Obesity and higher risk for severe complications of COVID-19: What to do when the two pandemics meet

Alessandra Valerio; Enzo Nisoli; Andrea P Rossi; Massimo  Pellegrini; Tiziana  Todesco; Marwan El Ghoch

doi:10.15586/jptcp.v27iSP1.708

Alessandra Valerio

Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Associate Editor – Journal of Population Therapeutics and Clinical Pharmacology, Brisbane, QLD, Australia.

Enzo Nisoli

Center for Study and Research on Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy; Editorial Board Member – Journal of Population Therapeutics and Clinical Pharmacology, Brisbane, QLD, Australia.

Andrea P Rossi

Division of Geriatrics, Department of Medicine, Healthy Aging Center, University of Verona, Verona, Italy.

Massimo Pellegrini

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical Nutrition Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Tiziana Todesco

Center for Eating Disorders, District for Health Services, Autonomous Province of Trento, Italy.

Marwan El Ghoch

Co-Editor-in-Chief – Journal of Population Therapeutics and Clinical Pharmacology, Brisbane, QLD, Australia; Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.

Keywords

COVID-19, obesity, pandemic, overweight, severe complications, mortality

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has spread around the globe, infecting more than ten million individuals, with more than 500,000 dead; about one half of the infected people have recovered. Despite this fact, a subgroup of individuals affected by COVID-19 is at greater risk of developing worse outcomes and experience a high rate of mortality. Data on the association between obesity and COVID-19 are growing; the available studies, have reported a high prevalence of overweight and obesity in patients experiencing a severe COVID-19 course, with serious complications requiring hospitalization and admission to intensive care units. This paper attempts to highlight potential mechanisms behind the greater vulnerability to COVID-19 of individuals with obesity. The presence of uncontrolled chronic obesity-related comorbidities, particularly pulmonary diseases, can present a primary fertile soil for respiratory tract infection. Combined with immune system impairments, such as alteration in the T-cell proliferation and macrophage differentiation, and the high pro-inflammatory cytokine production by the adipose organ, this may worsen the general condition toward a systemic diffusion of infection. Prevention remains the first line of intervention in these patients that can be achieved by adhering to social distancing and adopting hygiene precautions, combined with a healthy lifestyle. Patients with obesity require preferential access dedicated to primary care services to ensure they are regularly taking their medications for the treatment of any concurrent chronic diseases. Finally, their physicians must promptly manage any medical signs or symptoms in the case of suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection to prevent the risk of severe outcomes.

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References

1. Gralinski LE, Menachery VD. Return of the coronavirus: 2019-nCoV. Viruses. 2020;12(2):135. https://doi.org/10.3390/v12020135

2. Park M, Cook AR, Lim JT, Sun Y, Dickens BL. A systematic review of COVID-19 epidemiology based on current evidence. J Clin Med. 2020;9(4): 967. https://doi.org/10.3390/jcm9040967

3. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18): 1775–1776. https://doi.org/10.1001/jama.2020.4683

4. Coronavirus Disease 2019. Centres for Disease Control and Prevention (CDC): [cited 2020 May 30]. Available from: https://www.cdc.gov

5. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metab Clin Exp. 2020;108:154262. https://doi.org/10.1016/j.metabol.2020.154262

6. Petrilli CM, Jones SA, Yang JJ, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 dis-ease in New York City. BMJ. 2020;369:m1966. https://doi.org/10.1101/2020.04.08.20057794

7. Apovian CM. Obesity: Definition, comorbidities, causes, and burden. Am J Manag Care. 2016; 22(7 Suppl):s176–85.

8. El Ghoch M, Fakhoury R. Challenges and new directions in obesity management: Lifestyle modification programmes, pharmacotherapy and bariatric surgery. J Popul Ther Clin Pharmacol. 2019;26(2):e1–4. https://doi.org/ 10.15586/jptcp.v26i2.599

9. Huttunen R, Syrjanen J. Obesity and the risk and outcome of infection. Int J Obes (Lond). 2013; 37(3):333–40. https://doi.org/10.1038/ijo.2012.62

10. Fernandez C, Manuel A. Obesity, respiratory disease and pulmonary infections. Ann Res Hosp. 2017;1(5):9. https://doi.org/10.21037/arh.2017.08.06

11. 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. Obesity (Silver Spring). 2020;28(7):1195–1199. https://doi.org/10.1002/oby.22831

12. 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. 2020;ciaa415. https://doi.org/10.1093/cid/ciaa415

13. Neumann G, Noda T, Kawaoka Y. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature. 2009;459(7249):931–9. https://doi.org/10.1038/nature08157

14. 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. 2011;52(3):301–12. https://doi.org/10.1093/cid/ ciq152

15. Diaz E, Rodriguez A, Martin-Loeches I, et al. Impact of obesity in patients infected with 2009 influenza A (H1N1). Chest. 2011;139(2):382–6. https://doi.org/10.1378/chest.10-1160

