Mild obesity doubles risk for respiratory failure in COVID-19
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Adults with any degree of obesity are more than twice as likely to experience respiratory failure and four times as likely to experience ICU admission when diagnosed with COVID-19 compared with similar adults without excess weight.
“People of any grade of obesity are at a greater risk of severe illness due to COVID-19,” Matteo Rottoli, MD, PhD, a consultant surgeon in surgery of the alimentary tract at Sant’Orsola Hospital and Alma Mater Studiorum University of Bologna, Italy, told Healio. “People with obesity and COVID-19 should be carefully assessed and followed in order to prevent or treat the deterioration of the clinical picture due to the infection, particularly regarding the onset of respiratory failure.”
In a retrospective, single-center study, Rottoli and colleagues analyzed data from 482 consecutive patients with a confirmed diagnosis of COVID-19, hospitalized at Sant’Orsola Hospital in Bologna, Italy, between March 1 and April 20 (62.7% men; mean age, 66 years; 22.5% current smokers). Patients were stratified as having normal weight (n = 202), overweight (n = 176) or obesity (n = 104) according to WHO guidelines. Researchers used logistic regression analysis and Cox proportional hazard models to predict risk for onset of respiratory failure, ICU admission and mortality within 30 days from the onset of symptoms.
Compared with hospitalized adults with a BMI of less than 30 kg/m², researchers found that a BMI between 30 kg/m² and 34.9 kg/m² increased the risks for respiratory failure (OR = 2.32; 95% CI, 1.31-4.09), admission to the ICU (OR = 4.96; 95% CI, 2.53-9.74) and death (OR = 1.71; 95% CI, 0.8-3.64).
Among those with a BMI of at least 35 kg/m², risk for death from COVID-19 significantly increased, with an OR of 12.1 (95% CI, 3.25-45.1).
“Although 1-unit increase in BMI was significantly associated with all outcomes, overweight, as compared with normal weight, did not show a significant increase in the risk of any outcome, in any model, using any categorization,” the researchers wrote. “In fact, in all models, the BMI cutoff determining an increase of risk was 30 kg/m².”
The researchers noted that the findings demonstrate that it may be appropriate to include patients with BMI of at least 30 kg/m² among those at higher risk for severe progression of COVID-19.
“We should be able to understand the mechanisms responsible for a more severe illness in patients with obesity and SARS-CoV-2 infection,” Rottoli said. “This might also help us to understand why the virus might present different clinical pictures. Another important point of research would be differences in COVID-19 outcomes between metabolically healthy and unhealthy obesity.”
For more information:
Matteo Rottoli, MD, PhD, can be reached at Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; email: matteo.rottoli2@unibo.it; Twitter: @matteorottoli.
Perspective
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Ania M. Jastreboff, MD, PhD
Worldwide more than 650 million individuals have obesity, and obesity has been shown to be an independent risk factor for severity of COVID-19. In April, the CDC included class III obesity, defined as a BMI of at least 40 kg/m², in the list of risk factors for severe COVID-19 complications. Just 2 months later in June, the CDC lowered the BMI risk cutoff to include those with a BMI of at least 30 kg/m², underscoring that individuals with class I and II obesity, with a BMI of 30 to 39.9 kg/m², are also at higher risk for disease complications. Providing support for this recent change, the present study examined a cohort of 482 COVID-positive patients in Italy and found that patients with BMI in the range of 30 kg/m² to 34.9 kg/m² and 35 kg/m² to 39.9 kg/m² had higher risks for respiratory failure, with ORs of 2.32 and 3.24, respectively, and higher risks for admission to the ICU, with ORs of 4.96 and 6.58, respectively. These findings support the CDC inclusion of the lower BMI cutoff in conferring increased risk for COVID-19 severity.
Accruing literature continues to demonstrate that the disease of obesity, whether classified as “mild” or “severe,” is indeed a significant risk factor for COVID-19 severity and should not be missed, dismissed or underestimated.
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