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1.
Eur J Endocrinol ; 184(5): 637-645, 2021 May.
Artículo en Inglés | MEDLINE | ID: covidwho-1175452

RESUMEN

Objective: Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection. Design: Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN). Methods: The main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS. Results: We identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27-1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14-1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05-1.56), P = 0.015). Conclusion: Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic. Significance statement: Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.


Asunto(s)
/epidemiología , Síndrome del Ovario Poliquístico/epidemiología , Adulto , Factores de Edad , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Síndrome del Ovario Poliquístico/metabolismo , Estado Prediabético/epidemiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Testosterona/metabolismo , Reino Unido/epidemiología , Deficiencia de Vitamina D/epidemiología
3.
Front Cell Infect Microbiol ; 11: 590874, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1158345

RESUMEN

Gut microbiome alterations may play a paramount role in determining the clinical outcome of clinical COVID-19 with underlying comorbid conditions like T2D, cardiovascular disorders, obesity, etc. Research is warranted to manipulate the profile of gut microbiota in COVID-19 by employing combinatorial approaches such as the use of prebiotics, probiotics and symbiotics. Prediction of gut microbiome alterations in SARS-CoV-2 infection may likely permit the development of effective therapeutic strategies. Novel and targeted interventions by manipulating gut microbiota indeed represent a promising therapeutic approach against COVID-19 immunopathogenesis and associated co-morbidities. The impact of SARS-CoV-2 on host innate immune responses associated with gut microbiome profiling is likely to contribute to the development of key strategies for application and has seldom been attempted, especially in the context of symptomatic as well as asymptomatic COVID-19 disease.


Asunto(s)
/patología , Disbiosis/microbiología , Microbioma Gastrointestinal/inmunología , Tracto Gastrointestinal/microbiología , Inmunidad Innata/inmunología , /biosíntesis , /metabolismo , Bacterias/metabolismo , Enfermedades Cardiovasculares/patología , Diabetes Mellitus Tipo 2/patología , Tracto Gastrointestinal/inmunología , Tracto Gastrointestinal/metabolismo , Expresión Génica/genética , Humanos , Complejo de Antígeno L1 de Leucocito/biosíntesis , Obesidad/patología , Probióticos/farmacología , Índice de Severidad de la Enfermedad
4.
Front Endocrinol (Lausanne) ; 12: 620566, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1156117

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global public health challenge. Most patients do not experience severe complications, but approximately 25% of patients progress to acute respiratory distress syndrome (ARDS), and the mortality rate is approximately 5-7%. Clinical findings have determined several risk factors for severe complications and mortality in COVID-19 patients, such as advanced age, smoking, obesity, and chronic diseases. Obesity is a common and serious health problem worldwide that initiates a cascade of disorders, including hypertension, cardiovascular disease (CVD), diabetes mellitus, and chronic kidney disease (CKD). The presence of these disorders is linked to a more severe course of COVID-19. Given the "epidemic" of obesity worldwide and the importance of obesity in the progression of COVID-19, we investigated the mechanisms through which obesity increases the susceptibility to and severity of COVID-19 to support the selection of more appropriate therapies for individuals with obesity.


Asunto(s)
/epidemiología , Obesidad/epidemiología , /complicaciones , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/patología , Comorbilidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/patología , Progresión de la Enfermedad , Humanos , Obesidad/complicaciones , Obesidad/patología , Obesidad/terapia , Pandemias , Factores de Riesgo , Índice de Severidad de la Enfermedad
5.
Nutrients ; 13(4)2021 Mar 27.
Artículo en Inglés | MEDLINE | ID: covidwho-1154463

RESUMEN

SARS-CoV-2, the cause of the COVID-19 disease, is posing unprecedent challenges. In the literature, increasing evidence highlights how malnutrition negatively affects the immune system functionality, impairing protection from infections. The current review aims to summarize the complex relationship between SARS-CoV-2 infection and nutritional status and the effects of malnutrition in terms of disease severity, patients' recovery time, incidence of complications and mortality rate. Current studies evaluating the possibility of modulating nutrition and supplementation in combination with pharmacological treatments in the clinical setting to prevent, support, and overcome infection are also described. The discussion of the most recent pertinent literature aims to lay the foundations for making reasonable assumptions and evaluations for a nutritional "best practice" against COVID-19 pandemic and for the definition of sound cost-effective strategies to assist healthcare systems in managing patients and individuals in their recovery from COVID-19.


