L'obésité aggrave les dangers du COVID + la grippe!

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Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence
Silvia Helena de Carvalho Obesity Research & Clinical Practice Volume 14, Issue 5, September–October 2020, Pages 389-397

Objectives
To investigate the relationship between coronavirus disease 2019 (COVID-19) and obesity in critically ill patients admitted to the intensive care unit (ICU).

Methods
We systematically searched PubMed, SCOPUS, Embase, LILACS, and Web of Science for studies published up to April 27, 2020. The outcome of interest was composite poor outcome, comprising mortality and severe COVID-19. We used a standardized data extraction form to collect information from published reports of eligible studies. Heterogeneity and publication bias were assessed using I2 statistic and funnel plots, respectively.

Results
Nine studies including 6577 patients were selected for evaluation. The COVID-19 patients were 59.80% male and had comorbidities such as hypertension (51.51%), diabetes (30.3%), cardiovascular disease (16.66%), lung disease (15.99%), renal disease (7.49%), cancer (5.07%), and immunosuppression (1.8%). For patients with severe complications, the overall pooled event rates were 56.2% (random; 95% CI: 35.3–75.1; p = 0.015; I2 = 71.461) for obesity, 23.6% (random; 95% CI: 17.9–30.5; p = 0.000; I2 = 87.705) for type 2 diabetes, 45.9% (random; 95% CI: 38.0–53.9; p = 0.000; I2 = 90.152) for hypertension, 20.0% (random; 95% CI: 7.9–42.0; p = 0.000; I2 = 94.577) for smoking, 21.6% (random; 95% CI: 14.1–31.4%; p = 0.000, I2 = 92.983) for lung diseases, and 20.6% (random; 95% CI: 15.2–27.5; p = 0.000, I2 = 85.735) for cardiovascular diseases.

Discussion
This systematic review indicated the relationship between obesity, ICU admission, severe COVID-19, and disease progression in patients with COVID-19. Obese patients with hypertension, type 2 diabetes, smoking habit, lung disease, and/or cardiovascular disease should be cared for with increased attention.

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Being obese not only increases the risk of infection and complications for the individual, but recent evidence indicates that a large obese population increases the chance of appearance of more virulent viral strain, and prolonged virus shedding may increase the mortality rate of an influenza pandemic [22].

Luzi and Radaelli [22] identified three factors that make obese individuals infected with COVID-19 more contagious than normoweight individuals:
(a) obese individuals with influenza shed the virus for a longer period of time, potentially increasing the chance to spread the virus to others [34];
(b) the obese microenvironment favors the emergence of novel strains due to the reduced and delayed capacity to produce interferons by obese individuals. The delay in interferon production to oppose viral replication allows more viral RNA replication, increasing the chances of the appearance of novel, more virulent viral strains [35]; and
(c) the body mass index (BMI) correlates positively with infectious virus in exhaled breath [36].

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Obesity-related chronic inflammation with antigen participation causes reduced macrophage activation and blunted pro-inflammatory cytokine production upon macrophage stimulation [37]. B and T cell responses are impaired in obese and obese diabetic patients, and this causes increased susceptibility and delay in the resolution of viral infections. A dysregulated pro-inflammatory response contributes to the severe lung lesions observed in patients during the influenza pandemic [22].

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Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic
Livio Luzi Acta Diabetologica volume 57, pages759–764(2020)

Aims
Analyze the relationship between obesity and influenza.

Methods
Basal hormone milieu, defective response of both innate and adaptive immune system and sedentariness are major determinants in the severity of influenza viral infection in obese patients. Being overweight not only increases the risk of infection and of complications for the single obese person, but a large prevalence of obese individuals within the population might increase the chance of appearance of more virulent viral strain, prolongs the virus shedding throughout the total population and eventually might increase overall mortality rate of an influenza pandemic.

Results
Waiting for the development of a vaccination against COVID-19, isolation of positive cases and social distancing are the primary interventions. Nonetheless, evidence from previous influenza pandemics suggests the following interventions aimed at improving immune response: (1) lose weight with a mild caloric restriction; (2) include AMPK activators and PPAR gamma activators in the drug treatment for obesity associated with diabetes; and (3) practice mild-to-moderate physical exercise.

Conclusions
Due to prolonged viral shedding, quarantine in obese subjects should likely be longer than normal weight individuals.

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Firstly, obese subjects have chronically higher leptin (a pro-inflammatory adipokine) and lower adiponectin (an anti-inflammatory adipokine) concentrations. This unfavorable hormone milieu also leads to a dysregulation of the immune response and can contribute to the pathogenesis of obesity-linked complications [8].

