Division of Surgery and Interventional Science, Faculty Medical Sciences, University College London, London WC1E 6BT, United Kingdom;
Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, United Kingdom.
Proc Natl Acad Sci U S A. 2020 Sep 1;117(35):21011-21013. doi: 10.1073/pnas.2011086117. Epub 2020 Aug 11.
The role of obesity and overweight in occurrence of COVID-19 is unknown. We conducted a large-scale general population study using data from a community-dwelling sample in England ( = 334,329; 56.4 ±8.1 y; 54.5% women) with prospective linkage to national registry on hospitalization for COVID-19. Body mass index (BMI, from measured height and weight) was used as an indicator of overall obesity, and waist-hip ratio for central obesity. Main outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Around 0.2% ( = 640) of the sample were hospitalized for COVID-19. There was an upward linear trend in the likelihood of COVID-19 hospitalization with increasing BMI, that was evident in the overweight (odds ratio, 1.39; 95% CI 1.13 to 1.71; crude incidence 19.1 per 10,000) and obese stage I (1.70;1.34 to 2.16; 23.3 per 10,000) and stage II (3.38; 2.60 to 4.40; 42.7 per 10,000) compared to normal weight (12.5 per 10,000). This gradient was little affected after adjustment for a wide range of covariates; however, controlling for biomarkers, particularly high-density lipoprotein cholesterol and glycated hemoglobin, led to a greater degree of attenuation. A similar pattern of association emerged for waist-hip ratio. In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.
肥胖和超重在 COVID-19 发病中的作用尚不清楚。我们使用来自英国社区居民样本（n=334329；56.4±8.1 岁；54.5%为女性）的数据进行了一项大规模的一般人群研究，这些数据与全国 COVID-19 住院登记系统进行了前瞻性链接。体重指数（BMI，根据测量的身高和体重计算得出）用于表示总体肥胖，腰围-臀围比用于表示中心性肥胖。主要结局是因 COVID-19 而需要住院治疗的病例，时间范围为 2020 年 3 月 16 日至 4 月 26 日。约 0.2%（=640）的样本因 COVID-19 住院治疗。随着 BMI 的增加，COVID-19 住院的可能性呈上升线性趋势，在超重（比值比，1.39；95%置信区间 1.13 至 1.71；粗发病率为每 10000 人 19.1 例）和肥胖 I 期（1.70；1.34 至 2.16；每 10000 人 23.3 例）和 II 期（3.38；2.60 至 4.40；每 10000 人 42.7 例）更为明显，与正常体重（每 10000 人 12.5 例）相比。在调整了广泛的协变量后，这种梯度变化影响不大；然而，控制生物标志物，特别是高密度脂蛋白胆固醇和糖化血红蛋白，会导致更大程度的衰减。腰围-臀围比也出现了类似的关联模式。总之，总体和中心性肥胖是 COVID-19 住院的危险因素。即使体重略有增加，风险也明显增加。其机制可能涉及葡萄糖和脂质代谢受损。
