Department of Endocrinology, The Second Medical Centre & National Clinical Research Centre for Geriatric Disease, Chinese PLA General Hospital, Beijing, China.
Chinese PLA Center for Disease Control and Prevention, China.
Nutr Metab Cardiovasc Dis. 2021 Oct 28;31(11):3219-3226. doi: 10.1016/j.numecd.2021.07.030. Epub 2021 Aug 5.
Patients with multiple metabolic diseases are at high risk for the occurrence and death of COVID-19. Little is known about patients with underweight and metabolically healthy obesity. The aim of this study is to evaluate the impact of BMI and COVID-19 mortality in hospitalized patients, and also explore the association in different metabolically healthy (MHS) and unhealthy status (MUS).
A retrospective cohort study based on 3019 inpatients from Wuhan was conducted. Included patients were classified into four groups according the BMI level (underweight, normal weight, overweight and obesity), and patients with at least one of the metabolic abnormalities (diabetes, hypertension, dyslipidemia) was defined as MUS. Multiple Cox model was used to calculate the hazard ratio (HR). Compared to patients with normal weight, the HRs of overweight and obesity for COVID-19 mortality were 1.91 (95%CI:1.02-3.58) and 2.54 (95%CI:1.22-5.25) respectively in total patients, and 2.58 (95%CI:1.16-5.75) and 3.89 (95%CI:1.62-9.32) respectively in the elderly. The HR of underweight for COVID-19 mortality was 4.58 (95%CI:1.56-13.48) in the elderly. For different metabolic statuses, both underweight, overweight and obesity had obviously negative association with COVID-19 mortality in total and elderly patients with MUS. However, no significance was found in non-elderly and patients with MHS.
Not only overweight or obesity, but also underweight can be associated with COVID-9 mortality, especially in the elderly and in patients with MUS. More large-scale studies are needed for patients with underweight and metabolically healthy overweight or obesity.
患有多种代谢性疾病的患者发生 COVID-19 及死亡的风险较高。对于体重过轻和代谢健康肥胖的患者知之甚少。本研究旨在评估 BMI 和 COVID-19 住院患者死亡率的影响，并探讨不同代谢健康（MHS）和不健康状态（MUS）下的相关性。
本研究基于武汉的 3019 名住院患者进行了回顾性队列研究。根据 BMI 水平（体重过轻、正常体重、超重和肥胖）将纳入患者分为四组，至少有一种代谢异常（糖尿病、高血压、血脂异常）的患者被定义为 MUS。使用多 Cox 模型计算风险比（HR）。与正常体重患者相比，超重和肥胖患者 COVID-19 死亡率的 HR 分别为所有患者中的 1.91（95%CI：1.02-3.58）和 2.54（95%CI：1.22-5.25），老年患者中的 2.58（95%CI：1.16-5.75）和 3.89（95%CI：1.62-9.32）。老年患者体重过轻的 COVID-19 死亡率 HR 为 4.58（95%CI：1.56-13.48）。对于不同的代谢状态，在所有患者和 MUS 老年患者中，体重过轻、超重和肥胖与 COVID-19 死亡率均呈明显负相关。然而，在非老年患者和 MHS 患者中，这种相关性没有统计学意义。
不仅超重或肥胖，体重过轻也与 COVID-9 死亡率相关，尤其是在老年和 MUS 患者中。需要对体重过轻和代谢健康超重或肥胖的患者进行更多的大规模研究。
