The prevalence and contributing risk factors of coronavirus disease 2019 infection in patients with metabolic syndrome.

BACKGROUND: Components of metabolic syndrome (MetS) was reported to contribute to severe and worse outcomes of coronavirus disease 2019 (COVID-19). Hereby, we evaluated the association of MetS and its components with susceptibility to COVID-19. METHODS: Here, 1000 subjects with MetS were recruited that were diagnosed via the International Diabetes Federation (IDF) criterion. Real-time PCR was exerted to detect SARS-CoV-2 in the nasopharyngeal swabs. RESULTS: Among the MetS patients, 206 (20.6%) cases were detected to have COVID-19. Smoking (OR = 5.04, 95%CI = 3.53-7.21, P < 0.0001) and CVD (OR = 1.62, 95%CI = 1.09-2.40, P = 0.015) were associated with increased chance of COVID-19 infection in the MetS patients. BMI was significantly higher (P = 0.0001) in MetS cases with COVID-19 than those without COVID-19. Obesity was associated with increased susceptibility to COVID-19 in MetS patients (OR = 2.00, 95%CI = 1.47-2.74, P < 0.0001). Total cholesterol, TG, LDL were significantly higher in the MetS cases with COVID-19 than those without COVID-19. Dyslipidemia was associated with increased chance of COVID-19 (OR = 1.50, 95%CI = 1.10-2.05, P = 0.0104). FBS level was significantly higher in the MetS cases with COVID-19. T2DM was associated with increased risk of COVID-19 in MetS patients (OR = 1.43, 95%CI = 1.01-2.00, P = 0.0384). Hypertension was associated with increased chance of COVID-19 in the MetS patients (OR = 1.44, 95%CI = 1.05-1.98, P = 0.0234). CONCLUSIONS: MetS and its components, like obesity, diabetes, dyslipidemia, cardiovascular complications were associated with increased chance of COVID-19 infection development and probably with aggravated symptoms in such patients.

Increased Incidence of Pancreatic Steatosis Detected Using Computed Tomography at Initial Diagnosis of Coronavirus Disease 2019.

BACKGROUND: It is known that hepatic steatosis, diabetes, obesity, and metabolic syndrome are poor prognostic criteria for coronavirus disease 2019. Closely associated with these factors, pancreatic steatosis has yet to be clarified regarding its incidence in patients with coronavirus disease 2019 and its effect on prognosis. This study aimed to compare the incidence of pancreatic steatosis detected in non-contrast chest computed tomography examinations of patients with coronavirus disease 2019 pneumonia at the time of diagnosis with that of the general population. METHODS: In the present retrospective study, which included 399 patients, densities of 5 different regions of the pancreas and 4 different regions of the spleen were measured, and the mean value of the measured densities was obtained. The difference between the mean pancreatic attenuation and splenic attenuation was defined as pancreatic steatosis if pancreatic attenuation-splenic attenuation ≤-5. RESULTS: The median pancreatic density in patients with coronavirus disease 2019 was significantly lower than in those who tested negative (P = .034). In patients who were coronavirus disease 2019 positive, the incidence of pancreatic steatosis was statistically significantly higher (54.3% vs. 43.0%, P = .031). CONCLUSIONS: According to the non-contrast chest computed tomography examination of the patients with coronavirus disease 2019 performed at the time of admission, the incidence of pancreatic steatosis was higher than that of the normal population of a similar age group. Given that patients with pancreatic steatosis and the accompanying metabolic syndrome are more prone to inflammation, the findings suggest that these patients underwent more chest computed tomography examinations at the time of diagnosis. Therefore, pancreatic steatosis may be a poor prognostic factor in coronavirus disease 2019.

Clinical implications of COVID-19 in patients with metabolic-associated fatty liver disease.

