Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Abstract

Background: During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. Methods: The present systematic review summarises and analyses the data providing evidence for or against the “obesity-paradox” in COVID-19 patients. After applying the inclusion and exclusion criteria, 23 studies were included. We also analysed the presumably underlying basic mechanisms. Results: The patients with a body mass index (BMI) of 30–40 kg/m2 presented severe symptoms that led to intensive care unit (ICU) admission but not increased death rate. Those with a higher degree of obesity, with a BMI higher than 40 kg/m2, led to a rise in the death rate, particularly in young patients. Obesity was associated with a higher rate of ICU admission but was not determined as an independent predictor of increased mortality. In contrast, some studies suggest a strong association between obesity or morbid obesity and the risk of death. Conclusions: The existence of “obesity-paradox” cannot be stated; our study presents obesity as a critical risk factor in the evolution of COVID-19.

Genetics, shared environment, or individual experience? A cross-sectional study of the health status following SARS-CoV-2 infection in monozygotic and dizygotic twins

“…We also found that BMI was interdependent within pairs. Further, our findings indicate that higher BMI may be associated with higher symptom burden, which is consistent with several other studies pointing to obesity as a risk factor for more severe disease progression ( 39 , 43 – 47 ).…”

Low muscle strength and low phase angle predicts greater risk to mortality than severity scales (APACHE, SOFA, and CURB-65) in adults hospitalized for SARS-CoV-2 pneumonia

“…The association between the FMI and the BMI with mortality was not demonstrated. This lack of association is consistent with the results in several studies included in an interesting systematic review, (23) in which it is shown that there is an association between the high fat mass with hospital admission, severity of the disease, orotracheal intubation, among others, but with a contradictory association with mortality. The limitations of this study should be borne in mind.…”

Gastrointestinal microbiota: A predictor of COVID-19 severity?

“…Smoking led to an upregulation of ACE2 with an increased risk of severe disease[ 91 ]. Another condition that predicts severe outcomes is obesity[ 92 ]; it increased intensive care unit (ICU) admission and the requirement of invasive mechanical ventilation[ 93 ]. Also, attention should be taken in psychiatric patients (with anxiety and depression) because some possible associations between these comorbidities and sleep problems were reported[ 94 ].…”