Obesity in patients with COVID-19: a systematic review and meta-analysis
Open accessAbstract
Background Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation.Objective This study explores the effects of obesity with the risk of severe disease among patients with COVID-19.Methods Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity.Results A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001).Conclusions Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.
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Obesity is associated with severe Covid-19.
“Obesity is associated with severe Covid-19,20”
From Waning Immune Humoral Response to BNT162b2 Covid-19 Vaccine over 6 Months (2021) · cites this paper as [20]
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Kim, L., Garg, S., O’Halloran, A. C., et al. (2020) · medRxiv · doi:10.1101/2020.05.18.20103390 · Cited by 33 · see citing works
Hussain, A., Vasas, P., & El-Hasani, S. (2020) · Metabolism: Clinical and Experimental · doi:10.1016/j.metabol.2020.154256 · Cited by 28 · see citing works
COVID-19: Impact of Obesity and Diabetes in Disease SeverityPreprint
Al-Sabah, S. K., Al‐Haddad, M., Al‐Youha, S., et al. (2020) · medRxiv · doi:10.1101/2020.05.24.20111724 · Cited by 23 · see citing works
Early experience with COVID-19 patients at academic hospital in Southwestern United States
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Murillo‐Zamora, E., & Hernández-Suárez, C. (2020) · medRxiv · doi:10.1101/2020.05.25.20110684 · Cited by 9 · see citing works
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Waning Immune Humoral Response to BNT162b2 Covid-19 Vaccine over 6 Months
Levin, E. G., Lustig, Y., Cohen, C., Fluss, R., Indenbaum, V., Amit, S., Doolman, R., Asraf, K., Mendelson, E., Ziv, A., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2114583 · Cited by 1,703 · see citing works
Boutari, C., & Mantzoros, C. S. (2022) · Metabolism · doi:10.1016/j.metabol.2022.155217 · Cited by 1,068 · see citing works
Barber, R. M., Sorensen, R. J. D., Pigott, D. M., Bisignano, C., Carter, A., Amlag, J. O., Collins, J. K., Abbafati, C., Adolph, C., Allorant, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00484-6 · Cited by 298 · see citing works
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Effect of Antidepressants on Glucagon-Like Peptide-1 Receptor Agonist-Related Weight Loss
Durell, N., Franks, R., Coon, S., Cowart, K., & Carris, N. W. (2022) · Journal of Pharmacy Technology · doi:10.1177/87551225221110850 · Cited by 15 · see citing works
- Authors
- Huang, Y., Lu, Y., Huang, Y.-M., Wang, M., Ling, W., Sui, Y., & Zhao, H.-L.
- Affiliations
- Guilin Medical University (CN)
- Central South University (CN)
- The First Affiliated Hospital, Sun Yat-sen University (CN)
- Corresponding author
- Zhao, Hai-Lu
- Venue
- Metabolism
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 113
- Pages
- 154378
- ISSN
- 0026-0495 (ISSN-L)
- PMC
- PMC7521361
- OpenAlex
- W3089150590
- Cited by
- 454
- References
- 91
- Citations by year
- 2026: 9 · 2025: 23 · 2024: 56 · 2023: 73 · 2022: 135 · 2021: 153 · 2020: 5
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81471054, 81660150)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- obesity, COVID-19 pandemic, body mass index, visceral adipose tissue, severe COVID-19, hospitalization, intensive care unit admission, invasive mechanical ventilation, mortality, risk factors, comorbidities, sex differences, age differences
- MeSH terms
- COVID-19, SARS-CoV-2, Hospitalization, Humans, Intensive Care Units, Mortality, Obesity, Patient Admission, Prognosis, Respiration, Artificial, Risk Factors, Severity of Illness Index, Tomography, X-Ray Computed, Body Mass Index, Intra-Abdominal Fat, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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