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Severe obesity increases the risk of death in young men with COVID-19


Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center..

In California’s large-scale healthcare plan, among those with COVID-19, men under the age of 60 were at far greater risk of dying within 3 weeks of diagnosis in severe cases obesity Not normal weight, independent of other risk factors.

The study shows that obesity plays a significant role in the risk of COVID-19 mortality, especially in male patients and young people.

The data “emphasize the main role of severe obesity on correlated risk factors and provide a target for early intervention,” they conclude in the article. Published online August 12 Internal medicine record.

This study adds to about 300 articles reporting that severe obesity is associated with an increased risk of morbidity and mortality from COVID-19.

so Accompanying editorialAs David A. Cass, MD says:

Rather, these findings point out that “obesity is an important independent risk factor for serious COVID-19 disease,” he points out.

Based on this evidence, “probably the most difficult question to answer is what to do.” Cass at Johns Hopkins University in Baltimore, Maryland wonders.

Data consistently have a Body Mass Index (BMI) of 35 kg/m2 Kas predicts a major health risk and emphasizes that weight loss at that level of obesity is difficult and certainly not achieved rapidly.

“Therefore… keep social distances; change behaviors to reduce exposure to and exposure to viruses such as wearing masks; policies and medical approaches should be introduced to recognize the potential effects of obesity. He emphasizes. “These actions are helpful and certainly doable.”

In a similar vein, Tartov et al. said, “The findings also revealed a disastrous clash between the two pandemics of COVID-19 and obesity.

“COVID-19 continues to spread unabated, so we must focus our immediate efforts to contain the immediate crisis,” they claim.

However, the findings also underline the need for future collective efforts to combat the equally devastating and potentially synergistic epidemic of obesity.

COVID-19 pandemic clashes with obesity epidemic

Earlier studies on obesity and COVID-19 were small and did not include patients who could not regulate multiple confounders or were not hospitalized, Tartof and co-authors wrote.

Their study included 6916 members of the Kaiser Permanente Southern California Medical Plan diagnosed with COVID-19 from February 13, 2020 to May 2, 2020.

The researchers calculated mortality risk 21 days after COVID-19 diagnosis. The findings are age, gender, race/ethnicity, smoking, Myocardial infarction, Congestive heart failure, Peripheral vascular disease, Cerebrovascular disease, chronic lung disease, renal disease, metastatic or malignant tumor, other immune diseases, hyperlipidemia, High blood pressure, asthma, Organ transplant, diabetic condition.

Patients were classified as underweight, normal, overweight, or Class 1, 2, or 3 obese based on BMI. BMI 18.5 to 24 kg / m2 Defined as normal weight.

Class 3 obesity, also called severe obesity, includes moderate and severe obesity (BMI, 40-44 kg/m3)2) And very severe obesity (≥45 kg/m2).

More than half of the patients were female (55%) and more than 50% were Hispanic (54%).

A total of 206 patients (3%) died within 21 days of being diagnosed with COVID-19. Of these, 67% were hospitalized and 43% were intubated.

Overall, COVID-19 patients with moderately severe or very severe obesity had an increased risk of death of 2.7 and 4.2 times within 3 weeks, respectively, compared with normal weight patients.

Patients in other BMI categories were not at significantly higher risk of death during follow-up.

However, each decade of age increase after age 40 was associated with a gradual increase in mortality risk within 3 weeks of COVID-19 diagnosis.

Strategic risk by age and gender

Further analysis shows that “most surprisingly” among patients aged 60 and younger is that patients with moderately severe and very severe obesity have a follow-up risk compared with those at follow-up. The risk of dying inside was 17 and 12 times higher, respectively. Researchers report normal weight.

In patients over the age of 60, moderately severe obesity did not pose a significant increased risk of impending death from COVID-19. Extremely severe obesity made this risk smaller and tripled.

“We believe that severe obesity, especially among younger patients, outweighs the risk of death caused by other obesity-related conditions, such as a history of myocardial infarction (MI), diabetes, hypertension, or hyperlipidemia. What they found is excessive obesity and a serious COVID-19 illness, according to researchers.

This independent, increased risk of mortality from severe obesity was found in men but not in women.

Men with moderate and very severe obesity had a 4.8- and 10-fold higher risk of dying within 3 weeks, respectively, compared to men with normal weight.

“Younger patients may be at higher risk not because obesity is particularly harmful in this age group. Other serious comorbidities that develop later in life may continue to be major risk factors. Is higher,” Kass suggests in his editorial.

“Given that this fat is particularly inflammatory and contributes to metabolic and vascular disease, it may reflect that men are particularly affected because they have more visceral fat than women.” He added.

“As a cardiologist to study heart failure“I am amazed by the number of mechanisms mentioned in the Obesity Risk and Heart Disease review that are also mentioned in the Obesity and COVID-19 reviews.”

The research was funded by Roche Genentech. Kass does not disclose the financial relationships involved. The author’s disclosure can be found in the article.

Untern Med Published online August 12, 2020. Full text, editorial

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