Abstract
BackgroundObesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS‐CoV‐2 through the stimulation of inflammation, functional immunologic deficit and a pro‐thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism.MethodsObservational studies in COVID‐19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models.ResultsEight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID‐19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43‐3.86) and 3.52 (1.32‐9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72‐18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years).ConclusionsExcess adiposity is a risk factor for severe disease and mortality in people with SARS‐CoV‐2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS‐CoV‐2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures. Systematic review registration: PROSPERO 2020: CRD42020179783.
Highlights
| METHODSThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially reported in November 2019 in Wuhan, China, has claimed over 300 000 lives globally[1] and devastated the global economy
Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS-CoV-2 through the stimulation of inflammation, functional immunologic deficit and a pro-thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism
Pooled analysis of four studies each showed significantly higher body mass index (BMI) levels in COVID-19 patients with severe illness compared to patients without severe illness: mean difference of 3.08 kg/m2 (2.09, 4.08; P < .01; I2 = 87%; 95% confidence intervals (CIs) 69, 95%; P for heterogeneity < .01)
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially reported in November 2019 in Wuhan, China, has claimed over 300 000 lives globally[1] and devastated the global economy. The protocol was designed to include all observational studies (prospective cohort, retrospective, nested case-control and casecontrol), clinical studies, nonrandomized controlled trials (RCTs) and RCTs reporting a relationship between obesity and the clinical outcomes in patients with COVID-19. Article types such as opinion pieces, consensus reports, single case studies and narrative reviews were excluded. For data reported as medians, standard errors, ranges and 95% confidence intervals (CIs), means and standard deviations were estimated using methods as described by Hozo and colleagues.[20] Due to the different cut-offs used for BMI by the included studies, we employed the risk comparison: ≥25 vs
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