Respiratory and nonrespiratory COVID-19 complications in patients with obesity: recent developments
Publication: Journal of Comparative Effectiveness Research
Abstract
This narrative review summarizes recent reports to provide an updated understanding of the multiorgan effects of SARS-CoV-2 infection in obese individuals. A PubMed search of 528 primary articles was performed, with inclusion based on novelty, relevance and redundancy. Obesity confers an increased risk for hospitalization, intensive care unit admission, severe pneumonia, intubation and acute kidney injury in COVID-19 patients. Obesity is also associated with higher levels of inflammatory and thrombotic markers. However, the associations between obesity and mortality or cardiac injury in COVID-19 patients remain unclear. Obesity is a risk factor for several respiratory and nonrespiratory COVID-19 complications. Future work is needed to further explore these relationships and optimize the management of obese COVID-19 patients.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
COVID-19 Map [Internet]. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html
2.
Williamson EJ, Walker AJ, Bhaskaran K et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 584(7821), 430–436 (2020).
3.
Stefan N, Birkenfeld AL, Schulze MB. Global pandemics interconnected – obesity, impaired metabolic health and COVID-19. Nat. Rev. Endocrinol. 17(3), 135–149 (2021).
4.
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: when an epidemic and pandemic collide. Mayo Clin. Proc. 95(7), 1445–1453 (2020).
5.
Jia X, Yin C, Lu S et al. Two things about COVID-19 might need attention (2020). https://www.preprints.org/manuscript/202002.0315/v1
6.
Kruglikov IL, Scherer PE. The role of adipocytes and adipocyte-like cells in the severity of COVID-19 infections. Obesity 28(7), 1187–1190 (2020).
7.
Bourgeois C, Gorwood J, Barrail-Tran A et al. Specific biological features of adipose tissue, and their impact on HIV persistence. Front. Microbiol. 10, 2837 (2019).
8.
Shin J, Toyoda S, Nishitani S et al. Possible involvement of adipose tissue in patients with older age, obesity, and diabetes with coronavirus SARS-CoV-2 infection (COVID-19) via GRP78 (BIP/HSPA5): significance of hyperinsulinemia management in COVID-19. Diabetes 69(Suppl. 1), 1094-P (2020).
9.
Stefan N, Häring H-U, Schulze M. Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol. 6(3), 249–258 (2018).
10.
Stefan N. Causes, consequences, and treatment of metabolically unhealthy fat distribution. Lancet Diabetes Endocrinol. 8(7), 616–627 (2020).
11.
Sanchis-Gomar F, Lavie CJ, Neeland IJ, Lippi G. Does abdominal obesity influence immunological response to SARS-CoV-2 infection? Expert Rev. Endocrinol. Metab. 16(6), 271–272 (2021).
12.
Monteiro AC, Suri R, Emeruwa IO et al. Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: a retrospective, observational cohort study. PLoS One 15(12), e0238552 (2020).
13.
Kang Z, Luo S, Gui Y et al. Obesity is a potential risk factor contributing to clinical manifestations of COVID-19. Int. J. Obes. 2005 44(12), 2479–2485 (2020).
•• One of few studies assessing the relationship between obesity and inflammatory markers, lymphocyte levels and pathological changes in the lung in the context of COVID-19 infection.
14.
Zhang F, Xiong Y, Wei Y et al. Obesity predisposes to the risk of higher mortality in young COVID-19 patients. J. Med. Virol. 92(11), 2536–2542 (2020).
•• One of very few studies seeking to understand the relationship between obesity and cardiac injury or coagulation activity in the setting of COVID-19.
15.
Steinberg E, Wright E, Kushner B. In young adults with COVID-19, obesity is associated with adverse outcomes. West. J. Emerg. Med. 21(4), 752–755 (2020).
16.
Tartof SY, Qian L, Hong V et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann. Intern. Med. 173(10), 773–781 (2020).
17.
Anderson MR, Geleris J, Anderson DR et al. Body mass index and risk for intubation or death in SARS-CoV-2 infection: a retrospective cohort study. Ann. Intern. Med. 173(10), 782–790 (2020).
18.
Singh S, Bilal M, Pakhchanian H, Raiker R, Kochhar GS, Thompson CC. Impact of obesity on outcomes of patients with coronavirus disease 2019 in the United States: a multicenter electronic health records network study. Gastroenterology 159(6), 2221–2225 (2020).
19.
Kompaniyets L, Goodman AB, Belay B et al. Body mass index and risk for COVID-19-related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death — United States, March–December 2020. Morb. Mortal. Wkly Rep. 70(10), 355–361 (2021).
•• Demonstrates a dose-dependent, J-shaped relationship between BMI and hospitalization, intensive care unit admission and mortality. Patients were extracted from a large nationwide database of 148,494 US adults with COVID-19.
20.
Cottini M, Lombardi C, Berti A, Primary Care Physicians, ATS Province of Bergamo, Italy. Obesity is a major risk factor for hospitalization in community-managed COVID-19 pneumonia. Mayo Clin. Proc. 96(4), 921–931 (2021).
