COVID-19 and the role of chronic inflammation in patients with obesity

Abstract

Coronavirus disease 2019 (COVID-19) and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a particular risk to people living with preexisting conditions that impair immune response or amplify pro-inflammatory response. Low-grade chronic systemic inflammation, common in people with obesity, is associated with the development of atherosclerosis, type 2 diabetes, and hypertension, well known comorbidities that adversely affect the outcomes of patients with COVID-19. Risk stratification based on the Edmonton Obesity Staging System (EOSS), which classifies obesity based on the presence of medical, mental, and/or functional complications rather than on body mass index (BMI), has been shown to be a better predictor of all-cause mortality and it may well be that EOSS stages may better describe the risk of hyperinflammation in patients with COVID-19 infection. Analyzing a group of metabolic ill patients with obesity (EOSS 2 and 3), we found an increased interleukin-6 and linear regression analysis showed a positive correlation with C-reactive protein (CRP) (p = 0.014) and waist-to-hip-ratio (WHR) (p = 0.031). Physicians should be aware of these findings in patients with COVID-19 infection. Early identification of possible hyperinflammation could be fundamental and should guide decision making regarding hospitalization, early respiratory support, and therapy with immunosuppression to improve mortality.

A survival analysis of COVID-19 in the Mexican population

“…This data allows us to hypothesize that the presence of chronic diseases not only increases the risk of complicated disease but even the risk of acquiring the novel coronavirus. A possible explanation is that chronic in ammation, negative effects on immunomodulation and metabolic stress that characterized systemic diseases decrease the ability to react against external agents; in this case, SARS-CoV-2 (15)(16)(17)(18).…”

Obesity: A critical risk factor in the COVID‐19 pandemic

“…A hyperinflammatory response in which there are raised levels of interleukins and TNF‐α has been associated with increased mortality from COVID‐19 74 . The chronic inflammation in patients with obesity is speculated to be contributory to the observed increased mortality due to a potential enhancement of the inflammatory response to COVID‐19 infection and induced disturbances in T‐cell mediated immunity 75,76 . Indeed, obesity has been associated with increased activation of pro‐inflammatory T‐helper (Th‐) 1 and Th‐17 cells with reductions in anti‐inflammatory Th‐2 and regulatory T‐cells 77,78 .…”

Is Toll-like receptor 4 involved in the severity of COVID-19 pathology in patients with cardiometabolic comorbidities?

“…Obesity, especially visceral obesity, is known to increase the clinical risk of metabolic and cardiovascular disease [ 93 ]. In countries that had an early outbreak of COVID-19 including Italy [ 94 , 95 ] and the United States [ 96 ], multiple reports have emerged that implicate obesity as a comorbidity that leads to severe case of COVID-19.…”