Obesity and its association with aggravation of COVID-19: a systematic review with meta-analysis

Authors

DOI:

https://doi.org/10.33448/rsd-v10i15.22965

Keywords:

Coronavirus; Overweight; Mortality; Obesity; SARS-CoV-2; Intensive care unit; Mechanical ventilation.

Abstract

Objective: To analyze and compile studies linking obesity with complications from COVID-19. Methods: A systematic review with meta-analysis was carried out, using the PECOS strategy: Patient – obese; Exhibition - people with COVID-19; Comparison – not obese; “Outcome” – worsening of the clinical condition; and “Studies” - observational studies. Searches were performed on 06/16/2020 in PubMed, Lilacs and SciELO. Methodological quality was assessed using the STROBE scale and data were qualitatively synthesized. Meta-analysis models were performed for Intensive Care Unit (ICU) need, Invasive Mechanical Ventilation (IMV) and mortality. Results: 24 retrospective studies published in 2020 from different countries were evaluated. The sample size ranged from 53 to 3615 patients, of varying age, of different ethnicities, without gender restrictions and admitted to health centers. In the 8/11 quality assessment, they reached 77% in A or B. Regarding metabolic factors, studies showed that alterations caused by excess adipose tissue favor the deregulation of interleukin levels, triggering a chronic infectious condition. The meta-analysis of the frequency of ICU was 27% among obese, need for IMV was 34% and mortality was 14%. Conclusion: It was found that obesity is a predictor for the worsening of COVID-19. Therefore, obese individuals need an early approach as well as special care in case of contamination.

References

Balduzzi S, Rücker G, S. G. (2019). How to perform a meta-analysis with R: a practical tutorial. Evidence-Based Mental Health, 153–160.

Belančić, A., Kresović, A., & Rački, V. (2020). Potential pathophysiological mechanisms leading to increased COVID-19 susceptibility and severity in obesity. In Obesity Medicine (Vol. 19). Elsevier Ltd. https://doi.org/10.1016/j.obmed.2020.100259

Brasil. Ministério da Saúde. Secretaria de Ciência, T. e I. E. D. de C. e T. (2014). Diretrizes metodológicas: elaboração de revisão sistemática e metanálise de estudos observacionais comparativos sobre fatores de risco e prognóstico. www.saude.gov.br

Busetto, L., Bettini, S., Fabris, R., Serra, R., Dal Pra’, C., Maffei, P., Rossato, M., Fioretto, P., & Vettor, R. (2020). Obesity and COVID‐19: an Italian snapshot. Obesity. https://doi.org/10.1002/oby.22918

de Oliveira, A. C., Lucas, T. C., & Iquiapaza, R. A. (2020). What has the covid-19 pandemic taught us about adopting preventive measures? Texto e Contexto Enfermagem, 29, 1–15. https://doi.org/10.1590/1980-265X-TCE-2020-0106

de Siqueira, J. V. V., Almeida, L. G., Zica, B. O., Brum, I. B., Barceló, A., & de Siqueira Galil, A. G. (2020). Impact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review. In Obesity Research and Clinical Practice. Elsevier Ltd. https://doi.org/10.1016/j.orcp.2020.07.005

Dietz, W., & Santos-Burgoa, C. (2020). Obesity and its Implications for COVID-19 Mortality. In Obesity (Vol. 28, Issue 6, p. 1005). Blackwell Publishing Inc. https://doi.org/10.1002/oby.22818

Engin, A. B., Engin, E. D., & Engin, A. (2020). Two important controversial risk factors in SARS-CoV-2 infection: Obesity and smoking. In Environmental Toxicology and Pharmacology (Vol. 78). Elsevier B.V. https://doi.org/10.1016/j.etap.2020.103411

Estudo aponta que 60% dos adultos da América Latina ganharam peso na pandemia - 07/05/2021 - UOL Economia. (2021). https://economia.uol.com.br/noticias/efe/2021/05/07/estudo-aponta-que-60-dos-adultos-da-america-latina-ganharam-peso-na-pandemia.htm

Finer, N., Garnett, S. P., & Bruun, J. M. (2020). COVID‐19 and obesity. Clinical Obesity, 10(3). https://doi.org/10.1111/cob.12365

