The role of obesity and overweight in occurrence of COVID-19 is unknown. We conducted a large-scale general population study using data from a community-dwelling sample in England (n = 334,329; 56.4 ±8.1 y; 54.5% women) with prospective linkage to national registry on hospitalization for COVID-19. Body mass index (BMI, from measured height and weight) was used as an indicator of overall obesity, and waist−hip ratio for central obesity. Main outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Around 0.2% (n = 640) of the sample were hospitalized for COVID-19. There was an upward linear trend in the likelihood of COVID-19 hospitalization with increasing BMI, that was evident in the overweight (odds ratio, 1.39; 95% CI 1.13 to 1.71; crude incidence 19.1 per 10,000) and obese stage I (1.70;1.34 to 2.16; 23.3 per 10,000) and stage II (3.38; 2.60 to 4.40; 42.7 per 10,000) compared to normal weight (12.5 per 10,000). This gradient was little affected after adjustment for a wide range of covariates; however, controlling for biomarkers, particularly high-density lipoprotein cholesterol and glycated hemoglobin, led to a greater degree of attenuation. A similar pattern of association emerged for waist−hip ratio. In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.

肥胖和超重在 COVID-19 发生中的作用尚不清楚。我们使用来自英格兰社区居住样本的数据（ n = 334,329；56.4 ±8.1 岁；54.5% 女性）进行了一项大规模一般人群研究，并与国家 COVID-19 住院登记系统进行了前瞻性联系。体重指数（BMI，测量身高和体重）被用作整体肥胖的指标，腰臀比被用作中心性肥胖的指标。主要结果是 2020 年 3 月 16 日至 2020 年 4 月 26 日期间严重到需要入院的 COVID-19 病例。样本中约有 0.2% ( n = 640) 因 COVID-19 住院。随着 BMI 的增加，COVID-19 住院的可能性呈线性上升趋势，这在超重（优势比，1.39；95% CI 1.13 至 1.71；粗发生率 19.1/10,000）和肥胖 I 期（1.70；与正常体重（每 10,000 人 12.5）相比，第二阶段（每 10,000 人 1.34 至 2.16；23.3）和第二阶段（3.38；2.60 至 4.40；每 10,000 人 42.7）。在对大范围的协变量进行调整后，该梯度几乎没有受到影响；然而，控制生物标志物，特别是高密度脂蛋白胆固醇和糖化血红蛋白，会导致更大程度的衰减。腰臀比也出现了类似的关联模式。总之，整体肥胖和向心性肥胖是 COVID-19 入院的危险因素。即使体重适度增加，风险也会明显增加。其机制可能涉及葡萄糖和脂质代谢受损。