Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

Abstract

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s influenza surveillance system.SettingPublic and private hospitals across Brazil.ParticipantsEligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.Main outcome measuresSevere COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20–59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.ResultsA sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose–response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).ConclusionsThe combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose–response association between degrees of obesity and death in adults.

Clinical, Laboratory and Tomographic characteristics associated with obesity and BMI at Hospital admission in adult patients with COVID-19: a cross-sectional study

“…Although young adults are considered to be at lower risk for hospitalization and disease severity, they became more prevalent when obese 5 . Furthermore, we found an inverse relationship between BMI and age that was also found in similar studies [9][10][11][12] . COVID-19 was not consistent with Brazilian epidemiology, where obesity is more prevalent in older adults 3 .…”

Men, testosterone and Covid‐19

“…[56][57][58] SARS-CoV-2 infection also predisposes patients to the incidence of many comorbidities, including low testosterone, erectile dysfunction (ED) and possibly an earlier onset or worsening of type 2 DM. 59 Cytokine storm can cause β-cell damage and apoptosis, hypoxia and abnormal remodeling of pancreatic cells. 60 Endothelial dysfunction is the ground for more severe progression of Covid-19…”

“…Nie et al 43 Enikeev et al 44 Yang et al 66 SARS-CoV-2 can damage Sertoli cells (impairing spermatogenesis; ultimately leading to infertility) Enikeev et al 44 Yang et al 66 Achua et al 67 Ma et al 68 SARS-CoV-2 causes systemical endothelial dysfunction (leading to erectile dysfunction) Silva et al 59 Pons et al 61 Kresch et al 64 SARS-CoV-2 can cause cavernous endothelium damage (leading to erectile dysfunction) Kresch et al 64 SARS-CoV-2 causes orchitis Chen et al 65 Yang et al 66 Achua et al 67 Abbreviation: SARS-CoV-2, severe acute respiratory syndrome 2 coronavirus.…”

“…10,40 Thus, the acute and severe decline in testosterone concentrations in men during illness is a unique phenomenon that is not paralleled by any other hormonal change and not observed in women. It is not known if this is a physiological response or carries pathological consequences.GROTI ANTONIC ET AL.|59 …”

Caring for older adults during the COVID-19 pandemic

“…A meta-analysis including more than 600.000 subjects showed that mortality changes across age categories, ranging from 9.5% (8073/ 85.358) in patients of 60-69 years old up to 29.6% (41.958/ 141.745) in those aged >80 years [14]. Table 1 and 2 summarize mortality rates extrapolated from clinical studies conducted in elderly patients with COVID-19 and factors associated with poor outcome [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Among biomarkers of infection, the increase in procalcitonin (PCT) values was associated with increased risk of hospital death in subjects > 75 years old, but not in younger ones J o u r n a l P r e -p r o o f [33].…”