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1.
J Vasc Interv Radiol ; 32(1): 33-38, 2021 01.
Article in English | MEDLINE | ID: covidwho-1454337

ABSTRACT

PURPOSE: To determine effect of body mass index (BMI) on safety and cancer-related outcomes of thermal ablation for renal cell carcinoma (RRC). MATERIALS AND METHODS: This retrospective study evaluated 427 patients (287 men and 140 women; mean [SD] age, 72 [12] y) who were treated with thermal ablation for RCC between October 2006 and December 2017. Patients were stratified by BMI into 3 categories: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Of 427 patients, 71 (16%) were normal weight, 157 (37%) were overweight, and 199 (47%) were obese. Complication rates, local recurrence, and residual disease were compared in the 3 cohorts. RESULTS: No differences in technical success between normal-weight, overweight, and obese patients were identified (P = .72). Primary technique efficacy rates for normal-weight, overweight, and obese patients were 91%, 94%, and 93% (P = .71). There was no significant difference in RCC specific-free survival, disease-free survival, and metastasis-free survival between obese, overweight, and normal-weight groups (P = .72, P = .43, P = .99). Complication rates between the 3 cohorts were similar (normal weight 4%, overweight 2%, obese 3%; P = .71). CONCLUSIONS: CT-guided renal ablation is safe, feasible, and effective regardless of BMI.


Subject(s)
Body Mass Index , Carcinoma, Renal Cell/surgery , Cryosurgery , Kidney Neoplasms/surgery , Microwaves/therapeutic use , Obesity/diagnosis , Radiofrequency Ablation , Aged , Aged, 80 and over , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/secondary , Cryosurgery/adverse effects , Cryosurgery/mortality , Disease Progression , Disease-Free Survival , Female , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Male , Microwaves/adverse effects , Middle Aged , Neoplasm Recurrence, Local , Obesity/mortality , Patient Safety , Radiofrequency Ablation/adverse effects , Radiofrequency Ablation/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
2.
BMC Cardiovasc Disord ; 21(1): 332, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1344072

ABSTRACT

Recently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable "obesity paradox" is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.


Subject(s)
COVID-19/epidemiology , Metabolic Syndrome/epidemiology , Obesity/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cardiometabolic Risk Factors , Diet/adverse effects , Exercise , Hospitalization , Humans , Metabolic Syndrome/diagnosis , Metabolic Syndrome/therapy , Obesity/diagnosis , Obesity/therapy , Physical Distancing , Preventive Health Services , Prognosis , Risk Assessment , Sedentary Behavior
3.
Nutr Metab Cardiovasc Dis ; 31(9): 2605-2611, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1343328

ABSTRACT

BACKGROUND AND AIMS: To analyze lifestyle habits and weight evolution during the COVID-19 pandemic-associated lockdown, in diabetes and overweight/obesity patients (body mass index (BMI) [25-29.9] and ≥30 kg/m2, respectively). METHODS AND RESULTS: We collected information on participants' characteristics and behavior regarding lifestyle before and during the lockdown, through the CoviDIAB web application, which is available freely for people with diabetes in France. We stratified the cohort according to BMI (≥25 kg/m2vs < 25 kg/m2) and examined the determinants of weight loss (WL), WL > 1 kg vs no-WL) in participants with a BMI ≥25 kg/m2, in both univariate and multivariate analyses. Of the 5280 participants (mean age, 52.5 years; men, 49%; diabetes, 100% by design), 69.5% were overweight or obese (mean BMI, 28.6 kg/m2 (6.1)). During the lockdown, patients often quit or decreased smoking; overweight/obese participants increased alcohol consumption less frequently as compared with normal BMI patients. In addition, overweight/obese patients were more likely to improve other healthy behaviors on a larger scale than patients with normal BMI: increased intake of fruits and vegetables, reduction of snacks intake, and reduction of total dietary intake. WL was observed in 18.9% of people with a BMI ≥25 kg/m2, whereas 28.6% of them gained weight. Lifestyle favorable changes characterized patients with WL. CONCLUSIONS: A significant proportion of overweight/obese patients with diabetes seized the opportunity of lockdown to improve their lifestyle and to lose weight. Identifying those people may help clinicians to personalize practical advice in the case of a recurrent lockdown.


