COVID-19 and Obesity: Dangerous Liaisons

Abstract

Besides advanced age and the presence of multiple comorbidities as major contributors to increased risk of severe disease and fatal outcome from Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19), there is now emerging evidence that overweight and obesity predispose to severe symptoms and negative prognosis. Remarkably, the severity of COVID-19 appears to rise with increasing body mass index (BMI). The association between COVID-19 outcomes and overweight/obesity has biological and physiological plausibility. Potential pathophysiological mechanisms that may explain this strong association include the chronic pro-inflammatory state, the excessive oxidative stress response, and the impaired immunity that is commonly reported in these individuals. The role of cytokines, mammalian target of rapamycin (mTOR), and altered natural killer cell polarization in the dangerous liaison between COVID-19 and obesity are discussed here. These pathways can favor and accelerate the deleterious downstream cellular effects of SARS-CoV-2. Moreover, obesity is well known to be associated with reduced lung function and poor response to mechanical ventilation, thus placing these individuals at high risk of severe illness and mortality from COVID-19. Furthermore, obesity may lead to other complications, such as renal failure, cardiovascular dysfunction, hypertension, and vascular damage, which in turn can further accelerate negative clinical outcomes from COVID-19. Obese individuals should be shielded against any potential viral exposure to SARS-CoV-2 with consequential considerations for compulsory protection devices and social distancing. Health care providers should be aware that obesity predisposes to severe symptoms and negative prognosis in COVID-19 patients.

Cardiovascular Active Peptides of Marine Origin with ACE Inhibitory Activities: Potential Role as Anti-Hypertensive Drugs and in Prevention of SARS-CoV-2 Infection

“…Patients with comorbidities, in particular those affected by cardiovascular diseases [10], hypertension, and diabetes, have been reported to worsen their clinical conditions when infected by SARS-CoV-2 significantly. ACE inhibitors' role can also be very relevant for the development or protection of the clinical pattern of Covid-19 syndrome [18,19].…”

“…ACE2 acts as a monocarboxypeptidase, characterized by a single active site with higher affinity (~400-fold) for Ang II than Ang I [86], and is insensitive to ACE inhibitors (ACE-i) [22]. ACE2 expression is highly variable depending on tissue localization; elevated ACE2 expression levels are found in the kidney, lungs, intestine, heart, testis, adipose tissue, and endothelial cells [18,87]. ACE inhibitors and AT1R antagonists (ARBs) cause increasing ACE2 activity in the heart and kidneys in both normal and hypertensive rats [88][89][90].…”

“…However, when compared to the terrestrial counterpart, the marine environment remains under-investigated as by SARS-CoV-2 significantly. ACE inhibitors' role can also be very relevant for the development or protection of the clinical pattern of Covid-19 syndrome [18,19].…”

The Impact of Stress on Pathogenetic Mechanisms of Obesity (Systematic Review)

“…In addition, in condition when the significant number of countries is in quarantine associated with the COVID-19 pandemic, obesity becomes an additional risk factor for severe COVID-19. It is a well-known fact that overweight patients have impaired mechanical ventilation, furthermore, obesity is a chronic inflammatory disease in which increased production of cytokines, altered reactivity of natural killers occur [5]. According to statistics, obese patients have more severe course of COVID-19, are much more likely to be admitted to inpatient treatment and intensive care units, requiring oxygen therapy [6].…”

Patient Demographics Associated with ARDS Incidence, Hospital Length of Stay and Mortality

“…Emerging research has suggested that higher BMI is associated with increased LOS but decreased mortality for patients with ARDS [12,13]. However, recent fi ndings indicate that COVID-19 related deaths are more prevalent in patients with higher BMI [14] and that obesity should be considered an independent risk factor for mortality in patients with COVID-19 [15]. Obesity has been also linked to increased incidence of hospital admission in younger patients [16].…”