Obesity is Associated with Worse Outcomes in COVID‐19: Analysis of Early Data from New York City

Hajifathalian, Kaveh; Kumar, Sonal; Newberry, Carolyn; Shah, Shawn L.; Fortune, Brett E.; Krisko, Tibor I.; Ortiz-Pujols, Shiara; Zhou, Xi Kathy; Dannenberg, Andrew J.; Kumar, Rekha; Sharaiha, Reem Z.

doi:10.1002/oby.22923

Cited by 195 publications

(223 citation statements)

References 33 publications

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“…A few studies showed that individuals with obesity may decrease in‐hospital mortality 31,75,87,89 . Some studies showed that obesity may insignificantly decrease 41,47,81,90 or increase 55,67,68,84,91–96 the odds of death among individuals with obesity. The majority of studies showed that obesity significantly increased the odds of death among COVID‐19 patients with obesity.…”

Section: Epidemiological Relationships: Individuals With Overweight Amentioning

confidence: 99%

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

et al. 2020

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Summary The linkage of individuals with obesity and COVID‐19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID‐19, 75 studies were used to conduct a series of meta‐analyses on the relationship of individuals with obesity–COVID‐19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID‐19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID‐19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30–1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74–2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46–2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22–1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID‐19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID‐19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.

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Section: Epidemiological Relationships: Individuals With Overweight Amentioning

confidence: 99%

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

et al. 2020

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“…The MUST is assigned a point in the BMI domain for people with a BMI less than 20 kg/m 2 . Several studies have reported a high prevalence of overweight and obesity among patients with COVID-19, with few older adults with COVID-19 having low weight [ 56 , 57 ]. In a study including 37 patients with a mean age over 60 years, 23 were overweight (BMI > 24.9 kg/m 2 ), 13 were adequate weight (BMI between 18.5 and 24.9 kg/m 2 ), and only 1 was underweight (BMI < 18.5 kg/m 2 ) [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

et al. 2020

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Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

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“…Aging, obesity, uncompensated type 2 diabetes mellitus (T2DM), hypertension, male sex, and presence of male androgenetic alopecia (AGA) have been detected as risk factors for COVID-19 complications (1)(2)(3)(4)(5)(6).…”

Section: Covid-19 Is a Multi-systemic Infection Caused By The Severe mentioning

confidence: 99%

Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males with mild-to-moderate COVID-19 (The Pre-AndroCoV Male Trial).

Cadegiani

Goren²,

Wambier

et al. 2020

Preprint

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Background: COVID-19 is a multisystemic disorder caused by SARS-CoV-2 that has led to more than 1,000,000 deaths until the end of September 2020. Besides aging, obesity, and metabolic diseases, males, in particular those affected by androgenetic alopecia (AGA), are at higher risk to develop complications. While policies for diagnosis of COVID-19 still focus on the presence of fever or shortness of breath, these symptoms tend to appear only in later and more severe stages of the disease, when viral infectivity is already, hampering potential antiviral approaches. In addition, clinical characterization of early COVID-19 stages still lacks. The objective of the present observational study was to characterize prospectively clinical features and predictors in males during early COVID-19, and to evaluate whether the combination of more sensitive case-detection, early diagnosis and early pharmacological approaches would lead to improved clinical outcomes. Material and methods: Males confirmed for COVID-19 through positive real-time polymerase chain reaction (rtPCR) for SARS-CoV-2 with less than seven days of symptoms and three days of COVID-19 confirmation were divided into non-AGA, AGA not using dutasteride (AGA no-5ARi), and AGA using dutasteride (AGA-5ARi) groups. Patients were actively characterized for baseline and lifestyle characteristics, 22 different diseases, 42 drug classes and vaccines, 26 different symptoms, and 10 different parameters to measure COVID-19 related clinical outcomes. Azithromycin plus hydroxychloroquine, nitazoxanide 500mg or ivermectin, with or without dutasteride or spironolactone were used. Patients were then evaluated for COVID-19 clinical course, duration and progression.Results: A total of 305 males were enrolled, including 192 non-AGA, 71 AGA non-ARi and 52 AGA-5ARi. The prevailing symptoms were anosmia (68.9%), ageusia (61.2%), headache (37.5%), hyporexia (37.5%), fatigue (35.2%), dry cough (35.2%), fever or “feverish” (33.9%), thoracic pain (32.4%), conjunctival hyperemia (29.5%), weakness (29.5%), nasal congestion or rhinorrhea (28.6% and myalgia (26.3%). ARi users remained asymptomatic throughout COVID-19 treatment in 82.7% (43 of 52 males), and the only symptoms present in more than two patients were anosmia and ageusia. Thoracic, upper back, lower back pain, arthralgia affected a higher percentage of AGA no-5ARi than non-AGA males (all p < 0.01), but had similar durations (p = n/s). Anosmia, ageusia, headache, fatigue, myalgia and conjunctival hyperemia were more commonly present and lasted for longer periods in AGA no 5ARi patients (all p < 0.01). Self-reported perception of “sinusitis” and “sore throat”, dry cough and weakness were equally present (p = n/s) but had longer duration in AGA no-5ARi males (all p < 0.01).The different drug were equally distributed. AGA males were more severely affected than non-AGA in terms of duration of clinical manifestations (9.4 ± 6.0 vs 14.2 ± 7.3 days, p < 0.0001) and viral shedding (14.0 ± 5.2 vs 17.8 ± 6.2 days; p < 0.0001), which has been fully mitigated by the chronic use of dutasteride (p < 0.0001 and < 0.0001 vs non-AGA and AGA no-5ARi, respectively, for both clinical manifestations and viral shedding duration. Non-AGA, AGA no-5ARi and AGA-5ARi achieved 95% clinical recovery in seven, 14, and two days, respectively. In regards functional capacity, AGA no -5ARi males at Days 30, 14, 7, and 3 after treatment initiation were similar than non-AGA at Days 14, 7, 3, and 0, respectively (all p > 0.9). None of the patients required hospitalization and mechanical ventilation, or progressed to more severe states. Conclusion: The combination of more sensitive and earlier diagnosis of COVID-19 with a variety of drug combinations with preliminary demonstration of direct or indirect antiviral activity against SARS-CoV-2 demonstrated indisputable improved COVID-19 related clinical outcomes compared to the extensively described COVID-19 clinical course, and avoided the progression to more severe state in all patients included in the present analysis, independently of risk factors, demonstrating that any additional risk factor can be completely mitigated by the combination of more sensitive clinical suspect with early pharmacological approaches.The overwhelming differences indicate that full placebo control RCTs for early COVID-19 may be ethically questionable. Instead, double blind therapies with different options, or mixed open label placebo control for COVID-19 should be considered.

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Obesity is Associated with Worse Outcomes in COVID‐19: Analysis of Early Data from New York City

Cited by 195 publications

References 33 publications

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males with mild-to-moderate COVID-19 (The Pre-AndroCoV Male Trial).

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