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Meta-Analysis
. 2020 Nov-Dec;14(6):1897-1904.
doi: 10.1016/j.dsx.2020.09.029. Epub 2020 Sep 28.

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Arto Yuwono Soeroto  1 , Nanny Natalia Soetedjo  2 , Aga Purwiga  3 , Prayudi Santoso  4 , Iceu Dimas Kulsum  4 , Hendarsyah Suryadinata  4 , Ferdy Ferdian  4
Affiliations
Meta-Analysis

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Arto Yuwono Soeroto et al. Diabetes Metab Syndr. 2020 Nov-Dec.

Abstract

Background and aims: Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients.

Methods: We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality.

Results: Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m2). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67-1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25-2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension.

Conclusion: Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.

Keywords: Body mass index; Covid-19; Obesity; Poor outcome.

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Conflict of interest statement

Declaration of competing interest The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Prisma flowchart.
Fig. 2
Fig. 2
Forest plot presented BMI as dichotomous outcome with cut-off ≥30 kg/m2. Subgroup analysis showed obesity was not associated with ICU admission (p = 0.21) but associated with other poor outcomes (p < 0.001). Overall, obesity was associated with composite poor outcomes (P < 0.001).
Fig. 3
Fig. 3
Forest plot presented with BMI as continuous outcome. Subgroup analysis showed ICU admission was not associated with BMI (p = 0.55), but higher BMI was associated with severe COVID-19 (p < 0.001) and other poor outcomes (p < 0.001). Overall, higher BMI was associated with composite poor outcomes (P < 0.001).
Fig. 4
Fig. 4
Meta-regression for increased BMI (A–D) and obesity (E–H) showed both the association of higher BMI and obesity were affected by age, DM type 2, hypertension, and gender.
Fig. 5
Fig. 5
Funnel Plot showed asymmetrical non-inverted funnel. Harbord’s test was conducted with p = 0.204.
See this image and copyright information in PMC

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