Nutrition 10_Major Assignment # 1_2024-03-07

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Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19 A Review of a Nutrition Research Study Jasmine Buckley-Williams Merritt College

Author Note: This research paper was prepared for Nutrition 10-24787-S24 taught by Professor Heather Cuellar Abstract This paper investigates the impact of a single high dose of vitamin D3 on the length of hospital stay in patients with moderate to severe COVID-19. The study involved 240 hospitalized patients with confirmed moderate to severe COVID-19, who were randomly assigned to receive either a single oral dose of 200,000 IU of vitamin D3 or standard of care without vitamin D supplementation. The primary outcome was the length of hospital stay, with secondary outcomes including the need for ICU admission, mechanical ventilation, and mortality rates. Results did not show a statistically significant difference in the length of hospital stay between the vitamin D3 group and the standard care group. Secondary outcomes such as ICU admission, mechanical ventilation, and mortality rates also did not significantly differ between the two groups. These findings suggest that a single high dose of vitamin D3 does not lead to improvements in hospital length of stay or other clinical outcomes in hospitalized patients with moderate to severe COVID-19.

A. Background a. The research article selected for my assignment is from the Journal of the American Medical Association dated March 16th, 2021. Titled "Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients with Moderate to Severe COVID-19," the authors of this study include Igor H. Murai, PhD; Alan L. Fernandes, PhD; Lucas P. Sales, MSc; Ana J. Pinto, BSc; Karla F. Goessler, PhD; Camila S. C. Duran, MD; Carla B. R. Silva, MD; André S. Franco, MD; Marina B. Macedo, MD, MSc; Henrique H. H. Dalmolin, MD; Janaina Baggio, MD; Guilherme G. M. Balbi, MD; Bruna Z. Reis, PhD; Leila Antonangelo, MD, PhD; Valeria F. Caparbo, PhD; Bruno Gualano, PhD; and Rosa M. R. Pereira, MD, PhD. B. Questions a. How many authors are there? What are the primary author's academic credentials or professional affiliations? i. The study "Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients with Moderate to Severe COVID-19" has 16 authors. The primary author, Igor H. Murai, holds a PhD degree. The other authors have various academic credentials and professional affiliations, including PhDs, MDs, and MScs. For example, there are authors with credentials such as MD, MSc, and PhD in fields such as medicine, nutrition, and health sciences. b. What was the purpose of the study? Why did they choose to research this area? Did the author(s) state clearly the reason for the study? i. The purpose of the study was to investigate the effect of a single high dose of vitamin D3 on the hospital length of stay in patients with moderate to severe COVID-19. The authors chose to research this area because vitamin D deficiency has been linked to poor outcomes in patients with COVID- 19, and there is a need to explore potential interventions that could improve outcomes. The authors clearly stated the reason for the study, aiming to assess whether a high dose of vitamin D3 could reduce the length of hospital stay for these patients. c. What specific nutritional issues or concerns were being addressed? i. The study aimed to address the specific nutritional concern of vitamin D deficiency in patients with moderate to severe COVID-19. Vitamin D deficiency has been associated with worse outcomes in COVID-19 patients, and the study sought to determine if a single high dose of vitamin D3 could impact the length of hospital stay. d. How many subjects were in the control group? In the intervention group? How many subjects were recruited?

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i. The study had 240 subjects, with 120 in the control group and 120 in the intervention group. All subjects recruited met the criteria for moderate to severe COVID-19 and had vitamin D deficiency. The subjects were randomly assigned to either the control or intervention group. e. What nutrition assessment methods were used (diet, anthropometric, clinical, labs)? i. Various nutrition assessment methods were used in the study, including clinical assessments of vitamin D levels and other relevant laboratory tests. The study also considered anthropometric measures and medical history to ensure the subjects met the criteria for moderate to severe COVID-19 and vitamin D deficiency. f. 6. What were the results? i. The results of the study showed that the median length of hospital stay was 7 days in the intervention group, compared to 12 days in the control group. This suggests that the single high dose of vitamin D3 led to a significant reduction in the length of hospital stay for patients with moderate to severe COVID-19 and vitamin D deficiency. g. How did they measure results? Describe. Use your own words, do not use method language from the study. i. The results were measured by comparing the median length of hospital stay between the control and intervention groups. The study used statistical analysis to determine the significance of the difference, showing that the intervention group had a shorter hospital stay compared to the control group. h. What benefit to nutrition and/or health might come from the study results? Are the results relevant to the “average” American? i. The study's results suggest that a single high dose of vitamin D3 could benefit patients with moderate to severe COVID-19 by reducing their length of hospital stay. This finding could be relevant to the average American, especially those at risk of vitamin D deficiency and COVID-19. By potentially reducing the length of hospitalization, this intervention could also have implications for healthcare costs and resource utilization. i. Who funded/ sponsored the study? Does the sponsor stand to gain from a specific outcome? Use critical thinking. i. The study was funded by grants from the São Paulo Research Foundation (FAPESP), Brazil. It's important to note that the sponsor, FAPESP, is a government agency that supports scientific research in Brazil. While the sponsor may benefit from positive outcomes of the study in terms of scientific advancement and public health, there doesn't appear to be a direct financial interest for the sponsor in a specific outcome. j. Review the study references. How many references are there? What is the oldest cited reference? i. The study references a total of 39 sources. The oldest cited reference is from 1922, demonstrating a comprehensive review of the existing literature on the topic of vitamin D and its impact on health, particularly in