Subject(s)
COVID-19/prevention & control , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Healthy Lifestyle , Obesity/therapy , Risk Reduction Behavior , Weight Loss , Adult , Aged , Body Mass Index , COVID-19/epidemiology , COVID-19/transmission , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diet, Healthy , Exercise , Female , France/epidemiology , Habits , Health Behavior , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Middle Aged , Nutritive Value , Obesity/diagnosis , Obesity/epidemiology , Prevalence , Risk Assessment , Risk Factors , Smoking Cessation , Time Factors , Weight Gain
4.
Prev Chronic Dis ; 18: E66, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1323410

ABSTRACT

INTRODUCTION: Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness. METHODS: We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions. RESULTS: Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions). CONCLUSION: Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.


Subject(s)
COVID-19 , Diabetes Complications , Hospitalization/statistics & numerical data , Multimorbidity , Noncommunicable Diseases/epidemiology , Obesity , Phobic Disorders , Age Factors , Aged , COVID-19/mortality , COVID-19/therapy , Comorbidity , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Female , Humans , Male , Mortality , Obesity/diagnosis , Obesity/epidemiology , Phobic Disorders/diagnosis , Phobic Disorders/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology
5.
Nutrients ; 13(7)2021 Jun 23.
Article in English | MEDLINE | ID: covidwho-1282546

ABSTRACT

The aim of this study was to assess the impact of the nationwide total lockdown (LD) in France on weight loss and body composition modifications in subjects participating in a weight loss program and to evaluate the impact of remote consultations on participants' adherence to the weight loss program. The CO-RNPC study was a prospective multicentre cohort study including participants undergoing a two to six months program. The rate of weight loss in kg/week was computed before (15 days), during (99 days) and after LD (15 days). In the 1550 completing participants, body weight decreased from 87.1 kg [IQR 77.0; 100.2] to 82.3 kg [72.1; 94.3] resulting in a difference of -4.79 kg [-4.48; -5.10] (p < 0.01), with a corresponding reduction in waist circumference by 4 cm ([0; 9], p < 0.01). The median weight loss was 4.4 kg [0.5; 9.4] in those who used remote consultations, and 1.4 kg [0.8; 5.7] in the no remote consultation group (p < 0.01). In this large prospective cohort, we observed that the rate of weight loss was reduced during LD. This reduction was counterbalanced in participants involved in a remote consultation follow-up with a dose-effect response based on the number of remote consultations.


Subject(s)
Body Composition , COVID-19/prevention & control , Obesity/therapy , Physical Distancing , Remote Consultation , Weight Loss , Weight Reduction Programs , COVID-19/transmission , Female , France , Humans , Male , Middle Aged , Obesity/diagnosis , Obesity/physiopathology , Patient Compliance , Prospective Studies , Time Factors , Treatment Outcome
6.
J Diabetes Complications ; 35(8): 107967, 2021 08.
Article in English | MEDLINE | ID: covidwho-1253171

