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The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis

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posted on 2021-06-18, 08:40 authored by S Seidu, C Gillies, F Zaccardi, SK Kunutsor, J Hartmann-Boyce, T Yates, AK Singh, MJ Davies, K Khunti
Background: Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS-CoV-2 through the stimulation of inflammation, functional immunologic deficit and a pro-thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism. Methods: Observational studies in COVID-19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models. Results: Eight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID-19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43-3.86) and 3.52 (1.32-9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72-18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years). Conclusions: Excess adiposity is a risk factor for severe disease and mortality in people with SARS-CoV-2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS-CoV-2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures. Systematic review registration: PROSPERO 2020: CRD42020179783.

Funding

Acknowledge the support from the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre.

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Citation

Seidu, S, Gillies, C, Zaccardi, F, et al. The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis. Endocrinol Diab Metab. 2021; 4:e00176. https://doi.org/10.1002/edm2.176

Version

  • VoR (Version of Record)

Published in

Endocrinology, Diabetes and Metabolism

Volume

4

Issue

1

Pagination

e00176

Publisher

Wiley

issn

2398-9238

eissn

2398-9238

Acceptance date

2020-07-25

Copyright date

2020

Available date

2021-06-18

Language

en

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