Obesity, Increased BMI Associated With Poorer Outcomes in Patients With COVID-19

Findings indicated that obesity was a risk factor for poorer outcomes in COVID-19 patients, leading researchers to suggest that body mass index (BMI) be measured and prioritized in the management of COVID-19.

Researchers conducted a meta-analysis that included all English language studies from PubMed and Embase on adult patients with COVID-19 whose BMIs were calculated and recorded.

Obesity was defined as a BMI greater than or equal to 30 kg/m², and poor outcome was determined by the presence of intensive care unit admission, hospital admission, acute respiratory distress syndrome (ARDS), severe COVID-19, use of mechanical ventilation, and mortality.

Sixteen studies were analyzed, involving 6690 patients who were predominantly male (58%) and median 55.8 years of age.

ICU admission was the most prevalent outcome (42%). Additionally, hypertension was the most frequent comorbid condition (46.7%, n=15), followed by type 2 diabetes mellitus (41.3%, n=9).

Authors found that obesity was associated with related poor outcome (OR 1.78 [95% CI, 1.25-2.54, P<.001]) with heterogeneity (I=79.91%). Obesity was also associated with ARDS, severe COVID-19, mechanical ventilation, and hospital admission (OR 2.22 [95% CI, 1.40-3.53, P<.001]), but was not associated with ICU admission (OR 1.31 [95% CI, 0.87-1.99, P=.21]).

“Obesity results in a dysregulated immune response to respiratory infections,” study authors noted, adding that another “factor that probably explains the association between obesity and poor outcome of COVID-19 is that obesity has a negative effect on the immune system and host defense mechanism.”

Nine studies presented BMI as a continuous outcome, and 10 presented BMI as a dichotomous outcome. In studies that presented BMI continuously, higher BMI was associated with related poor outcome (mean difference 1.12 [95% CI, 0.67–1.57, P < 0.001]) with heterogeneity (I=20.96%).

Researchers also found that “the effect of higher BMI and obesity was less in older, [diabetes mellitus] type 2, and hypertensive patients. It is not certain why the meta-regression analysis results showed a smaller effect of obesity and it should be addressed by further existing literature.”

Study authors stressed that preventing transmission of COVID-19 should remain a primary concern. They also recommended that providers take BMI into account when treating patients who have contracted the virus, and “special attention should be given to patients with obesity.”

“Stakeholders have an obligation to encourage the community to implement a healthy lifestyle to reduce the prevalence of overweight and obesity especially during [the] COVID-19 pandemic,” authors concluded.

Reference:
Soeroto AY, Soetedjo NN, Purgiwa A, et al. Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis. Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1897-1904. doi:10.1016/j.dsx.2020.09.029