Other issues that may be important for critical illness outcomes include vitamin D related effects on vascular endothelial growth factor, endothelin and the renin-angiotensin-aldosterone system.38–40 Further, comorbidities including incident hypertension, glucose intolerance, the metabolic syndrome, obesity and cardiovascular disease are all associated with low 25(OH)D and higher mortality.41–45. Here, VEGFA is linked to obesity due to melanocortin 4 receptor deficiency.