Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis

Abstract

Background Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical studies to clarify the obesity relationship with COVID-19 severity, comorbidities, and discussing possible mechanisms. Materials and methods The electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, were searched and all studies conducted on COVID-19 and obesity were reviewed. All studies were independently screened by reviewers based on their titles and abstracts. Results Forty relevant articles were selected, and their full texts were reviewed. Obesity affects the respiratory and immune systems through various mechanisms. Cytokine and adipokine secretion from adipose tissue leads to a pro-inflammatory state in obese patients, predisposing them to thrombosis, incoordination of innate and adaptive immune responses, inadequate antibody response, and cytokine storm. Obese patients had a longer virus shedding. Obesity is associated with other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, and vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. Reduced physical activity, unhealthy eating habits and, more stress and fear experienced during the COVID-19 pandemic may result in more weight gain and obesity. Conclusions Obesity should be considered as an independent risk factor for the severity of COVID-19. Paying more attention to preventing weight gain in obese patients with COVID-19 infection in early levels of disease is crucial during this pandemic.

Changes in the Prevalence of Metabolic Syndrome, Its Components, and Relevant Preventive Medication between 2011 and 2018 in the Northeast Hungarian Roma Population

“…The impact of MetS and its components imposes a significant burden on the healthcare system and the country’s economy. It is further aggravated by the COVID-19 pandemic since it is a well-known fact that MetS and its components are risk factors strongly influencing the progression and prognosis of the disease [ 34 , 35 , 36 , 37 ]. Moreover, studies have also shown that ethnic minorities are less likely to follow the Government’s restrictions designed to stop the spread of COVID-19 [ 38 ] and tend to have a more critical attitude towards vaccination [ 39 ].…”

Hipertensi, Diabetes Mellitus, Dan Obesitas Sebagai Faktor Komorbiditas Utama Terhadap Mortalitas Pasien Covid-19: Sebuah Studi Literatur

“…Pasien COVID-19 dengan obesitas memiliki risiko lebih tinggi terhadap diabetes melitus tipe 2, penyakit kardiovaskular, dan gagal ginjal. [15]…”

Adiponectin to leptin ratio reflects inflammatory burden and survival in COVID-19

“…Obesity is an independent risk factor for severe coronavirus disease 2019 (COVID-19), increasing the risk of hospitalisation, severe pneumonia, admission to the intensive care unit (ICU), and death [ 1 , 2 ]. Several mechanisms have been proposed to explain these associations.…”

“…VAT inflammation is a key event triggering whole body metabolic abnormalities. The increase in inflammatory cytokines produced in adipose tissue (AT) such as leptin, tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) reflects excessive and dysfunctional AT [6] , and could amplify systemic inflammation in COVID-19 patients with obesity [ 1 , 3 ]. The role of adiponectin, an insulin-sensitizing and anti-inflammatory adipokine that is usually reduced in obesity [7] , has been largely overlooked until recently, when a non-significant increase in adiponectin levels in patients with severe COVID-19 has been reported [8] .…”