式吸收，所以两者都获取最理想；日照补充随暴露时长×皮肤面积×强度变化，时间少可用更大面积和/或正午弥补；纬度、海拔和颗粒物污染也有影响；家中/车内普通玻璃和某些防晒会阻挡相关UV。仍应咨询医生，好东西未必越多越好。
mrandish查看英文原文
When the third supportive pre-print paper was released in late April I started my elderly mother on a D3 supplement. As more papers came out in May I started my whole family on it. I read up on dosing and it's pretty hard to overdose unless megadosing over a sustained period of time and negative reactions/interactions are rare. We've been supplementing ~5k to 10k IU daily (total, incl any multi-vitamins) depending on age/body weight (note: IU is not the same as mg). We also try to get 20-30m a day of actual sun exposure when possible. N=1 but so far no one in my family as gotten CV19 or even had any ILI symptoms despite some probable exposure. I got my blood run last month and my D3 is at 89mL (normal range is ~30-100 on my provider's test). While dietary supplementation is shown to be effective in studies, keep in mind that some experts believe sunlight generated D may be absorbed differently in ways that might matter, so getting some of both is ideal if possible. Sunlight supplementation scales with exposure duration * skin area * intensity, so less time can be partly offset with more area and/or peak time-of-day. Latitude, altitude and significant particulate air pollution can also matter. Also, be aware many common types of window glass in homes/autos as well as some sunblocks can reduce or block UV types which may contribute to the benefits. Of course, the usual warnings about consulting your medical provider and more of a good thing is not always 'better' apply, so be careful not to over do it. Although rare, some people who have megadosed huge amounts over long time periods (usually many times 10k IU daily) have built up potentially problematic amounts of D3.
质疑质疑因果，认为维D低只是体弱/少出门的标记。
我记得也有结果显示，已经感染COVID后再补维生素D并没有帮助。所以在我看来这更像相关性而非因果：年老体弱者本来就不常出门、维生素D更低；这大概也能解释为何会“发现”酒精的健康益处——生病的人会戒酒。
andi999查看英文原文
I remember that there also was the result that supplementing does not help if you have covid. So to me it looks just like correlation and not causation (old sick people do not go out often and have less vitamin D. Probably same reason while you can find health benifits for alcohol: sick people stop drinking )
补充引用作者原话，指出维D缺乏可能是整体健康差的替代指标。
被引用论文之一的作者写道：“换言之，在观察性研究设计中，不能排除维生素D缺乏只是一般微量营养素缺乏的替代标记，而后者又只反映患者的整体健康状态。”也就是说，如果你本来健康状况就差，COVID-19更可能致命。
yborg查看英文原文
>In other words, in an observational study design, it cannot be excluded that VitD deficiency represents a surrogate marker for a general micronutrient deficiency, which in turn reflects only the patient’s overall health status. From the authors of one of the cited papers. I.e. if you are in generally poor health already, COVID-19 is more likely to kill you.
亲历亲历补充吸收难，建议随脂肪餐服用。
作为一个长期维生素D不足的人，我想提醒大家吸收很困难——必须随含脂肪的一餐服用！“随餐摄入脂肪会显著增强维生素D3补充剂的吸收。”（PMID:25441954）
wraptile查看英文原文
As someone with a constant vitamin D insufficiency I'd like to remind people that absorbtion is very difficult - you have to take it with a fatty meal! > The presence of fat in a meal with which a vitamin D-3 supplement is taken significantly enhances absorption of the supplement [1] 1 - https://www.ncbi.nlm.nih.gov/pubmed/25441954
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