16. Fezeu L, Julia C, Henegar A, et al. Obesity is associated with higher risk of intensive care unit admission and death in influenza A (H1N1) patients: A systematic review and meta-analysis. Obes Rev. 2011;12(8):653–9. https://doi.org/ 10.1111/j.1467-789X.2011.00864.x

17. Van Kerkhove MD, Vandemaele KA, Shinde V, et al. Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: A global pooled analysis. PLoS Med. 2011;8(7):e1001053. https://doi.org/10.1371/journal.pmed.1001053

18. Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin Cornerstone. 1999;2(3):17–31. https://doi.org/ 10.1016/S1098-3597(99)90002-9

19. Francisco V, Pino J, Campos-Cabaleiro V, et al. Obesity, fat mass and immune system: Role for leptin. Front Physiol. 2018;9:640. https://doi.org/ 10.3389/fphys.2018.00640

20. Bahr I, Spielmann J, Quandt D, Kielstein H. Obesity-associated alterations of natural killer cells and immunosurveillance of cancer. Front Immunol. 2020;11:245. https://doi.org/10.3389/fimmu.2020. 00245

21. Nave H, Beutel G, Kielstein JT. Obesity-related immunodeficiency in patients with pandemic influenza H1N1. Lancet Infect Dis. 2011;11(1): 14–15. https://doi.org/10.1016/S1473-3099(10) 70304-2

22. Diao B,Wang C, Tan Y, et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Front Immunol. 2020;11:827. https://doi.org/10.3389/ fimmu.2020.00827

23. Huttunen R, Karppelin M, Syrjanen J. Obesity and nosocomial infections. J Hosp Infect. 2013;85(1):8–16. https://doi.org/10.1016/j.jhin. 2013.06.012

24. Mehuys E, Kayitare E, Vervaet C, Remon JP. Adjustment of dosing of antimicrobial agents for bodyweight in adults. Lancet. 2010;375(9719): 983–4. https://doi.org/10.1016/S0140-6736(10) 60439-4

25. O’Brien KB, Vogel P, Duan S, et al. Impaired wound healing predisposes obese mice to severe influenza virus infection. J Infect Dis. 2012;205(2):252–61. https://doi.org/10.1093/ infdis/jir729

26. Epingeac ME, Gaman MA, Diaconu CC, Gad M, Gaman AM. The evaluation of oxidative stress levels in obesity. Rev Chim. 2019;70(6): 2241–4. https://doi.org/10.37358/RC.19.6.7314

27. Miles J, Anderson DP, Engelke M, et al. Barriers to transition of obese patients from hospital to community. Am J Manag Care. 2012;18(6):e234–7.

28. El Ghoch M, Valerio A. Let food be the medicine, but not for coronavirus: Nutrition and food science, telling myths from facts. J Popul Ther Clin Pharmacol. 2020;27(SP1):4. https://doi.org/ 10.15586/jptcp.v27iSP1.682

29. Banos RM, Mensorio MS, Cebolla A, et al. An internet-based self-administered intervention for promoting healthy habits and weight loss in hypertensive people who are overweight or obese: A randomized controlled trial. BMC Cardiovasc Disord. 2015;15:83. https://doi. org/10.1186/s12872-015-0078-1

30. Johnson WD, Brashear MM, Gupta AK, Rood JC, Ryan DH. Incremental weight loss improves cardiometabolic risk in extremely obese adults. Am J Med. 2011;124(10):931–8. https://doi. org/10.1016/j.amjmed.2011.04.033

31. Assari S, Wisseh C, Bazargan M. Obesity and polypharmacy among African American older adults: Gender as the moderator and multimorbidity as the mediator. Int J Environ Res Public Health. 2019;16:2181. https://doi.org/ 10.3390/ijerph16122181

32. Ziere G, Dieleman JP, Hofman A, Pols HAP, van der Cammen TJM, Stricker BHC. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61:218–23. https://doi. org/10.1111/j.1365-2125.2005.02543.x

33. Flaherty JH, Perry HM, Lynchard GS, Morley JE. Polypharmacy and hospitalization among older home care patients. J Gerontol A Biol Sci Med Sci. 2000;55:M554–9. https://doi.org/ 10.1093/gerona/55.10.M554

34. Dobric? EC, G?man MA, Cozma MA, Bratu OG, Pantea Stoian A, Diaconu CC. Polypharmacy in type 2 diabetes mellitus: Insights from an internal medicine department. Medicina. 2019;55:436. https://doi.org/10.3390/medicina55080436

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Published

Jun 29, 2020

DOI https://doi.org/10.15586/jptcp.v27iSP1.708

How to Cite

Valerio, A., Nisoli, E., Rossi, A. P., Pellegrini, M. ., Todesco, T. ., & El Ghoch, M. (2020). Obesity and higher risk for severe complications of COVID-19: What to do when the two pandemics meet. Journal of Population Therapeutics and Clinical Pharmacology, 27(SP1), e31-e36. https://doi.org/10.15586/jptcp.v27iSP1.708