Nutrition Department, Federal University of Health Science of Porto Alegre, Sarmento Leite street, 245, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil; Graduate Program of Nutrition Science, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Graduate Program of Nutrition Science, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Clin Nutr ESPEN. 2023 Feb;53:13-25. doi: 10.1016/j.clnesp.2022.08.014. Epub 2022 Aug 17.
BACKGROUND & AIMS: This umbrella review of systematic reviews with meta-analysis (SR-MAs) aimed to evaluate the risk of bias and the certainty of the evidence of SR-MAs on the association between obesity and mortality in patients with SARS-CoV-2.
We conducted a comprehensive literature search until April 22, 2022, in several databases and assessed the risk of bias of SR-MAs according to AMSTAR-2 and the certainty of evidence using the GRADE approach. The degree of overlap between meta-analyses was based on the corrected covered area (CCA) index. The results of each MA [relative risk (RR), hazard ratio (HR), or odds ratio (OR)] were extracted to evaluate the magnitude of the association between obesity and mortality.
A total of 24 SR-MAs were eligible, and the association between obesity and mortality was not statistically significant in eight (33.3%) of them, while the OR/HR/RR ranged from 1.14 to 3.52 in the other SR-MAs. The overlap was slight (CCA = 4.82%). The majority of SR-MAs presented critically low quality according to AMSTAR-2 (66.7%), and the certainty of the evidence for most of them (83.4%) was "very low".
Obesity was associated with an increased risk of death in patients with SARS-CoV-2 infection in most SR-MAs; however, a critical appraisal pointed to a high risk of bias, and the certainty of their evidence was not well graded. The dissemination of poor SR-MAs may limit the interpretation of findings, and we should always aspire to trustworthy scientific evidence.
PROSPERO 2021 CRD42021253142.
本项系统评价的荟萃分析（SR-MA）旨在评估肥胖与 SARS-CoV-2 感染患者死亡率之间相关性的 SR-MA 的偏倚风险和证据确定性。
我们对多个数据库进行了全面的文献检索，截止至 2022 年 4 月 22 日，并根据 AMSTAR-2 评估 SR-MA 的偏倚风险，使用 GRADE 方法评估证据确定性。根据校正涵盖面积（CCA）指数评估荟萃分析之间的重叠程度。提取每个 MA 的结果[相对风险（RR）、风险比（HR）或比值比（OR）]来评估肥胖与死亡率之间关联的大小。
共有 24 项 SR-MA 符合条件，其中 8 项（33.3%）肥胖与死亡率之间的相关性无统计学意义，而其他 SR-MA 的 OR/HR/RR 范围在 1.14 至 3.52 之间。重叠度较低（CCA=4.82%）。根据 AMSTAR-2，大多数 SR-MA 的质量被评为严重低质量（66.7%），并且大多数（83.4%）的证据确定性为“极低”。
大多数 SR-MA 表明肥胖与 SARS-CoV-2 感染患者的死亡风险增加相关；然而，批判性评价指出偏倚风险较高，且证据确定性评分不佳。不良 SR-MA 的传播可能会限制对研究结果的解释，我们应始终追求可信的科学证据。
PROSPERO 2021 CRD42021253142。
