CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2022; 58(01): 002-010
DOI: 10.1055/s-0041-1736506
Review Article

Obesity, A Risk Factor for Mortality in SARS CoV-2 Infection: A Narrative Systematic Review

Sekhar Reddy
1   Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Mohd Ashraf Ganie
1   Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Parvaiz A. Koul
2   Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Tajali Sahar
1   Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Shaista Showkat
1   Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
› Author Affiliations

Abstract

SARS CoV-2 is a β-coronavirus responsible for the current COVID-19 pandemic. Although there is increase severity and mortality described in the elderly population and people with co-morbidities, all age groups are susceptible to COVID-19. Recent data showed that obesity has also emerged as a significant risk factor for COVID-19 mortality. As per the WHO, most of the world's population lives in countries where obesity is highly prevalent. In this context, we aimed to review various studies that showed obesity as an independent risk factor for mortality in SARS CoV-2 infection. We followed the PRISMA guidelines to search for two databases including PubMed and Google Scholar using the key terms “COVID-19, OBES* and MORTALITY,” SARS CoV-2, OBES* and MORTALITY” “COVID-19, OBESITY, and MORTALITY,” SARS Cov-2, OBESITY and MORTALITY,” respectively, up to August 3, 2020. Twelve studies were finally included in this review after applying inclusion and exclusion criteria. All 12 studies included in the review consistently showed that obesity is a risk factor for mortality in patients with SARS CoV-2 infection. These studies have also shown evidence that obesity leads to increased hospitalization, ICU admission, increased need for mechanical ventilation, and poor prognosis among patients with SARS CoV-2 infection. Obesity is an independent risk factor for mortality in patients infected with this novel coronavirus. Appropriate triage, monitoring, and vigilance are required while dealing with individuals with obesity with SARS CoV2 infection, especially in the young obese population. More epidemiological studies need to be done taking BMI also into consideration in COVID-19 patients to find the exact cause of increased severity and mortality and develop appropriate preventive and therapeutic strategies.



