Severe COVID-19: younger patients are obese

May 13, 2020-Severely young ICU patients COVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing The more Obese According to a new analysis published in Lancet..

“By itself, obesity It seems like a sufficient risk factor to start seeing young people landing in the ICU. ”

“In that sense, there is a simple message. OverweightI don’t think 35 is much safer[Fromsevere[fromsevere[fromsevereCOVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing]More than your mother or grandparents or anyone else in their 60s or 70s. ” Medscape Medical News..

The findings, which Kass describes as “two-week snapshots” of 265 patients (58% male) in late March and early April at some college hospitals in the United States, confirm with other recent studies. We are strengthening. obesity Is one of the biggest risk factors for seriousness COVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing Illness, especially among young patients. In addition, a large British study has shown that obesity is an important factor associated with in-hospital death in hospital after adjusting for comorbidities COVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing..

However, this new analysis stands out as the only dataset to date that specifically “questions in relation to age” whether it is serious or not. COVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing The disease is correlated with ICU treatment, he said.

The average age of his study population of ICU patients was 55 years, “it was not what we expected, it was young.”

“Even in the first 20 patients we were already seeing young people, and they were definitely heavier, and many patients BMI 35 kg / m or more²“The relationship was pretty tight and very quick.”

“If this is actually part of our body, don’t assume that any of us will be too young and vulnerable,” he said.

Former Chairman of the Society of Obesity and Spokesperson Dr. Steven Heimsfield agrees with Kas’ conclusions.

“One of the things that came to our mind is that the prototype of this sick person is old … [a patient] Who is symptomatic and is 40 years old Obese, You shouldn’t assume they have other illnesses, “said Haemsfield. Medscape Medical News..

“We should think of them as susceptible groups,” he said.

Kas and colleagues agree. “Public message to young adults, reducing the threshold of virus testing in obese individuals and keeping vigilant against this at-risk population should reduce the prevalence of severe disease. COVID-19 (New Coronavirus Infection) (# If there is no character limit, add parentheses when first appearing Disease [among those with obesity]”It has said.

“I think it’s a mental adjustment from a health care perspective, and hopefully it could help target high-risk people before the problem occurs,” Cass said. Said Medscape Medical News..

Trio mechanism explains additional COVID-19 risk of obesity

In analyzing the data, Kass and co-authors said they expected results similar to the largest study of 1591 Italian ICU patients, who were only 203 under 51 years of age. Common comorbidities among those patients included High blood pressure, Cardiovascular disease,and Type 2 diabetes, China reported similar data.

When the COVID-19 epidemic accelerated in the United States, older people were also identified as risk factors. Obesity had not yet been added to this list, Kas noted. However, following informal discussions with colleagues in other ICUs across the country, he decided to investigate further whether it was an undervalued risk factor.

Kas and colleagues BMI Age and age of COVID-19 patients admitted to the ICU at Johns Hopkins, University of Cincinnati, University of New York, University of Washington, Florida Health, University of Pennsylvania.

A “significant inverse correlation between age and BMI” showed that young ICU patients were not gender-dependent and were more likely to be obese.

Median BMI of study participants was 29.3 kg / m², Only in quarters with BMI less than 26 kg / m² And an additional 25% have a BMI higher than 34.7 kg / m²..

Kas admitted that it was impossible to explain other potential confounders with this simple dataset, Medscape Medical News in the meantime Diabetes, Cardiovascular disease,and High blood pressureFor example, it can occur in obesity, but it is less common in younger populations because other comorbidities take longer to develop. “

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He said several mechanisms could explain why obesity makes patients with COVID-19 more susceptible to severe illness.

For one thing, obesity diaphragm Lying on the back, restricted Breathing..

“Morbid obesity itself is a kind of proinflammatory,” he continued.

“Here we have a viral infection. Earlier reports suggest that the viral cytokine storm and immune misoperation are much more severe than other forms of coronavirus seen to date.” Inflammatory conditions, which may be the reason for the higher risk. ”

Furthermore, angiotensin converting enzyme 2 (ACE-2) receptor SARS-The CoV-2 virus that causes the attachment of COVID-19 is more expressed in adipose tissue lung, Kas pointed out.

“This could turn into a kind of virus replication depot,” he explained. “You may be brewing more viruses as a component of obesity.”

Sensitivity required for public messaging about risk, but tested faster

The obesity rate in the United States is about 40%, and results are particularly relevant to Americans, says Kass and Heymsfield, pointing out that the country’s “obesity zone” runs south.

Haemsfield, who wasn’t part of the new analysis, said public messaging about serious COVID-19 risk to obese young adults, especially because the virus is “still quite common in non-obese people.” “Tricky”.

Cass agreed, pointing out that “it’s difficult to look at 40% of the population and say,” You guys have to see it. “

However, as research results grow, it may be necessary to link obesity with severe COVID-19 disease and virally test patients in this category before symptoms become severe.

And notable is that Breathing difficulty Although common in obese people regardless of illness, he noted that similar symptoms of COVID-19 may go unnoticed in these people.

“They may notice that they can’t literally breathe, and the worry is to wait too long for them to come in,” he said. Usually, people can get worse on days 7-10 of a COVID-19 infection.

“While individuals who need to be educated to recognize the serious complications of COVID-19 often appear suddenly, the virus has long passed through the body,” he concluded.

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