Background

Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation.

Objective

This study explores the effects of obesity with the risk of severe disease among patients with COVID-19.

Methods

Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity.

Results

A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001).

Conclusions

Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.

中文翻译：

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COVID-19 患者的肥胖：系统评价和荟萃分析

背景

肥胖在 2019 年冠状病毒病 (COVID-19) 患者中很常见。肥胖对 COVID-19 临床结果的影响值得系统研究。

客观的

本研究探讨了肥胖对 COVID-19 患者患严重疾病的风险的影响。

方法

体重指数（BMI）和内脏脂肪组织（VAT）积累程度被用作肥胖状况的指标。包括预印本在内的出版物数据库检索截止日期为 2020 年 8 月 10 日。重症 COVID-19 的临床结果包括住院治疗、需要在重症监护室 (ICU) 治疗、有创机械通气 (IMV) 和死亡率。对于 BMI 定义的肥胖队列研究，严重 COVID-19 结果的风险以比值比 (OR) 和 95% 置信区间 (95%CI) 表示，对于增值税对照研究以标准化均差 (SMD) 和 95%CI 表示-定义过度肥胖。

结果

来自 30 项 BMI 定义的肥胖研究和 3 项 VAT 定义的肥胖对照研究的总共 45, 650 名参与者被纳入评估严重 COVID-19 的风险。单变量分析显示，BMI较高的重症COVID-19的OR显着较高：住院为1.76（95％：1.21，2.56，P  = 0.003），入住ICU为1.67（95％CI：1.26，2.21，P <0.001），入住ICU为2.19对于 IMV 要求（95%CI：1.56, 3.07，P <0.001），对于死亡为 1.37（95%CI：1.06, 1.75， P  = 0.014），严重 COVID-19 的总体 OR 为 1.67（95%CI） ：1.43，1.96；P <0.001）。多变量分析显示，重症 COVID-19 的 OR 增加与 BMI 较高相关： 住院为2.36 (95% CI: 1.37, 4.07, P = 0.002)，需要入住 ICU 为 2.32 (95% CI: 1.38, 3.90, P  = 0.001) ，  IMV 支持为2.63 (95%CI: 1.32, 5.25, P = 0.006)，死亡率为 1.49 (95%CI: 1.20, 1.85, P <0.001)，严重 COVID-19 的总体 OR 为 2.09 (95 %CI：1.67、2.62；P <0.001）。与非重症 COVID-19 患者相比，重症 COVID-19 病例的增值税累积显着较高，住院 SMD 为 0.49 (95% CI: 0.11, 0.87; P  = 0.011)、0.57 (95% CI: 0.33, 0.81) ; P <0.001) 对于需要入住 ICU 的情况，以及 0.37 (95% CI: 0.03, 0.71; P  = 0.035) 对于 IMV 支持。重症 COVID-19 的总体 SMD 为 0.50（95% CI：0.33，0.68；P <0.001）。

结论

肥胖会增加 COVID-19 患者住院、入住 ICU、IMV 需求和死亡的风险。此外，过度内脏肥胖似乎与严重的 COVID-19 结局相关。这些发现强调，个人、公众和政府需要采取有效行动，提高对肥胖带来的风险以及这些风险在当前全球大流行中如何加剧的认识。