Mechanisms contributing to adverse outcomes of COVID-19 in obesity

Abstract

A growing amount of epidemiological data from multiple countries indicate an increased prevalence of obesity, more importantly central obesity, among hospitalized subjects with COVID-19. This suggests that obesity is a major factor contributing to adverse outcome of the disease. As it is a metabolic disorder with dysregulated immune and endocrine function, it is logical that dysfunctional metabolism contributes to the mechanisms behind obesity being a risk factor for adverse outcome in COVID-19. Emerging data suggest that in obese subjects, (a) the molecular mechanisms of viral entry and spread mediated through ACE2 receptor, a multifunctional host cell protein which links to cellular homeostasis mechanisms, are affected. This includes perturbation of the physiological renin-angiotensin system pathway causing pro-inflammatory and pro-thrombotic challenges (b) existent metabolic overload and ER stress-induced UPR pathway make obese subjects vulnerable to severe COVID-19, (c) host cell response is altered involving reprogramming of metabolism and epigenetic mechanisms involving microRNAs in line with changes in obesity, and (d) adiposopathy with altered endocrine, adipokine, and cytokine profile contributes to altered immune cell metabolism, systemic inflammation, and vascular endothelial dysfunction, exacerbating COVID-19 pathology. In this review, we have examined the available literature on the underlying mechanisms contributing to obesity being a risk for adverse outcome in COVID-19.

Obesity and COVID-19: What are the Consequences?

“…Emerging data suggest that several mechanisms are responsible for this increased susceptibility of people with obesity for severe COVID-19 including, amongst others, an impaired immune system and changes in SARS-CoV-2 entry receptors in obese individuals 9 10 11 12 . In the current review, we discuss these mechanisms in order to understand why patients with obesity have a higher risk of developing severe COVID-19 symptoms not only in the acute phase of the disease but also in relation to long-COVID, vaccine breakthrough infections and re-infections.…”

Reduction in Serum Magnesium Levels and Renal Function Are Associated with Increased Mortality in Obese COVID-19 Patients

“…Obesity is a complex metabolic disorder, linked to the development of multiorgan disorders, including hypertension, type 2 diabetes (T2D), cardiovascular diseases (CVD), dyslipidemia, stroke, and certain types of cancer. These disorders may exacerbate and aggravate COVID-19 [ 5 ].…”

Beneficial Effects of Anti-Inflammatory Diet in Modulating Gut Microbiota and Controlling Obesity

“…Obesity is a complex multifactorial disease that is directly related to the chance of developing insulin resistance and an increased risk of diabetes, dyslipidemia, hypertension, cardiovascular diseases [ 1 , 2 ], and other metabolic disorders [ 3 ]. With growing concerns about obesity and related diseases, there has been scientific interest in understanding the mechanisms associated with obesity and exploring innovative management strategies to control it.…”