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Review
. 2020 Aug 14;4(1):e00176.
doi: 10.1002/edm2.176. eCollection 2021 Jan.

The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis

Samuel Seidu  1   2 , Clare Gillies  1   2 , Francesco Zaccardi  1   2 , Setor K Kunutsor  3   4 , Jamie Hartmann-Boyce  5 , Thomas Yates  1   6 , Awadhesh Kumar Singh  7 , Melanie J Davies  1   6 , Kamlesh Khunti  1   2
Affiliations
Review

The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis

Samuel Seidu et al. Endocrinol Diabetes Metab. .

Abstract

Background: Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS-CoV-2 through the stimulation of inflammation, functional immunologic deficit and a pro-thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism.

Methods: Observational studies in COVID-19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models.

Results: Eight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID-19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43-3.86) and 3.52 (1.32-9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72-18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years).

Conclusions: Excess adiposity is a risk factor for severe disease and mortality in people with SARS-CoV-2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS-CoV-2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures. Systematic review registration: PROSPERO 2020: CRD42020179783.

Keywords: SARS‐CoV‐2; mortality; obesity; severe disease.

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Conflict of interest statement

KK reports personal fees from Berlin‐Chemie AG/ Menarini Group, personal fees from Sanofi‐Aventis, personal fees from Servier, personal fees from Boehringer Ingelheim, grants from Pfizer, grants from Boehringer Ingelheim, grants from AstraZeneca, grants from Novartis, grants from Novo Nordisk, grants from Sanofi‐Aventis, grants from Lilly, grants from Merck Sharp & Dohme, grants from Servier, outside the submitted work. SS reports personal fees from Amgen, personal fees from Astrazeneca, personal fees from NAPP, personal fees from Lilly, personal fees from Merck Sharp & Dohme, personal fees from Novartis, personal fees from Novo Nordisk, personal fees from Roche, personal fees from Sanofi‐Aventis, personal fees from Boehringer Ingelheim, grants from AstraZeneca, grants from Sanofi‐Aventis, grants from Servier, grants from Janssen, outside the submitted work. MJD reports personal fees and grants from Boehringer Ingelheim, Janssen, Novo Nordisk and Sanofi, and personal fees from AstraZeneca, Eli Lilly, Gilead Sciences Ltd., Intarcia/Servier, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc.

Figures

FIGURE 1
FIGURE 1
Selection of studies included in the meta‐analysis
FIGURE 2
FIGURE 2
Associations of BMI ≥ 25 vs <25 kg/m2 with risk of severe illness and mortality in COVID‐19 patients. BMI, body mass index; CI, confidence interval (bars); RR, relative risk
FIGURE 3
FIGURE 3
Associations of BMI > 35 vs <25 kg/m2 with risk of severe illness in COVID‐19 patients. BMI, body mass index; CI, confidence interval (bars); RR, relative risk
FIGURE 4
FIGURE 4
BMI levels in COVID‐19 patients with or without severe illness. BMI, body mass index; CI, confidence interval (bars); RR, relative risk
FIGURE 5
FIGURE 5
Associations of BMI ≥ 25 vs <25 kg/m2 with risk of severe illness in COVID‐19 patients, by study‐level characteristics. BMI, body mass index; CI, confidence interval (bars); RR, relative risk
See this image and copyright information in PMC

Comment in

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