Patients with COVID-19 and obesity have poor outcomes not driven by inflammation

December 16, 2020

(Boston)--Obesity is associated with poor COVID-19 outcomes but a new study suggests this is not due to increased inflammation, but instead may be driven by respiratory issues or other factors.

Multiple studies suggest those who are overweight or have obesity are more likely to experience invasive mechanical ventilation, intensive care unit (ICU) admission or death. Population-level studies also suggest a higher COVID-19 mortality rate in countries with greater prevalence of obesity. What was not known before was whether patients with obesity had more inflammation, the so-called cytokine storm of COVID.

According to the researchers, additional factors may explain the unexpected finding of lower inflammatory markers in patients with obesity. "Though definitive reasons for poor COVID-19 outcomes in obesity remain uncertain, patients with obesity are uniquely vulnerable. They may have independent risk factors (type-2 diabetes, hypertension and coronary artery disease) for poor outcomes in COVID-19, conditions that are inflammatory and immune-mediated," explained Ana Mostaghim, MD, the lead author for the study who conducted the work while an internal medicine resident at Boston Medical Center (BMC).

In an effort to better understand these potential factors, the researchers compared outcomes and inflammatory markers in patients with and without obesity who were hospitalized with COVID-19 at BMC, a safety-net hospital. They found that body mass index (BMI) greater or equal to 35 was associated with a two-fold increased risk of ICU transfer and a four-fold risk of all-cause mortality; BMI in the 30-34.9 range (Class I obesity) was also associated with increased risk of ICU transfer, but not significantly associated with increased mortality. They also found that patients with obesity had mostly lower inflammatory markers on the first and second hospital days compared to those without obesity.

"While patients with obesity had worse clinical outcomes than those without obesity in our study, this effect does not appear to be mediated by a higher degree of inflammation," added Natasha Hochberg, MD, associate professor of medicine at Boston University School of Medicine and an infectious disease physician at BMC. "Patients with obesity are at higher risk of fatty liver disease and greater viral invasion with organ dysfunction may contribute to the increased mortality seen in these patients. Alternately, patients with obesity may have reduced respiratory reserve."

The researchers believe further studies are needed to determine whether this decreased inflammatory response persists during hospitalization, whether pro-inflammatory complications are seen less commonly among patients with obesity and whether anti-inflammatory therapy should be utilized differently in patients with obesity.
-end-
These findings appear online in the journal PLOS ONE.

Boston University School of Medicine

Related Obesity Articles from Brightsurf:

11 years of data add to the evidence for using testosterone therapy to treat obesity, including as an alternative to obesity surgery
New research covering 11 years of data presented at this year's European and International Congress on Obesity (ECOICO 2020) show that, in obese men suffering from hypogonadism (low testosterone), treatment with testosterone injections lowers their weight and improves a wide range of other metabolic parameters.

Overlap between immunology of COVID-19 and obesity could explain the increased risk of death in people living with obesity, and also older patients
Data presented in a special COVID-19 session at the European and International Congress on Obesity (ECOICO 2020) suggests that there are overlaps between the immunological disturbances found in both COVID-19 disease and patients with obesity, which could explain the increased disease severity and mortality risk faced by obese patients, and also elderly patients, who are infected by the SARS-CoV-2 virus that causes COVID-19 disease.

New obesity guideline: Address root causes as foundation of obesity management
besity management should focus on outcomes that patients consider to be important, not weight loss alone, and include a holistic approach that addresses the root causes of obesity, according to a new clinical practice guideline published in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.191707.

Changing the debate around obesity
The UK's National Health Service (NHS) needs to do more to address the ingrained stigma and discrimination faced by people with obesity, says a leading health psychologist.

Study links longer exposure to obesity and earlier development of obesity to increased risk of type 2 diabetes
Cumulative exposure to obesity could be at least as important as actually being obese in terms of risk of developing type 2 diabetes (T2D), concludes new research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]).

How much do obesity and addictions overlap?
A large analysis of personality studies has found that people with obesity behave somewhat like people with addictions to alcohol or drugs.

Should obesity be recognized as a disease?
With obesity now affecting almost a third (29%) of the population in England, and expected to rise to 35% by 2030, should we now recognize it as a disease?

Is obesity associated with risk of pediatric MS?
A single-center study of 453 children in Germany with multiple sclerosis (MS) investigated the association of obesity with pediatric MS risk and with the response of first-line therapy in children with MS.

Women with obesity prior to conception are more likely to have children with obesity
A systematic review and meta-analysis identified significantly increased odds of child obesity when mothers have obesity before conception, according to a study published June 11, 2019 in the open-access journal PLOS Medicine by Nicola Heslehurst of Newcastle University in the UK, and colleagues.

Obesity medicine association announces major updates to its adult obesity algorithm
The Obesity Medicine Association (OMA) announced the immediate availability of the 2019 OMA Adult Obesity Algorithm, with new information for clinicians including the relationship between Obesity and Cardiovascular Disease, Diabetes Mellitus, Dyslipidemia, and Cancer; information on investigational Anti-Obesity Pharmacotherapy; treatments for Lipodystrophy; and Pharmacokinetics and Obesity.

Read More: Obesity News and Obesity Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.