Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease

Zheng, Kenneth I.; Gao, Feng; Wang, Xiao Bo; Sun, Qing; Pan, Ke; Wang, Ting Yao; Hong, Lei; Chen, Yong Ping; Liu, Wen‐Yue; George, Jacob; Zheng, Ming

doi:10.1016/j.metabol.2020.154244

Cited by 306 publications

(346 citation statements)

References 13 publications

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“…Besides the findings in our study, some other factors might also contribute to the mortality of COVID-19 patients, among which obesity would be a potential candidate. A recent study in the New York area showed that 41.7% of the patients were obese, and an increasing number of reports have linked obesity to more severe COVID-19 illness (35)(36)(37).…”

Section: Resultsmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

et al. 2020

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OBJECTIVEDiabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODSThis two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N 5 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sexand age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTSOf 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0-72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P 5 0.01) and more fatal cases (20.3% vs. 10.5%, P 5 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ‡70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONSCOVID-19 patients with diabetes had worse outcomes compared with the sex-and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.

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Section: Resultsmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

et al. 2020

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“…Patients with obesity are at an increased risk of developing COVID-19 [5,6], possibly aggravated further by the presence of nonalcoholic fatty liver disease [6]. Obe-sity is also characterized by low-grade chronic inflammation.…”

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confidence: 99%

HMGB1: A Possible Crucial Therapeutic Target for COVID-19?

Street

2020

Horm Res Paediatr

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“…Obesity, measured as body mass index (BMI), is reported to associate with increase the risk of developing severe pneumonia in COVID-19 (1). Indeed, the risk correlated to obesity with COVID-19 severity is greater in metabolic associated fatty liver patients (2). At the basis, we found altered mechanism of inflammation and immune response typic of obesity and correlated with alteration in the levels of circulating cytokines (3).…”

Section: Introductionmentioning

confidence: 79%

Fat mass prevalence and influence on nutritional status in ICU COVID-19 patients

Lorenzo

Tarsitano

Falcone

et al. 2020

Preprint

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Background: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between FM% and immune-inflammatory response, after 10th days in ICU.Methods: Prospective observational study in single cohort of 22 adult patients, affected by COVID-19 pneumonia and admitted to the Intensive Care Unit (ICU) and classified (10) lean and (12) obese, according to Percentage of Fat Mass (FM%) and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day.Results: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients.Conclusion: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.

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Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease

Cited by 306 publications

References 13 publications

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

HMGB1: A Possible Crucial Therapeutic Target for COVID-19?

Fat mass prevalence and influence on nutritional status in ICU COVID-19 patients

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