People across the world are affected by the "coronavirus disease 2019 (COVID-19)", brought on by the "SARS-CoV type-2 coronavirus". Due to its high incidence in individuals with diabetes, metabolic syndrome, and metabolic-associated fatty liver disease (MAFLD), COVID-19 has gained much attention. The metabolic syndrome's hepatic manifestation, MAFLD, carries a significant risk of type-2-diabetes. The link between the above two conditions has also drawn increasing consideration since MAFLD is intricately linked to the obesity epidemic. Independent of the metabolic syndrome, MAFLD may impact the severity of the viral infections, including COVID-19 or may even be a risk factor. An important question is whether the present COVID-19 pandemic has been fueled by the obesity and MAFLD epidemics. Many liver markers are seen elevated in COVID-19. MAFLD patients with associated comorbid conditions like obesity, cardiovascular disease, renal disease, malignancy, hypertension, and old age are prone to develop severe disease. There is an urgent need for more studies to determine the link between the two conditions and whether it might account for racial differences in the mortality and morbidity rates linked to COVID-19. The role of innate and adaptive immunity alterations in MAFLD patients may influence the severity of COVID-19. This review investigates the implications of COVID-19 on liver injury and disease severity and vice-versa. We also addressed the severity of COVID-19 in patients with prior MAFLD and its potential implications and therapeutic administration in the clinical setting.

Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial.

OBJECTIVES: to analyze the effects of a multiprofessional remote intervention and telenursing in the treatment of obesity. METHODS: pragmatic clinical trial of intervention, conducted with obese adults. The multiprofessional remote intervention with a nurse occurred for 16 weeks through a messaging application. The application analyzed body composition, hemodynamic and laboratory variables, comparing the results obtained with the group that participated in face-to-face multiprofessional intervention without a nurse. The study investigated the effects of the intervention comparing the intervention groups and the moments through the ANOVA test for repeated measures. RESULTS: Group 1 obtained significance in the variables: percentage of body fat (p = 0.008); blood glucose (p = 0.014); insulin (p = 0.001); abdominal and waist circumference; and HDL cholesterol (p = 0.000). CONCLUSIONS: the effects of multiprofessional remote intervention and telenursing significantly decreased the risk variables for metabolic syndrome in the treatment of obesity.

Intrahepatic Fat Content and COVID-19 Lockdown in Adults with NAFLD and Metabolic Syndrome.

BACKGROUND: COVID-19 lockdowns had a significant impact on people's health, triggering levels of anxiety, perceived stress, and changes in food and nutritional status. OBJECTIVES: To assess the changes in dietary habits, metabolic syndrome (MetS) and liver parameters before and after the COVID-19 lockdown according to changes in intrahepatic fat content in adults with non-alcoholic fatty liver disease (NAFLD) and MetS. DESIGN: Pre- and post-lockdown observation of the COVID-19 lockdown on fifty-nine 40-60-year-old participants with MetS and NAFLD, in a parallel group, randomised experiment intended to treat NAFLD. METHODS: Anthropometrics, liver and MetS biochemical parameters, intrahepatic fat content by abdominal magnetic resonance imaging, and dietary assessment using a validated 148-item Food Frequency Questionnaire were collected pre-COVID-19 lockdown and post-lockdown. RESULTS: COVID-19 lockdown led to negative changes in the liver of patients with NAFLD and MetS, with weight gain and increases in glycemia, ALT and intrahepatic fat content post lockdown. Participants with worsened liver status had low consumption of fibre, cheese, nuts and coffee, and high consumption of sweets and pastries. Participants who improved liver status ameliorated ALT values, waist circumference, and intrahepatic fat content, assessed by magnetic resonance imaging post-lockdown. CONCLUSIONS: The maintenance of healthy lifestyle habits is vital, especially for populations with NAFLD and MetS, to reduce unhealthy lifestyle patterns displayed during lockdown.

Derivation and validation of sex-specific continuous metabolic syndrome scores for the Mexican adult population.

Traditionally the diagnosis of Metabolic syndrome (MetS) is binary (present/absent). The goal of this work is to propose a sex-specific continuous score to measure the severity of MetS in Mexican adults using waist circumference and body mass index as adiposity measures. MetSx-WC and MetSx-BMI indexes by sex were derived by confirmatory factor analysis (CFA) using data for 6567 adult participants of the National Health and Nutrition Survey 2018. The overall fit of the two proposed CFA models was excellent. We then validated these scores using a community-based health study of 862 university participants and determined that the reliability and strength of agreement between the MetSx-WC and MetSx-BMI scores were excellent. The ROC analysis of the resulting indexes indicates that they have excellent ability to discriminate a MetS classification according to the different criteria. The correlations of MetSx scores and surrogate markers of insulin resistance and obesity ranged from weak to strong. Subsequently, a retrospective study of 310 hospitalized patients with COVID-19 was used to determined that MetSx-BMI score was associated with the mortality of patients with COVID-19. The proposed indices provide a continuous measure in the identification of MetS risk in Mexican adults.

