Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
Department of Internal Medicine & Rush Institute of Healthy Aging, Rush University Medical Center, Chicago, IL, USA.
Clin Nutr. 2023 Sep;42(9):1690-1700. doi: 10.1016/j.clnu.2023.07.004. Epub 2023 Jul 23.
BACKGROUND & AIMS: Systematic reviews, meta-analyses and Mendelian randomization studies suggest that cardiometabolic diseases may be associated with COVID-19 risk and prognosis, with evidence implicating insulin resistance (IR) as a common biological mechanism. As driving factors for IR, we examined body mass index (BMI) and waist circumference (WC) among postmenopausal women in association with COVID-19 outcomes (positivity and hospitalization), and the role of glucose homeostasis as a mediator of this relationship.
Associations of BMI and WC at baseline (1993-1998) with COVID-19 outcomes collected at Survey 1 (June-December, 2020) and/or Survey 2 (September-December, 2021) were evaluated among 42,770 Women's Health Initiative (WHI) participants (baseline age: 59.36 years) of whom 16,526 self-reported having taken ≥1 COVID-19 test, with 1242 reporting ≥1 positive COVID-19 test and 362 reporting ≥1 COVID-19 hospitalization. We applied logistic regression and causal mediation analyses to sub-samples with available fasting biomarkers of glucose homeostasis (glucose, insulin, Homeostatic Model Assessment for Insulin Resistance, Homeostasis Model Assessment for β-cell function, Quantitative Insulin-sensitivity Check Index, Triglyceride-Glucose index (TyG)) at baseline, whereby 57 of 759 reported COVID-19 test positivity and 23 of 1896 reported COVID-19 hospitalization.
In fully adjusted models, higher BMI, WC and TyG were associated with COVID-19 test positivity and hospitalization. Glucose concentrations mediated associations of BMI and WC with COVID-19 positivity, whereas TyG mediated BMI and WC's associations with COVID-19 hospitalization.
Obesity and central obesity markers collected an average of 24 years prior were associated with COVID-19 outcomes among postmenopausal women. Glucose concentration and TyG partly mediated these associations.
系统评价、荟萃分析和孟德尔随机化研究表明，心血管代谢疾病可能与 COVID-19 风险和预后相关，有证据表明胰岛素抵抗（IR）是一种常见的生物学机制。作为 IR 的驱动因素，我们研究了绝经后妇女的体重指数（BMI）和腰围（WC）与 COVID-19 结局（阳性和住院）之间的关系，并研究了葡萄糖稳态作为这种关系中介的作用。
在 42770 名参加妇女健康倡议（WHI）的参与者中（基线年龄：59.36 岁），评估了基线（1993-1998 年）BMI 和 WC 与 2020 年 6 月至 12 月（调查 1）和/或 2021 年 9 月至 12 月（调查 2）收集的 COVID-19 结局之间的关联，其中 16526 名自我报告接受了≥1 次 COVID-19 检测，1242 名报告了≥1 次 COVID-19 阳性检测，362 名报告了≥1 次 COVID-19 住院治疗。我们应用逻辑回归和因果中介分析，对具有基线葡萄糖稳态的空腹生物标志物（血糖、胰岛素、胰岛素抵抗评估的稳态模型、β细胞功能的稳态模型、定量胰岛素敏感性检查指数、甘油三酯-血糖指数（TyG））的亚样本进行分析，其中 759 名报告 COVID-19 检测阳性中有 57 名，1896 名报告 COVID-19 住院中有 23 名。
在完全调整的模型中，较高的 BMI、WC 和 TyG 与 COVID-19 检测阳性和住院有关。血糖浓度介导了 BMI 和 WC 与 COVID-19 阳性之间的关联，而 TyG 则介导了 BMI 和 WC 与 COVID-19 住院之间的关联。
绝经后妇女平均 24 年前收集的肥胖和中心性肥胖标志物与 COVID-19 结局相关。血糖浓度和 TyG 部分介导了这些关联。
