Obesity: a risk factor in patients with COVID-19
Keywords:
obesity, COVID-19, SARS-CoV-2, body mass index, immune systemAbstract
Recent reports indicate a strong association between obesity and the severity of COVID-19 infection, which is based on the presence of a chronic pro-inflammatory state in obese patients, linked to metabolic and immune system disorders. This paper aims to reviewing the most recent studies on the positive association established between obesity, as a risk factor, and severity and mortality of patients with COVID-19; it also aims to renew the involved mechanisms, for which articles published—mainly in the last five years—in the PubMed, SciELO, Clinical Key and LILACS databases, and in the Google Scholar search engine were selected. These studies included, among other parameters, the body mass index and its association to severity and mortality due to COVID-19. As a result, the clinical evidence suggests that overweight and obesity have a high prevalence in severe cases of adult patients with COVID-19. It is concluded that obesity, in these patients, requires a particular management, as it should be considered a risk factor independent of other comorbidities. This is due to its contribution to a greater susceptibility and severity, positively associated to alterations of the immune system and to hyper-inflammatory reactions by excessive release of cytokines, compromising the functioning of organs and systems and enhancing the complications of SARS-CoV-2 infection and mortality.Downloads
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References
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15. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet [Internet]. 2020 [citado 15/03/2021];395(10229):1033-4. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
16. Hussain A, Mahawar K, Xia Z, et al. RETRACTED: Obesity and mortality of COVID-19. Meta-analysis. Obes Res Clin Pract [Internet]. 2020 [citado 15/03/2021];14(4):295-300. Disponible en: https://www.sciencedirect.com/science/article/pii/S1871403X20305500
17. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clinical Infect Dis [Internet]. 2020 [citado 15/03/2021];71(15):896-7. Disponible en: https://academic.oup.com/cid/article/71/15/896/5818333?login=false
18. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA [Internet]. 2020 [citado 22/03/2021];323(20):2052-9. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2765184/
19. Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity [Internet]. 2020 [citado 22/03/2021];28(7):1195-9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22831
20. Barrasa H, Rello J, Tejada S, et al. SARS-Cov-2 in Spanish intensive care: early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med [Internet]. 2020 [citado 22/03/2021];39(5):553-61. Disponible en: https://www.sciencedirect.com/science/article/pii/S2352556820300643
21. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA [Internet]. 2020 [citado 22/03/2021];323(18):1775-6. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2763667
22. Huang JF, Wang XB, Zheng KI, et al. Obesity hypoventilation syndrome and severe COVID-19. Metabolism [Internet]. 2020 [citado 22/03/2021];108. Disponible en: https://www.metabolismjournal.com/article/S0026-0495(20)30113-X/fulltext
23. Pandey A, Patel KV, Lavie CJ. Obesity, central adiposity, and fitness: understanding the obesity paradox in the context of other cardiometabolic parameters. Mayo Clin Proc [Internet]. 2018 [citado 22/03/2021];93(6):676-8. Disponible en: https://www.mayoclinicproceedings.org/article/S0025-6196(18)30314-8/fulltext
24. Sanchis-Gomar F, Perez-Quilis C, Lavie CJ. Should atrial fibrillation be considered a cardiovascular risk factor for a worse prognosis in COVID-19 patients? Eur Heart J [Internet]. 2020 [citado 22/03/2021];41(32):3092-3. Disponible en: https://academic.oup.com/eurheartj/article/41/32/3092/5874071?login=false
25. Kwaifa IK, Bahari H, Yong YK, et al. Endothelial dysfunction in obesity-induced inflammation: molecular mechanisms and clinical implications. Biomolecules [Internet]. 2020 [citado 04/04/2021];10(2). Disponible en: https://www.mdpi.com/2218-273X/10/2/291
26. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endothelitis in COVID-19. The Lancet [Internet]. 2020 [citado 04/04/2021];395(10234):1417-8. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext?a=true
27. Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med [Internet]. 2020 [citado 04/04/2021];173(4):268-77. Disponible en: https://www.acpjournals.org/doi/full/10.7326/M20-2003
28. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost [Internet]. 2020 [citado 04/04/2021];18(4):844-7. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14768
29. Malavazos AE, Goldberger JJ, Iacobellis G. Does epicardial fat contribute to COVID-19 myocardial inflammation? Eur Heart J [Internet]. 2020 [citado 04/04/2021];41(24):2333. Disponible en: https://academic.oup.com/eurheartj/article/41/24/2333/5848374?login=false
30. Neeland IJ, Ross R, Despres JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol [Internet]. 2019 [citado 04/04/2021];7(9):715-25. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30084-1/fulltext
2. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med [Internet]. 2019 [citado 05/03/2021];381:2440-50. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMsa1909301
3. Ulhaq ZS, Soraya GV. Interleukin‐6 as a potential biomarker of COVID‐19 progression. Med mal Infect. 2020;50(4):382-3. Citado en PubMed; PMID: 32259560.
