Obesity is Associated with Poor Covid-19 Outcomes: A Systematic Review and Meta-Analysis

Hoong, Caroline Wei Shan; Hussain, Ikram; Aravamudan, Veeraraghavan Meyyur; Phyu, Ei Ei; Lin, Jaime; H, Koh

doi:10.1055/a-1326-2125

Cited by 44 publications

(53 citation statements)

References 48 publications

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“…The results of this study suggest that significant positive relationships exist between the point prevalence of depression and obesity and the COVID-19 crude mortality rate across countries. These results are consistent with the results of earlier research which has found that both these disorders confer an added risk of mortality in COVID-19 patients [13,[17][18][19]28,29]. On bivariate analyses, sugar consumption was also associated with the crude mortality rate; however, on multivariate analyses, this relationship, unlike the former two, was no longer statistically significant.…”

Section: Discussionsupporting

confidence: 91%

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Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

Rajkumar

2021

Diseases

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Background: The COVID-19 pandemic has been characterized by wide variations in mortality across nations. Some of this variability may be explained by medical comorbidities such as obesity and depression, both of which are strongly correlated with dietary practices such as levels of sugar and seafood consumption. Methods: COVID-19 mortality indices for 156 countries were obtained from the Johns Hopkins University’s data aggregator. Correlations between these variables and (a) per capita consumption of sugar and seafood, and (b) country-wise prevalence of depression and obesity were examined. Results: Sugar consumption (r = 0.51, p < 0.001) and prevalence of obesity (r = 0.66, p < 0.001) and depression (r = 0.56, p < 0.001) were positively correlated with crude mortality rates, while seafood consumption was negatively correlated with the infection fatality rate (r = −0.28, p = 0.015). These effects were significant even after correcting for potential confounders. The associations with depression and obesity remained significant upon multivariate regression. Conclusions: Both obesity and depression, which are associated with inflammatory dysregulation, may be related to cross-national variations in COVID-19 mortality, while seafood consumption may be protective. These findings have implications in terms of protecting vulnerable individuals during the current pandemic.

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Section: Discussionsupporting

confidence: 91%

“…In a similar manner, evidence has emerged linking obesity with increased mortality in patients with COVID-19 [28,29]. This association appears to be consistent across countries, and is significant even after controlling for associated conditions such as diabetes mellitus or systemic hypertension [12].…”

Section: Introductionmentioning

confidence: 70%

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

Rajkumar

2021

Diseases

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“…The wealth of evidence is such that more than a dozen meta-analyses have been conducted on this topic, for example [ 5 , 6 ]. The reported levels of risk, however, vary somewhat between studies as differing study populations—population based versus hospital based—can lead to differing findings with the latter being less informative of risks in the general population as patients in hospital with COVID represent a high-risk group with more severe manifestations, and decisions to admit to hospital are influenced by varying, often health system specific, factors.…”

Section: Epidemiologymentioning

confidence: 99%

Obesity as a Risk Factor for Severe COVID-19: Summary of the Best Evidence and Implications for Health Care

Sattar

Valabhji

2021

Curr Obes Rep

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Purpose of Review To collate the best evidence from several strands—epidemiological, genetic, comparison with historical data and mechanistic information—and ask whether obesity is an important causal and potentially modifiable risk factor for severe COVID-19 outcomes. Recent Findings Several hundred studies provide powerful evidence that body mass index (BMI) is a strong linear risk factor for severe COVID-19 outcomes, with recent studies suggesting ~5-10% higher risk for COVID-19 hospitalisation per every kg/m2 higher BMI. Genetic data concur with hazard ratios increasing by 14% per every kg/m2 higher BMI. BMI to COVID-19 links differ markedly from prior BMI-infection associations and are further supported as likely causal by multiple biologically plausible pathways. Summary Excess adiposity appears to be an important, modifiable risk factor for adverse COVID-19 outcomes across all ethnicities. The pandemic is also worsening obesity levels. It is imperative that medical systems worldwide meet this challenge by upscaling investments in obesity prevention and treatments.

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“…In our cohort, all obese patients had SARS-CoV-2 RNA detected in stools. Obesity is one of the main risk factors for severe COVID-19 and poor clinical outcomes[ 20 , 21 ], and is associated with a strong inflammatory response both in the general population and in COVID-19 patients[ 22 ]. This could justify a more prolonged viral shedding in this subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients: A proof-of-concept study

Zerbato

Bella

Giuffrè

et al. 2021

WJG

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BACKGROUND One third of coronavirus disease 2019 (COVID-19) patients have gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA has been detected in stool samples of approximately 50% of COVID-19 individuals. Fecal calprotectin is a marker of gastrointestinal inflammation in the general population. AIM To investigate if fecal calprotectin correlates with SARS-CoV-2 intestinal shedding in COVID-19 patients with pneumonia. METHODS Patients with SARS-CoV-2 pneumonia admitted to the Infectious Disease Unit (University Hospital of Trieste, Italy) from September to November 2020 were consecutively enrolled in the study. Fecal samples were collected and analyzed for quantification of fecal calprotectin (normal value < 50 mg/kg) and SARS-CoV-2 RNA presence by polymerase chain reaction (PCR). Inter-group differences were determined between patients with and without diarrhea and patients with and without detection of fecal SARS-CoV-2. RESULTS We enrolled 51 adults (40 males) with SARS-CoV-2 pneumonia. Ten patients (20%) presented with diarrhea. Real-time-PCR of SARS-CoV-2 in stools was positive in 39 patients (76%), in all patients with diarrhea (100%) and in more than two thirds (29/41, 71%) of patients without diarrhea. Obesity was one of the most common comorbidities (13 patients, 25%); all obese patients (100%) ( P = 0.021) tested positive for fecal SARS-CoV-2. Median fecal calprotectin levels were 60 mg/kg [interquartile range (IQR) 21; 108]; higher fecal calprotectin levels were found in the group with SARS-CoV-2 in stools (74 mg/kg, IQR 29; 132.5) compared to the group without SARS-CoV-2 (39 mg/kg, IQR 14; 71) ( P < 0.001). CONCLUSION High fecal calprotectin levels among COVID-19 patients correlate with SARS-CoV-2 detection in stools supporting the hypothesis that this virus can lead to bowel inflammation and potentially to the ‘leaky gut’ syndrome.

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Obesity is Associated with Poor Covid-19 Outcomes: A Systematic Review and Meta-Analysis

Cited by 44 publications

References 48 publications

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

Obesity as a Risk Factor for Severe COVID-19: Summary of the Best Evidence and Implications for Health Care

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients: A proof-of-concept study

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