ABSTRACT

OBJECTIVE: To explore predictors of severe COVID-19 disease in patients with diabetes hospitalized for COVID-19. METHODS: This is a retrospective observational study of adults with diabetes admitted for COVID-19. Bivariate tests and multivariable Cox regression were used to identify risk factors for severe COVID-19, defined as a composite endpoint of intensive care unit admission/intubation or in-hospital death. RESULTS: In 1134 patients with diabetes admitted for COVID-19, more severe disease was associated with older age (HR 1.02, p<0.001), male sex (HR 1.28, p=0.017), Asian race (HR 1.34, p=0.029 [reference: white]), and greater obesity (moderate obesity HR 1.59, p=0.015; severe obesity HR 2.07, p=0.002 [reference: normal body mass index]). Outpatient diabetes medications were not associated with outcomes. CONCLUSIONS: Age, male sex, Asian race, and obesity were associated with increased risk of severe COVID-19 disease in adults with type 2 diabetes hospitalized for COVID-19. SUMMARY: In patients with type 2 diabetes hospitalized for COVID-19 disease, we observed that age, male sex, Asian race, and obesity predicted severe COVID-19 outcomes of intensive care unit admission, intubation, or in-hospital death. The risk conferred by obesity increased with worsening obesity. Outpatient diabetes medications were not observed to be significant predictors of study outcomes.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Patient Admission/statistics & numerical data , Adult , Aged , Aged, 80 and over , Body Mass Index , COVID-19/pathology , COVID-19/therapy , Comorbidity , Continental Population Groups/statistics & numerical data , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , New York/epidemiology , Obesity/complications , Obesity/diagnosis , Obesity/epidemiology , Obesity/therapy , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index
7.
S Afr Med J ; 111(2): 159-165, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1168063

ABSTRACT

BACKGROUND: Hypertension (HPT) and its complications continue to pose a global threat and contribute to premature mortality worldwide. The adverse interactions between HPT, obesity and COVID-19 are currently being witnessed globally and represent a collision of pandemics. Understanding the burden that this non-communicable disease (NCD) poses in KwaZulu-Natal (KZN) Province, South Africa (SA), would help in developing improved public healthcare strategies. OBJECTIVES: To describe the burden of HPT in all the districts of KZN over a 6-year period. METHODS: HPT data are routinely collected from all KZN public health facilities (both clinics and hospitals) as part of the District Health Information System (DHIS). In this retrospective study, we accessed HPT records from the DHIS over a period of 6 years (2014 - 2019, inclusive). Data collected included the number of patients screened, diagnosed and initiated on therapy for HPT, together with the number of obese patients. RESULTS: The slopes for HPT screening were positive at both clinics and hospitals in KZN (considerably more at clinics than hospitals, with a difference in elevations of slopes of p<0.001), with a significantly greater percentage of the population having been screened at rural clinics than at hospitals (difference in elevation of slopes p<0.001). A significantly greater number of patients aged <40 years (p<0.001) were being screened for HPT at clinics than at hospitals (2017/18, 2018/19, 2019/20), while hospitals screened considerably more patients aged ≥40 years in 2017 - 2018 (p<0.001). The numbers of new hypertensives diagnosed and having treatment initiated were on an upward slope at both clinics and hospitals, with clinics having a greater elevation of slope than hospitals (p<0.001), irrespective of patient age. A significantly greater number of patients aged ≥40 years (p<0.05) were diagnosed with HPT at both clinics and hospitals in KZN (2017/18, 2018/19, 2019/20). KZN clinics remained the first port of call for known hypertensives throughout the study period. Obesity was prevalent at both clinic and hospital level, although figures were significantly higher at clinics. Over 80% of the obesity burden was carried by the rural clinics and hospitals. CONCLUSIONS: Screening, diagnosis, treatment initiation and chronic management of HPT occur mainly at rural clinic level. The SA government needs to heed these findings and redirect resources (staffing and equipment) to this level. The prevalence of obesity was highest at rural healthcare facilities (clinics more than hospitals). More needs to be done to combat the obesity pandemic if we are to win the battle against NCDs (HPT and diabetes mellitus). A significant number of patients aged <40 years are being screened for HPT, which bodes well for the province, as early diagnosis and treatment of HPT are vital to prevent complications.


