For patients under 60 years, living in countries with a low Human Development Index (HDI) value, hospitalized with COVID-19, obesity was found to increase the risk of mortality, according to a study published in Obesity Reviews.
Researchers conducted a systematic review and meta-analysis to investigate whether obesity was a risk factor for mortality among hospitalized adults with COVID-19. Databases were searched from inception to May 2022.The researchers included studies that followed a cohort or case-control design performed in hospitalized adults (≥18 years) with COVID-19 that evaluated mortality rates among patients with and without obesity. To investigate heterogeneity, meta-regression and subgroup analyses were performed, taking into account HDI value, age, sex, and follow-up period.
A total of 49studies with 20,361,168 patients were eligible for qualitative synthesis and 33 studies with 42,905 patients were eligible for quantitative analysis. The median HDI value (0.92) was adopted to determine patient subgroups. Patients were assigned to 4 subgroups by age (<60, ≥60, and <65, and ≥65 years). In 33 studies, a set BMI score was used to determine obesity (< 30 kg/m2) in the control group. In 10 studies, the eutrophic range (BMI, 18.5–24.9 kg/m2) was used. In 6 studies the BMI range of the control group was not reported.
The researchers noted an association between age, obesity, as well as HDI value and mortality. In countries with a low HDI value (<0.92) patients with obesity hospitalized with COVID-19 had an increased risk of mortality when compared with patients without obesity (risk ratio [RR], 1.28; 95% CI, 1.10-1.48; I2=45.4%).
Additionally, in countries with low HDI values, patients younger than 60 years with obesity had an increased risk for mortality when hospitalized with COVID-19 (RR, 1.31; 95% CI, 1.18-1.45)
The main limitation was a lack of multivariate adjustment or other epidemiological strategies to control independent risk factors in the included studies. In addition, information bias may be present due to the methods of BMI data collection. Finally, the majority of studies included patients identified as eutrophic or overweight in their respective control groups, therefore, obscuring results.
“The present study showed that obesity among patients hospitalized with COVID-19 increases the risk of death among those aged [below] 60 years and living in countries with low HDI, thereby indicating the need for early intervention in this group,” the researchers concluded.
Marano D, Amaral Y, Rebelo F, et al. The effect of obesity on the mortality of hospitalized adults with COVID-19 considering the human development index: a systematic review and meta-analysis. Obesity Reviews. Published online June 21, 2023. doi:10.1111/obr.13591