Abstract
Aging and obesity-related conditions seem to worsen the effect of Coronavirus Disease 2019 (COVID-19). This study assessed the possible roles of metabolic/obesity phenotypes and vitamin D status in increasing the greater severity of COVID-19. We studied 353,299 UK Biobank participants from England with a mean age of 67.7 years. Metabolic/obesity phenotypes were defined as a combination of metabolic components (hypertension, high cholesterol, and diabetes) and obesity. Multivariate logistic regression analysis was performed to test whether the addition of metabolic disorders and vitamin D insufficiency increased obesity associations with COVID-19 hospitalization, confirmed COVID-19, and severe COVID-19. Metabolically unhealthy obesity (MUHO) represented 12.3% of the total analytic samples, and 21.5%, 18.5%, and 19.8% of the included subpopulations with COVID-19 hospitalization, confirmed COVID-19, and severe COVID-19, respectively. Vitamin D insufficiency phenotypes represented 53.5% of the total analytic samples, and 59.5%, 61.7%, and 61.5% of the included subpopulations with COVID-19 hospitalization, confirmed COVID-19, and severe COVID-19, respectively. In multivariate logistic regression, MUHO and vitamin D insufficiency and their combination were significantly associated with COVID-19 illness severity (odds ratio [OR] for COVID-19 hospitalization = 2.33, 95% confidence interval [CI], 2.02-2.70; OR for confirmed COVID-19 = 2.06, 95% CI, 1.58-2.70; OR for severe COVID-19 = 2.06, 95% CI, 1.47-2.87). Elderly men were prone to have a higher risk of COVID-19 than women. Our findings showed that MUHO and vitamin D insufficiency are associated with a significantly increased risk of COVID-19 severity, especially for adults 65 years and older. Susceptible individuals should be aware of their conditions and avoid contact with new coronavirus.
Highlights
Coronavirus Disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is threatening human health worldwide [1]
Participants who were identified with COVID-19 hospitalization, confirmed COVID-19, and severe COVID-19 had higher percentages of obesity, smoking, metabolically unhealthy overweight (MUHOW), and slightly lower vitamin D levels than negative ones
We conducted a combined analysis of metabolic/obesity phenotypes and vitamin D status related to COVID-19 using a total sample of 353,299 adults in England
Summary
Coronavirus Disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is threatening human health worldwide [1]. Low vitamin D status has been examined whether it may be associated with increased susceptibility to COVID-19, as well as hospitalization and critical illness in patients with COVID-19 [7]. Studies have identified preexisting metabolic abnormalities, such as type 2 diabetes and hypertension, as the most common comorbidities for coronavirus infections [10,11], it remains unknown whether obesity, metabolic health and extended combinations of vitamin D sufficiency predispose individuals to develop COVID-19. We pursued two hypotheses: 1) the health risk and illness severity for individuals with COVID-19 may increase disproportionately within different combinations of metabolic and obesity phenotypes; and 2) the discrepancy is likely to become even more pronounced when low vitamin D levels are present. Understanding how COVID-19 outcomes are associated with a broad combination of metabolic/obesity phenotypes and vitamin D status could inform future public health prevention programs, highlighting new atrisk individuals and populations
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