Why should obese youth be prioritized in COVID-19 vaccination programs? A nationwide retrospective study

Abstract

Background The dominant effect of age on COVID-19 mortality obscures the impact of other risk factors. Although the elderly is at a greater risk of severe disease and death due to COVID-19, the interaction of obesity and age was not carefully assessed. This analysis is especially critical for prioritizing groups to receive COVID-19 vaccination. Methods Starting with 1,120,767 unvaccinated individuals registered in a Brazilian surveillance system, we selected 313,898 hospitalized COVID-19 patients aged 20 to 89 who had a BMI ≥ 25 kg/m 2 and cardiovascular diseases (CVD) or diabetes, as well as individuals with no risk factors associated with severe COVID-19. Patient data were stratified by age, obesity, BMI, and comorbidities, and subsequently, subjected to crude and adjusted odds ratio, hazard ratio, and Kaplan–Meier curves. Disease outcomes were invasive and non-invasive ventilatory support, intensive care unit (ICU) admission, and death. Findings Obesity alone is a risk factor for in-hospital mortality and is more significant than cardiovascular disease and diabetes. Furthermore, obesity, cardiovascular disease, and diabetes increase the risk of severity and death by COVID-19 more significantly in young adults than in the elderly. When categorizing patients by obesity classes, the severity of obesity was found to be associated with a higher risk of admission to the ICU and death from COVID-19 than the non-obese young adults or elderly population. Interpretation Our findings highlight the increased risk of severe COVID-19 on the Brazilian obese youth. As SARS-CoV-2 may become a recurrent seasonal infection, future vaccination campaigns against COVID-19 should prioritize obese young individuals. Fundings This work was supported by the Brazilian National Council for Scientific and Technological Development (grant number 313662/2017-7 and 307356/2017-5; the São Paulo Research Foundation (grant numbers 2018/14933-2); and CAPES.

Obesity contributes to mortality and displays alterations in calcium, urea and hemoglobin levels in SARS-CoV-2 infected individuals

“…We showed death in patients with overweight and obesity compared to normal weight, confirming that overnutrition is a risk factor for coronavirus disease. These data corroborate a recent retrospective study confirming obesity as an independent risk factor for COVID-19 severity [10]. We hypothesized that the differences related to plasmatic urea concentrations may be due to the increased age in normal weight patients, once in our population the patients with obesity were significantly younger.…”

“…The literature reveals that laboratory analysis of obese patients with COVID-19 embrace variations such as higher C-reactive protein count, lower lymphocyte count, lower platelet count, higher levels of hemoglobin, CK, creatinine and, LDH [7,8]. Similar to our data, some studies have already demonstrated that obesity is an important risk factor among young people, suggesting a positive correlation between higher BMI, the severity of the disease, and mortality risk [9,10].…”

A potential association between obesity and reduced effectiveness of COVID‐19 vaccine‐induced neutralizing humoral immunity

“… 15 , 16 , 17 , 18 Thereby, several reports recommended prioritization of obese people to obtain COVID‐19 vaccination. 11 , 19 , 20 …”

Obesity and COVID-19: What are the Consequences?

“…In addition, infected people with obesity (particularly those under 60 years of age) are more likely to require acute care, admission to the intensive care unit, intubation, and mechanical ventilation 3 . Even young patients are at higher risk for a nonfavorable COVID-19 prognosis if they suffer from metabolic dysfunctions 4 5 . Children usually develop an asymptomatic to moderate infection causing few hospitalizations; but a recent meta-analysis indicates that even childhood obesity is likely to increase the risk of severe COVID-19 6 .…”