Association of obesity with the clinical severity of COVID-19 among hospitalized patients in a tertiary care hospital in Bangladesh
Keywords:Association, Bangladesh, Obesity, Severity, COVID-19 disease
Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is increasingly drawing worldwide attention. Among multiple risk factors, obesity is one of the factors that can influence the disease severity. This study aimed to explore the impact of obesity on the severity of COVID-19 infection.
Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2020 to February 2021. The Adult (Aged ≥18 years) patients of both genders, who were COVID-19 positive, were included in this study. Ninety-one COVID-19 patients with BMI≥25 kg/m2 were set as case and another ninety-one patients with BMI<25 kg/m2 were selected as control. The patient's BMI and waist circumference (WC) were recorded. Disease severity was evaluated by the management of COVID-19 disease guidelines by the World Health Organization (WHO) 2020.
Results: The maximum patients were male (65.38%), in the sixth and seventh decades. The proportion of severe illness was higher in the obese group 69.2% compared to the non-obese 47.3%. Patients with obesity require more ICU support (15.4% versus 5.5%) and invasive mechanical ventilation (9.9% versus 2.2%) compared to non-obese patients. In multivariate logistic regression analysis, after adjusting age, diabetes mellitus, and hypertension, obesity (BMI>25 kg/m2) was an independent risk factor for severe illness.
Conclusions: Obese patients are associated with severe COVID-19 pneumonia. As BMI increases, disease severity increases, needs more ICU support, and needs more invasive mechanical ventilation.
Kalligeros M, Shehadeh F, Mylona EK, Benitez G, Beckwith CG, Chan PA, et al. Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019. Obesity (Silver Spring). 2020;28(7):1200-4.
Sattar N, McInnes IB, McMurray JJ V. Obesity Is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020;142(1):4-6.
Lim JU, Lee JH, Kim JS, Hwang Y Il, Kim T-H, Lim SY, et al. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis. 2017;12:2465-75.
Islam F, Kathak RR, Sumon AH, Molla NH. Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh. PLoS One. 2020;15(5):e0233754.
Jia X, Yin C, Lu S, Chen Y, Liu Q, Bai J, Lu Y. Two things about COVID-19 might need attention. 2020.
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: when an epidemic and pandemic collide. Mayo Clin Proc. 2020;95(7):1445-53.
Dietz W, Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality. Vol. 28, Obesity (Silver Spring, Md.). United States; 2020:1005.
Gao F, Zheng KI, Wang XB, Sun QF, Pan KH, Wang TY, et al. Obesity is a risk factor for greater COVID-19 severity. Diab Care. 2020;43(7):e72-4.
Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diab Care. 2020;43(7):1392-8.
Coronavirus disease (COVID-19). World Health Organization. Accessed: Oct. 25, 2023. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19). Accessed on 25 October 2023.
Girdhar S, Sharma S, Chaudhary A, Bansal P, Satija M. An epidemiological study of overweight and obesity among women in an urban area of North India. Ind J Comm Med Off Publ Indian Assoc Prev Soc Med. 2016;41(2):154-7.
Liu X, Yue X, Liu F, Wei L, Chu Y, Bao H, et al. Analysis of clinical features and early warning signs in patients with severe COVID-19: A retrospective cohort study. PLoS One. 2020;15(6):e0235459.
Farsalinos K, Bagos PG, Giannouchos T, Niaura R, Barbouni A, Poulas K. Smoking prevalence among hospitalized COVID-19 patients and its association with disease severity and mortality: an expanded re-analysis of a recent publication. Harm Reduct J. 2021;18(1):9.
Aggarwal S, Garcia-Telles N, Aggarwal G, Lavie C, Lippi G, Henry BM. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis (Berlin, Ger. 2020;7(2):91-6.
Wang J, Zhu L, Liu L, Zhao XA, Zhang Z, Xue L, et al. Overweight and obesity are risk factors of severe illness in patients with COVID-19. Obesity (Silver Spring). 2020;28(11):2049-55.
Honardoost M, Janani L, Aghili R, Emami Z, Khamseh ME. The association between presence of comorbidities and COVID-19 severity: a systematic review and meta-analysis. Cerebrovas Dis. 2021;50(2):132-40.
Goossens GH, Dicker D, Farpour-Lambert NJ, Frühbeck G, Mullerova D, Woodward E, et al. Obesity and COVID-19: a perspective from the European association for the study of obesity on immunological perturbations, therapeutic challenges, and opportunities in obesity. Obes Facts. 2020;13(4):439-52.
Sahin S, Sezer H, Cicek E, Yagız Ozogul Y, Yildirim M, Icli TB, et al. The role of obesity in predicting the clinical outcomes of COVID-19. Obes Facts. 2021;14(5):481-489.
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, 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):1195-9.
Battisti S, Pedone C, Napoli N, Russo E, Agnoletti V, Nigra SG, et al. Computed tomography highlights increased visceral adiposity associated with critical illness in COVID-19. Diabetes Care. 2020;43(10):e129-30.
Prasad DS, Kabir Z, Revathi Devi K, Peter PS, Das BC. Gender differences in central obesity: Implications for cardiometabolic health in South Asians. Indian Heart J. 2020;72(3):202-4.
Petersen A, Bressem K, Albrecht J, Thieß HM, Vahldiek J, Hamm B, et al. The role of visceral adiposity in the severity of COVID-19: Highlights from a unicenter cross-sectional pilot study in Germany. Metabolism. 2020;110:154317.
Yang Y, Ding L, Zou X, Shen Y, Hu D, Hu X, et al. Visceral adiposity and high intramuscular fat deposition independently predict critical illness in patients with SARS‐CoV‐2. Obesity. 2020;28(11):2040.