Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China.
Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Metabolism. 2020 Dec;113:154378. doi: 10.1016/j.metabol.2020.154378. Epub 2020 Sep 28.
Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation.
This study explores the effects of obesity with the risk of severe disease among patients with COVID-19.
Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity.
A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001).
Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.
肥胖症在 2019 年冠状病毒病（COVID-19）患者中很常见。肥胖对 COVID-19 临床结局的影响需要系统研究。
本研究探讨肥胖症与 COVID-19 患者发生严重疾病的风险之间的关系。
使用体重指数（BMI）和内脏脂肪组织（VAT）堆积程度作为肥胖状态的指标。截至 2020 年 8 月 10 日，检索预印本在内的文献数据库。严重 COVID-19 的临床结局包括住院、入住重症监护病房（ICU）的需求、有创机械通气（IMV）和死亡。严重 COVID-19 结局的风险以 BMI 定义肥胖的队列研究的比值比（OR）和 95%置信区间（95%CI），以及 VAT 定义过度肥胖的对照研究的标准化均数差（SMD）和 95%CI 表示。
共有来自 30 项 BMI 定义肥胖的队列研究和 3 项 VAT 定义肥胖的对照研究的 45650 名参与者纳入严重 COVID-19 风险评估。单因素分析显示，BMI 较高与严重 COVID-19 的 OR 显著升高：住院的 OR 为 1.76（95%CI：1.21，2.56，P=0.003），入住 ICU 的 OR 为 1.67（95%CI：1.26，2.21，P<0.001），需要 IMV 的 OR 为 2.19（95%CI：1.56，3.07，P<0.001），死亡的 OR 为 1.37（95%CI：1.06，1.75，P=0.014），严重 COVID-19 的总体 OR 为 1.67（95%CI：1.43，1.96；P<0.001）。多因素分析显示，BMI 较高与严重 COVID-19 的 OR 升高相关：住院的 OR 为 2.36（95%CI：1.37，4.07，P=0.002），入住 ICU 的 OR 为 2.32（95%CI：1.38，3.90，P=0.001），需要 IMV 的 OR 为 2.63（95%CI：1.32，5.25，P=0.006），死亡的 OR 为 1.49（95%CI：1.20，1.85，P<0.001），严重 COVID-19 的总体 OR 为 2.09（95%CI：1.67，2.62；P<0.001）。与非严重 COVID-19 患者相比，严重 COVID-19 患者的 VAT 堆积明显更高，其住院的 SMD 为 0.49（95%CI：0.11，0.87；P=0.011），入住 ICU 的 SMD 为 0.57（95%CI：0.33，0.81；P<0.001），需要 IMV 的 SMD 为 0.37（95%CI：0.03，0.71；P=0.035）。严重 COVID-19 的总体 SMD 为 0.50（95%CI：0.33，0.68；P<0.001）。
肥胖症增加了 COVID-19 患者住院、入住 ICU、需要 IMV 和死亡的风险。此外，过多的内脏脂肪似乎与严重 COVID-19 结局相关。这些发现强调了个人、公众和政府需要采取有效行动，提高对肥胖相关风险的认识，以及在当前全球大流行中这些风险如何加剧。
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