Obesity as a clinical predictor for severe manifestation of dengue: a systematic review and meta-analysis

Abstract

Background Severe dengue often leads to poor clinical outcomes and high mortality; as a result, it is of vital importance to find prognostic factors associated with the severe form of dengue. Obesity is known to deteriorate many infectious diseases due to impaired immune responses. Several studies have suggested that obese patients with dengue infection tend to have more severe manifestations with poorer prognosis. However, a firm conclusion could not be drawn due to the varied results of these studies. Here, we aimed to conduct a systematic review and meta-analysis to investigate the association between obesity and dengue severity. Methods A literature search for relevant studies was conducted in PubMed, Embase, Ovid Medline and Cochrane from inception to September 9, 2022. The two main keywords were “dengue” and “obesity”. Mantel-Haenszel method and random effects model was used to analyze the pooled odds ratio with 95% confidence intervals. Results A total of 15 article involving a total of 6,508 patients were included in the meta-analysis. Included patients in most studies were hospitalized pediatric patients. Only one study included adulthood data. Three cohort studies, four case-control studies, and one cross-sectional studies found a significant association between obesity and dengue severity. In contrast, three cohort studies, three case-control studies, and one cross-sectional study reported no significant relationship between obesity and dengue severity. Our analysis results showed that patient with obesity is 50% (OR = 1.50; 95%CI: 1.15–1.97) more likely to develop severe manifestation of dengue. Conclusion This meta-analysis revealed that overweight could be a clinical predictor for severe disease for pediatric patients with dengue infection.

Obesity is associated with increased pediatric dengue virus infection and disease: A 9-year cohort study in Managua, Nicaragua

“…Specifically, we found that obesity was associated with higher odds of presenting fever, headache, and rash in children infected with DENV. Several studies have shown an association between obesity and a higher risk of severe dengue as compared to non-severe dengue [14,15,[35][36][37][38][39][40]. However, we are not aware of reports of the association between obesity and non-severe dengue.…”

“…Pediatric obesity, whose worldwide prevalence increased 7-fold from 1975 to 2016, has been shown to negatively influence infectious disease outcomes [13]. A meta-analysis of multiple dengue studies revealed that obesity is associated with severe pediatric dengue, though individual reports are mixed [14,15]. Furthermore, greater body surface area and body weight were found to positively correlate with Zika and chikungunya virus infection, respectively [16,17].…”

Circulation of DENV-2 serotype associated with increased risk of cumulative incidence of severe dengue and dengue with warning signs: A 16-year retrospective study in Peru

“…We showed that when regional poverty increased, the cumulative incidence of SD-DWS reduced by about 7%. Some studies have found that poor nutritional status can be protective against severe disease at the individual level [29,30]. Many host and environmental factors associated with poverty have multiple and complex impacts on dengue virus transmission, requiring detailed and long-term longitudinal research studies.…”

Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue?

“…The relationship between obesity and development severe dengue had been observed for many years and reported in children in studies in the 1990s from Thailand, India and El Salvodor [ 23 – 25 ]. Many subsequent studies showed that obesity was an independent risk factor for developing severe dengue in hospitalized patients [ 13 , 14 ] including a recent metanalysis [ 26 ]. However, this is the first study reporting that obesity may also associate with higher rates of hospitalization, which needs further examination with longitudinal studies.…”