Proactive measures can reduce COVID-19 severity risk in obesity
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Obesity and elevated BMI are “the common soil” that grow adverse outcomes related to COVID-19, and clinicians must work with patients to appropriately control risk factors for severe disease, according to a speaker.
“We know, for example, that obesity is associated with death and disability through its association with diabetes, kidney disease, cancers and then cardiovascular disease, which conveys the highest morbidity and mortality,” Christos S. Mantzoros, MD, DSc, director of the human nutrition unit at Beth Israel Deaconess Medical Center, said during an online presentation at the virtual Heart in Diabetes conference. “The same is happening with COVID-19.”
Data now demonstrate that COVID-19 causes beta cell damage, decreased insulin secretion and a cytokine storm that builds on a chronic inflammatory condition already present in the setting of obesity and diabetes, which leads to insulin resistance, Mantzoros said during a session on COVID-19 and cardiometabolic health. To date, more than 4 million U.S. residents have been infected with the novel coronavirus and more than 150,000 have died; risk for COVID-19 death increases fourfold among adults with a BMI of at least 35 kg/m², Mantzoros said.
“This is the perfect storm that leads to hyperglycemia in COVID-19, endothelial dysfunction and multi-organ damage,” Mantzoros said.
Drivers of obesity, poor outcomes
Mantzoros noted that social determinants of health — access to healthy food and health care, socioeconomic status, education level and employment — are important factors linked with obesity rates, comorbidities and severe outcomes from COVID-19.
In addition to social factors, there are distinct biological factors that play a role, he said.
“Obesity is also associated with low-grade inflammation, so the virus is imposing a cytokine storm on a low-grade inflammation and this is explosive,” Mantzoros said. “Then hypertension, diabetes, hyperlipidemia, in addition to the low-grade inflammation and hypercoagulability, lead to increased risk for heart and kidney disease.”
Mantzoros offered guidance to clinicians treating adults with excess weight to reduce risks for COVID-19 and for complications for those who do contract the disease:
- Focus on diet — Plant-based diets with decreased energy intake but high in antioxidants and polyphenols are recommended to decrease CV risk, but also play a role in potentially lowering risk for COVID-19 adverse outcomes, Mantzoros said. “The Mediterranean diet or a DASH-type diet are recommended in these cases,” he said.
- Possible benefit of vitamin D — Research on vitamin D suggests low vitamin D status is associated with risk for intubation and COVID-19-related mortality, Mantzoros said. “It remains to be seen if this is a risk factor or whether by replacing vitamin D we could protect people,” he said. “Clinical trials are being designed as we speak.”
- Glycemic, blood pressure control — “We don’t have trials on this, but my expert opinion is that we must focus on controlling blood pressure and blood glucose on an outpatient and inpatient or ICU setting,” Mantzoros said. “In the outpatient setting, we must use telehealth to keep in touch with our patients and make sure blood glucose and BP is where we want it to be. For those on continuous glucose monitor therapy, we would like them to be in [recommended blood glucose ] target range more than 70% of the time.”
- Be vigilant — “Everyone is at risk for COVID-19, but obese people must be more vigilant,” Mantzoros said. “Wear a mask, stay at home, wash your hands, social distance, and pay attention to sleep, exercise, and nutrition, so we can limit the effects of obesity and the comorbidities.”
“COVID-19 is here to stay for a while, and everyone can be affected — lean, obese, younger, older,” Mantzoros said. “We need to be more vigilant with our patients who are older, male and obese and teach our patients about diet, exercise, appropriate control of all risk factors and comorbidities associated with increased hospitalization, intubation and mortality, including diabetes control.”
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Mantzoros C. Obesity, a major predictor of mortality by COVID-19: Associations with diabetes and CVD and implications for therapy. Presented at: Heart in Diabetes CME Conference; Aug. 21- 24, 2020, 2019; (virtual meeting).
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