21.
Motaib I, Zbiri S, Elamari S, Dini N, Chadli A, El Kettani C. Obesity and disease severity among patients with COVID-19. Cureus 13(2), e13165 (2021).
22.
Wu X, Li C, Chen S et al. Association of body mass index with severity and mortality of COVID-19 pneumonia: a two-center, retrospective cohort study from Wuhan, China. Aging 13(6), 7767–7780 (2021).
23.
Nyabera A, Lakhdar S, Li M, Trandafirescu T, Ouedraogo Tall S. The association between BMI and inpatient mortality outcomes in older adults with COVID-19. Cureus 12(10), e11183 (2020).
24.
Al-Salameh A, Lanoix J-P, Bennis Y et al. The association between body mass index class and coronavirus disease 2019 outcomes. Int. J. Obes. 2005 45(3), 700–705 (2021).
25.
Louie JK, Acosta M, Samuel MC et al. A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1). Clin. Infect. Dis. 52(3), 301–312 (2011).
26.
Wang J, Zhu L, Liu L et al. Overweight and obesity are risk factors of severe illness in patients with COVID-19. Obes. Silver Spring Md. 28(11), 2049–2055 (2020).
27.
Goyal P, Ringel JB, Rajan M et al. Obesity and COVID-19 in New York City: a retrospective cohort study. Ann. Intern. Med. 173(10), 855–858 (2020).
• Demonstrates that obesity is a risk factor for respiratory failure and explains how this may contribute to greater use of invasive mechanical ventilation. The study included a relatively large sample size of 1687 patients in New York.
28.
Suresh S, Siddiqui M, Abu Ghanimeh M et al. Association of obesity with illness severity in hospitalized patients with COVID-19: a retrospective cohort study. Obes. Res. Clin. Pract. 15(2), 172–176 (2021).
29.
Lavie CJ, Sanchis-Gomar F, Arena R. In reply – cardiorespiratory fitness attenuates the impact of risk factors associated with COVID-19 hospitalization. Mayo Clin. Proc. 96(3), 823–824 (2021).
30.
Morgan OW, Bramley A, Fowlkes A et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A (H1N1) disease. PLoS One 5(3), e9694 (2010).
31.
Kerrigan DJ, Brawner CA, Ehrman JK, Keteyian S. Cardiorespiratory fitness attenuates the impact of risk factors associated with COVID-19 hospitalization. Mayo Clin. Proc. 96(3), 822–823 (2021).
32.
Hajifathalian K, Kumar S, Newberry C et al. Obesity is associated with worse outcomes in COVID-19: analysis of early data from New York City. Obes. Silver Spring Md. 28(9), 1606–1612 (2020).
33.
Jayanama K, Srichatrapimuk S, Thammavaranucupt K et al. The association between body mass index and severity of Coronavirus Disease 2019 (COVID-19): a cohort study. PLoS One 16(2), e0247023 (2021).
•• Suggests that COVID-19 patients with higher BMI may have greater risk of acute kidney injury, in addition to higher rates of pneumonia.
34.
Sharma A, Garg A, Rout A, Lavie CJ. Association of obesity with more critical illness in COVID-19. Mayo Clin. Proc. 95(9), 2040–2042 (2020).
35.
Sattar N, Ho FK, Gill JM et al. BMI and future risk for COVID-19 infection and death across sex, age and ethnicity: preliminary findings from UK Biobank. Diabetes Metab. Syndr. 14(5), 1149–1151 (2020).
36.
Ullah W, Roomi S, Nadeem N et al. Impact of body mass index on COVID-19-related in-hospital outcomes and mortality. J. Clin. Med. Res. 13(4), 230–236 (2021).
37.
Huang H-K, Bukhari K, Peng CC-H et al. The J-shaped relationship between body mass index and mortality in patients with COVID-19: a dose-response meta-analysis. Diabetes Obes. Metab. 23(7), 1701–1709 (2021).
38.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403), 157–163 (2004).
39.
Dana R, Bannay A, Bourst P et al. Obesity and mortality in critically ill COVID-19 patients with respiratory failure. Int. J. Obes. 45, 2028–2037 (2021).
• Suggests a possible obesity paradox in COVID-19 mortality for intensive care unit patients.
40.
Cai Q, Chen F, Fang L et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Social Science Research Network, NY, USA. https://papers.ssrn.com/abstract=3556658
41.
Lemyze M, Courageux N, Maladobry T et al. Implications of obesity for the management of severe coronavirus disease 2019 pneumonia. Crit. Care Med. 48(9), e761–e767 ( 2020).
42.
Dietz W, Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality. Obesity 28(6), 1005–1005 (2020).
43.
Nakeshbandi M, Maini R, Daniel P et al. The impact of obesity on COVID-19 complications: a retrospective cohort study. Int. J. Obes. 44(9), 1832–1837 (2020).
44.
Frank RC, Mendez SR, Stevenson EK, Guseh JS, Chung M, Silverman MG. Obesity and the risk of intubation or death in patients with coronavirus disease 2019. Crit. Care Med. 48(11), e1097–e1101 (2020).
