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Meta-Analysis
. 2025 Apr;49(4):586-595.
doi: 10.1038/s41366-024-01660-x. Epub 2024 Oct 31.

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium

Bette Loef  1 , Jolanda M A Boer  2 , Marian Beekman  3 , Sophie L Campman  4   5   6 , Emiel O Hoogendijk  7 , Floris Huider  8 , Demi M E Pagen  9   10 , Marije J Splinter  11 , Jeroen H P M van der Velde  12 , Dorret I Boomsma  8 , Pieter C Dagnelie  13 , Jenny van Dongen  8 , Eco J C de Geus  8   14 , Martijn Huisman  7   15 , M Arfan Ikram  11 , Annemarie Koster  9 , Silvan Licher  11 , Jochen O Mierau  16   17   18 , Renée de Mutsert  12 , H Susan J Picavet  2 , Frits R Rosendaal  12 , Miranda T Schram  11   13 , P Eline Slagboom  3 , Evie van der Spoel  3 , Karien Stronks  19 , W M Monique Verschuren  2   20 , Saskia W van den Berg  2 ; Lifelines Corona Research initiative
Affiliations
Meta-Analysis

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium

Bette Loef et al. Int J Obes (Lond). 2025 Apr.

Abstract

Background: Obesity may affect an individual's immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection.

Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements.

Results: Individuals with overweight (25 ≤ BMI < 30 kg/m2) (odds ratio (OR) = 1.08, 95%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m2) (OR = 1.43, 95%-CI 1.18-1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95%-CI 1.04-1.14, I2 = 0%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95%-CI 0.999-1.55, I2 = 57%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk.

Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: All cohort studies were approved by an Institutional Review Board (Doetinchem Cohort Study: Medical Ethical Committee of Utrecht and the Netherlands Organization for Applied Scientific Research; Healthy Life in an Urban Setting study: Medical Ethical Committee of the Academic Medical Center Amsterdam; Longitudinal Aging Study Amsterdam: Medical Ethical Committee of the VU University Medical Center; Leiden Longevity Study: Medical Ethical Committee of the Leiden University Medical Center; Lifelines: Medical Ethical Committee of the University Medical Center Groningen; The Netherlands Twin Register: Medical Ethical Committee of the VU University Medical Center; The Maastricht Study: Medical Ethical Committee Maastricht University Medical Center and the Dutch Ministry of Health, Welfare and Sport; The Netherlands Epidemiology of Obesity: Medical Ethical Committee of the Leiden University Medical Center; The Rotterdam Study: Medical Ethics Committee of the Erasmus MC and the Dutch Ministry of Health, Welfare, and Sport) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

Figures

Fig. 1
Fig. 1. Forest plot of the association between overweight (vs. healthy weight) and SARS-CoV-2 infection measured by self-report.
CI confidence interval, HELIUS Healthy Life in an Urban Setting study, LASA Longitudinal Aging Study Amsterdam, NEO Netherlands Epidemiology of Obesity, NTR The Netherlands Twin Register, OR odds ratio. Odds ratios are adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements (and ethnicity for one cohort).
Fig. 2
Fig. 2. Forest plot of the association between obesity (vs. healthy weight) and SARS-CoV-2 infection measured by self-report.
CI confidence interval, HELIUS Healthy Life in an Urban Setting study, LASA Longitudinal Aging Study Amsterdam, NEO Netherlands Epidemiology of Obesity, NTR The Netherlands Twin Register, OR odds ratio. Odds ratios are adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements (and ethnicity for one cohort).
Fig. 3
Fig. 3. Forest plot of the association between only recent obesity (vs. no obesity) and SARS-CoV-2 infection measured by self-report.
CI confidence interval, HELIUS Healthy Life in an Urban Setting study, LASA Longitudinal Aging Study Amsterdam, NEO Netherlands Epidemiology of Obesity, NTR The Netherlands Twin Register, OR odds ratio. Odds ratios are adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements (and ethnicity for one cohort).
Fig. 4
Fig. 4. Forest plot of the association between long-term obesity (vs. no obesity) and SARS-CoV-2 infection measured by self-report.
CI confidence interval, HELIUS Healthy Life in an Urban Setting study, LASA Longitudinal Aging Study Amsterdam, NEO Netherlands Epidemiology of Obesity, NTR The Netherlands Twin Register, OR odds ratio. Odds ratios are adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements (and ethnicity for one cohort).
Fig. 5
Fig. 5. Forest plot of the association between only former obesity (vs. no obesity) and SARS-CoV-2 infection measured by self-report.
CI confidence interval, HELIUS Healthy Life in an Urban Setting study, LASA Longitudinal Aging Study Amsterdam, NEO Netherlands Epidemiology of Obesity, NTR The Netherlands Twin Register, OR odds ratio. Odds ratios are adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements (and ethnicity for one cohort).
See this image and copyright information in PMC

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