More evidence that diabetes/overweight tied to severe COVID-19 — Hospital meta-analysis

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Overweight and obese people are more likely to suffer severe symptoms of COVID-19 and require supplementary oxygen and invasive mechanical ventilation than healthy-weight peers, according to a study that further spotlights these key risk factors.

But according to the study – based on 7,244 COVID-19 patients from 18 hospitals in 11 countries – being overweight or obese was not associated with an increased risk of death.

Among the patients, 34.8% were overweight and 30.8% were obese. The 65.6% patients who were obese and overweight were more likely to require oxygen or non-invasive ventilatory support (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.15 to 1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI, 1.03–1.46) than patients with normal body mass indexes (BMIs).

There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI, 0.74–1.04), the authors said.

The results were similar to patients who had diabetes. The authors said about 90% of patients with type 2 diabetes are overweight or obese. The authors suggested that obese and overweight patients may experience higher levels of inflammation and more shortness of breath.

“Our findings highlight the importance of maintaining a healthy BMI, because patients with either overweight or obesity are at risk for severe COVID-19. Although reducing the current levels of overweight and obesity is unlikely in the short term to have an impact on the COVID-19 pandemic, doing so may contribute to reducing disease burden in future viral pandemics,” the authors concluded.


Study details
Diabetes and Overweight/Obesity Are Independent, Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International, Multicenter Retrospective Meta-analysis

Danielle K Longmore, Jessica E. Miller, Siroon Bekkering, Christoph Saner, Edin Mifsud, Yanshan Zhu, Richard Saffery, Alistair Nichol, Graham Colditz, Kirsty R Short, David P Burgner on behalf of the International BMI-COVID consortium

Published in Diabetes Care on 15 April 2021

Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes.
Research design and Methods
We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Sitespecific estimates were combined in a meta-analysis.
Among 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15–1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI 1.03–1.46). There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI 0.74–1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity.
In adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.


Diabetes Care study (Open access)


See also MedicalBrief archives:

Overweight or obese patients risk more severe COVID-19 — 11-country analysis

Super-spreaders: Exhale increases with COVID-19 infection, age, and obesity

Relationship between COVID-19 deaths and morbid obesity — large US analysis

Increasingly a link found between obesity and COVID-19 outcome risk

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