Researchers from the German Center for Diabetes Research (DZD) have highlighted the interconnection of obesity and impaired metabolic health with the severity of COVID-19, they reported their findings in the paper, ‘Global pandemics interconnected—obesity, impaired metabolic health and COVID-19’, published in Nature Reviews Endocrinology.
Firstly, they provided information about the independent relationships of obesity, disproportionate fat distribution and impaired metabolic health with the severity of COVID-19. Then they discussed mechanisms for a complicated course of COVID-19 and how this disease may impact on the global obesity and cardiometabolic pandemics. Finally, they provided recommendations for prevention and treatment in clinical practice and in the public health sector to combat these global pandemics.
Norbert Stefan, Andreas Birkenfeld and Matthias Schulze summarise and discuss data from large and well-performed studies that investigated independent relationships of obesity with the severity of COVID-19. They then examined the contribution of obesity, visceral fatness and impaired metabolic health for the course of COVID-19. In this respect they found convincing evidence that obesity and overt diabetes, but also visceral obesity and even mild hyperglycaemia, represent important risk factors for the disease course. Thus, these risk factors most probably may have an additive effect on the severity of COVID-19.
The impact of the SARS-CoV-2 infection on organ function, focusing on the cardiometabolically relevant tissues and organs as the vessel wall, heart, kidneys, liver, gut and pancreas. Thereby, they address both, the immediate damage of COVID-19 to the organs and the long-term effects of the disease, most probably boosting the development of obesity and cardiometabolic diseases. Thus, obesity and cardiometabolic diseases do not only trigger a more severe course of COVID-19, the SARS-CoV-2 infection does promote the development of these conditions.
The authors further highlighted how treatment of obesity and impaired cardiometabolic health helps to avert a severe COVID-19 in patients infected with SARS-CoV-2. In this respect health professionals and politicians should now, more than ever, promote the health benefits of physical activity and support efforts to implement programmes and policies to facilitate increased physical activity and to promote a healthy diet. This might not only be relevant to directly reduce the burden of COVID-19 related morbidity and mortality among those infected, but may also be important in the context of SARS-CoV-2 vaccination, where response should be carefully evaluated in patients with obesity and/or diabetes mellitus, because of a potentially reduced or shortened response.
- Obesity, particularly severe obesity, is a strong and independent determinant of severe coronavirus disease 2019 (COVID-19); novel studies also suggest that visceral obesity increases the risk of complications.
- Although diabetes mellitus is an established risk factor for severe COVID-19, evidence is increasing that hyperglycaemia in the non-diabetic and diabetic range also strongly predicts severe COVID-19.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets organs and tissues that are relevant for cardiometabolic health; SARS-CoV-2-induced organ or tissue dysfunction could result in an increased incidence of cardiometabolic diseases.
- Targeted interventions for metabolic pathologies could improve management of COVID-19; the SARS-CoV-2 vaccination response should be carefully evaluated in patients with obesity and/or diabetes mellitus because of a potentially reduced response.
- Programmes resulting in weight loss and the improvement of metabolic health in people with metabolically unhealthy obesity should be implemented at the patient level and in the public health sector.
- Research to understand how diet and nutritional status modify the immune response could help explain some of the variability in COVID-19 morbidity and mortality and improve patient outcomes.
“Based on data from large studies that investigated relationships of comorbidities with the course of COVID-19 using multivariate adjustment, obesity emerged as a strong and independent determinant of increased risk of morbidity and mortality in patients infected with SARS-CoV-2,” they concluded. “Weight loss and improvement of metabolic health in people with obesity and/or those who are metabolically unhealthy might help them to better cope with COVID-19. Newly launched national and international programmes at the political level and in the public health sector, as well as projected novel research funding are more than welcome to help achieve this important goal.”
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