Insight into the relationship between obesity-induced low-level chronic inflammation and COVID-19 infection

Kim, Jihye; Nam, Jae Hwan

doi:10.1038/s41366-020-0602-y

Cited by 62 publications

(63 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, there is in obesity a chronic low-grade systemic inflammation (pro-inflammatory state), characterized by increased proinflammatory cytokine secretion from the adipose tissue (especially adipokines, the fat tissue-associated cytokines) [ 6 ]. Obese individuals usually also have insulin resistance, reduced beta-cell function, as well chronically higher leptin and lower adiponectin concentrations, an unfavorable profile that may lead to a functional immunologic deficit, as the integrated regulation of metabolism required for the complex cellular interactions, and for effective host defense, are lost [ 20 – 22 ]. Imbalanced activity of the renin–angiotensin–aldosterone system in obese people also seem to have a role in this pathogenesis, as it is also known that SARS-CoV-2 penetrates human cells through binding with angiotensin-converting enzyme 2 (ACE2) [ 2 ]; although ACE2 in lung tissue is considered to be a key entry site of the SARS-CoV-2, ACE2 expression in adipose tissue is thought to be even higher than in the lungs, increasing vulnerability of obese people to SARS-CoV-2 [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Imbalanced activity of the renin–angiotensin–aldosterone system in obese people also seem to have a role in this pathogenesis, as it is also known that SARS-CoV-2 penetrates human cells through binding with angiotensin-converting enzyme 2 (ACE2) [ 2 ]; although ACE2 in lung tissue is considered to be a key entry site of the SARS-CoV-2, ACE2 expression in adipose tissue is thought to be even higher than in the lungs, increasing vulnerability of obese people to SARS-CoV-2 [ 2 ]. Moreover, B- and T-cell responses are impaired in obese individuals, with numerical and functional alterations of lymphocytes, which may increase susceptibility to viral infection [ 20 ]. Under viral infection, in turn, the obesity-related dysregulated proinflammatory response also leads to reduced macrophage activation (which may explain the poor vaccination response in obese patients) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, B- and T-cell responses are impaired in obese individuals, with numerical and functional alterations of lymphocytes, which may increase susceptibility to viral infection [ 20 ]. Under viral infection, in turn, the obesity-related dysregulated proinflammatory response also leads to reduced macrophage activation (which may explain the poor vaccination response in obese patients) [ 20 ]. Finally, obesity may increase antiviral resistance [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Higher frequency of hepatic steatosis at CT among COVID-19-positive patients

et al. 2020

View full text Add to dashboard Cite

Purpose Recent studies have demonstrated that obesity is significantly associated with increased disease severity, hospitalizations and mortality in COVID-19, with a potential role in the pathogenesis and prevalence in the new pandemic. The association with hepatic steatosis, however, a condition closely related to obesity within the spectrum of systemic metabolic dysfunctions, remains to be elucidated. We aimed to evaluate the frequency of hepatic steatosis as incidentally detected in chest CT examinations of COVID-19 positive patients in comparison to non-infected controls. Methods A retrospective study was performed with 316 patients (204 RT-PCR positive; 112 RT-PCR negative and chest CT negative). Steatosis was measured with placement of a single ROI in the right lobe of the liver (segments VI-VII) and defined as a liver attenuation value ≤ 40 HU. Results The frequency of hepatic steatosis was higher in the RT-PCR positive group in comparison to controls (31.9% vs. 7.1%, p < 0.001). Logistic linear regression analysis showed a 4.7 times odds of steatosis in the COVID-19 positive group as compared to controls after adjusting for age and sex (OR 4.698; 95% IC 2.12-10.41, p < 0.001). Conclusion A significantly higher prevalence of steatosis was found among COVID-19 positive individuals. These findings are in accordance with other recent studies linking obesity and COVID-19 infection, as there is an intricate relationship between liver steatosis, metabolic syndrome and obesity. Further studies are required to confirm if such association remains after accounting for multiple variables, as well as possible relationships with disease severity and worst clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Higher frequency of hepatic steatosis at CT among COVID-19-positive patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“… 96 In relation to COVID-19, whose severe conditions evolve with an intense and severe systemic inflammatory reaction (cytokine storms), the imbalance of immune system observed in obesity may contribute to a worse clinical outcome. 79 Adipocytokines, especially leptin, play an important role in this process, as they influence number and function of immune cells through directly effects on cell metabolism. In this context, there may be an increase in cytotoxic and effector T-cells (Th1 and Th7) and M1 macrophages and, in parallel, a reduction in Treg cells and M2 macrophages.…”

Section: Pathophysiology Of Obesity and Its Relationship With Covid-1mentioning

confidence: 99%

COVID-19 and obesity in childhood and adolescence: a clinical review

Nogueira‐de‐Almeida

Ciampo

Ferraz

et al. 2020

Jornal de Pediatria

174

136

View full text Add to dashboard Cite

Objective To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. Sources Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. Summary of findings Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. Conclusions The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

show abstract

“…Therefore, together, SARS-CoV-2 infection and obesity may lead to a dysregulated immune response and increased viral shedding, which could impact the outcome of COVID-19 patients [28].…”

Section: Discussionmentioning

confidence: 99%

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Rossi

Gottin

Donadello

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background/Objectives: Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19).The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU and to compare the observed trend of C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK), as potential pathophysiological mechanisms linking disease severity with Body Mass Index (BMI).Subjects/Methods: 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study. Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, CRP, CPK, as well as ICU and hospital length of stay and comorbidities were evaluated. Results: Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). In the full adjusted model, age was independently associated with mortality (HR:1.13,95%C.I:1.05-1.21).Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects.Conclusions: Our study shows that in COVID-19 subjects admitted to ICU obesity is a risk factor for unfavourable health outcomes with higher mortality and longer hospital stay. The increase in CRP and CPK levels observed in this population could at least in part explain the unfavourable outcomes observed in individuals with obesity. In those subjects, careful management of any medical signs or symptoms and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.

show abstract

Insight into the relationship between obesity-induced low-level chronic inflammation and COVID-19 infection

Cited by 62 publications

References 10 publications

Higher frequency of hepatic steatosis at CT among COVID-19-positive patients

Higher frequency of hepatic steatosis at CT among COVID-19-positive patients

COVID-19 and obesity in childhood and adolescence: a clinical review

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Contact Info

Product

Resources

About