Földi, M., Farkas, N., Kiss, S., Zádori, N., Váncsa, S., Szakó, L., Dembrovszky, F., Solymár, M., Bartalis, E., Szakács, Z., Hartmann, P., Pár, G., Erőss, B., Molnár, Z., Hegyi, P., & Szentesi, A. (2020). Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis. Obesity Reviews, 21(10). https://doi.org/10.1111/obr.13095

Hajifathalian, K., Kumar, S., Newberry, C., Shah, S., Fortune, B., Krisko, T., Ortiz‐Pujols, S., Zhou, X. K., Dannenberg, A. J., Kumar, R., & Sharaiha, R. Z. (2020). Obesity is associated with worse outcomes in COVID‐19: Analysis of Early Data From New York City. Obesity. https://doi.org/10.1002/oby.22923

Inês Grenha, A., Alves, F., Ribeiro, F., & Cavaco, T. (2013). Obesidade e imunodepressão: Factos e números.

Kalligeros, M., Shehadeh, F., Mylona, E. K., Benitez, G., Beckwith, C. G., Chan, P. A., & Mylonakis, E. (2020). Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019. Obesity, 28(7), 1200–1204. https://doi.org/10.1002/oby.22859

Kass, D. A., Duggal, P., & Cingolani, O. (2020). Obesity could shift severe COVID-19 disease to younger ages. In The Lancet (Vol. 395, Issue 10236, pp. 1544–1545). Lancet Publishing Group. https://doi.org/10.1016/S0140-6736(20)31024-2

Kassir, R. (2020). Risk of COVID-19 for patients with obesity. In Obesity Reviews (Vol. 21, Issue 6). Blackwell Publishing Ltd. https://doi.org/10.1111/obr.13034

Lighter, J., Phillips, M., Hochman, S., Sterling, S., Johnson, D., Francois, F., & Stachel, A. (2020). Obesity in Patients Younger Than 60 Years Is a Risk Factor for COVID-19 Hospital Admission. In Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Vol. 71, Issue 15, pp. 896–897). NLM (Medline). https://doi.org/10.1093/cid/ciaa415

Luiz Do Prado, W., Lofrano, M. C., Oyama, L. M., & Dâmaso, A. R. (2009). Artigo de revisão Obesidade e Adipocinas Inflamatórias: Implicações Práticas para a Prescrição de Exercício Obesity and Inflammatory Adipokines: Practical Implications for Exercise Prescription Endereço para correspondência. In Rev Bras Med Esporte (Vol. 15).

Luzi, L., & Radaelli, M. G. (2020). Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetologica, 57(6), 759–764. https://doi.org/10.1007/s00592-020-01522-8

Malavazos, A. E., Corsi Romanelli, M. M., Bandera, F., & Iacobellis, G. (2020). Targeting the Adipose Tissue in COVID-19. Obesity. https://doi.org/10.1002/oby.22844

Malik, V. S., Ravindra, K., Attri, S. V., Bhadada, S. K., & Singh, M. (2020). Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. Environmental Science and Pollution Research, 1–9. https://doi.org/10.1007/s11356-020-10132-4

Messina, G., Polito, R., Monda, V., Cipolloni, L., Di Nunno, N., Di Mizio, G., Murabito, P., Carotenuto, M., Messina, A., Pisanelli, D., Valenzano, A., Cibelli, G., Scarinci, A., Monda, M., & Sessa, F. (2020). Functional role of dietary intervention to improve the outcome of COVID-19: A hypothesis of work. International Journal of Molecular Sciences, 21(9). https://doi.org/10.3390/ijms21093104

Michalakis, K., & Ilias, I. (2020). SARS-CoV-2 infection and obesity: Common inflammatory and metabolic aspects. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14(4), 469–471. https://doi.org/10.1016/j.dsx.2020.04.033

Moriconi, D., Masi, S., Rebelos, E., Virdis, A., Manca, M. L., De Marco, S., Taddei, S., & Nannipieri, M. (2020). Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding. Obesity Research & Clinical Practice, 14(3), 205–209. https://doi.org/10.1016/j.orcp.2020.05.009

Muscogiuri, G., Pugliese, G., Barrea, L., Savastano, S., & Colao, A. (2020). Obesity: The “Achilles heel” for COVID-19? Metabolism: Clinical and Experimental, 108. https://doi.org/10.1016/j.metabol.2020.154251

