|Posted on April 29, 2021 at 6:15 AM|
Obesity and impaired metabolic health are established risk factors for the non-communicable diseases (NCDs) type 2 diabetes mellitus, cardiovascular disease, neurodegenerative diseases, cancer and nonalcoholic fatty liver disease, otherwise known as metabolic associated fatty liver disease (MAFLD). With the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), obesity and impaired metabolic health also emerged as important determinants of severe coronavirus disease 2019 (COVID-19). Furthermore, novel findings indicate that specifically visceral obesity and characteristics of impaired metabolic health such as hyperglycaemia, hypertension and subclinical inflammation are associated with a high risk of severe COVID-19. In this Review, we highlight how obesity and impaired metabolic health increase complications and mortality in COVID-19. We also summarize the consequences of SARS-CoV-2 infection for organ function and risk of NCDs. In addition, we discuss data indicating that the COVID-19 pandemic could have serious consequences for the obesity epidemic. As obesity and impaired metabolic health are both accelerators and consequences of severe COVID-19, and might adversely influence the efficacy of COVID-19 vaccines, we propose strategies for the prevention and treatment of obesity and impaired metabolic health on a clinical and population level, particularly while the COVID-19 pandemic is present.
Indexed for Nature Reviews Endocrinology
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.