Summary Obesity is a major risk factor for the development of severe COVID-19 infection and mortality. However, it is not known whether patients with obesity are at increased risk of developing post-acute sequelae of COVID-19 (PASC). At a median follow-up of 8 months and counting from 30 days after the positive viral test of 2839 patients who did not require admission to the ICU and survived the acute phase of COVID-19, 1230 (43%) patients required medical diagnostic tests, 1255 (44%) patients were hospitalized and 29 (1%) patients died. Compared with patients with normal BMI, the risk of hospital admission was 28% and 30% higher in patients with moderate and severe obesity, respectively. The need for diagnostic tests to evaluate different medical problems, compared to patients with normal BMI, was 25% and 39% higher in patients with moderate and severe obesity, respectively. The findings of this study suggest that moderate and severe obesity (BMI ≥ 35 kg/m2) is associated with an increased risk of PASC. |
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A study from the Cleveland Clinic shows that COVID-19 survivors who have moderate or severe obesity may be at higher risk of experiencing long-term consequences of the disease, compared to patients who are not obese. The study was recently published online in the journal Diabetes, Obesity and Metabolism .
Multiple studies have identified obesity as a risk factor for developing a severe form of COVID-19 that may require hospital admission, intensive care and respiratory support in the early phase of the disease.
Obesity, which is a complex disease caused by multiple factors, is associated with an increased risk of cardiovascular disease, blood clots and lung conditions. Additionally, obesity weakens the immune system and creates a chronic inflammatory state. Those conditions can lead to poor outcomes after infection with SARS-CoV-2, which is the virus that causes COVID-19.
"To our knowledge, this current study suggests for the first time that patients with moderate to severe obesity are at increased risk of developing long-term complications of COVID-19 beyond the acute phase," said Ali Aminian, MD, director of Cleveland. Bariatric and Metabolic Institute of the Clinic and principal investigator of the research.
In this observational study, researchers used a registry of patients who tested positive for SARS-CoV-2 infection within the Cleveland Clinic health system over a five-month period from March 2020 to July 2020, with follow-up. until January 2021.
The researchers examined three indicators of potential long-term complications of COVID-19 (hospital admission, mortality, and need for diagnostic medical testing) that occurred 30 days or after the first positive viral test for SARS-CoV-2.
The results were compared between five groups of patients according to their body mass index (BMI): 18.5-24.9 (normal), 25-29.9 (overweight), 30-34.9 (mild obesity), 35 -39.9 (moderate obesity) and 40 or more (severe obesity). Obesity is a disease classified with a BMI of 30 or more.
A total of 2,839 patients who did not require ICU admission and survived the acute phase of COVID-19 were included in the final results of this study. The normal BMI group was considered as reference.
The study found that a health condition called post-acute sequelae of SARS-CoV-2 infection (PASC) is an extremely common problem in COVID-19 survivors. Specifically, during a 10-month follow-up after the acute phase of COVID-19, 44% of study participants had required hospital admission and 1% died.
Furthermore, the results show that compared to patients with normal BMI, the risk of hospital admission was 28% and 30% higher in patients with moderate and severe obesity, respectively.
The need for diagnostic tests to evaluate different medical problems, compared to patients with normal BMI, was 25% and 39% higher in patients with moderate and severe obesity, respectively.
More specifically, the need for diagnostic tests to evaluate heart, lung, vascular, kidney, gastrointestinal, and mental health problems was significantly higher in patients with a BMI of 35 or higher, compared to patients with a normal BMI.
"The observations from this study can possibly be explained by underlying mechanisms operating in patients who have obesity, such as hyperinflammation, immune dysfunction, and comorbidities," said Bartolome Burguera, M.D., Ph.D., president of the Institute of Endocrinology and Metabolism and co-investigator of the study. "Such conditions may lead to poor outcomes in the acute phase of COVID-19 in patients with obesity and could possibly lead to an increased risk of long-term complications of COVID-19 in this patient population."
Future studies are planned to confirm the findings of this study that obesity is an important risk factor for the development of PASC and determine the long-term and rigorous follow-up that patients with obesity need after SARS-CoV- infection. 2.