Why are obese patients potentially more contagious than lean subjects?
Three factors make obese subjects more contagious than leans:
First, obese subjects with influenza shed the virus for a longer period of time (up to 104% longer) than lean subjects, potentially increasing the chance to spread the virus to others [22].
Secondly, the obese microenvironment favors the emergence of novel more virulent virus strains. This is due mainly to the reduced and delayed capacity to produce interferons by obese individuals and animals [17, 18]. The delay in producing interferon to contrast viral replication allows more viral RNA replication increasing the chances of the appearance of novel, more virulent viral strains [18].
Thirdly, body mass index correlates positively with infectious virus in exhaled breath [23]. This finding was especially significant for males, which leads to the hypothesis that the higher ventilation volumes or a differential chest conformation might explain this fact [23].

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The effects of influenza virus on infected mammalian cells generally result in a metabolic shift toward an increase in glycolytic rate and a decrease in ATP production [29].

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Impact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review
João Vitor Vieirade Siqueira Obesity Research & Clinical Practice Volume 14, Issue 5, September–October 2020, Pages 398-403


The aim of the current review was to assess whether there was an association between obesity and higher levels of hospitalization, poor outcomes and mortality due to the disease of novel coronavirus (COVID-19).

Methodology: A systematic review of articles on the novel coronavirus, containing information on obesity and its association with COVID-19 morbidity and mortality. In the bibliographic research, four databases were used, with the terms ['COVID-19′] AND ['hospitalization'] AND ['obesity'] AND ['mortality']. Studies published from 12/01/2019 until 05/01/2020 were included. The research contains inclusive criteria targeting studies of humans adults infected by Sars-Cov-2, with or without comorbidities. This research was selected from publications in Spanish and English languages.

Results: 96 articles were identified, 15 being presented in two databases. Twenty articles were included, with a population total estimated from 1 to 7671 patients, with a prevalence of obesity ranging from 13.3% to 68.6%. The association of obesity and mortality has been observed in at least 4 studies, that 85.3% of the population was hospitalized. Among 19 of the 20 studies, more severe forms of the disease were observed and in 14 of them, higher rates of complications among obese people infected with the new coronavirus. Limitation differences in the definition of obesity was observed among publications, of which obesity was considered from a body mass index >25 kg/m².

Conclusions: In the current review, obesity and overweight were represented an unfavorable factor for infection of novel coronavirus, where the higher the BMI the worse the outcomes. This occurred by worsening the infection itself, as well as increasing the prevalence of hospitalizations, worst outcomes and greater lethality; especially when co-occurring with other chronic conditions and in the elderly as well. Given this evidence, greater attention is suggested to the obese and overweight population in the face of the current pandemic.

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Traduction de l'étude

Impact de l'obésité sur les hospitalisations et la mortalité, due au COVID-19: une revue systématique
João Vitor Vieirade Siqueira Obesity Research & Clinical Practice Volume 14, Numéro 5, septembre-octobre 2020, pages 398-403


Le but de la présente revue était d'évaluer s'il existait une association entre l'obésité et des niveaux plus élevés d'hospitalisation, de mauvais résultats et la mortalité due à la maladie du nouveau coronavirus (COVID-19).

Méthodologie: Une revue systématique d'articles sur le nouveau coronavirus, contenant des informations sur l'obésité et son association avec la morbidité et la mortalité du COVID-19. Dans la recherche bibliographique, quatre bases de données ont été utilisées, avec les termes ['COVID-19'] ET ['hospitalisation'] ET ['obésité'] ET ['mortalité']. Les études publiées du 12/01/2019 au 05/01/2020 ont été incluses. La recherche contient des critères inclusifs ciblant des études sur des humains adultes infectés par Sars-Cov-2, avec ou sans comorbidités. Cette recherche a été sélectionnée parmi des publications en espagnol et en anglais.

Résultats: 96 articles ont été identifiés, 15 étant présentés dans deux bases de données. Vingt articles ont été inclus, avec une population totale estimée de 1 à 7671 patients, avec une prévalence de l'obésité allant de 13,3% à 68,6%. L'association obésité et mortalité a été observée dans au moins 4 études, que 85,3% de la population était hospitalisée. Parmi 19 des 20 études, des formes plus graves de la maladie ont été observées et dans 14 d'entre elles, des taux plus élevés de complications chez les personnes obèses infectées par le nouveau coronavirus. Des différences de limitation dans la définition de l'obésité ont été observées parmi les publications, dont l'obésité était considérée à partir d'un indice de masse corporelle> 25 kg / m².

Conclusions: Dans la revue actuelle, l'obésité et le surpoids représentaient un facteur défavorable pour l'infection du nouveau coronavirus, où plus l'IMC est élevé, plus les résultats sont mauvais. Cela s'est produit en aggravant l'infection elle-même, ainsi qu'en augmentant la prévalence des hospitalisations, les pires résultats et une plus grande mortalité; en particulier en cas de co-occurrence avec d'autres affections chroniques et chez les personnes âgées également. Compte tenu de ces preuves, une plus grande attention est suggérée à la population obèse et en surpoids face à la pandémie actuelle