School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
BMJ Open. 2021 Nov 3;11(11):e055003. doi: 10.1136/bmjopen-2021-055003.
To investigate the associations of physical activity level with COVID-19 mortality risk across body mass index (BMI) categories, and to determine whether any protective association of a higher physical activity level in individuals with obesity may be explained by favourable levels of cardiometabolic and inflammatory biomarkers.
Prospective cohort study (baseline data collected between 2006 and 2010). Physical activity level was assessed using the International Physical Activity Questionnaire (high: ≥3000 Metabolic Equivalent of Task (MET)-min/week, moderate: ≥600 MET-min/week, low: not meeting either criteria), and biochemical assays were conducted on blood samples to provide biomarker data.
UK Biobank.
Logistic regressions adjusted for potential confounders were performed to determine the associations of exposure variables with COVID-19 mortality risk. Mortality from COVID-19 was ascertained by death certificates through linkage with National Health Service (NHS) Digital.
Within the 259 397 included participants, 397 COVID-19 deaths occurred between 16 March 2020 and 27 February 2021. Compared with highly active individuals with a normal BMI (reference group), the ORs (95% CIs) for COVID-19 mortality were 1.61 (0.98 to 2.64) for highly active individuals with obesity, 2.85 (1.78 to 4.57) for lowly active individuals with obesity and 1.94 (1.04 to 3.61) for lowly active individuals with a normal BMI. Of the included biomarkers, neutrophil count and monocyte count were significantly positively associated with COVID-19 mortality risk. In a subanalysis restricted to individuals with obesity, adjusting for these biomarkers attenuated the higher COVID-19 mortality risk in lowly versus highly active individuals with obesity by 10%.
This study provides novel evidence suggesting that a high physical activity level may attenuate the COVID-19 mortality risk associated with obesity. Although the protective association may be partly explained by lower neutrophil and monocyte counts, it still remains largely unexplained by the biomarkers included in this analysis.
研究身体质量指数（BMI）类别内的体力活动水平与 COVID-19 死亡率风险之间的关联，并确定肥胖个体中较高体力活动水平的任何保护关联是否可通过有利的心血管代谢和炎症生物标志物水平来解释。
前瞻性队列研究（基线数据收集于 2006 年至 2010 年之间）。使用国际体力活动问卷（高：≥3000 代谢当量任务（MET）-min/周，中：≥600 MET-min/周，低：不符合任何标准）评估体力活动水平，并对血液样本进行生化检测以提供生物标志物数据。
英国生物库。
通过调整潜在混杂因素的逻辑回归来确定暴露变量与 COVID-19 死亡率风险的关联。通过与国民保健服务（NHS）数字系统链接，通过死亡证明确定 COVID-19 死亡。
在纳入的 259397 名参与者中，有 397 人在 2020 年 3 月 16 日至 2021 年 2 月 27 日期间死于 COVID-19。与正常 BMI 的高体力活动个体（参考组）相比，肥胖个体中 COVID-19 死亡率的 OR（95%CI）分别为 1.61（0.98 至 2.64），肥胖个体中体力活动水平低的个体为 2.85（1.78 至 4.57），正常 BMI 的体力活动水平低的个体为 1.94（1.04 至 3.61）。在纳入的生物标志物中，中性粒细胞计数和单核细胞计数与 COVID-19 死亡率风险呈显著正相关。在仅纳入肥胖个体的亚分析中，调整这些生物标志物可使肥胖个体中体力活动水平低与体力活动水平高的个体相比，COVID-19 死亡率风险降低 10%。
这项研究提供了新的证据，表明较高的体力活动水平可能会降低肥胖与 COVID-19 死亡率相关的风险。尽管这种保护关联可能部分通过较低的中性粒细胞和单核细胞计数来解释，但它仍然很大程度上无法通过本分析中包含的生物标志物来解释。