Subject(s)
COVID-19/epidemiology , Cost of Illness , Hypertension/diagnosis , Hypertension/epidemiology , Adult , Age Distribution , Age Factors , Aged , Ambulatory Care Facilities/organization & administration , Comorbidity , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Humans , Male , Middle Aged , Obesity/diagnosis , Obesity/epidemiology , Quality of Life , Retrospective Studies , Risk Factors , South Africa
9.
Emerg Infect Dis ; 27(4): 1164-1168, 2021.
Article in English | MEDLINE | ID: covidwho-1146202

ABSTRACT

We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient's age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus , Glycated Hemoglobin A/analysis , Hospitalization/statistics & numerical data , Hypertension , Obesity , Patient Care Management , Age Factors , COVID-19/epidemiology , COVID-19/psychology , COVID-19/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Disease Progression , Female , Georgia/epidemiology , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged , Multimorbidity , Obesity/diagnosis , Obesity/epidemiology , Patient Acceptance of Health Care , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/statistics & numerical data , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2
10.
Biomed Res Int ; 2021: 6696357, 2021.
Article in English | MEDLINE | ID: covidwho-1140377

ABSTRACT

Background: Sedentary lifestyle and work from home schedules due to the ongoing COVID-19 pandemic in 2020 have caused a significant rise in obesity across adults. With limited visits to the doctors during this period to avoid possible infections, there is currently no way to measure or track obesity. Methods: We reviewed the literature on relationships between obesity and facial features, in white, black, hispanic-latino, and Korean populations and validated them against a cohort of Indian participants (n = 106). The body mass index (BMI) and waist-to-hip ratio (WHR) were obtained using anthropometric measurements, and body fat mass (BFM), percentage body fat (PBF), and visceral fat area (VFA) were measured using body composition analysis. Facial pictures were also collected and processed to characterize facial geometry. Regression analysis was conducted to determine correlations between body fat parameters and facial model parameters. Results: Lower facial geometry was highly correlated with BMI (R 2 = 0.77) followed by PBF (R 2 = 0.72), VFA (R 2 = 0.65), WHR (R 2 = 0.60), BFM (R 2 = 0.59), and weight (R 2 = 0.54). Conclusions: The ability to predict obesity using facial images through mobile application or telemedicine can help with early diagnosis and timely medical intervention for people with obesity during the pandemic.


Subject(s)
Anthropometry/methods , Automated Facial Recognition/methods , COVID-19/epidemiology , Obesity/diagnosis , Adult , Body Composition , Body Mass Index , Body Weight , Facial Recognition/physiology , Female , Humans , Male , Middle Aged , Obesity/epidemiology , Obesity/metabolism , Pandemics , Predictive Value of Tests , Prognosis , Risk Factors , SARS-CoV-2/isolation & purification , Waist Circumference , Waist-Hip Ratio
11.
PLoS Med ; 18(3): e1003553, 2021 03.
Article in English | MEDLINE | ID: covidwho-1117467

ABSTRACT

BACKGROUND: Epidemiological studies report associations of diverse cardiometabolic conditions including obesity with COVID-19 illness, but causality has not been established. We sought to evaluate the associations of 17 cardiometabolic traits with COVID-19 susceptibility and severity using 2-sample Mendelian randomization (MR) analyses. METHODS AND FINDINGS: We selected genetic variants associated with each exposure, including body mass index (BMI), at p < 5 × 10-8 from genome-wide association studies (GWASs). We then calculated inverse-variance-weighted averages of variant-specific estimates using summary statistics for susceptibility and severity from the COVID-19 Host Genetics Initiative GWAS meta-analyses of population-based cohorts and hospital registries comprising individuals with self-reported or genetically inferred European ancestry. Susceptibility was defined as testing positive for COVID-19 and severity was defined as hospitalization with COVID-19 versus population controls (anyone not a case in contributing cohorts). We repeated the analysis for BMI with effect estimates from the UK Biobank and performed pairwise multivariable MR to estimate the direct effects and indirect effects of BMI through obesity-related cardiometabolic diseases. Using p < 0.05/34 tests = 0.0015 to declare statistical significance, we found a nonsignificant association of genetically higher BMI with testing positive for COVID-19 (14,134 COVID-19 cases/1,284,876 controls, p = 0.002; UK Biobank: odds ratio 1.06 [95% CI 1.02, 1.10] per kg/m2; p = 0.004]) and a statistically significant association with higher risk of COVID-19 hospitalization (6,406 hospitalized COVID-19 cases/902,088 controls, p = 4.3 × 10-5; UK Biobank: odds ratio 1.14 [95% CI 1.07, 1.21] per kg/m2, p = 2.1 × 10-5). The implied direct effect of BMI was abolished upon conditioning on the effect on type 2 diabetes, coronary artery disease, stroke, and chronic kidney disease. No other cardiometabolic exposures tested were associated with a higher risk of poorer COVID-19 outcomes. Small study samples and weak genetic instruments could have limited the detection of modest associations, and pleiotropy may have biased effect estimates away from the null. CONCLUSIONS: In this study, we found genetic evidence to support higher BMI as a causal risk factor for COVID-19 susceptibility and severity. These results raise the possibility that obesity could amplify COVID-19 disease burden independently or through its cardiometabolic consequences and suggest that targeting obesity may be a strategy to reduce the risk of severe COVID-19 outcomes.


