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3.
Front Endocrinol (Lausanne) ; 11: 530, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-719724

RESUMEN

COVID-19, caused by SARS-CoV-2, is characterized by pneumonia, lymphopenia, exhausted lymphocytes and a cytokine storm. Several reports from around the world have identified obesity and severe obesity as one of the strongest risk factors for COVID-19 hospitalization and mechanical ventilation. Moreover, countries with greater obesity prevalence have a higher morbidity and mortality risk of developing serious outcomes from COVID-19. The understanding of how this increased susceptibility of the people with obesity to develop severe forms of the SARS-CoV-2 infection occurs is crucial for implementing appropriate public health and therapeutic strategies to avoid COVID-19 severe symptoms and complications in people living with obesity. We hypothesize here that increased ACE2 expression in adipose tissue displayed by people with obesity may increase SARS-CoV-2 infection and accessibility to this tissue. Individuals with obesity have increased white adipose tissue, which may act as a reservoir for a more extensive viral spread with increased shedding, immune activation and pro-inflammatory cytokine amplification. Here we discuss how obesity is related to a pro-inflammatory and metabolic dysregulation, increased SARS-CoV-2 host cell entry in adipose tissue and induction of hypercoagulopathy, leading people with obesity to develop severe forms of COVID-19 and also death. Taken together, it may be crucial to better explore the role of visceral adipose tissue in the inflammatory response to SARS-CoV-2 infection and investigate the potential therapeutic effect of using specific target anti-inflammatories (canakinumab or anakinra for IL-1ß inhibition; anti-IL-6 antibodies for IL-6 inhibition), anticoagulant or anti-diabetic drugs in COVID-19 treatment of people with obesity. Defining the immunopathological changes in COVID-19 patients with obesity can provide prominent targets for drug discovery and clinical management improvement.


Asunto(s)
Tejido Adiposo/fisiopatología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Inflamación/fisiopatología , Obesidad/complicaciones , Neumonía Viral/mortalidad , Trombofilia/fisiopatología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/virología , Pronóstico , Tasa de Supervivencia
4.
Proc Natl Acad Sci U S A ; 117(35): 21011-21013, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-713458

RESUMEN

The role of obesity and overweight in occurrence of COVID-19 is unknown. We conducted a large-scale general population study using data from a community-dwelling sample in England (n = 334,329; 56.4 ±8.1 y; 54.5% women) with prospective linkage to national registry on hospitalization for COVID-19. Body mass index (BMI, from measured height and weight) was used as an indicator of overall obesity, and waist-hip ratio for central obesity. Main outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Around 0.2% (n = 640) of the sample were hospitalized for COVID-19. There was an upward linear trend in the likelihood of COVID-19 hospitalization with increasing BMI, that was evident in the overweight (odds ratio, 1.39; 95% CI 1.13 to 1.71; crude incidence 19.1 per 10,000) and obese stage I (1.70;1.34 to 2.16; 23.3 per 10,000) and stage II (3.38; 2.60 to 4.40; 42.7 per 10,000) compared to normal weight (12.5 per 10,000). This gradient was little affected after adjustment for a wide range of covariates; however, controlling for biomarkers, particularly high-density lipoprotein cholesterol and glycated hemoglobin, led to a greater degree of attenuation. A similar pattern of association emerged for waist-hip ratio. In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Hospitalización , Obesidad/complicaciones , Sobrepeso/complicaciones , Neumonía Viral/complicaciones , Adulto , Anciano , Betacoronavirus , Índice de Masa Corporal , Estudios de Cohortes , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Factores de Riesgo , Reino Unido
5.
Aten Primaria ; 52(7): 496-500, 2020.
Artículo en Español | MEDLINE | ID: covidwho-706679

RESUMEN

Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/etiología , Obesidad/complicaciones , Neumonía Viral/etiología , Infecciones por Coronavirus/epidemiología , Humanos , Obesidad/epidemiología , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología
7.
J Transl Med ; 18(1): 299, 2020 08 03.
Artículo en Inglés | MEDLINE | ID: covidwho-691901

RESUMEN

BACKGROUND: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU). METHODS: Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day. RESULTS: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients. CONCLUSION: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.