Asunto(s)
/prevención & control , Estado Nutricional , /epidemiología , Humanos , Desnutrición/complicaciones , Obesidad/complicaciones
6.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artículo en Inglés | MEDLINE | ID: covidwho-1153657

RESUMEN

A 54-year-old woman presented with pruritic rash and hives of 3 days' duration followed by shortness of breath for 1 day. SARS-CoV-2 PCR test for COVID-19 was positive. Cutaneous manifestations of COVID-19 include acral lesions, urticarial rash, erythematous maculopapular rash, vascular rashes and vesicular rash. The cutaneous manifestations are mostly described as self-limiting. Urticarial rashes are not reported as the initial presentation symptom of COVID-19 infection but mostly noted to occur at the same time or after the onset of non-cutaneous symptoms. Management of cutaneous manifestations of COVID-19 affecting quality of life has not been well studied. Antihistamine therapy is the primary recommended therapy. Role of antiviral therapy for severe cases of rash needs to be further assessed.


Asunto(s)
/complicaciones , Exantema/virología , Urticaria/virología , Antivirales/uso terapéutico , Fibrilación Atrial/complicaciones , Exantema/patología , Exantema/terapia , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Hipertensión Pulmonar/complicaciones , Persona de Mediana Edad , Obesidad/complicaciones , Insuficiencia Renal Crónica/complicaciones , Piel/patología , Apnea Obstructiva del Sueño/complicaciones , Resultado del Tratamiento , Urticaria/patología , Urticaria/terapia
7.
Cochrane Database Syst Rev ; 3: CD013879, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1151840

RESUMEN

BACKGROUND: A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES: To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS: We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA: We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS: We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%)  are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS: This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Arritmias Cardíacas/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Incidencia , Isquemia Miocárdica/epidemiología , Obesidad/epidemiología , Prevalencia , Trombosis/epidemiología
8.
Gut Microbes ; 13(1): 1-9, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1149877

RESUMEN

Gut microbiome manipulation to alter the gut-lung axis may potentially protect humans against respiratory infections, and clinical trials of probiotics show promise in this regard in healthy adults and children. However, comparable studies are lacking in overweight/obese people, who have increased risks in particular of viral upper respiratory tract infections (URTI). This Addendum further analyses our recent placebo-controlled trial of probiotics in overweight/obese people (focused initially on weight loss) to investigate the impact of probiotics upon the occurrence of URTI symptoms. As well as undergoing loss of weight and improvement in certain metabolic parameters, study participants taking probiotics experienced a 27% reduction in URTI symptoms versus control, with those ≥45 years or BMI ≥30 kg/m2 experiencing greater reductions. This symptom reduction is apparent within 2 weeks of probiotic use. Gut microbiome diversity remained stable throughout the study in probiotic-treated participants. Our data provide support for further trials to assess the potential role of probiotics in preventing viral URTI (and possibly also COVID-19), particularly in overweight/obese people.


Asunto(s)
Obesidad/complicaciones , Sobrepeso/complicaciones , Probióticos/uso terapéutico , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/terapia , Adulto , Anciano , Método Doble Ciego , Microbioma Gastrointestinal , Humanos , Persona de Mediana Edad , Pandemias , Autoinforme
9.
Emerg Infect Dis ; 27(4): 1164-1168, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1146202
10.
Int J Med Sci ; 18(8): 1768-1777, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1145693

