Abstract
BackgroundAlthough obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Furthermore, given that BMI is an insensitive indicator of adiposity, the effect of adipose volume on Covid-19 outcomes is also unknown.MethodsWe used the UK Biobank repository, which contains clinical and anthropometric data and is linked to Public Health England Covid-19 healthcare records, to address our research question. We performed age- and sex- adjusted logistic regression and Chi-squared test to compute the odds for Covid-19-related mortality as a consequence of increasing BMI, and other more sensitive indices of adiposity such as waist:hip ratio (WHR) and percent body fat, as well as concomitant cardiometabolic illness.Results13,502 participants were tested for Covid-19 (mean age 70 ± 8 years, 48.9% male). 1582 tested positive (mean age 68 ± 9 years, 52.8% male), of which 305 died (mean age 75 ± 6 years, 65.5% male). Increasing adiposity was associated with higher odds for Covid-19-related mortality. For every unit increase in BMI, WHR and body fat, the odds of death amongst Covid19-positive participants increased by 1.04 (95% CI 1.01–1.07), 10.71 (95% CI 1.57–73.06) and 1.03 (95% CI 1.01–1.05), respectively (all p < 0.05). Referenced to Covid-19 positive participants with a normal weight (BMI 18.5–25 kg/m2), Covid-19 positive participants with BMI > 35 kg/m2 had significantly higher odds of Covid-19-related death (OR 1.70, 95% CI 1.06–2.74, p < 0.05). Covid-19-positive participants with metabolic (diabetes, hypertension, dyslipidaemia) or cardiovascular morbidity (atrial fibrillation, angina) also had higher odds of death.ConclusionsAnthropometric indices that are more sensitive to adipose volume and its distribution than BMI, as well as concurrent cardiometabolic illness, are associated with higher odds of Covid-19-related mortality amongst the UK Biobank cohort that tested positive for the infection. These results suggest adipose volume may contribute to adverse Covid-19-related outcomes associated with obesity.
Highlights
Obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality
BMI is the most commonly used metric for categorising obesity, it is an insensitive measure of adiposity as it does not account for differences in body composition
Metabolic syndrome has been identified as a risk factor influencing progression of the infection [8], the added risk of mortality conferred by its constituent parts, i.e. diabetes, hypertension and dyslipidaemia, has not been reported
Summary
Obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Given that adipose tissue may serve as a reservoir for Covid-19 virus and a more severe course of illness [7], using alternative anthropometric indices that are more sensitive to adipose volume and its distribution to identify patients at risk of Covid-19related death would be clinically helpful. As such data are not routinely collected before or during hospitalisation the association between Covid-19 outcomes and body composition remains unknown. Metabolic syndrome has been identified as a risk factor influencing progression of the infection [8], the added risk of mortality conferred by its constituent parts, i.e. diabetes, hypertension and dyslipidaemia, has not been reported
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