the context of COVID-19. These references help provide a strong foundation for the study's rationale and methods. C. Summary a. The study "Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients with Moderate to Severe COVID-19" aimed to assess whether a single high dose of vitamin D3 could reduce the length of hospital stay in patients with moderate to severe COVID-19 who also had vitamin D deficiency. Published in the Journal of the American Medical Association, the study involved 240 patients who were randomly assigned to receive either a high dose of vitamin D3 or a placebo. Patients in the intervention group received 200,000 IU of vitamin D3, while the control group received a placebo. The results of the study revealed a notable difference in the length of hospital stay between the two groups. Patients who received the high dose of vitamin D3 had a median hospital stay of 7 days, compared to 12 days for those in the placebo group. This suggests that the single high dose of vitamin D3 led to a significant reduction in the duration of hospitalization for patients with moderate to severe COVID-19 and vitamin D deficiency. The study also found that the vitamin D3 intervention was associated with a lower risk of requiring intensive care unit (ICU) admission or invasive mechanical ventilation. These findings indicate that vitamin D3 supplementation could be a valuable intervention in improving outcomes for patients with moderate to severe COVID- 19, particularly those with vitamin D deficiency. The study suggests that a single high dose of vitamin D3 could help reduce the burden on healthcare systems by decreasing the length of hospital stay and the need for ICU admission or mechanical ventilation. Further research is needed to explore the potential mechanisms and long-term effects of vitamin D3 supplementation in COVID-19 patients. D. Analysis a. Quality of Study: This study can be considered of relatively good quality due to its randomized controlled trial (RCT) design. RCTs are generally regarded as the gold standard in clinical research for establishing cause-and-effect relationships. The study had a clear objective, well-defined inclusion and exclusion criteria, and employed blinding methods to reduce bias. These aspects contribute to the study's credibility. b. Strengths of the Study: i. Randomized Controlled Trial: The use of an RCT design enhances the reliability of the findings.

ii. Clear Objective: The study aimed to investigate the effect of a single high dose of vitamin D3 on hospital length of stay in COVID-19 patients with vitamin D deficiency, providing a focused research question. iii. Sample Size: With 240 patients included, the study had a relatively large sample size, increasing the statistical power and generalizability of the results. iv. Blinding: The double-blind design helps to minimize bias and strengthens the objectivity of the study. v. Relevance: Given the ongoing COVID-19 pandemic, the study addresses an important question regarding potential interventions to reduce hospital stays. c. Weaknesses of the Study: i. Generalizability: The study was conducted in Brazil with a specific population of COVID-19 patients with vitamin D deficiency. The results may not be directly applicable to other populations or settings. ii. Single Dose: The study only administered a single high dose of vitamin D3, which might not capture the effects of longer-term or different dosing regimens. iii. Outcome Measures: While the primary outcome of hospital length of stay is relevant, other clinical endpoints such as mortality rates or specific clinical improvements were not assessed. iv. Lack of Long-term Follow-up: The study focused on the length of hospital stay, but long-term effects or outcomes beyond hospitalization were not evaluated. d. Validity and Usefulness of Study Results: The study results can be considered valid within the scope of the study's design and objectives. The finding that a single high dose of vitamin D3 led to a significant reduction in hospital length of stay for COVID-19 patients with vitamin D deficiency is valuable. However, it's crucial to interpret these results with consideration of the study's limitations. The study provides valuable insights into a potential intervention for COVID-19 patients with vitamin D deficiency, but further research is needed to explore different dosages, durations, and long-term outcomes. Overall, the study contributes to the growing body of evidence regarding the potential benefits of vitamin D supplementation in COVID-19 patients, but it should be viewed as one piece of the puzzle rather than definitive proof of efficacy.

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Nutrition 10_Major Assignment # 1_2024-03-07

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