MMWR Morb Mortal Wkly Rep. 2021 Mar 12;70(10):355-361. doi: 10.15585/mmwr.mm7010e4.
Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers. The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR), CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m, 25.9 kg/m, and 23.7 kg/m, respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m to 60 kg/m. As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including continued vaccine prioritization (6) and masking, and policies to ensure community access to nutrition and physical activities that promote and support a healthy BMI.
肥胖*是严重 COVID-19 的公认危险因素（1,2），可能与慢性炎症有关，这种炎症会破坏对病原体的免疫和血栓形成反应（3），以及超重导致的肺功能受损（4）。肥胖是一种常见的代谢性疾病，影响美国 42.4%的成年人（5），也是其他慢性疾病的危险因素，包括 2 型糖尿病、心脏病和某些癌症。免疫实践咨询委员会认为肥胖是 COVID-19 疫苗优先接种的高风险医疗条件（6）。疾病预防控制中心利用 Premier Healthcare Database Special COVID-19 Release（PHD-SR）的数据，评估了体重指数（BMI）与严重 COVID-19 结果（即住院、重症监护病房[ICU]或降阶梯病房入院、有创机械通气和死亡）之间的关联。在 2020 年 3 月至 12 月期间，在美国 238 家医院的急诊科或住院患者中，有 148494 名成年人被诊断出 COVID-19，其中 28.3%超重，50.8%肥胖。超重和肥胖是有创机械通气的危险因素，肥胖是住院和死亡的危险因素，尤其是在年龄<65 岁的成年人中。BMI 为 24.2kg/m、25.9kg/m 和 23.7kg/m 的患者住院、入住 ICU 和死亡的风险最低，然后随着 BMI 的升高而急剧增加。BMI 范围内的风险最高，从 15kg/m 到 60kg/m。随着临床医生为 COVID-19 患者制定护理计划，他们应考虑 BMI 较高患者发生严重后果的风险，尤其是严重肥胖患者。这些发现强调了较高 BMI 的临床和公共卫生意义，包括随着肥胖严重程度的增加，需要加强 COVID-19 疾病管理，促进 COVID-19 预防策略，包括持续优先接种疫苗（6）和戴口罩，以及确保社区获得促进和支持健康 BMI 的营养和体育活动的政策。