The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia.

BACKGROUND & AIMS: Obesity has been described as a predisposing risk factor to severe forms of COVID-19, but conflicting results are emerging on its real impact on the mortality of COVID-19. We aimed to compare clinical outcomes and mortality among COVID-19 patients according to obesity, metabolic syndrome and adiposity distribution. METHODS: We conducted a prospective observational study of all consecutive adult patients with a confirmed diagnosis of SARS-CoV-2 infection admitted to the Infectious Diseases Clinic at Udine Hospital, Italy, from January 2021 to February 2021. At admission, the study population was submitted to specific anthropometric, laboratory and bioimpedance analysis (BIA) measurements and divided into five groups according to: 1) BMI < or >30 kg/m2; 2) waist circumference (WC) < or >98 cm for women, < or >102 cm for men; 3) presence or absence of metabolic syndrome (MS); 4) visceral adipose tissue (VAT) distribution; and 5) presence or absence of sarcopenia (SP) both based on BIA. We then compared clinical outcomes (ventilatory support, intensive care unit (ICU) admission, ICU length of stay, total hospital length of stay and mortality), immune and inflammatory makers and infectious and non-infectious acute complications within the five groups. RESULTS: A total of 195 patients were enrolled in the study. The mean age of patients was 71 years (IQR 61-80) and 64.6% (126) were male. The most common comorbidities were hypertension (55.9%) and MS (55.4%). Overall mortality was 19.5%. Abdominal adiposity, measured both with WC and with BIA, and SP were significantly associated with need for increased ventilator support (p = 0.013 for WC; p = 0.037, 0.027 and 0.009 for VAT; p = 0.004 and 0.036 for FMI; and p = 0.051 for SP), but not with ICU admission (WC p = 0.627, VAT p = 0.153, FMI p = 0.519 and SP p = 0.938), length of stay (WC p = 0.345, VAT p = 0.650, FMI p = 0.159 and SP p = 0.992) and mortality (WC p = 0.277, VAT p = 0.533, FMI p = 0.957 and SP p = 0.211). Obesity and MS did not discriminate for the intensity of ventilatory outcome (p = 0.142 and p = 0.198, respectively), ICU admission (p = 0.802 and p = 0.947, respectively), length of stay (p = 0.471 and p = 0.768, respectively) and mortality (p = 0.495 and p = 0.268, respectively). We did not find significant differences in inflammatory markers and secondary complications within the five groups. CONCLUSIONS: In patients admitted with COVID-19, increased WC, visceral abdominal fat and SP are associated with higher need for ventilatory support. However, obesity, MS, SP and abdominal adiposity are not sensitive predictive factors for mortality.

Continuation of fibrate therapy in patients with metabolic syndrome and COVID-19: a beneficial regime worth pursuing.

Based on separate protective mechanisms related to lipid metabolism, viral cell entry and inflammation, fibrate treatment might be advantageous among patients who have been taking fibrates before SARS-CoV-2 infection and continue taking them during the infection. Based on published data on hospitalized COVID-19 patients, we recommend that the clinicians should ask their patients with metabolic syndrome who are already taking fibrates to continue fibrate treatment during the COVID-19 illness. This recommendation applies to both outpatients and hospitalized patients. However, results from the ongoing randomized controlled trials (RCTs) using fenofibrate treatment for the prevention or treatment of COVID-19 have yet to prove that fenofibrate is clinically significant for this indication.KEY MESSAGESThe role of fibrates as a repurpose to treat SARS-CoV-2 is under investigation in at least three ongoing RCTs.Obesity, diabetes, hypertension and dyslipidaemia, individually or clustered as a discrete phenotype, the metabolic syndrome, typically associate with a more severe course of COVID-19.Fibrate treatment seems to be most advantageous among patients who have been taken fibrates before SARS-CoV-2 infection and are continuing to take them during the infection.We recommend that the clinicians encourage their patients who are already taking fibrate to continue using the drug throughout the COVID-19 illness.

