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. 2021 May-Jun;15(3):275-280.
doi: 10.1016/j.orcp.2021.02.008. Epub 2021 Mar 3.

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

Mohammad Abumayyaleh  1 , Iván J Núñez Gil  2 , Ibrahim El-Battrawy  3 , Vicente Estrada  4 , Víctor Manuel Becerra-Muñoz  5 , Alvaro Aparisi  6 , Inmaculada Fernández-Rozas  7 , Gisela Feltes  8 , Ramón Arroyo-Espliguero  9 , Daniela Trabattoni  10 , Javier López-País  11 , Martino Pepe  12 , Rodolfo Romero  13 , Diego Raúl Villavicencio García  14 , Carloalberto Biole  15 , Thamar Capel Astrua  16 , Charbel Maroun Eid  17 , Emilio Alfonso  18 , Lucia Fernandez-Presa  19 , Carolina Espejo  20 , Danilo Buonsenso  21 , Sergio Raposeiras  22 , Cristina Fernández  23 , Carlos Macaya  4 , Ibrahim Akin  3 ; HOPE COVID-19 investigators
Affiliations

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

Mohammad Abumayyaleh et al. Obes Res Clin Pract. 2021 May-Jun.

Abstract

Background: Obesity has been described as a protective factor in cardiovascular and other diseases being expressed as 'obesity paradox'. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).

Methods: We retrospectively collected data up to May 31st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m2; n = 1110, 25-30 kg/m2; n = 1464, and >30 kg/m2; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.

Results: The rate of respiratory insufficiency was more recorded in BMI 25-30 kg/m2 as compared to BMI < 25 kg/m2 (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m2 than BMI < 25 kg/m2, respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25-30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25-30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m2 and BMI > 30 kg/m2 did not impact the mortality rate (HR 1.15, 95% CI: 0.889-1.508; p = 0.27) (HR 1.15, 95% CI: 0.893-1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m2 is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538-1.004; p = 0.05).

Conclusions: HOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.

Keywords: BMI; COVID-19; Obesity paradox; SARS-CoV-2.

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Figures

Fig. 1
Fig. 1
Flow chart of study selection process.
Fig. 2
Fig. 2
Survival analysis in normal weight, overweight, and obese patients with COVID-19.
Fig. 3
Fig. 3
Predictors for mortality, sepsis, and respiratory insufficiency. Abbreviations: BMI, body mass index; SPO2, peripheral oxygen saturation; ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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