Inflammation and oxidative stress, the links between obesity and COVID-19: a narrative review

Abstract

COVID-19, an acute respiratory disease caused by SARS-CoV-2, has rapidly become a pandemic. On the other hand, obesity is also reaching dramatic dimensions and it is a risk factor for morbidity and premature mortality. Obesity has been linked to a high risk of serious-associated complications to COVID-19, due to the increased risk of concomitant chronic diseases, which highlights the health public relevance of the topic. Obese subjects have a pro-inflammatory environment, which can further exacerbate COVID-19-induced inflammation and oxidative stress, explaining the increased risk of serious complications in these patients. Another factor that favors infection in obese patients is the high expression of ACE2 receptors in the adipose tissue. The negative impact of COVID-19 in obesity is also associated with a decrease in respiratory function, the concurrence of multiple comorbidities, a low-degree chronic inflammatory state, immunocompromised situation, and therefore a higher rate of hospitalization, mechanical ventilation, in-hospital complications such as pneumonia, and death. In this review, the link between obesity and COVID-19 was analyzed, exploring the potential common mechanisms in both diseases, with special attention to oxidative stress and inflammation, due to the crucial role of both pathways in the development of the disease.

Keywords: Body mass index; COVID-19; Immunity; Inflammation; Nutrition; Obesity; Oxidative stress.

Fig. 1

Obesity induces immune pathophysiologic modifications, increasing susceptibility to SARS-CoV-2 infection. Abbreviation: TNF-α: tumor necrosis factor-alpha; Interleukins: IL; MCP-1: monocyte chemoattractant protein-1; RBP-4: retinol-binding protein 4; ACE2: angiotensin-converting enzyme 2

Fig. 2

Comorbidities associated with obesity and COVID-19 and their main clinical manifestations. Abbreviation: ACE2: angiotensin-converting enzyme 2