Headache in the Workplace: Analysis of Factors Influencing Headaches in Terms of Productivity and Health.

Headache is a very common condition that can have a significant impact on work. This study aimed to assess the prevalence of headaches and their impact on a sample of 1076 workers from 18 small companies operating in different sectors. The workers who volunteered to participate were asked to fill in the Headache Impact Test-6 (HIT-6) and answer questions designed to assess stressful and traumatic factors potentially associated with headaches. The volunteers subsequently underwent a medical examination and tests for diagnosing metabolic syndrome. Out of the 1044 workers who completed the questionnaire (participation rate = 97%), 509 (48.8%) reported suffering from headaches. In a multivariate logistic regression model, female gender, recent bereavement, intrusive leadership, and sleep problems were significantly associated with headaches. In univariate logistic regression models, headache intensity was associated with an increased risk of anxiety (OR 1.10; CI95% 1.09; 1.12) and depression (OR 1.09; CI95% 1.08; 1.11). Headache impact was also associated with the risk of metabolic syndrome (OR 1.02; CI95% 1.00, 1.04), obesity (OR 1.02, CI95% 1.01; 1.03), and reduced HDL cholesterol (OR 1.03; CI95% 1.01; 1.04). The impact of headache calls for intervention in the workplace not only to promote a prompt diagnosis of the different forms of headaches but also to improve work organization, leadership style, and the quality of sleep.

The effect of COVID-19 restriction on metabolic syndrome in primary hypertension.

BACKGROUND: Primary hypertension (HT) has been increasingly reported in parallel to the increase in the prevalence of obesity in children, both of which are important components of metabolic syndrome. The aim of this study was to investigate the effects of COVID-19 restrictions, which are believed to induce lifestyle changes and physical inactivity, on the parameters of metabolic syndrome in children with primary hypertension. METHODS: This was an observational, pre-post study conducted on pediatric patients with primary HT. The first phase of the study was the period prior to when COVID-19 restrictions were put in place in Turkey, and the second phase was up to the date when the restrictions were lifted. Anthropometric and blood pressure measurements, laboratory tests, and hypertensive-mediated organ damage at both phases of the study were compared. RESULTS: Severe restrictions due to the COVID-19 pandemic were associated with an increase in mean ± standard deviation body mass index (BMI) (26.4 ± 7.3 vs. 27.2 ± 7.1, P = 0.002), antihypertensive drug use (n = 53 (57.6%) vs. n = 59 (64.1%), P < 0.0001), fasting blood glucose level (89.4 ± 12.6 vs. 94.1 ± 14.2, P = 0.013), and a borderline elevation in total cholesterol (21 [22.8%] vs. 28 [30.4%], P < 0.0001). These increases negatively affected end organs, with an increased frequency of interventricular septum hypertrophy (n = 12 [13%] vs. n = 17 [18.5%], P = 0.031). CONCLUSIONS: COVID-19 restrictions were associated with an increased risk of parameters associated with metabolic syndrome in patients with primary hypertension. Physicians should carefully monitor the weight, blood pressure, fasting plasma glucose level, and total cholesterol levels in patients during periods of movement/activity restrictions such as during the COVID-19 pandemic.

Metabolic Syndrome, Alzheimer's Disease, and Covid 19: A Possible Correlation.

