Being overweight increases the risk of severe COVID-19 in the hospital

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In a global meta-analysis of more than 7,000 patients hospitalized with COVID-19, overweight people or obesity they were more likely to need respiratory support, but were no more likely to die in the hospital than individuals of normal weight.

Compared with patients without diabetes, those with diabetes were more likely to need invasive respiratory support (with intubation), but not to need non-invasive respiratory support or die in hospital.

“Surprisingly,” among patients with diabetes, being overweight or obese did not further increase the chances of any of these outcomes, according to the researchers. They note that the finding should be confirmed in broader studies, as the sample sizes in these subanalyses were small and the confidence intervals were large.

The study by Dr. Danielle K. Longmore of the Murdoch Children’s Research Institute (MCRI), Melbourne, Australia, and colleagues from the BMI-COVID international consortium was published online April 15 a Diabetes care.

This new research “adds to known data on the associations between obesity and severe COVID-19 disease and expands these results” to overweight and / or diabetic patients, Longmore, a pediatric endocrinologist with a clinical interest and researcher in childhood and juvenile obesity, summarized in an email at Medscape Medical News.

Immunologist Siroon Bekkering, PhD, from Radboud University Medical Center, Nijmegen, the Netherlands, explained that never before had so much data of different types on obesity been combined in a large study. Bekkering is the author of the article and was a principal investigator.

“Several national and international observations have already shown the important role of overweight and obesity in a more severe COVID-19 course. This study adds to these observations by combining data from several countries with the possibility of looking at the factors of risk separately, ”he said. in a statement from his institution.

“Regardless of other risk factors (such as heart disease or diabetes), we now see that the BMI is too high [body mass index] it can lead to a more severe course in crown infection, ”he said.

Implications of the study: Data show that being overweight and obese increases the risk

These latest findings highlight the urgent need to develop public health policies to address the socioeconomic and psychological factors of obesity, Longmore said.

“While taking measures to address short-term obesity is unlikely to have an immediate impact on the COVID-19 pandemic, it is likely to reduce the burden of disease in future viral pandemics and reduce the risk of complications such as disease. of the heart i stroke“, he observed in a statement issued by MCRI.

Co-author Kirsty R. Short, PhD, a researcher at the University of Queensland, Brisbane, Australia, noted that “obesity is associated with numerous poor health outcomes, including an increased risk of cardiometabolic and respiratory diseases and more serious viral diseases. grip, dengueand SARS-CoV-1.

“Given the large scale of this study,” he said, “we have conclusively demonstrated that overweight or obesity are independent risk factors for worse outcomes in adults hospitalized with COVID-19.”

“So far, the World Health Organization has not had enough high-quality data to include overweight or obesity as a risk factor for severe COVID-19 disease,” added another author, David P. Burgner, Ph.D. in Pediatric Infectious Diseases. MCRI scientific clinician.

“Our study should help inform decisions about which high-risk groups should be vaccinated as a priority,” he noted.

Does being overweight increase your risk of having worse COVID results?

About 13% of the world’s population is overweight and 40% are obese. There are wide variations between countries in these data and about 90% of patients with type 2 diabetes Researchers point out that they are overweight or obese.

He Organization for Economic Cooperation and Development reported that the prevalence of obesity in 2016-2017 ranged from 5.7% to 8.9% in Asia, 9.8% to 16.8% in Europe, 26.5% in the South -Africa and 40.0% in the United States, they add.

Obesity is common and has emerged as a major risk factor for severe COVID-19. However, most previous studies of COVID and elevated BMI were conducted in individual centers and did not focus on overweight patients.

To investigate, researchers identified 7,244 patients (two-thirds were overweight or obese) who were hospitalized with COVID-19 in 69 hospitals (18 locations) in 11 countries from January 17, 2020 to June 2, 2020. .

Most patients were hospitalized with COVID-19 in the Netherlands (2260), followed by New York City (1682), Switzerland (920), St. Louis, Missouri (805), Norway, Italy, China, South Africa, Indonesia, Denmark, Los Angeles, Austria, and Singapore.

Just over half (60%) of the individuals were male and 52% were over 65 years of age.

Overall, 34.8% were overweight and 30.8% were obese, but the average weight varied considerably between countries and places.

Increased need for respiratory support, same risk of mortality

Compared with normal weight patients, overweight patients had a 44% increased risk of needing supplemental oxygen /non-invasive ventilation, and obese people had an increased risk of 75%, after adjusting for age (<65, ≥65), sex, hypertension, diabetes or cardiovascular disease or pre-existing respiratory conditions.

Overweight patients had a 22% higher risk of needing invasive (mechanical) ventilation, and obese patients had a 73% higher risk, after a multivariable adjustment.

However, being overweight or obese was not associated with a significant increase in the risk of dying in the hospital.

“In other virals respiratory infections“Like the flu, there is a similar pattern of higher ventilatory support requirement, but lower in-hospital mortality among obese individuals, compared to those with a normal-range BMI,” Longmore said. more extensive studies to further explore this finding on COVID-19.

Compared to patients without diabetes, those with diabetes had a 21% increased risk of requiring invasive ventilation, but did not have a higher risk of needing non-invasive ventilation or dying in the hospital.

According to previous studies, people with pre-existing cardiovascular and respiratory diseases were no longer at risk for needing oxygen or mechanical ventilation but they had a higher risk of death in the hospital. Men had a higher risk of needing invasive mechanical ventilation and people over the age of 65 had a higher risk of requiring oxygen or dying in the hospital.

A living meta-analysis, a call for more collaborators

“We consider it a‘ living meta-analysis ’and invite other centers to join us,” Longmore said. “We hope to update the analyzes as more data is provided.”

No specific project funded the study. The authors have not disclosed any relevant financial relationship.

Diabetes care. Published online April 15, 2021. Summary

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