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Meta-Analysis
. 2020 Dec 2;25(1):64.
doi: 10.1186/s40001-020-00464-9.

Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis

Yanan Chu  1 , Jinxiu Yang  1 , Jiaran Shi  1 , Pingping Zhang  1   2 , Xingxiang Wang  3
Affiliations
Meta-Analysis

Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis

Yanan Chu et al. Eur J Med Res. .

Abstract

Background: Obesity has been widely reported to be associated with the disease progression of coronavirus disease 2019 (COVID-19); however, some studies have reported different findings. We conducted a systematic review and meta-analysis to investigate the association between obesity and poor outcomes in patients with COVID-19 pneumonia.

Methods: A systematic review and meta-analysis of studies from the PubMed, Embase, and Web of Science databases from 1 November 2019 to 24 May 2020 was performed. Study quality was assessed, and data extraction was conducted. The meta-analysis was carried out using fixed-effects and random-effects models to calculate odds ratios (ORs) of several poor outcomes in obese and non-obese COVID-19 patients.

Results: Twenty-two studies (n = 12,591 patients) were included. Pooled analysis demonstrated that body mass index (BMI) was higher in severe/critical COVID-19 patients than in mild COVID-19 patients (MD 2.48 kg/m2, 95% CI [2.00 to 2.96 kg/m2]). Additionally, obesity in COVID-19 patients was associated with poor outcomes (OR = 1.683, 95% CI [1.408-2.011]), which comprised severe COVID-19, ICU care, invasive mechanical ventilation use, and disease progression (OR = 4.17, 95% CI [2.32-7.48]; OR = 1.57, 95% CI [1.18-2.09]; OR = 2.13, 95% CI [1.10-4.14]; OR = 1.41, 95% CI [1.26-1.58], respectively). Obesity as a risk factor was greater in younger patients (OR 3.30 vs. 1.72). However, obesity did not increase the risk of hospital mortality (OR = 0.89, 95% CI [0.32-2.51]).

Conclusions: As a result of a potentially critical role of obesity in determining the severity of COVID-19, it is important to collect anthropometric information for COVID-19 patients, especially the younger group. However, obesity may not be associated with hospital mortality, and efforts to understand the impact of obesity on the mortality of COVID-19 patients should be a research priority in the future.

Keywords: COVID-19; Meta-analysis; Obesity; Poor outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection process. COVID-19: coronavirus disease 2019
Fig. 2
Fig. 2
a Forest plot of MD in BMI between COVID-19 patients with and without severe disease. b Funnel plot of the included studies addressing the association between BMI and the severity of COVID-19. MD mean difference
Fig. 3
Fig. 3
Obesity and poor composite outcomes. a Forest plot showed that obesity was associated with an increased risk of composite poor outcomes and its subgroup, which comprised severe COVID-19, need for ICU care, need for IMV, and disease progression in patients with COVID-19. b Filled funnel plot for obesity and the composite poor outcomes of COVID-19. c Funnel plot for obesity and severe COVID-19. d Funnel plot for obesity and COVID-19 progression. ICU intensive care unit, IMV invasive mechanical ventilation
Fig. 4
Fig. 4
Bubble-plot for meta-regression. Meta-regression analysis showed that the association between obesity and composite poor outcome was affected by age (a) but not by diabetes (b), cardiovascular disease (c), hypertension (d), or COPD (e). COPD chronic obstructive pulmonary disease. Circles in the picture indicate studies. The red lines indicate fitted meta-regression line
Fig. 5
Fig. 5
a Subgroup analyses based on age groups suggested that the association between obesity and poor composite outcomes was stronger in patients with a mean age < 60 years. b Funnel plot for obesity and composite poor outcomes of younger COVID-19 patients. c Funnel plot for obesity and composite poor outcomes of older COVID-19 patients
See this image and copyright information in PMC

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