Age and comorbidities are key indicators of hospital admission, serious illness, and mortality in COVID-19 patients. Patients with age-related comorbidities, such as cardiovascular disease, hypertension, diabetes, chronic kidney disease, NAFLD, obesity, and metabolic syndrome, are more likely to require hospitalization and suffer severe sickness of COVID-19. Patients with Alzheimer's disease and risk factors associated with dementia may also be more vulnerable to serious COVID-19 infection. Peripheral inflammation, including in patients who recover from illness, may promote the course of neurodegenerative disorders through neuroinflammatory pathways. The aim of this study is to examine the impact of COVID-19 on immunity in patients with age-related diseases such as metabolic syndrome and Alzheimer's disease and also to hypothesize the possible correlation between metabolic syndrome, Alzheimer's disease, and COVID-19. Identifying the mechanisms that explain the complicated interaction between metabolic syndrome, Alzheimer's disease, COVID-19, inflammation, and immunity could be crucial to designing effective pharmacological therapies and procedures. This study adds to our basic information about the new coronavirus by synthesizing current knowledge of these linkages. To reduce inflammation and enhance immunity, patients should acquire good lifestyle practices. Walking, breathing exercises, and a nutritious diet all help in improving lung capacity and immunity. Future research into novel therapeutics for patients with metabolic syndrome, Alzheimer's disease, and COVID-19 inflammation and immunology is encouraged by this paper.

Impact of Metabolic Syndrome on Severity of COVID-19 Illness.

Background: Hypertension, diabetes, and obesity are common comorbidities that portend worse outcomes due to coronavirus disease 2019 (COVID-19). Metabolic syndrome is the common denominator of these conditions. This study aims to characterize the association of metabolic syndrome and its surrogate biomarkers with severity of COVID-19 illness. Methods: This retrospective study included adult patients who tested for COVID-19 at an academic tertiary care institution between March 8, 2020, and May 17, 2020. Metabolic syndrome was defined by the modified World Health Organization criteria. Outcomes of hospitalization, intensive care unit (ICU) admission, and death were analyzed. Results: There were 23,282 patients who tested for COVID-19 and 3679 (15.8%) had a positive result. Of these, metabolic syndrome was present in 834 (39%) of 2139 patients with available data. Patients with metabolic syndrome tended to be older, male, African American, heavier, and with more comorbidities. Metabolic syndrome was associated with higher rates of hospital admission and death (P < 0.001). On multivariable analysis, patients with metabolic syndrome had an increased risk of 77% for hospitalization, 56% for ICU admission, and 81% for death (P < 0.001). High AST:ALT and TG:HDL-C ratios were associated with hospitalization and ICU admission, but not mortality. Conclusions: Patients with metabolic syndrome had significantly worse hospitalization and mortality rates due to COVID-19, even after adjusting for covariates. Targeting obesity, hyperglycemia, dyslipidemia, and hypertension could address modifiable risk factors to reduce mortality due to COVID-19.

Association of Metabolic Syndrome with COVID-19 in the Republic of Korea.

BACKGROUND: Metabolic syndrome (MetS) is reportedly a crucial risk factor for coronavirus disease 2019 (COVID-19). Since the epidemiological studies that examine this association are few and include small samples, we investigated the relationship between MetS and COVID-19 severity and death using a larger sample in the Republic of Korea. METHODS: We analyzed 66,321 patients, 4,066 of whom had COVID-19. We used chi-square tests to examine patients' characteristics. We performed logistic regression analysis to analyze differences in COVID-19 infection and clinical outcomes according to the presence of MetS. RESULTS: Although MetS was not significantly associated with COVID-19 risk, acquiring MetS was significantly associated with the risk of severe COVID-19 outcomes (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.34 to 2.91; P=0.001). The mortality risk was significantly higher in COVID-19 patients with MetS (OR, 1.74; 95% CI, 1.17 to 2.59; P=0.006). Patients with abnormal waist circumference were approximately 2.07 times more likely to develop severe COVID-19 (P<0.001), and high-density lipoprotein cholesterol (HDL-C) levels were significantly associated with COVID-19; the mortality risk due to COVID-19 was 1.74 times higher in men with an HDL-C level of <40 mg/dL and in women with an HDL-C level of <50 mg/dL (P=0.012). CONCLUSION: COVID-19 is likely associated with severity and death in patients with MetS or in patients with MetS risk factors. Therefore, patients with MetS or those with abnormal waist circumference and HDL-C levels need to be treated with caution.

Anti-inflammatory adipokines: chemerin, vaspin, omentin concentrations and SARS-CoV-2 outcomes.

Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation. A wide range of adipokines activities suggests they influence pathogenesis and infection course. The aim was to assess concentrations of chemerin, omentin, and vaspin among COVID-19 patients with an emphasis on adipokines relationship with COVID-19 severity, concomitant metabolic abnormalities and liver dysfunction. Serum chemerin, omentin and vaspin concentrations were measured in serum collected from 70 COVID-19 patients at the moment of admission to hospital, before any treatment was applied and 20 healthy controls. Serum chemerin and omentin concentrations were significantly decreased in COVID-19 patients compared to healthy volunteers (271.0 vs. 373.0 ng/ml; p < 0.001 and 482.1 vs. 814.3 ng/ml; p = 0.01, respectively). There were no correlations of analyzed adipokines with COVID-19 severity based on the presence of pneumonia, dyspnea, or necessity of Intensive Care Unit hospitalization (ICU). Liver test abnormalities did not influence adipokines levels. Elevated GGT activity was associated with ICU admission, presence of pneumonia and elevated concentrations of CRP, ferritin and interleukin 6. Chemerin and omentin depletion in COVID-19 patients suggests that this adipokines deficiency play influential role in disease pathogenesis. However, there was no relationship between lower adipokines level and frequency of COVID-19 symptoms as well as disease severity. The only predictive factor which could predispose to a more severe COVID-19 course, including the presence of pneumonia and ICU hospitalization, was GGT activity.

Impact of Metabolic Syndrome in the Clinical Outcome of Disease by SARS-COV-2.

BACKGROUND: It has been observed that subjects with comorbidities related to metabolic syndrome (MetS) as hypertension, obesity, cardiovascular disease (CVD), and diabetes mellitus (DM2) show severe cases and a higher mortality by COVID-19. To date, there is little information available on the impact of the interaction between these comorbidities in the risk of death by COVID-19. AIM OF THE STUDY: To evaluate the impact of the combinations of MetS components in overall survival (OS) and risk of death among COVID-19 patients. METHODS: Using public data of the Ministry of Health, suspected, and confirmed COVID-19 cases from February 25-June 6, 2020 was analyzed. Mortality odds ratio (OR) was calculated with a univariate analysis (95% CI) and attributable risk. Interactions between components and survival curves were analyzed and a multivariate logistics regression analysis was conducted. RESULTS: The analysis included 528,651 cases out of which 202,951 were confirmed for COVID-19. Probabilities of OS among confirmed patients were 0.93, 0.89, 0.87, 0.86, and 0.83 while the OR of multivariate analysis was 1.83 (1.77-1.89), 2.58 (2.48-2.69), 2.83 (2.66-3.01), and 3.36 (2.83-3.99) for zero, one, two, three, and four MetS components, respectively. The combination with the highest risk was DM2 + hypertension at 2.22 (2.15-2.28), and the attributable risk for any component was 9.35% (9.21-9.49). Only the combination obesity + CVD showed no significant interaction. CONCLUSION: The presence of one MetS component doubles the risk of death by COVID-19, which was higher among patients with DM2 + hypertension. Only obesity and CVD do not interact significantly.

The cardiac molecular setting of metabolic syndrome in pigs reveals disease susceptibility and suggests mechanisms that exacerbate COVID-19 outcomes in patients.

Although metabolic syndrome (MetS) is linked to an elevated risk of cardiovascular disease (CVD), the cardiac-specific risk mechanism is unknown. Obesity, hypertension, and diabetes (all MetS components) are the most common form of CVD and represent risk factors for worse COVID-19 outcomes compared to their non MetS peers. Here, we use obese Yorkshire pigs as a highly relevant animal model of human MetS, where pigs develop the hallmarks of human MetS and reproducibly mimics the myocardial pathophysiology in patients. Myocardium-specific mass spectroscopy-derived metabolomics, proteomics, and transcriptomics enabled the identity and quality of proteins and metabolites to be investigated in the myocardium to greater depth. Myocardium-specific deregulation of pro-inflammatory markers, propensity for arterial thrombosis, and platelet aggregation was revealed by computational analysis of differentially enriched pathways between MetS and control animals. While key components of the complement pathway and the immune response to viruses are under expressed, key N6-methyladenosin RNA methylation enzymes are largely overexpressed in MetS. Blood tests do not capture the entirety of metabolic changes that the myocardium undergoes, making this analysis of greater value than blood component analysis alone. Our findings create data associations to further characterize the MetS myocardium and disease vulnerability, emphasize the need for a multimodal therapeutic approach, and suggests a mechanism for observed worse outcomes in MetS patients with COVID-19 comorbidity.

