Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness

Abstract

Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness The recent impact of SARS-CoV-2 and coronavirus disease 2019 (COVID-19) has shown major differences in infrastructure and approach across healthcare systems worldwide. One thing we can already be certain of is that governments and policy makers worldwide will place a greater focus on pandemic preparedness in the future. However, as well as ensuring that robust pipelines for rapid test, highly effective treatment or vaccine, and personal protective equipment (PPE) production are in place, we must address underlying resilience and susceptibility of our populations to infectious disease. Although the true spread and case fatality rate of SARS-CoV-2 may not be known for several months or even years, what is becoming increasingly clear is the significant degree to which underlying conditions associated with suboptimal metabolic health appear to be associated with poor outcomes in those with COVID-19. 1-4 Considering the nature of these underlying conditions such as obesity and hypertension, lifestylebased approaches are likely to be one of our best tools in order to address ongoing and future disease burden during pandemics. Based on the largest available studies at time of writing, the comorbidities particularly associated with hospitalization and poor outcome in patients with COVID-19 are age, obesity, hypertension, and diabetes. For instance, one study in New York City found that, of 5700 patients hospitalized with COVID-19, 57%, 42%, and 34% had hypertension, obesity, and diabetes, respectively. 1 Of 72 314 cases from the Chinese Center for Disease Control and Prevention, reported case fatality rate was elevated in those with comorbid conditions: at least 10% for cardiovascular diseases, 7% for diabetes, and 6% for hypertension. 2 Importantly, however, the diabetes diagnoses associated with increased risk have not routinely been separated by type (1 or 2) or duration, and this is a key area of future research. As outlined below, with metabolic derangement (eg, systemic insulin resistance) and hyperglycemia potentially underlying changes in the immune system seen in the comorbid conditions associated with worse COVID-19 outcome, it is possible that the well-controlled type 1 diabetic is not at increased risk. In studies of COVID-19 patients requiring invasive mechanical ventilation in Italy and New York City, the latter as a preprint at time of writing, both age and obesity were significant contributors to risk, with the mechanical disadvantage of ventilation in obese patients a potential contributor. 3,4 In the United Kingdom, the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

COVID-19: A Challenge to Physiology of Aging

“…Specific regimens of exercises accounting for the peculiarities of the current epidemiological situation are being developed and tested ( Dominski and Brandt, 2020 ; Ravalli and Musumeci, 2020 ; Zhu, 2020 ). “Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness” ( Wood and Jóhannsson, 2020 ).…”

The metabolic signatures of cardiometabolic diseases: Does the shared metabotype offer new therapeutic targets?

“…This can be achieved through lifestyle interventions and pharmacologic treatment approaches. Lifestyle modifications such as dietary interventions, caloric restriction, exercise, and intermittent fasting are effective approaches that work on the implicated pathogenetic pathways 12,211–215,64,216–219 . Pharmacological treatment such as DM and CVDs drugs may work also on the same pathways.…”

“…With the current available data, it has been well documented that patients suffering from CMDs have a high risk for coronavirus disease 2019 (COVID‐19), and they may suffer from severe outcomes. 9–12 This has increased the global concern on advancing efforts for preventing and treating CMDs. 12,13 …”

“… 9–12 This has increased the global concern on advancing efforts for preventing and treating CMDs. 12,13 …”

Inaugural Lifestyle Medicine Editorial

“…The final two questions—on COVID‐19 and the relationship to Lifestyle Medicine—are eloquently addressed in the accompanying editorial, 27 which draws together a large amount of very recent work to explain how inflammation from ageing and chronic disease provides a unifying mechanism to explain much of the COVID‐19 risk. The positive message is that many of these risks are modifiable using lifestyle interventions.…”