Obesity and COVID-19 in New York City: A Retrospective Cohort Study

Abstract

Background: Some reports suggest that obesity could be a risk factor for complications in coronavirus disease 2019 (COVID-19) (1). Several mechanisms could explain this. First, adipocytes, which activate the inflammatory cascade, can increase risk for thromboembolism and susceptibility to the cytokine storm described in COVID-19 (2). Second, obesity negatively affects lung mechanics, which could predispose obese persons to more severe respiratory distress and failure (3). Finally, obesity can alter mitochondrial bioenergetics in lung epithelial cells and increase risk for acute lung injury (4). However, some have suggested an obesity paradox in some critical illnesses, including acute respiratory distress syndrome, where patients with obesity may have improved outcomes; whether this phenomenon occurs in patients with COVID-19 is unclear (5). Objective: To study the association between obesity and outcomes among a diverse cohort of 1687 persons hospitalized with confirmed COVID-19 at 2 New York City hospitals. Methods and Findings: This retrospective observational cohort study included consecutive adults with confirmed COVID-19 who were hospitalized between 3 March and 15 May 2020 at an 862-bed quaternary referral center or a 180bed community hospital in New York City. We excluded 46 patients who did not have height or weight data available to calculate body mass index (BMI). Patient data were manually abstracted (1) from the electronic health record through 6 June 2020. We determined BMI on the basis of the most recent height and weight listed in the electronic health record. Height and weight were collected during hospitalization for 95.5% of the cohort; the remaining BMIs were collected during ambulatory encounters within 3 months of hospitalization. We defined BMI categories as underweight (<18.5 kg/m 2), normal (18.5 to 24.9 kg/m 2), overweight (25.0 to 29.9 kg/m 2), mild to moderate obesity (30.0 to 39.9 kg/m 2), and morbid obesity (≥40.0 kg/m 2). To examine the association between BMI and in-hospital mortality, we used a Cox proportional hazards model adjusted for age, sex, race, smoking, diabetes, hypertension, chronic obstructive pulmonary disease, asthma, end-stage renal disease, coronary artery disease, heart failure, and cancer. These characteristics were chosen on the basis of risk factors for severe COVID-19 identified by the Centers for Disease Control and Prevention. We also examined for effect modification by age, sex, and race. To examine the association between BMI and respiratory failure, defined as a need for invasive mechanical ventilation, we used a Fine and Gray model to account for the competing risk for death and adjusted for the same 12 variables used in the model for mortality. We excluded the underweight group from this analysis because of low numbers. Finally, we repeated the adjusted Cox proportional hazards model analysis for mortality among persons with respiratory failure, again excluding the underweight group. To account for missing data (12% for race), we did multiple imputation.

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

“…In another analysis in 331 patients with COVID-19, ICU admission was more revealed in patients with BMI > 30 kg/m 2 , but the obesity was not associated with a high mortality rate [ 12 ]. Additionally, the obesity paradox in COVID-19 was also reported [ 31 ].…”

Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

“…There is evidence that obesity/overweight increases the risk of severe COVID-19. A descriptive multicentre study (n = 1687) found that patients who were overweight (BMI 25-29.9 kg/m 2 , OR 1.32, 95% CI 1.03-1.69; p = 0.05), or had mild-to-moderate obesity (BMI = 30-39.9 kg/m 2 , OR 1.8, 95% CI 1.39-2.35; p = 0.05), or had morbid obesity (BMI 9 40 kg/m 2 , OR 1.74, 95% CI 1.08-2.8; p = 0.05) were likelier to have severe COVID-19 vs. patients with normal weight [57]. Other studies found similar results [2,58,59].…”

Asthma in patients with coronavirus disease 2019

“…Subsequently, 44 articles were excluded because of a sample size less than 100, 47 articles were eliminated due to the potential duplicate patients, and two articles were removed because they reported unclear prevalence of asthma in COVID-19 patients (eTable 2). Ultimately, 116 articles (119 studies) 4 , 6 , 7 , 8 , 9 , 10 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”