Metabolically unhealthy individuals, either with obesity or not, have a higher risk of critical coronavirus disease 2019 outcomes than metabolically healthy individuals without obesity.

BACKGROUND: This study aimed to determine the relative and independent contributions of impaired metabolic health and obesity to critical coronavirus disease 2019 (COVID-19). METHODS: We analyzed 4069 COVID-19 patients between January and June 2020 in South Korea, classified into four groups according to metabolic health status and body mass index (BMI): metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). The primary outcome was a composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), extracorporeal membrane oxygenation (ECMO), and death. Multivariable Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for the outcome. RESULTS: The incidence rate (per 100 person-months) of critical COVID-19 was the lowest in the MHNW group (0.90), followed by the MHO (1.64), MUNW (3.37), and MUO (3.37) groups. Compared with MHNW, a significantly increased risk of critical COVID-19 was observed in MUNW (HR, 1.41; 95% CI, 1.01-1.98) and MUO (HR, 1.77; 95% CI, 1.39-2.44) but not in MHO (HR, 1.48; 95% CI, 0.98-2.23). The risk of ICU admission or IMV/ECMO was increased only in MUO; however, the risk of death was significantly higher in MUNW and MUO. The risk of critical COVID-19 increased insignificantly by 2% per 1 kg/m2 BMI increase but significantly by 13% per 1 metabolically unhealthy component increase, even after mutually adjusting for BMI and metabolic health status. CONCLUSIONS: Metabolic health is more important to COVID-19 outcomes than obesity itself, suggesting that metabolic health status should be considered for a precise and tailored management of COVID-19 patients.

Increasing adiposity and the presence of cardiometabolic morbidity is associated with increased Covid-19-related mortality: results from the UK Biobank.

BACKGROUND: Although obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Furthermore, given that BMI is an insensitive indicator of adiposity, the effect of adipose volume on Covid-19 outcomes is also unknown. METHODS: We used the UK Biobank repository, which contains clinical and anthropometric data and is linked to Public Health England Covid-19 healthcare records, to address our research question. We performed age- and sex- adjusted logistic regression and Chi-squared test to compute the odds for Covid-19-related mortality as a consequence of increasing BMI, and other more sensitive indices of adiposity such as waist:hip ratio (WHR) and percent body fat, as well as concomitant cardiometabolic illness. RESULTS: 13,502 participants were tested for Covid-19 (mean age 70 ± 8 years, 48.9% male). 1582 tested positive (mean age 68 ± 9 years, 52.8% male), of which 305 died (mean age 75 ± 6 years, 65.5% male). Increasing adiposity was associated with higher odds for Covid-19-related mortality. For every unit increase in BMI, WHR and body fat, the odds of death amongst Covid19-positive participants increased by 1.04 (95% CI 1.01-1.07), 10.71 (95% CI 1.57-73.06) and 1.03 (95% CI 1.01-1.05), respectively (all p < 0.05). Referenced to Covid-19 positive participants with a normal weight (BMI 18.5-25 kg/m2), Covid-19 positive participants with BMI > 35 kg/m2 had significantly higher odds of Covid-19-related death (OR 1.70, 95% CI 1.06-2.74, p < 0.05). Covid-19-positive participants with metabolic (diabetes, hypertension, dyslipidaemia) or cardiovascular morbidity (atrial fibrillation, angina) also had higher odds of death. CONCLUSIONS: Anthropometric indices that are more sensitive to adipose volume and its distribution than BMI, as well as concurrent cardiometabolic illness, are associated with higher odds of Covid-19-related mortality amongst the UK Biobank cohort that tested positive for the infection. These results suggest adipose volume may contribute to adverse Covid-19-related outcomes associated with obesity.