RESUMEN

Aim: In other respiratory infectious diseases, obesity may be associated with a poor outcome. For coronavirus disease 2019 (COVID-19), the association between obesity and severity or prognosis requires further analysis. Methods: This was a retrospective, single-center study. Hospitalized patients were recruited in Renmin Hospital of Wuhan University from January 2, 2020 to February 20, 2020. The data of body mass index (BMI) was obtained from follow-up of surviving patients. According to BMI, normal weight was defined as 18.5-23.9 kg/m2, overweight as 24.0-27.9 kg/m2 and obesity as > 28.0 kg/m2. Results: A total of 463 patients were enrolled, of which 242 (52.3%) patients were in the normal weight group; 179 (38.7%) were in the overweight group; and 42 (9.1%) were in the obesity group. Compared to the normal group, obese patients were more likely to have a higher heart rate; lower finger oxygen saturation; higher levels of white blood cells, neutrophil counts, basophil counts, intravenous glucose, triacylglycerol, uric acid, alanine aminotransferase, creatine kinase-MB, CD19+ cell counts and percentage; and lower levels of monocyte percentage, high density lipoprotein and CD3+ cell percentage. In addition, the proportions of hypertension (21.5% vs. 42.6%) and severe+critical illness (47.8 vs. 81.0 %) were significantly higher in the obesity group than those in normal group. However, no significant differences were observed between the normal and obesity groups in critical illness, organ damage and defined endpoint (mechanical ventilation or intensive care unit). Multiple logistic regression showed that obesity increased the risk of developing severe+critical illness (Odd ratio 3.586, 95% CI 1.550-8.298, P=0.003) in patients with COVID-19, and did not affect the risk of critical illness, organ damage and endpoints. Overweight did not affect the risk of severity, organ damage or endpoint in patients with COVID-19. Conclusion: Obesity may be a risk factor for developing severity in patients with COVID-19.


Asunto(s)
/complicaciones , Obesidad/complicaciones , Anciano , Recuento de Linfocito CD4 , /diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/diagnóstico por imagen , Radiografía Torácica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
11.
Nutrients ; 13(3)2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1143547

RESUMEN

Severe obesity is associated with an increased risk of admission to intensive care units and need for invasive mechanical ventilation in patients with COVID-19. The association of obesity and COVID-19 prognosis may be related to many different factors, such as chronic systemic inflammation, the predisposition to severe respiratory conditions and viral infections. The ketogenic diet is an approach that can be extremely effective in reducing body weight and visceral fat in the short term, preserving the lean mass and reducing systemic inflammation. Therefore, it is a precious preventive measure for severely obese people and may be considered as an adjuvant therapy for patients with respiratory compromise.


Asunto(s)
/dietoterapia , Dieta Cetogénica/métodos , /etiología , Humanos , Inflamación/prevención & control , Obesidad/complicaciones , Sistema Respiratorio/fisiopatología , Sistema Respiratorio/virología
12.
Sci Rep ; 11(1): 6428, 2021 03 19.
Artículo en Inglés | MEDLINE | ID: covidwho-1142462

RESUMEN

Hyperactivation of the immune system through obesity and diabetes may enhance infection severity complicated by Acute Respiratory Distress Syndrome (ARDS). The objective was to determine the circulatory biomarkers for macrophage activation at baseline and after serum glucose normalization in obese type 2 diabetes (OT2D) subjects. A case-controlled interventional pilot study in OT2D (n = 23) and control subjects (n = 23). OT2D subjects underwent hyperinsulinemic clamp to normalize serum glucose. Plasma macrophage-related proteins were determined using Slow Off-rate Modified Aptamer-scan plasma protein measurement at baseline (control and OT2D subjects) and after 1-h of insulin clamp (OT2D subjects only). Basal M1 macrophage activation was characterized by elevated levels of M1 macrophage-specific surface proteins, CD80 and CD38, and cytokines or chemokines (CXCL1, CXCL5, RANTES) released by activated M1 macrophages. Two potent M1 macrophage activation markers, CXCL9 and CXCL10, were decreased in OT2D. Activated M2 macrophages were characterized by elevated levels of plasma CD163, TFGß-1, MMP7 and MMP9 in OT2D. Conventional mediators of both M1 and M2 macrophage activation markers (IFN-γ, IL-4, IL-13) were not altered. No changes were observed in plasma levels of M1/M2 macrophage activation markers in OT2D in response to acute normalization of glycemia. In the basal state, macrophage activation markers are elevated, and these reflect the expression of circulatory cytokines, chemokines, growth factors and matrix metalloproteinases in obese individuals with type 2 diabetes, that were not changed by glucose normalisation. These differences could potentially predispose diabetic individuals to increased infection severity complicated by ARDS. Clinical trial reg. no: NCT03102801; registration date April 6, 2017.