Subject(s)
Body Mass Index , COVID-19 , Coronary Artery Disease , Diabetes Mellitus, Type 2 , Disease Susceptibility , Obesity , Renal Insufficiency, Chronic , Stroke , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/genetics , Cardiometabolic Risk Factors , Causality , Coronary Artery Disease/epidemiology , Coronary Artery Disease/genetics , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/genetics , Genetic Variation , Genome-Wide Association Study/statistics & numerical data , Humans , Mendelian Randomization Analysis , Meta-Analysis as Topic , Obesity/diagnosis , Obesity/epidemiology , Obesity/metabolism , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/genetics , SARS-CoV-2 , Severity of Illness Index , Stroke/epidemiology , Stroke/genetics
12.
Chest ; 159(3): e159-e162, 2021 03.
Article in English | MEDLINE | ID: covidwho-1108124

ABSTRACT

CASE PRESENTATION: A 78-year-old woman was admitted to the ED with a 10-day history of diarrhea and recent onset of dry cough, fever, and asthenia. She had a medical history of obesity (BMI 32) and arterial hypertension treated with irbesartan. In the context of a large-scale lockdown in France during the COVID-19 pandemic, she only had physical contact with her husband, who did not report any symptoms. She required mechanical ventilation because of severe hypoxemia within 1 hour after admission to the ED.


Subject(s)
COVID-19 Testing/methods , COVID-19 , Lung/diagnostic imaging , Respiration, Artificial/methods , Respiratory Insufficiency , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Diagnosis, Differential , Diarrhea/diagnosis , Diarrhea/etiology , Female , Humans , Obesity/diagnosis , Obesity/epidemiology , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Treatment Outcome
14.
Clin Obes ; 11(2): e12442, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1069385

ABSTRACT

Excess weight is associated with severe outcomes of coronavirus disease 2019 (COVID-19). We aimed to estimate the total secondary care costs by body mass index (BMI, kg/m2 ) category when hospitalized due to COVID-19 in Europe during the first wave of the pandemic from January to June 2020. Building a health-care cost model, this study aimed to estimate the total costs of COVID-19. Information on risk of hospitalization, admission to intensive care unit (ICU) and risk of ventilation were based on published data. Average cost per patient and in total were calculated based on risks of admission to ICU, risk of invasive mechanical ventilation and length of hospital stay when hospitalized and published costs associated with hospitalization. The total direct costs of secondary care during the first wave of COVID-19 in Europe were estimated at EUR 13.9 billon, whereof 76% accounted for treating people with overweight and obesity. The average cost per hospital admission increased with BMI, from EUR 15831 for BMI <25 kg/m2 to EUR 30982 for BMI ≥40 kg/m2 . This study reveals that excess weight contributes disproportionally to the costs of COVID-19. This might reflect that overweight and obesity caused the COVID-19 pandemic to result in more severe outcomes for citizens and higher secondary care costs throughout Europe.


