MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, Hunan Province 410081, China.
Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province 410013, China.
Metabolism. 2021 Apr;117:154373. doi: 10.1016/j.metabol.2020.154373. Epub 2020 Sep 16.
The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented health crisis to the entire world. As reported, the body mass index (BMI) may play an important role in COVID-19; however, this still remains unclear. The aim of this study was to explore the association between BMI and COVID-19 severity and mortality.
The Medline, PubMed, Embase and Web of science were systematically searched until August 2020. Random-effects models and dose-response meta-analysis were used to synthesize the results. Combined odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated, and the effect of covariates were analyzed using subgroup analysis and meta-regression analyses.
A total of 16 observational studies involving 109,881 patients with COVID-19 were included in the meta-analysis. The pooled results showed that patients with a BMI ≥ 30 kg/m had a 2.35-fold risk (OR = 2.35, 95%CI = 1.64-3.38, P < 0.001) for critical COVID-19 and a 2.68-fold risk for COVID-19 mortality (OR = 2.68, 95%CI = 1.65-4.37, P < 0.001) compared with patients with a BMI <30 kg/m. Subgroup analysis results showed that patients with obesity and age > 60 years was associated with a significantly increased risk of critical COVID-19 (OR = 3.11, 95%CI = 1.73-5.61, P < 0.001) and COVID-19 mortality (OR = 3.93, 95%CI = 2.18-7.09, P < 0.001). Meta-regression analysis results also showed that age had a significant influence on the association between BMI and COVID-19 mortality (Coef. = 0.036, P = 0.048). Random-effects dose-response meta-analysis showed a linear association between BMI and both critical COVID-19(P = 0.242) and mortality (P = 0.116). The risk of critical COVID-19 and mortality increased by 9%(OR = 1.09, 95%CI = 1.04-1.14, P < 0.001) and 6%(OR = 1.06, 95%CI = 1.02-1.10, P = 0.002) for each 1 kg/m increase in BMI, respectively.
Evidence from this meta-analysis suggested that a linear dose-response association between BMI and both COVID-19 severity and mortality. Further, obesity (BMI ≥ 30 kg/m) was associated with a significantly increased risk of critical COVID-19 and in-hospital mortality of COVID-19.
2019 年冠状病毒病（COVID-19）大流行给全世界带来了前所未有的健康危机。据报道，体重指数（BMI）可能在 COVID-19 中发挥重要作用；然而，这仍然不清楚。本研究旨在探讨 BMI 与 COVID-19 严重程度和死亡率之间的关系。
系统检索了 Medline、PubMed、Embase 和 Web of science 数据库，检索时间截至 2020 年 8 月。采用随机效应模型和剂量反应荟萃分析来综合结果。计算合并的比值比（OR）及其 95%置信区间（CI），并使用亚组分析和荟萃回归分析来分析协变量的影响。
共纳入 16 项观察性研究，涉及 109881 例 COVID-19 患者。汇总结果显示，BMI≥30kg/m 的患者发生重症 COVID-19 的风险增加 2.35 倍（OR=2.35，95%CI=1.64-3.38，P<0.001），COVID-19 死亡率增加 2.68 倍（OR=2.68，95%CI=1.65-4.37，P<0.001），与 BMI<30kg/m 的患者相比。亚组分析结果显示，肥胖和年龄>60 岁的患者发生重症 COVID-19（OR=3.11，95%CI=1.73-5.61，P<0.001）和 COVID-19 死亡率（OR=3.93，95%CI=2.18-7.09，P<0.001）的风险显著增加。荟萃回归分析结果也表明年龄对 BMI 与 COVID-19 死亡率之间的关系有显著影响（Coef. =0.036，P=0.048）。随机效应剂量反应荟萃分析显示，BMI 与重症 COVID-19（P=0.242）和死亡率（P=0.116）之间呈线性关联。BMI 每增加 1kg/m，重症 COVID-19（OR=1.09，95%CI=1.04-1.14，P<0.001）和死亡率（OR=1.06，95%CI=1.02-1.10，P=0.002）的风险分别增加 9%和 6%。
本荟萃分析的证据表明，BMI 与 COVID-19 严重程度和死亡率之间存在线性剂量反应关系。此外，肥胖（BMI≥30kg/m）与重症 COVID-19 和 COVID-19 住院死亡率显著增加相关。
