The severity of COVID-19 begins in the normal range of BMI, especially in young people


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The risk of serious outcomes with COVID-19 increases with excess weight linearly from normal body mass index ranges, with the seemingly independent effect of obesity-related diseases such as diabetes and more. strong among young people and blacks, according to new research.

“Even a small increase in body mass index above 23 kg / m² is a risk factor for adverse outcomes after SARS-CoV-2 infection,” the authors state. reported.

“Being overweight is a modifiable risk factor and an investment in the treatment of overweight and overweight obesity, and long-term preventative strategies could help reduce the severity of COVID-19 disease, ”they wrote.

The findings shed new light on ongoing efforts to understand the effects of COVID-19, said Krishnan Bhaskaran, a doctor in an interview.

“These results confirm and add details to the links established between overweight and obesity and COVID-19, and also add new information on the risks among people with low levels of BMI,” said Bhaskaran, a London epidemiologist. School of Hygiene & Tropical Medicine, which was the author of a companion editorial.

Obesity has established itself as a major risk factor for poor outcomes among people with COVID-19; however, less is known about the risk of serious outcomes in a broad spectrum of overweight and its relationship to other factors.

For the future community-based study, Carmen Piernas, PhD, of the University of Oxford (England) and colleagues, evaluated data from nearly 7 million people registered in the QResearch database of the United Kingdom United during January 24 to April 30, 2020.

In general, patients had an average BMI of 27 kg / m². Among them, 13,503 (.20%) were admitted to hospital during the study period, 1,601 (.02%) were admitted to an ICU and 5,479 (.0.08%) died after testing positive for SARS. -CoV-2.

The risk of BMI increases by 23 kg / m²

In examining the risk of hospitalization with COVID-19, the authors found a J-shaped relationship with BMI, with an increased risk with a BMI of 20 kg / m² or less, as well as an increased risk that it starts with a BMI of 23 kg / m² (considered normal weight) or higher (hazard ratio, 1.05).

The risk of death from COVID-19 was also J-shaped, although the association with BMI increases began to be greater than 28 kg / m² (adjusted HR, 1.04).

Regarding the risk of admission to the ICU with COVID-19, the curve was not J-shaped, with only a linear admission association with an increase in BMI from 23 kg / m2 (FC adjusted, 1.10).

“It was surprising to see that the lowest risk of severe COVID-19 was found with a BMI of 23 and that each additional unit of BMI was associated with a significantly higher risk, but we do not yet know what the reason is. ‘that, “Piernas said in an interview.

The association between the increase in BMI and the risk of hospitalization for COVID-19 starting with a BMI of 23 kg / m² was more significant among young people aged 20 to 39 years than in those aged 80 to 100 years, with an adjusted FC for hospital admission. per unit BMI greater than 23 kg / m² of 1.09 versus 1.01 (Pg <.0001).

In addition, the risk associated with BMI and hospital admission was stronger in black people, compared with white people (1.07 vs 1.04), as was the risk of death. for COVID-19 (1.08 vs. 1.04; Pg <.0001 for both).

“In terms of the risk of death, blacks have an 8% higher risk with each additional BMI unit, while whites have a 4% increase, which is half the risk,” Piernas said.

It should be noted that the increased risk of hospitalization and ICU admission due to COVID-19 observed with increased BMI was slightly lower among people with type 2 diabetes, hypertension, and cardiovascular disease compared with patients who did not present with these comorbidities, suggesting that the association with BMI is not explained by these risk factors.

Piernas speculated that the effect could reflect that people with diabetes or cardiovascular disease already have a pre-existing condition that makes them more susceptible to SARS-CoV-2.

Therefore, “the association with BMI in this group may not be as strong as the association found among those without these conditions, in which BMI accounts for a higher proportion of this increased risk, given the ‘absence of these pre-existing conditions’.

Similarly, the effect of BMI on COVID-19 outcomes in younger patients may appear stronger because their rates of other comorbidities are much lower than in older patients.

“Among older people, pre-existing conditions and perhaps a weaker immune system may explain their much higher rates of severe COVID results,” Piernas noted.

In addition, elderly patients may present with fragility and high comorbidities that could explain their lower ICU admission rates with COVID-19, Bhaskaran added in other comments.

The overall findings emphasize that being overweight can pose a risk to COVID-19 outcomes that is significantly modifiable and “suggest that supporting people to achieve and maintain a healthy weight will help people reduce risk of suffering serious illness results, now or in any future wave, “he concluded.

Legs and Bhaskaran had no disclosures to report. Disclosures by co-authors are detailed in the published study.

Lancet Diabetes Endocrinol. Published online April 28, 2021. Full text, Editorial

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