The Obesity Paradox in Infections and Implications for COVID-19

Lavie, Carl J.; Coursin, Douglas B.; Long, Micah T.

doi:10.1016/j.mayocp.2021.01.014

Cited by 22 publications

(25 citation statements)

References 21 publications

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“…Several hypotheses have been proposed to explain how obesity increases morbidity and mortality in patients with COVID-19 in the general population, including reduced baseline respiratory function due to body habitus, immune dysregulation due to dysmetabolism, and the additional risk conferred by obesity-associated comorbidities such as diabetes, hypertension and other cardiovascular diseases [ 17 ]. Moreover, the abundant expression of ACE-2 receptors on human adipocytes suggests the potential for adipose tissue to function as a viral reservoir for SARS-CoV-2 [ 18 ].…”

Section: Possible Explanations For the Discrepancy In Risk Determinants Between Patients With And Without Cancermentioning

confidence: 99%

Is Obesity a Risk Factor in Cancer Patients with COVID-19?

et al. 2021

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Section: Possible Explanations For the Discrepancy In Risk Determinants Between Patients With And Without Cancermentioning

confidence: 99%

Is Obesity a Risk Factor in Cancer Patients with COVID-19?

et al. 2021

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“…As of August 2021, there were almost 37 million infections and over 600,000 deaths due to SARS-COV-2 in the United States alone (2). Most infected individuals (40-80%) experience an asymptomatic or mild disease (3,4) with the remaining 20% of cases requiring medical attention or hospitalization are over-represented by elderly patients (>60 years) and those with pre-existing comorbidities, notably obesity, diabetes, and cardiovascular diseases (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Obesity Correlates With Pronounced Aberrant Innate Immune Responses in Hospitalized Aged COVID-19 Patients

et al. 2021

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Both age and obesity are leading risk factors for severe coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, although most infections occur in individuals under the age of 55 years, 95% of hospitalizations, admissions to the intensive care unit, and deaths occur in those over the age of 55 years. Moreover, hospitalized COVID-19 patients have a higher prevalence of obesity. It is generally believed that chronic low-grade inflammation and dysregulated innate and adaptive immune responses that are associated with aging and obesity are responsible for this elevated risk of severe disease. However, the impact of advanced age and obesity on the host response to SARS-CoV-2 infection remains poorly defined. In this study, we assessed changes in the concentration of soluble immune mediators, IgG antibody titers, frequency of circulating immune cells, and cytokine responses to mitogen stimulation as a function of BMI and age. We detected significant negative correlations between BMI and myeloid immune cell subsets that were more pronounced in aged patients. Similarly, inflammatory cytokine production by monocytes was also negatively correlated with BMI in aged patients. These data suggest that the BMI-dependent impact on host response to SARS-CoV-2 is more pronounced on innate responses of aged patients.

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“…Accessed on 29 March 2021); obesity has reached epidemic levels in most Western countries. It is reported that 75% of the US population is either overweight or obese [ 30 ]. In the UK, it was reported that 63% of adults were either overweight or obese in the year 2018 (Statistics on Obesity, Physical Activity and Diet, England, 2020.…”

mentioning

confidence: 99%

“…Obesity has adverse effects on health outcomes, healthcare systems and economies [ 30 ]. Obesity is a major risk factor for vascular disease, non-vascular disease and all-cause mortality.…”

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confidence: 99%

“…Furthermore, individuals with obesity typically have an increased amount of lean mass, which is associated with improved CRF [ 7 ]. Another reason is that because HF is associated with frailty, having more body mass and weight could be itself protective [ 30 ]. It is known that the frailty phenotype is predictive of increased morbidity, hospitalisation, and mortality [ 1 ].…”

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Obesity paradox in joint replacement for osteoarthritis — truth or paradox?

2021

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Obesity is associated with an increased risk of cardiovascular disease (CVD) and other adverse health outcomes. In patients with pre-existing heart failure or coronary heart disease, obese individuals have a more favourable prognosis compared to individuals who are of normal weight. This paradoxical relationship between obesity and CVD has been termed the ‘obesity paradox’. This phenomenon has also been observed in patients with other cardiovascular conditions and diseases of the respiratory and renal systems. Taking into consideration the well-established relationship between osteoarthritis (OA) and CVD, emerging evidence shows that overweight and obese individuals undergoing total hip or knee replacement for OA have lower mortality risk compared with normal weight individuals, suggesting an obesity paradox. Factors proposed to explain the obesity paradox include the role of cardiorespiratory fitness (“fat but fit”), the increased amount of lean mass in obese people, additional adipose tissue serving as a metabolic reserve, biases such as reverse causation and confounding by smoking, and the co-existence of older age and specific comorbidities such as CVD. A wealth of evidence suggests that higher levels of fitness are accompanied by prolonged life expectancy across all levels of adiposity and that the increased mortality risk attributed to obesity can be attenuated with increased fitness. For patients about to have joint replacement, improving fitness levels through physical activities or exercises that are attractive and feasible, should be a priority if intentional weight loss is unlikely to be achieved.

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The Obesity Paradox in Infections and Implications for COVID-19

Cited by 22 publications

References 21 publications

Is Obesity a Risk Factor in Cancer Patients with COVID-19?

Is Obesity a Risk Factor in Cancer Patients with COVID-19?

Obesity Correlates With Pronounced Aberrant Innate Immune Responses in Hospitalized Aged COVID-19 Patients

Obesity paradox in joint replacement for osteoarthritis — truth or paradox?

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