Asunto(s)
/etiología , Diabetes Mellitus Tipo 2/complicaciones , Activación de Macrófagos , Obesidad/complicaciones , Adulto , Anciano , Biomarcadores/sangre , /inmunología , Citocinas/sangre , Citocinas/inmunología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/inmunología , Femenino , Humanos , Inflamación/sangre , Inflamación/complicaciones , Inflamación/inmunología , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/inmunología , Proyectos Piloto , Estudios Prospectivos , Factores de Riesgo
13.
CNS Drugs ; 35(3): 317-330, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1141535

RESUMEN

BACKGROUND: Disease-modifying therapies (DMTs) for multiple sclerosis (MS) target immunity and have the potential to increase the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and alter its clinical course. We assessed these risks in patients with MS (PwMS). OBJECTIVE: The objective of this study was to describe the overall risk of coronavirus disease 2019 (COVID-19) infection, severe disease course, and potential population-level predictors of COVID-19 infection in PwMS, and to provide a context using a cohort of patients with systemic lupus erythematosus (SLE). In addition, the association of different MS DMTs with the incidence and clinical course of COVID-19 was evaluated. Safety data from the Biogen Global Safety Database are also presented on reported cases of COVID-19 in patients treated with Biogen MS therapies. METHODS: The IBM® Explorys electronic health record database of > 72,000,000 patients from US healthcare networks identified patients with MS or SLE, with and without polymerase chain reaction-confirmed COVID-19. COVID-19 cumulative incidence, hospitalization, and deaths among DMT classes were compared using logistic regression (adjusted for age, sex, body mass index, comorbidities, and race/ethnicity). As a secondary data source to assess safety data, COVID-19 reports for Biogen MS therapies were extracted and described from Biogen's Global Safety Database. RESULTS: 30,478 PwMS with an open DMT prescription were identified within Explorys; 344 were COVID-19 positive. The most significant risk factors for acquiring COVID-19 were comorbidity score ≥ 1, body mass index ≥ 30, and Black/African ancestry. Similar risk factors were also identified for patients with SLE. Patients with MS were less likely to develop COVID-19 when treated with interferons (0.61%) and glatiramer acetate (0.51%), vs all other MS DMTs (both p < 0.001); anti-CD20 therapy was associated with the highest risk (3.45%; p < 0.0001). In the Biogen Global Safety Database, we identified 1217 patients who were COVID-19 positive treated with intramuscular interferon beta-1a, peginterferon beta-1a, natalizumab, dimethyl fumarate, diroximel fumarate, or fampridine. CONCLUSIONS: Comorbidities, obesity, and Black/African ancestry, but not age, were associated with a higher risk of SARS-CoV-2 infection in PwMS. Interferons and glatiramer acetate were associated with a reduced COVID-19 risk, whereas anti-CD20 therapies were associated with an increased risk, within the treated MS cohort. COVID-19 safety reports for patients receiving Biogen MS therapies were consistent with the Explorys database and MS literature, illustrating the replicability and power of this approach.


Asunto(s)
/epidemiología , Hospitalización/estadística & datos numéricos , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Alemtuzumab/uso terapéutico , Azatioprina/uso terapéutico , Cladribina/uso terapéutico , Comorbilidad , Crotonatos/uso terapéutico , Ciclofosfamida/uso terapéutico , Ciclosporina/uso terapéutico , Bases de Datos Factuales , Dimetilfumarato/uso terapéutico , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Clorhidrato de Fingolimod/uso terapéutico , Humanos , Factores Inmunológicos/uso terapéutico , Incidencia , Interferón beta/uso terapéutico , Modelos Logísticos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/epidemiología , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Mitoxantrona/uso terapéutico , Esclerosis Múltiple/epidemiología , Ácido Micofenólico/uso terapéutico , Natalizumab/uso terapéutico , Obesidad/epidemiología , Factores de Riesgo , Rituximab/uso terapéutico , Toluidinas/uso terapéutico , Estados Unidos/epidemiología , Adulto Joven
14.
Biomed Res Int ; 2021: 6696357, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1140377

RESUMEN

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.


