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The First Randomized Controlled Trial on Vitamin D and Covid-19

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Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#271

Post by Emphere »

mlyle wrote: post #146
Emphere wrote: post #76

This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 - 0.25). For randomised trials, it makes no sense to say that the difference in baseline is not significant because we have already observed the outcomes. It is better to use ASDs and in such small trials, small differences in baseline matter a lot. In this case it's pretty obvious the effect of vitamin D would easily be non significant if yo…

> This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 - 0.25) Are you for real? Smallest effect in the 95% CI is a 4x reduction in ICU admission. Yes, it's probably closer to the bottom end of this range, but this is a fantastically different. > For randomised trials, it makes no sense to say that the difference in baseline is not significant For randomized trials, the baselines are not likely…

I...had such an epic brain fart, I don't even know what to say. Please disregard my entire comment.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#272

Post by Emphere »

sauwan wrote: post #88
Emphere wrote: post #76

This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 - 0.25). For randomised trials, it makes no sense to say that the difference in baseline is not significant because we have already observed the outcomes. It is better to use ASDs and in such small trials, small differences in baseline matter a lot. In this case it's pretty obvious the effect of vitamin D would easily be non significant if yo…

Can you elaborate? As a statistical noob, this feels like a huge effect (1 of 50, or 2% - vs - 13 of 26, or 50%).

You're absolutely right. Please disregard my entire comment.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#273

Post by [deleted] »

Reelin wrote: post #266
noodlesUK wrote: post #262

Earlier quoted context omitted.

(Not OP) I’m not an athlete anymore, but I used to be. It would be physically impossible for me to maintain my muscle mass and have a BMI considered normal, whilst also having a body fat percentage >5%. I know many other (pretty much exclusively taller men) people in the same situation.

I guess it would be interesting to see how those numbers interacted graphically. Are the "bad" areas (ie high muscle mass at reasonable fat percentage) associated with health problems according to experts? Or should people with significantly above average muscle mass be using a different scale instead?

[deleted]

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#274

Post by ravenstine »

JshWright wrote: post #253
ellyagg wrote: post #203

Earlier quoted context omitted.

It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body. As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress res…

> there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.

Wouldn't it be fairly easy to separate the elderly who aren't vitamin D deficient from the ones who are? Sounds like a basic measure that could be taken.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#275

Post by mattmanser »

ellyagg wrote: post #203
maxander wrote: post #3

From the results: “Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p Which sounds like as strong a signal as a study of this scale could hope to show.

It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body. As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress res…

We actually have an expert on this comment here quite often, too high Vit D dose can cause problems with calcium:

https://news.ycombinator.com/user?id=devaboone

And she's done a series on it:

https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#276

Post by rrrrrrrrrrrryan »

BurningFrog wrote: post #58
outworlder wrote: post #41

Earlier quoted context omitted.

Be careful. Vitamin D is a hormone and is not risk-free. Unless you have been prescribed by your doctor. In general, be careful with any fat-soluble "vitamins", as they can build up.

A daily dose of 2000-4000 is enough and is very safe. 42% of Americans are deficient, much more the darker your skin is. https://www.healthline.com/nutrition/vitamin-d-deficiency-sy...

The literature states 1000-2000 is safe for basically anyone, but you really shouldn't be taking more than that without actually going to a doctor and getting your deficiency confirmed. Just because you have darker skin, it doesn't mean taking a higher oral dose won't cause other issues.

IIRC daily doses above 2000 over a longer timespan can (infrequently) cause your vitamin B12 levels to fall off, and/or the amount of calcium in your blood to build up, so your doctor might want to schedule a follow-up appointment after some time has passed to make sure those levels still look okay, and adjust supplements for those variables accordingly.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#277

Post by zaroth »

Reelin wrote: post #256
shajznnckfke wrote: post #248

Earlier quoted context omitted.

I guess people are downvoting because it’s not super relevant to the discussion, but I have a similar opinion that the BMI normal weight range is unreasonable for me. I’ve been in these two modes: 1) genuinely overweight with too much fat and not enough muscle 2) nearly overweight according to BMI while very fit, with low fat and high muscle. got here from the other state by exercising a lot, losing fat and gaining m…

> nearly overweight according to BMI while very fit, with low fat and high muscle Not knowing you personally, it seems statistically more likely to me that your idea of "fit, low fat, high muscle" is what's at fault here (as opposed to BMI). Sure, you could be an exception. But all things being equal, you probably aren't. (Also maybe I misunderstand - if you mean that BMI was saying you were at the high end of normal…

I understand the desire to be contrarian, but BMI is widely regarded as totally obsolete with cheap and accurate ways to actually measure body fat percentages.

It’s well understood that BMI is totally wrong for athletes or anyone remotely muscular.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#278

Post by sokoloff »

shajznnckfke wrote: post #224
sokoloff wrote: post #165

Earlier quoted context omitted.

Vitamin D pills look to be 3-5¢ per day. Hardly seems like something I’d be supportive of creating a “free” supply chain for.

If the costs are low, then the free supply chain won’t cost much to create. If the public health savings are greater than the costs, it may be better to just mail free supplements to people than mail them postcards advising they go out and purchase them (advice most people will ignore, no matter how low the cost).

How many people will need to be paid to operate this free supply chain to provide a good that is perfectly well-supplied inexpensively privately now? How many to answer questions, field calls about missed shipments, lost pills, changes of address, etc?

The answer to every problem shouldn’t be “create a new government-funded agency to make this happen ‘for free’”. Mr Market isn’t the answer for every single thing, but sometimes it’s fine to let existing private supply chains operate. Supplying cheap dietary supplements seems to me like an area where that’s the case.

It may need to be added to SNAP/WIC; that’s a reasonable task for government to busy itself supporting this.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#279

Post by greenbush »

altvali wrote: post #181
zamfi wrote: post #24

Earlier quoted context omitted.

Yes, this is strong. Worth noting the limitations though: > Randomization generated groups with comparable percentage of unfavorable risk factors as there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression [2], which were more frequent in patients not treated with calcifediol. These are H…

Is BMI a good indicator of obesity, though?

The issue with BMI is that the thresholds vary by ethnicity: https://www.hsph.harvard.edu/obesity-prevention-source/ethni...

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#280

Post by greenbush »

SketchySeaBeast wrote: post #210
altvali wrote: post #206

Earlier quoted context omitted.

It most definitely would, but measuring body fat percentage would be better.

But then you couldn't easily extrapolate to the population. Well, you could, but you'd require the population to have an understanding of their body fat percentages. BMI isn't ideal, but it's quick and dirty, easy to collect and it should be relatively reliable for the population.

It's not that straightforward as the BMI thresholds vary by ethnicity: https://www.hsph.harvard.edu/obesity-prevention-source/ethni...
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