Status de vitamina D e fatores presentes em indivíduos com obesidade grave submetidos ou não à cirurgia bariátrica e sua relação com a susceptibilidade à Covid -19

Abstract

Vitamin D has various biological actions, and its deficiency has been associated with obesity and bariatric surgery (BS). Furthermore, studies suggest its relationship with poor COVID-19 prognosis. The proposed study is observational, analytical, case-control, and retrospective, aiming to investigate the association between vitamin D nutritional status in patients with severe obesity, whether or not they underwent bariatric surgery, in relation to the presence and severity of COVID-19, as well as to identify the main factors related to inadequate vitamin D levels. One hundred ninety-six individuals were analyzed and divided according to the presence of COVID-19 or, subsequently, according to vitamin D adequacy levels. Retrospective data on body composition, dietary intake, micronutrient supplement use, comorbidities, susceptibility and severity of COVID-19, and biochemical parameters were collected. Statistical analysis included normality tests, t-tests, chi-square tests, Fisher's exact test, Spearman correlation, and binary logistic regression. When the volunteers were analyzed according to COVID-19 involvement, only a longer time post-BS was associated with the occurrence of COVID-19 (>60 months; p=0.022). Furthermore, the presence and severity of COVID-19 were not influenced by vitamin D status (p=0.341) or other factors analyzed. When individuals were analyzed for vitamin D adequacy, the results showed that patients with extreme obesity had lower vitamin D levels, even after BS. Vitamin D inadequacy was associated with a higher body mass index (BMI) (adequate group = 41.47±10.47 / inadequate group = 45.09±9.93; p=0.015), body fat (adequate group = 47.2±17.2 / inadequate group = 56.4±18.3; p<0.0001), energy intake (adequate group = 1681.9±712.8 / inadequate group = 1997.4±1074.1; p=0.015), protein intake (g/day) (adequate group = 99.6±39.9 / inadequate group = 117.4±53.3; p=0.008), lipids intake (g/day) (adequate group = 44.3±19.7 / inadequate group = 57.4±34.6; p=0.001), % caloric intake from ultraprocessed foods (adequate group = 16.9±12.0 / inadequate group = 20.8±13.0; p=0.034), and hypertension (adequate group = 39 / inadequate group = 71; p=0.007). Moreover, inadequacy was negatively associated with the use of vitamin/mineral and calcium supplements (OR=0.28). No association was observed between vitamin D inadequacy, PTH status, blood calcium levels, or COVID-19 susceptibility and severity. Multivariate analysis showed that hypertension is the only parameter that increases the chances of vitamin D inadequacy after adjusting for sex, age, BMI, and vitamin-mineral supplementation (OR=2.67). Thus, the coexistence of obesity and hypertension increases the risk of vitamin D inadequacy independent of other associated factors