Asunto(s)
Antropometría/métodos , /epidemiología , Obesidad/diagnóstico , Adulto , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Reconocimiento Facial/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/metabolismo , Pandemias , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Circunferencia de la Cintura , Relación Cintura-Cadera
15.
N Engl J Med ; 384(11): 989, 2021 03 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1139778

RESUMEN

BACKGROUND: Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed. METHODS: In this double-blind trial, we enrolled 1961 adults with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or greater (≥27 in persons with ≥1 weight-related coexisting condition), who did not have diabetes, and randomly assigned them, in a 2:1 ratio, to 68 weeks of treatment with once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo, plus lifestyle intervention. The coprimary end points were the percentage change in body weight and weight reduction of at least 5%. The primary estimand (a precise description of the treatment effect reflecting the objective of the clinical trial) assessed effects regardless of treatment discontinuation or rescue interventions. RESULTS: The mean change in body weight from baseline to week 68 was -14.9% in the semaglutide group as compared with -2.4% with placebo, for an estimated treatment difference of -12.4 percentage points (95% confidence interval [CI], -13.4 to -11.5; P<0.001). More participants in the semaglutide group than in the placebo group achieved weight reductions of 5% or more (1047 participants [86.4%] vs. 182 [31.5%]), 10% or more (838 [69.1%] vs. 69 [12.0%]), and 15% or more (612 [50.5%] vs. 28 [4.9%]) at week 68 (P<0.001 for all three comparisons of odds). The change in body weight from baseline to week 68 was -15.3 kg in the semaglutide group as compared with -2.6 kg in the placebo group (estimated treatment difference, -12.7 kg; 95% CI, -13.7 to -11.7). Participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo. Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%]). CONCLUSIONS: In participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight. (Funded by Novo Nordisk; STEP 1 ClinicalTrials.gov number, NCT03548935).


Asunto(s)
Fármacos Antiobesidad/administración & dosificación , Péptido 1 Similar al Glucagón/agonistas , Péptidos Similares al Glucagón/administración & dosificación , Obesidad/tratamiento farmacológico , Adulto , Fármacos Antiobesidad/efectos adversos , Composición Corporal/efectos de los fármacos , Índice de Masa Corporal , Colelitiasis/inducido químicamente , Diarrea/inducido químicamente , Método Doble Ciego , Femenino , Péptidos Similares al Glucagón/efectos adversos , Estilo de Vida Saludable , Humanos , Inyecciones Subcutáneas , Lípidos/sangre , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Obesidad/complicaciones , Estado Prediabético/complicaciones , Pérdida de Peso/efectos de los fármacos
16.
Int J Environ Res Public Health ; 18(6)2021 03 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1136482

RESUMEN

Adolescence is a complex developmental phase, made more complex by obesity and the social isolation imposed by the COVID-19 pandemic. The literature related to the impact of social isolation on obesity self-management in adolescents is scant and inconsistent. This paper describes the phenomenon from the perspectives of a sample of adolescents with obesity enrolled in an inpatients' multidisciplinary rehabilitation program for weight-loss and their caregivers, and its impact on different life domains. Individual semi-structured ad hoc interviews were conducted with 10 adolescent-caregiver dyads, and narratives were qualitatively investigated using an interpretative phenomenology approach to data. Twenty participants took part in the study. The major themes that emerged from this study fall into five basic categories: (1) COVID-19 as an opportunity to reconsider what makes a good life; (2) Persistence in life; (3) Empowering relationship; (4) Daily routine in quarantine; (5) Lives on hold. Understandings drawn from this study may assist health care professionals in providing holistic support, and guidance to adolescents with weight-related issues and their caregivers who experience social isolation during the COVID-19 pandemic.


Asunto(s)
Cuidadores , Adolescente , Humanos , Salud Mental , Obesidad/epidemiología , Pandemias , Investigación Cualitativa , Aislamiento Social
17.
Front Endocrinol (Lausanne) ; 12: 598249, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1133904