Asunto(s)
Adiposidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Estado Nutricional , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Tejido Adiposo/patología , Tejido Adiposo/fisiopatología , Adulto , Betacoronavirus , Índice de Masa Corporal , Femenino , Humanos , Inflamación , Unidades de Cuidados Intensivos , Masculino , Evaluación Nutricional , Obesidad/complicaciones , Pandemias , Pronóstico , Estudios Prospectivos
8.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Artículo en Español | LILACS (Américas) | ID: covidwho-679083

RESUMEN

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria del Adulto/microbiología , Infecciones por Coronavirus/terapia , Fenotipo , Síndrome de Dificultad Respiratoria del Adulto/genética , Mecánica Respiratoria , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Tos/etiología , Disnea/etiología , Fiebre/etiología , Hipertensión/complicaciones , Unidades de Cuidados Intensivos , Hipoxia/fisiopatología , Obesidad/complicaciones
13.
BMC Med ; 18(1): 220, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: covidwho-645540

RESUMEN

BACKGROUND: In women of reproductive age, polycystic ovary syndrome (PCOS) constitutes the most frequent endocrine disorder. Women with PCOS are considered to typically belong to an age and sex group which is at lower risk for severe COVID-19. MAIN BODY: Emerging data link the risk of severe COVID-19 with certain factors such as hyper-inflammation, ethnicity predisposition, low vitamin D levels, and hyperandrogenism, all of which have known direct associations with PCOS. Moreover, in this common female patient population, there is markedly high prevalence of multiple cardio-metabolic conditions, such as type 2 diabetes, obesity, and hypertension, which may significantly increase the risk for adverse COVID-19-related outcomes. This strong overlap of risk factors for both worse PCOS cardio-metabolic manifestations and severe COVID-19 should be highlighted for the clinical practice, particularly since women with PCOS often receive fragmented care from multiple healthcare services. Comprehensively informing women with PCOS regarding the potential risks from COVID-19 and how this may affect their management is also essential. CONCLUSION: Despite the immense challenges posed by the COVID-19 outbreak to the healthcare systems in affected countries, attention should be directed to maintain a high standard of care for complex patients such as many women with PCOS and provide relevant practical recommendations for optimal management in the setting of this fast moving pandemic.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hiperandrogenismo/complicaciones , Hiperandrogenismo/epidemiología , Hipertensión/complicaciones , Hipertensión/epidemiología , Enfermedades Metabólicas/complicaciones , Enfermedades Metabólicas/epidemiología , Obesidad/complicaciones , Obesidad/epidemiología , Pandemias , Neumonía Viral/epidemiología , Síndrome del Ovario Poliquístico/epidemiología , Prevalencia , Factores de Riesgo
14.
Obes Res Clin Pract ; 14(4): 295-300, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-643477

RESUMEN

BACKGROUND: Obesity is a global disease with at least 2.8 million people dying each year as a result of being overweight or obese according to the world health organization figures. This paper aims to explore the links between obesity and mortality in COVID-19. METHODS: Electronic search was made for the papers studying obesity as a risk factor for mortality following COVID-19 infection. Three authors independently selected the papers and agreed for final inclusion. The outcomes were the age, gender, body mass index, severe comorbidities, respiratory support and the critical illness related mortality in COVID-19. 572 publications were identified and 42 studies were selected including one unpublished study data. Only 14 studies were selected for quantitative analysis. RESULTS: All the primary points but the gender are significantly associated with COVID-19 mortality. The age >70, [odd ratio (OR): 0.17, CI; 95%, P-value: <0.00001], gender [OR: 0.89; CI: 95%, P-value: 0.32], BMI > 25 kg/m2 [OR: 3.68, CI: 95%, P-value: <0.003], severe comorbidities [OR: 1.84, CI:95%, P-value: <0.00001], advanced respiratory support [OR: 6.98, CI: 95%, P-value: <0.00001], and critical illness [OR: 2.03, CI: 95%, P-value: <0.00001]. CONCLUSIONS: Patients with obesity are at high risk of mortality from COVID-19 infection.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Obesidad/complicaciones , Neumonía Viral/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Infecciones por Coronavirus/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/inmunología , Pandemias , Peptidil-Dipeptidasa A/fisiología , Neumonía Viral/etiología
17.
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e31-e36, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: covidwho-639793

RESUMEN

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


Asunto(s)
Infecciones por Coronavirus/complicaciones , Obesidad/complicaciones , Neumonía Viral/complicaciones , Betacoronavirus , Humanos , Obesidad/inmunología , Obesidad/virología , Pandemias , Factores de Riesgo , Índice de Severidad de la Enfermedad
18.
Leuk Res ; 96: 106407, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-639364
20.
Int J Mol Sci ; 21(13)2020 Jun 30.
Artículo en Inglés | MEDLINE | ID: covidwho-635082

RESUMEN

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 hours and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.


Asunto(s)
Caquexia , Infecciones por Coronavirus/patología , Obesidad/patología , Neumonía Viral/patología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Composición Corporal , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/metabolismo , Masculino , Persona de Mediana Edad , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/metabolismo , Estado Nutricional , Obesidad/complicaciones , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Estudios Prospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X
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