4. Fischer-Posovszky P, Moller P. The immune system of adipose tissue: obesity-associated inflammation. Der Pathologe [Internet]. 2020 [citado 05/03/2021];41(3):224-9. Disponible en: https://europepmc.org/article/med/32253498
5. Dennis JM, McGovern AP, Vollmer SJ, et al. Improving Survival of Critical Care Patients with Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020. Crit Care Med [Internet]. 2021 [citado 15/04/2021];49(2):209-14. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803441/
6. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City [Internet]. New York: medRxiv; 2020 [citado 05/03/2021]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1
7. Moser JS, Galindo-Fraga A, Ortiz-Hernández AA, et al. Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses. Influenza Other Respir Viruses [Internet]. 2019 [citado 12/03/2021];13(1):3-9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12618
8. Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol [Internet]. 2020 [citado 12/03/2021];251(3):228-48. Disponible en: https://pathsocjournals.onlinelibrary.wiley.com/doi/full/10.1002/path.5471
9. Aksoy H, Karadag AS, Wollina U. Angiotensin II receptors: Impact for COVID-19 severity. Dermatol Ther [Internet]. 2020 [citado 12/03/2021];33(6):e13989. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.13989
10. Naveed M, Naeem M, Ur Rahman M, et al. Review of potential risk groups for coronavirus disease 2019 (COVID-19). New Microbes New Infect [Internet]. 2021 [citado 27/07/2021];41:100849. Disponible en: https://www.sciencedirect.com/science/article/pii/S2052297521000135
11. Goumenou M, Sarigiannis D, Tsatsakis A, et al. COVID 19 in Northern Italy: An integrative overview of factors possibly influencing the sharp increase of the outbreak. Mol Med Rep [Internet]. 2020 [citado 12/03/2021];22(1):20-32. Disponible en: https://www.spandidos-publications.com/10.3892/mmr.2020.11079?text=fulltext
12. Reddy P, Lent-Schochet D, Ramakrishnan N, et al. Metabolic syndrome is an inflammatory disorder: a conspiracy between adipose tissue and phagocytes. Clin Chim Acta [Internet]. 2019 [citado 12/03/2021];496:35-44. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S000989811931928X
13. Landecho MF, Marin-Oto M, Recalde-Zamacona B, et al. Obesity as an adipose tissue dysfunction disease and a risk factor for infections - Covid-19 as a case study. Eur J Intern Med [Internet]. 2021 [citado 12/03/2021];91:3-9. Disponible en: https://www.sciencedirect.com/science/article/pii/S0953620521000972
14. Ryan PM, Caplice NM. Is adipose tissue a reservoir for viral spread, immune activation, and cytokine amplification in coronavirus disease 2019? Obesity [Internet]. 2020 [citado 15/03/2021];28(7):1191-4. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.22843
15. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet [Internet]. 2020 [citado 15/03/2021];395(10229):1033-4. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
16. Hussain A, Mahawar K, Xia Z, et al. RETRACTED: Obesity and mortality of COVID-19. Meta-analysis. Obes Res Clin Pract [Internet]. 2020 [citado 15/03/2021];14(4):295-300. Disponible en: https://www.sciencedirect.com/science/article/pii/S1871403X20305500
17. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clinical Infect Dis [Internet]. 2020 [citado 15/03/2021];71(15):896-7. Disponible en: https://academic.oup.com/cid/article/71/15/896/5818333?login=false
18. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA [Internet]. 2020 [citado 22/03/2021];323(20):2052-9. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2765184/
19. Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity [Internet]. 2020 [citado 22/03/2021];28(7):1195-9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22831
20. Barrasa H, Rello J, Tejada S, et al. SARS-Cov-2 in Spanish intensive care: early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med [Internet]. 2020 [citado 22/03/2021];39(5):553-61. Disponible en: https://www.sciencedirect.com/science/article/pii/S2352556820300643
21. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA [Internet]. 2020 [citado 22/03/2021];323(18):1775-6. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2763667
22. Huang JF, Wang XB, Zheng KI, et al. Obesity hypoventilation syndrome and severe COVID-19. Metabolism [Internet]. 2020 [citado 22/03/2021];108. Disponible en: https://www.metabolismjournal.com/article/S0026-0495(20)30113-X/fulltext
23. Pandey A, Patel KV, Lavie CJ. Obesity, central adiposity, and fitness: understanding the obesity paradox in the context of other cardiometabolic parameters. Mayo Clin Proc [Internet]. 2018 [citado 22/03/2021];93(6):676-8. Disponible en: https://www.mayoclinicproceedings.org/article/S0025-6196(18)30314-8/fulltext
24. Sanchis-Gomar F, Perez-Quilis C, Lavie CJ. Should atrial fibrillation be considered a cardiovascular risk factor for a worse prognosis in COVID-19 patients? Eur Heart J [Internet]. 2020 [citado 22/03/2021];41(32):3092-3. Disponible en: https://academic.oup.com/eurheartj/article/41/32/3092/5874071?login=false
25. Kwaifa IK, Bahari H, Yong YK, et al. Endothelial dysfunction in obesity-induced inflammation: molecular mechanisms and clinical implications. Biomolecules [Internet]. 2020 [citado 04/04/2021];10(2). Disponible en: https://www.mdpi.com/2218-273X/10/2/291
26. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endothelitis in COVID-19. The Lancet [Internet]. 2020 [citado 04/04/2021];395(10234):1417-8. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext?a=true
27. Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med [Internet]. 2020 [citado 04/04/2021];173(4):268-77. Disponible en: https://www.acpjournals.org/doi/full/10.7326/M20-2003
28. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost [Internet]. 2020 [citado 04/04/2021];18(4):844-7. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14768
29. Malavazos AE, Goldberger JJ, Iacobellis G. Does epicardial fat contribute to COVID-19 myocardial inflammation? Eur Heart J [Internet]. 2020 [citado 04/04/2021];41(24):2333. Disponible en: https://academic.oup.com/eurheartj/article/41/24/2333/5848374?login=false
30. Neeland IJ, Ross R, Despres JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol [Internet]. 2019 [citado 04/04/2021];7(9):715-25. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30084-1/fulltext
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2023-05-19
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Rufín-Gómez L Ángel, Benítez-Fuentes B, Méndez-Martínez J. Obesity: a risk factor in patients with COVID-19. Rev Méd Electrón [Internet]. 2023 May 19 [cited 2025 Jan. 22];45(3):e4660. Available from: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/4660
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