RESUMEN

Background and Objective: Obesity has been reported as a risk factor for adverse outcomes in COVID-19. However, available studies presenting data on obesity prevalence in patients with COVID-19 have conflicting results. The objective of this systematic review and meta-analysis is to evaluate the prevalence of obesity in these patients and to stratify the estimates by illness severity. Methods: We performed a literature search with the use of Medline/PubMed and Google Scholar database from December 1, 2019 to June 27, 2020 and systematically reviewed studies reporting the number of obese patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed SARS-CoV-2 infection. Results: Nineteen studies were identified. The pooled obesity prevalence rates were 0.32 (95% CI: 0.24-0.41) in hospitalized patients, 0.41 (95% CI: 0.36-0.45) in patients admitted to intensive care unit, 0.43 (95% CI: 0.36-0.51) in patients needing invasive mechanic ventilation (IMV), and 0.33 (95% CI: 0.26-0.41) in those who died. Obesity was associated with a higher risk for hospitalization [Odds ratio (OR): 1.3, 95% CI: 1.00-1.69; I2 52%, p = 0.05], ICU admission (OR: 1.51, 95% CI: 1.16-1.97; I2 72%, p = 0.002), and IMV requirement (OR: 1.77, 95% CI: 1.34-2.35; I2 0%, p < 0.001). The increase in risk of death did not reach statistical significance (OR: 1.28, 95% CI: 0.76-2.16, p = 0.35) which might be due to obesity survival paradox and/or unidentified factors. Conclusions: Our data indicate that obese subjects may be at higher risk for serious illness if infected and obesity may play a role in the progression of COVID-19.


Asunto(s)
/epidemiología , Obesidad/epidemiología , /complicaciones , Progresión de la Enfermedad , Humanos , Obesidad/complicaciones , Prevalencia , Resultado del Tratamiento
18.
Biomed Res Int ; 2021: 6695707, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1133374

RESUMEN

Background: The UAE reported its first cluster of COVID 2019 in a group of returned travellers from Wuhan in January 2020. Various comorbidities are associated with worse disease prognosis. Understanding the impact of ethnicity on the disease outcome is an important public health issue but data from our region is lacking. Aim: We aim to identify comorbidities among patients hospitalized for COVID-19 that are associated with inhospital death. Also, to assess if ethnicity is correlated with increased risk of death. Patients and Method. The study is a single-centre, observational study in Shaikh Shakhbout Medical City, Abu Dhabi. Patients admitted with COVID-19, between 1st of March and the end of May, were enrolled. Records were studied for demography, comorbidity, and ethnicity. Ethnicity was divided into Arabs (Gulf, North Africa, and the Levant), South Asia (India, Pakistan, Bangladesh, Nepal, and Afghanistan), Africans, the Philippines, and others. The study was approved by the Department of Health of Abu Dhabi. Results: 1075 patients (972 males) were enrolled. There were 24 nationalities under 5 ethnicity groups. Mean (average) age was 51 years (20-81). 101 (9.4%) died with deceased patients being significantly older. Death risk was not significantly influenced by sex. Duration of hospitalization among survivors was 6.2 days (0.2-40.4) with older patients and men staying longer (P < 0.01). Comorbidities of diabetes, hypertension, cardiovascular disease, chronic renal disease, liver disease, and malignancy were associated with higher risk of mortality univariate, but only liver disease reached statistical significance after adjustment for age. The highest percentage of death was seen in Arab Levant (21.2) followed by the Asian Afghan (18.8); however, differences among ethnicities did not reach statistical significance (P = 0.086). Conclusion: COVID-19 outcome was worse in older people and those with comorbidities. Men and older patients required longer hospitalization. Ethnicity is not seen to impact the risk of mortality.


Asunto(s)
/etnología , /mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Árabes/estadística & datos numéricos , Asia Sudoriental/etnología , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Estudios Retrospectivos , Emiratos Árabes Unidos/epidemiología , Adulto Joven
19.
Nutr Hosp ; 37(5): 1039-1042, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: covidwho-1128242

RESUMEN

Introduction: Background: coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection. Methods: patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes. Results: we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages. Conclusions: in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.


Asunto(s)
Factores de Edad , Betacoronavirus , Infecciones por Coronavirus/etiología , Neumonía Viral/etiología , Deficiencia de Vitamina D/complicaciones , Vitamina D/análogos & derivados , Adulto , Anciano , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/epidemiología , Femenino , Cardiopatías/complicaciones , Humanos , Enfermedades Renales/complicaciones , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pandemias , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Estudios Retrospectivos , Factores Sexuales , España/epidemiología , Vitamina D/sangre
20.
MMWR Morb Mortal Wkly Rep ; 70(10): 355-361, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1128181

RESUMEN

Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers.† The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR),§ CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m2 to 60 kg/m2. As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including continued vaccine prioritization (6) and masking, and policies to ensure community access to nutrition and physical activities that promote and support a healthy BMI.


Asunto(s)
Índice de Masa Corporal , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
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