COVID-19: Impact of Obesity and Diabetes in Disease Severity

Abstract

Background: The Coronavirus disease 2019 (COVID19) pandemic is straining the healthcare system, particularly for patients with severe outcomes who require admittance to the intensive care unit (ICU). This study aimed to investigate the potential associations of obesity and diabetes with COVID19 severe outcomes, assessed as ICU admittance. Subjects: Demographic and patient characteristics from a retrospective cohort of 1158 patients hospitalized with COVID19 in a single center in Kuwait, along with their medical history, were analyzed. Univariate and multivariate analyses were performed to explore the associations between different variables and ICU admittance. Results: From the 1158 hospitalized patients, 271 (23.4%) had diabetes, 236 (20.4%) had hypertension and 104 (9%) required admittance into the ICU. From patients with available measurements, 157 (21.6%) had body mass index (BMI)≥25 kg/m2. Univariate analysis showed that overweight (BMI=25.0~29.9 kg/m2), obesity class I (BMI=30~34.9 kg/m2) and morbid obesity (BMI≥40 kg/m2) associated with ICU admittance (odds ratio (OR) [95% confidence intervals (CI)]: 2.45 [1.26~4.74] p value=0.008; OR [95% CI]: 3.51 [1.60~7.69] p value=0.002; and OR [95% CI]: 5.18 [1.50~17.85] p value=0.009], respectively). Patients with diabetes were more likely to be admitted to ICU (OR [95% CI]: 9.38 [5.49~16.02]). Two models for multivariate regression analysis were used, assessing either BMI or diabetes on ICU outcomes. In the BMI model, class I obesity and morbid obesity were associated with ICU admittance (adjusted OR (AOR) [95% CI]: 2.7 [1.17~6.20] p value=0.019 and AOR [95% CI]: 3.95 [1.00~15.20] p value=0.046, respectively). In the diabetes model, diabetes was associated with higher ICU admittance (AOR [95% CI]: 5.49 [3.13~9.65] p value<0.001) whereas hypertension had a protective effect on ICU admittance (AOR [95% CI]: 0.51 (0.28−0.91). Conclusions: In our cohort, overweight, obesity and diabetes in patients with COVID19 were associated with ICU admittance, putting these patients at higher risk of poor outcomes.

Association of body mass index (BMI) with critical COVID-19 and in-hospital mortality: A dose-response meta-analysis

“…A total of six studies[ 21 , 23 , 24 , 25 , 28 , 29 ] were included in the dose-response meta-analysis of the association between BMI and critical COVID-19. It was found that there was a linear relationship (P non-linearity = 0.242) between BMI and the risk of critical COVID-19 ( Fig.…”

Obesity and COVID-19: Molecular Mechanisms Linking Both Pandemics

“…Another Mexican study with 51,633 patients showed similar results, with a significant increased lethality rate in patients with obesity (HR: 1.25 (1.17–1.34, p < 0.001) [ 27 ]. These reports with large patient cohorts are further strengthened by multiple clinical studies with smaller collectives worldwide [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Interestingly, Lighter et al and Ebinger et al showed that middle aged patients with an age below 52 and up to 60 years were more affected by obesity (BMI 30–34 and ≥35) with an HR: 2.0 (1.6–2.6, p < 0.0001)) and HR: 2.2 (1.7–2.9, p < 0.0001), respectively, resulting in increased morbidity rates compared to >60 years old patients [ 31 , 43 ].…”

Obesity, Diabetes and COVID-19: An Infectious Disease Spreading From the East Collides With the Consequences of an Unhealthy Western Lifestyle

“…An audit of 124 patients admitted to ICU in France observed that among patients with COVID-19, obesity (BMI >30-<35 kg/m 2 ) and severe obesity (BMI >35 kg/m 2 ) were more prevalent than in control patients admitted to ICU for other causes: 47.6 vs. 25.2% and 28.2 vs. 10.8%, respectively, and those requiring invasive mechanical ventilation were also more obese (24). In a multivariate analysis of hospitalized patients in Kuwait, the risk of requirement for ICU was increased in the obese OR 2.7 (CI 1.17, 6.20) and those with morbid obesity (BMI >40) OR 3.95 (CI 1.0-15.2) (19). A similar study from New York that included 1,331 hospitalized COVID-19 patients, of whom 431 were admitted to ICU, found that the association with obesity was only evident in younger patients <60 years old with a higher risk of ICU admission for those with obesity (OR 1.8, CI 1.2, 2.7) and severe obesity (OR 3.6, CI 2.5, 5.3) compared to patients with a BMI <30 (25).…”