Obesity found to increase COVID-19 severity – The Diabetes Times

Obesity has been found to increase the severity of COVID-19 but more data collection is needed to further understand how one condition impacts the other, researchers have said.

In China comorbidities among people aged 65 or older was also associated with a more acute bout of coronavirus.

Among the comorbid conditions, the highest fatality rate was found for cardiovascular disease (CVD) (10.5%) and diabetes (7.3%), followed by chronic respiratory diseases (6.3%), hypertension (6.0%) and cancer (5.6%).

In response to the findings a direct endocrine and metabolic link between hypertension, diabetes and coronavirus infection, which might involve angiotensin-converting enzyme 2, is being discussed.

Studies from China and the Lombardy region of Italy that have reported comorbidities among people with COVID-19 have not provided body weight and height data. However, a small sample of 24 (63% were men) critically ill patients diagnosed with COVID-19 in the Seattle region was among the first to report BMI data.

Among the participants there were three people with a BMI in the normal category, seven classed as overweight, 13 deemed as obese and one with missing data.

Although the numbers are too small for meaningful statistical analyses, 85% of the patients with obesity required mechanical ventilation and 62% of the patients with obesity died.

Mechanical ventilation

These proportions are greater than those among people without obesity, in which 64% required mechanical ventilation and 36% died. As CVD and diabetes are strongly associated with elevated adipose tissue mass, a high BMI might be an important risk factor for a severe course of disease, particularly of pneumonia, in these people.

Concern about the effects of BMI is further substantiated by preliminary data from Shenzhen in China, and New York, although the data has not been peer-reviewed.

Among 383 people from Shenzhen with COVID-19, being overweight was associated with an 86% higher, and obesity with a 142% higher, risk of developing severe pneumonia compared with people of normal weight in statistical models.

Among 4,103 patients with COVID-19 at an academic health system in New York City, BMI >40kg/m2 was the second strongest independent predictor of hospitalisation, after old age.

Furthermore, in a small study from a university hospital in Lille, France, reporting data from 124 people with COVID-19, the need for invasive mechanical ventilation was associated with a BMI 35kg/m2, independently of other comorbidities.

Conversely, an obesity survival paradox has been observed in people with pneumonia. That is, despite the increased risk of pneumonia and difficulties of intubation and mask ventilation, the risk of death among obese people and pneumonia might be decreased.

Aggressive treatment

Potentially counter-balancing effects of obesity might include the more aggressive treatment provided to these people, their increased metabolic reserve or other unidentified factors.

Thus, as a result of a potentially critical role of body weight or adiposity in determining the incidence and severity of pneumonia (and possibly other complications), it is important to collect anthropometric information for people with COVID-19.

Furthermore, the impaired metabolic health, characterised by hypertension, dyslipidaemia and hyperglycaemia, associated with obesity might also be present in those with normal weight or overweight.

Prediabetes, which is present in 38% of the adult population in the USA, was identified as an important risk factor for CVD and renal disease. To what extent these cardiometabolic risk factors predispose individuals to severe disease independently of BMI remains to be determined.

In conclusion, to better estimate the risk of complications in patients with COVID-19, in addition to evaluation of standard hospital parameters (such as the Sequential Organ Failure Assessment, d-dimer and pro-inflammatory markers), the measurement of anthropometrics and metabolic parameters is crucial.

These parameters include BMI, waist and hip circumferences and levels of glucose and insulin. The latter two parameters can be used for the estimation of insulin resistance, for example by calculation of the HOMA-IR.

Knowledge about insulin resistance is important, because it is among the strongest determinants of impaired metabolic health, cardiac dysfunction and CVD-related mortality. Such measurements might be useful both in a primary care setting and in a hospital setting to assess the risk of a complicated course of disease in patients with a positive SARS-CoV-2 test.

To read the study in full, click here.

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Obesity found to increase COVID-19 severity - The Diabetes Times