Subject(s)
COVID-19 , Cost of Illness , Health Care Costs/statistics & numerical data , Hospitalization , Obesity , Body Mass Index , COVID-19/economics , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Europe/epidemiology , Female , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Obesity/diagnosis , Obesity/economics , Obesity/epidemiology , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Risk Assessment , Risk Factors , SARS-CoV-2
16.
Clin Obes ; 11(2): e12440, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1063008

ABSTRACT

Studies have shown the negative impact of COVID-19 lockdown orders on mental health and substance use in the general population. The aim of this study was to examine the impact of the COVID-19 pandemic onsubstance use, mental health and weight-related behaviors in a sample of adults with obesity after lockdown orders were lifted (June-September 2020). A retrospective medical chart review identified patients with obesity from one university-based obesity medicine clinic, and two metabolic and bariatric surgery (MBS) practices. Patients who completed an online survey from June 1, 2020 to September 30, 2020 were included. The primary outcome measure was substance use (various drugs, alcohol, tobacco). Substance use and mental health survey questions were based on standardized, validated instruments. A total of 589 patients (83.3% female, mean age 53.6 years [SD 12.8], mean BMI 35.4 [SD 9.1], 54.5% Non-Hispanic white, 22.3% post-MBS) were included. Seventeen patients (2.9%) tested positive for SARS-CoV-2 and 13.5% reported symptoms. Nearly half (48.4%) of the sample reported recreational substance use and 9.8% reported increased use since the start of the pandemic. There was substantial drug use reported (24.3% opioids, 9.5% sedative/tranquilizers, 3.6% marijuana, and 1% stimulants). Patients who reported stockpiling food more (adjusted Odds Ratio [aOR] 1.50, 95% CI 1.03-2.18), healthy eating more challenging (aOR 1.47, 95% CI 1.01-2.16), difficulty falling asleep (aOR 1.64, 95% CI 1.14-2.34), and anxiety (aOR 1.47, 95% CI 1.01-2.14) were more likely to report substance use versus non-users. Results here show that the COVID-19 pandemic is having a deleterious impact on substance use, mental health and weight-related health behaviors in people with obesity regardless of infection status.


Subject(s)
Bariatric Surgery/statistics & numerical data , COVID-19 , Feeding Behavior , Mental Health , Obesity , Quarantine , Substance-Related Disorders , Body Mass Index , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Health Behavior , Humans , Male , Mental Health/statistics & numerical data , Mental Health/trends , Middle Aged , Obesity/diagnosis , Obesity/epidemiology , Obesity/psychology , Quarantine/methods , Quarantine/psychology , Retrospective Studies , SARS-CoV-2 , Substance-Related Disorders/classification , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , United States/epidemiology
17.
Mayo Clin Proc ; 96(4): 921-931, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062512

ABSTRACT

OBJECTIVE: We aimed to investigate whether the stratification of outpatients with coronavirus disease 2019 (COVID-19) pneumonia by body mass index (BMI) can help predict hospitalization and other severe outcomes. PATIENTS AND METHODS: We prospectively collected consecutive cases of community-managed COVID-19 pneumonia from March 1 to April 20, 2020, in the province of Bergamo and evaluated the association of overweight (25 kg/m2 ≤ BMI <30 kg/m2) and obesity (≥30 kg/m2) with time to hospitalization (primary end point), low-flow domiciliary oxygen need, noninvasive mechanical ventilation, intubation, and death due to COVID-19 (secondary end points) in this cohort. We analyzed the primary end point using multivariable Cox models. RESULTS: Of 338 patients included, 133 (39.4%) were overweight and 77 (22.8%) were obese. Age at diagnosis was younger in obese patients compared with those overweight or with normal weight (P<.001), whereas diabetes, dyslipidemia, and heart diseases were differently distributed among BMI categories. Azithromycin, hydroxychloroquine, and prednisolone use were similar between BMI categories (P>.05). Overall, 105 (31.1%) patients were hospitalized, and time to hospitalization was significantly shorter for obese vs over- or normal-weight patients (P<.001). In the final multivariable analysis, obese patients were more likely to require hospitalization than nonobese patients (hazard ratio, 5.83; 95% CI, 3.91 to 8.71). Results were similar in multiple sensitivity analyses. Low-flow domiciliary oxygen need, hospitalization with noninvasive mechanical ventilation, intubation, and death were significantly associated with obesity (P<.001). CONCLUSION: In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than for nonobese patients.