Publication History

Article published online:
03 December 2021

© 2021. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
  • 2 Situation reports. Accessed April 16, 2020 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
  • 3 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323 (13) 1239-1242
  • 4 Certain medical conditions and risk for severe COVID-19 illness | CDC. Accessed September 22, 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  • 5 Li Q, Guan X, Wu P. et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
  • 6 Grasselli G, Zangrillo A, Zanella A. et al; COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020; 323 (16) 1574-1581
  • 7 Bhatraju PK, Ghassemieh BJ, Nichols M. et al. Covid-19 in critically ill patients in the Seattle region-case series. N Engl J Med 2020; 382 (21) 2012-2022
  • 8 Lighter J, Phillips M, Hochman S. et al. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission. Clin Infect Dis 2020; 71 (15) 896-897
  • 9 Simonnet A, Chetboun M, Poissy J. et al; LICORN and the Lille COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring) 2020; 28 (07) 1195-1199
  • 10 Obesity and overweight. Accessed September 26, 2020 at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  • 11 Van Kerkhove MD, Vandemaele KAH, Shinde V. et al; WHO Working Group for Risk Factors for Severe H1N1pdm Infection. Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis. PLoS Med 2011; 8 (07) e1001053
  • 12 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 13 Giacomelli A, Ridolfo AL, Milazzo L. et al. 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: a prospective cohort study. Pharmacol Res 2020; 158: 104931
  • 14 Palaiodimos L, Kokkinidis DG, Li W. et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism 2020; 108: 154262
  • 15 Zhang F, Xiong Y, Wei Y. et al. Obesity predisposes to the risk of higher mortality in young COVID-19 patients. J Med Virol 2020; 92 (11) 2536-2542
  • 16 Steinberg E, Wright E, Kushner B. In young adults with COVID-19, obesity is associated with adverse outcomes. West J Emerg Med 2020; 21 (04) 752-755
  • 17 Klang E, Kassim G, Soffer S, Freeman R, Levin MA, Reich DL. Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50. Obesity (Silver Spring) 2020; 28 (09) 1595-1599
  • 18 Rottoli M, Bernante P, Belvedere A. et al. Obesity is one of the strongest risk factor for respiratory failure and death in COVID-19 patients: a retrospective multicentric cohort study. SSRN 2020 DOI: 10.2139/ssrn.3578779
  • 19 Hajifathalian K, Kumar S, Newberry C. et al. Obesity is associated with worse outcomes in COVID-19: analysis of early data from New York city. Obesity (Silver Spring) 2020; 28 (09) 1606-1612\
  • 20 Nakeshbandi M, Maini R, Daniel P. et al. The impact of obesity on COVID-19 complications: a retrospective cohort study. Int J Obes 2020; 44 (09) 1832-1837
  • 21 Pettit NN, MacKenzie EL, Ridgway JP. et al. Obesity is associated with increased risk for mortality among hospitalized patients with COVID-19. Obesity (Silver Spring) 2020; 28 (10) 1806-1810
  • 22 Shah P, Owens J, Franklin J. et al. Demographics, comorbidities and outcomes in hospitalized COVID-19 patients in rural southwest Georgia. Ann Med 2020; 52 (07) 354-360
  • 23 Singh S, Bilal M, Khan A. et al. Outcomes of COVID-19 in patients with obesity in United States: a large research network study. SSRN Electron J 2020; DOI: 10.2139/ssrn.3611983.
  • 24 Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE. et al. Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab 2020; 105 (08) 1-28
  • 25 Yadav R, Aggarwal S, Singh A. SARS-CoV-2-host dynamics: increased risk of adverse outcomes of COVID-19 in obesity. Diabetes Metab Syndr 2020; 14 (05) 1355-1360
  • 26 Brazzale DJ, Pretto JJ, Schachter LM. Optimizing respiratory function assessments to elucidate the impact of obesity on respiratory health. Respirology 2015; 20 (05) 715-721
  • 27 Amirkhizi F, Siassi F, Minaie S, Djalali M, Rahimi A, Chamari M. Is obesity associated with increased plasma lipid peroxidation and oxidative stress in women?. ARYA Atherosclerosis 2007; 2 (4[8]): 189-192
  • 28 Olechnowicz J, Tinkov A, Skalny A, Suliburska J. Zinc status is associated with inflammation, oxidative stress, lipid, and glucose metabolism. J Physiol Sci 2018; 68 (01) 19-31
  • 29 Haase H, Rink L. The immune system and the impact of zinc during aging. Immun Ageing 2009; 6: 9
  • 30 Zhao L. Obesity accompanying COVID-19: the role of epicardial fat. Obesity (Silver Spring) 2020; 28 (08) 1367
  • 31 Kuba K, Imai Y, Rao S. et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 2005; 11 (08) 875-879
  • 32 Wrapp D, Wang N, Corbett KS. et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020; 367 (6483): 1260-1263
  • 33 Tipnis SR, Hooper NM, Hyde R, Karran E, Christie G, Turner AJ. A human homolog of angiotensin-converting enzyme. Cloning and functional expression as a captopril-insensitive carboxypeptidase. J Biol Chem 2000; 275 (43) 33238-33243
  • 34 Raj VS, Mou H, Smits SL. et al. Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC. Nature 2013; 495 (7440): 251-254
  • 35 Vankadari N, Wilce JA. Emerging WuHan (COVID-19) coronavirus: glycan shield and structure prediction of spike glycoprotein and its interaction with human CD26. Emerg Microbes Infect 2020; 9 (01) 601-604
  • 36 Zhong J, Rao X, Deiuliis J. et al. A potential role for dendritic cell/macrophage-expressing DPP4 in obesity-induced visceral inflammation. Diabetes 2013; 62 (01) 149-157
  • 37 Redinger RN. The pathophysiology of obesity and its clinical manifestations. Gastroenterol Hepatol (NY) 2007; 3 (11) 856-863
  • 38 Masmiquel L, Leiter LA, Vidal J. et al; LEADER investigators. LEADER 5: prevalence and cardiometabolic impact of obesity in cardiovascular high-risk patients with type 2 diabetes mellitus: baseline global data from the LEADER trial. Cardiovasc Diabetol 2016; 15: 29
  • 39 Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020; 323 (18) 1775-1776
  • 40 Yang J, Zheng Y, Gou X. et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020; 94: 91-95
  • 41 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
  • 42 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062