Netto, F. de F., Benassi, G., Nogueira, L. S., Ciriaco, E. M., Santos, G. C. dos, Lopes, H., & Cabral, G. (2020). Novo coronavírus e a COVID-19 - NUTEAD. https://ead.uepg.br/site/moocs/218

Obesidade e excesso de peso. (2020). https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Ong, S. W. X., Young, B. E., Leo, Y. S., & Lye, D. C. (2020). Association of higher body mass index (BMI) with severe coronavirus disease 2019 (COVID-19) in younger patients. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciaa548

ONU vê “epidemia de obesidade” na América Latina e Caribe | As Nações Unidas no Brasil. (2019, July 9). https://brasil.un.org/pt-br/83657-onu-ve-epidemia-de-obesidade-na-america-latina-e-caribe

OPAS/OMS Brasil - Folha informativa – COVID-19 (doença causada pelo novo coronavírus). (2020). OPAS/OMS Brasil - Início. https://www.paho.org/bra/

Palaiodimos, L., Kokkinidis, D. G., Li, W., Karamanis, D., Ognibene, J., Arora, S., Southern, W. N., & Mantzoros, C. S. (2020). Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism: Clinical and Experimental, 108. https://doi.org/10.1016/j.metabol.2020.154262

Petrakis, D., Margină, D., Tsarouhas, K., Tekos, F., Stan, M., Nikitovic, D., Kouretas, D., Spandidos, D. A., & Tsatsakis, A. (2020). Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review). In Molecular Medicine Reports (Vol. 22, Issue 1, pp. 9–19). Spandidos Publications. https://doi.org/10.3892/mmr.2020.11127

Ryan, D. H., Ravussin, E., & Heymsfield, S. (2020). COVID 19 and the Patient with Obesity – The Editors Speak Out. In Obesity (Vol. 28, Issue 5, p. 847). Blackwell Publishing Inc. https://doi.org/10.1002/oby.22808

Ryan, P. M. D., & Caplice, N. M. (2020). Is Adipose Tissue a Reservoir for Viral Spread, Immune Activation, and Cytokine Amplification in Coronavirus Disease 2019? In Obesity (Vol. 28, Issue 7, pp. 1191–1194). Blackwell Publishing Inc. https://doi.org/10.1002/oby.22843

Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., Labreuche, J., Mathieu, D., Pattou, F., Jourdain, M., Caizzo, R., Caplan, M., Cousin, N., Duburcq, T., Durand, A., El kalioubie, A., Favory, R., Garcia, B., Girardie, P., … Verkindt, H. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity. https://doi.org/10.1002/oby.22831

Singh, J. (2010). Mendeley: A free research management tool for desktop and web. In Journal of Pharmacology and Pharmacotherapeutics (Vol. 1, Issue 1, pp. 62–63). Wolters Kluwer -- Medknow Publications. https://doi.org/10.4103/0976-500X.64539

Tamara, A., & Tahapary, D. L. (2020). Obesity as a predictor for a poor prognosis of COVID-19: A systematic review. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14(4), 655–659. https://doi.org/10.1016/j.dsx.2020.05.020

Watanabe, M., Risi, R., Tuccinardi, D., Baquero, C. J., Manfrini, S., & Gnessi, L. (2020). Obesity and SARS-CoV-2: a population to safeguard. In Diabetes/Metabolism Research and Reviews. John Wiley and Sons Ltd. https://doi.org/10.1002/dmrr.3325

Zhang, F., Xiong, Y., Wei, Y., Hu, Y., Wang, F., Li, G., Liu, K., Du, R., Wang, C. Y., & Zhu, W. (2020). Obesity predisposes to the risk of higher mortality in young COVID-19 patients. Journal of Medical Virology. https://doi.org/10.1002/jmv.26039

Published

27/11/2021

How to Cite

CASTRO, A. C. B. de .; PARLOW, J. M. .; MARTINS, C. M. .; MÜLLER, E. V. . Obesity and its association with aggravation of COVID-19: a systematic review with meta-analysis. Research, Society and Development, [S. l.], v. 10, n. 15, p. e350101522965, 2021. DOI: 10.33448/rsd-v10i15.22965. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/22965. Acesso em: 15 nov. 2024.

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Section

Health Sciences