Subject(s)
COVID-19 , Community Health Services , Obesity , Pneumonia, Viral , Age Factors , Body Mass Index , COVID-19/epidemiology , COVID-19/therapy , Community Health Services/methods , Community Health Services/statistics & numerical data , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Obesity/diagnosis , Obesity/epidemiology , Outcome and Process Assessment, Health Care , Pneumonia, Viral/etiology , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Proportional Hazards Models , Risk Assessment/methods , Risk Factors , SARS-CoV-2
18.
BMJ Open ; 11(1): e044526, 2021 01 31.
Article in English | MEDLINE | ID: covidwho-1060157

ABSTRACT

OBJECTIVES: To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN: Retrospective cohort study. SETTING: Urban tertiary care center in New York City. PARTICIPANTS: 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS: Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS: Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS: In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.


Subject(s)
COVID-19 , Diabetes Mellitus , Glycated Hemoglobin A/analysis , Obesity , SARS-CoV-2/isolation & purification , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Body Mass Index , COVID-19/blood , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , Comorbidity , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Female , Humans , Male , Middle Aged , Mortality , New York City/epidemiology , Obesity/diagnosis , Obesity/epidemiology , Outcome and Process Assessment, Health Care , Random Allocation , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors
19.
Diabetes Metab Syndr ; 15(1): 343-350, 2021.
Article in English | MEDLINE | ID: covidwho-1039333

ABSTRACT

BACKGROUND & AIMS: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices. METHODS: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics. RESULTS: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r2 = 0.51, 0.43), NCDs (r2 = 0.32, 0.16) and healthcare (r2 = 0.52, 0.38). CONCLUSIONS: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.


Subject(s)
COVID-19/epidemiology , Cost of Illness , Noncommunicable Diseases/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Humans , India/epidemiology , Noncommunicable Diseases/therapy , Obesity/diagnosis , Obesity/epidemiology , Obesity/therapy , Risk Factors
20.
Front Endocrinol (Lausanne) ; 11: 595109, 2020.
Article in English | MEDLINE | ID: covidwho-1013337

ABSTRACT

Since December 2019, COVID-19 has aroused global attention. Studies show the link between obesity and severe outcome of influenza and COVID-19. Thus, we aimed to compare the impacts of obesity on the severity and mortality of influenza and COVID-19 by performing a meta-analysis. A systematic search was performed in MEDLINE, EMASE, ClinicalTrials.gov, and Web of Science from January 2009 to July 2020. The protocol was registered onto PROSPERO (CRD42020201461). After selection, 46 studies were included in this meta-analysis. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were analyzed. We found obesity was a risk factor for the severity and mortality of influenza (ORsevere outcome = 1.56, CI: 1.28-1.90; ORmortality = 1.99, CI: 1.15-3.46). For COVID-19, obesity was a significant risk factor only for severe outcome (OR = 2.07, CI: 1.53-2.81) but not for mortality (OR = 1.57, CI: 0.85-2.90). Compared with obesity, morbid obesity was linked with a higher risk for the severity and mortality of both influenza (OR = 1.40, CI: 1.10-1.79) and COVID-19 (OR = 3.76, CI: 2.67-5.28). Thus, obesity should be recommended as a risk factor for the prognosis assessment of COVID-19. Special monitoring and earlier treatment should be implemented in patients with obesity and COVID-19.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Influenza, Human/diagnosis , Influenza, Human/mortality , Obesity/mortality , Body Mass Index , COVID-19/epidemiology , COVID-19/pathology , Comorbidity , Hospitalization/statistics & numerical data , Humans , Influenza, Human/epidemiology , Influenza, Human/pathology , Obesity/diagnosis , Obesity/epidemiology , Prognosis , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index
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