45.
Singh R, Rathore SS, Khan H et al. Association of obesity with COVID-19 severity and mortality: a systemic review and meta-regression. medRxiv https://www.medrxiv.org/content/10.1101/2021.05.08.21256845v1
46.
Simonnet A, Chetboun M, Poissy J et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obes. Silver Spring Md. 28(7), 1195–1199 (2020).
47.
Lighter J, Phillips M, Hochman S et al. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission. Clin. Infect. Dis. 71(15), 896–897 (2020).
48.
Pasquarelli-do-Nascimento G, Braz-de-Melo HA, Faria SS, Santos I de O, Kobinger GP, Magalhães K. Hypercoagulopathy and adipose tissue exacerbated inflammation may explain higher mortality in COVID-19 patients with obesity. Front. Endocrinol. 11, 530 (2020).
49.
McNeill JN, Lau ES, Paniagua SM et al. The role of obesity in inflammatory markers in COVID-19 patients. Obes. Res. Clin. Pract. 15(1), 96–99 (2021).
50.
Hendren NS, de Lemos JA, Ayers C et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation 143(2), 135–144 (2021).
•• One of few studies assessing the relationship between obesity and nonrespiratory outcomes such as dialysis, venous thromboembolism and cardiac events in the setting of COVID-19.
51.
Onder G, Palmieri L, Vanacore N, Giuliano M, Brusaferro S, Italian National Institute of Health COVID-19 Mortality Group. Nonrespiratory complications and obesity in patients dying with COVID-19 in Italy. Obes. Silver Spring Md. 29(1), 20–23 (2021).
52.
Deng M, Qi Y, Deng L et al. Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study. Obes. Silver Spring Md. 28(10), 1815–1825 (2020).
53.
Batlle D, Soler MJ, Sparks MA et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J. Am. Soc. Nephrol. 31(7), 1380–1383 (2020).
54.
Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229), 1054–1062 (2020).
55.
Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289(1), 76–79 (2003).
Information & Authors
Information
Published In
Pages: 371 - 381
PubMed: 35023362
Copyright
© 2022 Future Medicine Ltd.
History
Received: 1 October 2021
Accepted: 15 December 2021
Published online: 13 January 2022
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Respiratory and nonrespiratory COVID-19 complications in patients with obesity: recent developments. (2022) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2021-0237
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Risha Kumari, Poonam Negi, Shweta Agarwal, Obesity and COVID-19 Severity: Dissecting the Combined Relationship, Mechanisms, Diagnostic Obstacles, Management Approaches, and Treatment Plans, Coronaviruses, 10.2174/0126667975313356240920051635, 6, 4, (2025).
- Ekaterina S. Frolova, Pavel P. Veselovsky, Galina A. Chumakova, Nadezhda G. Veselovskaya, Anna V. Ott, COVID-19 and post-disease features in patients with obesity, CardioSomatics, 10.17816/CS626503, 15, 4, (344-353), (2024).
- Timothy Phillips, Abdallah Mughrabi, Levindo J. Garcia, Christopher El Mouhayyar, Laith Hattar, Hocine Tighiouart, Andrew H. Moraco, Claudia Nader, Bertrand L. Jaber, Association of Body Mass Index with Multiple Organ Failure in Hospitalized Patients with COVID-19: A Multicenter Retrospective Cohort Study, Journal of Intensive Care Medicine, 10.1177/08850666241232362, 39, 8, (768-777), (2024).
- Henry E. Wang, Xabier Jaureguibeitia, Elisabete Aramendi, Michelle Nassal, Ashish Panchal, Erik Alonso, Graham Nichol, Tom Aufderheide, Mohamud R. Daya, Jestin Carlson, Ahamed Idris, Methods for calculating ventilation rates during resuscitation from out-of-hospital cardiac arrest, Resuscitation, 10.1016/j.resuscitation.2022.109679, 184, (109679), (2023).
- Khlood Bookari, Jamila Arrish, Sara Zaher, Majid Alkhalaf, Mudi Alharbi, Najla Alkhattaf, Ziad Harb, Eiman Al Hinai, Nahla Alanqodi, Sana Almajed, Maryam Aldwarji, Nawal Alqaoud, Jalila Elati, Maha Hoteit, A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study, Nutrients, 10.3390/nu14224904, 14, 22, (4904), (2022).
- Kuo-Chuan Hung, Hsiao-Tien Chen, Chung-Hsi Hsing, Kuo Jinn-Rung, Chun-Ning Ho, Yao-Tsung Lin, Ying-Jen Chang, Sheng-Fu Chiu, Cheuk-Kwan Sun, Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies, Obesity Research & Clinical Practice, 10.1016/j.orcp.2022.10.005, 16, 6, (439-446), (2022).
- Rahul Chaturvedi, Briana Lui, Jamie A Aaronson, Robert S White, Jon D Samuels, COVID-19 complications in males and females: recent developments, Journal of Comparative Effectiveness Research, 10.2217/cer-2022-0027, 11, 9, (689-698), (2022).