What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Influenza and COVID-19 (n=4033682). Intervention: Obesity vs. Non-obese patients. Primary outcome: Severe outcome of COVID-19 (OR 2.07, 95% CI 1.53-2.81).

December 21, 2020Open Access

Obesity Increases the Severity and Mortality of Influenza and COVID-19: A Systematic Review and Meta-Analysis

Key Result

Obesity significantly increased the risk of severe outcomes in patients with COVID-19 (OR 2.07) and influenza (OR 1.56), as well as influenza mortality (OR 1.99), but did not significantly increase COVID-19 mortality.

Study Design

Type

Meta-Analysis (n=4,033,682)

PICO

Population

A systematic review and meta-analysis of 46 studies comprising over 4 million patients to evaluate the impact of obesity on the severity and mortality of influenza and COVID-19.

Exposure / Comparator

Obesity vs Non-obese patients

Primary Outcome

Severe outcome of COVID-19 — OR 2.07 (1.53-2.81)

Main Result

Odds Ratio: 2.07 (95% CI 1.53–2.81)

Limitations

Majority of the included studies are retrospective studies
High heterogeneity of included studies limits the ability to accurately estimate the size of the effects
BMI definition and the criteria for admission to ICU might be different across different countries
Limited number of included studies for some analyses

Abstract

Since December 2019, COVID-19 has aroused global attention. Studies show the link between obesity and severe outcome of influenza and COVID-19. Thus, we aimed to compare the impacts of obesity on the severity and mortality of influenza and COVID-19 by performing a meta-analysis. A systematic search was performed in MEDLINE, EMASE, ClinicalTrials.gov, and Web of Science from January 2009 to July 2020. The protocol was registered onto PROSPERO (CRD42020201461). After selection, 46 studies were included in this meta-analysis. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were analyzed. We found obesity was a risk factor for the severity and mortality of influenza (ORsevere outcome = 1.56, CI: 1.28-1.90; ORmortality = 1.99, CI: 1.15-3.46). For COVID-19, obesity was a significant risk factor only for severe outcome (OR = 2.07, CI: 1.53-2.81) but not for mortality (OR = 1.57, CI: 0.85-2.90). Compared with obesity, morbid obesity was linked with a higher risk for the severity and mortality of both influenza (OR = 1.40, CI: 1.10-1.79) and COVID-19 (OR = 3.76, CI: 2.67-5.28). Thus, obesity should be recommended as a risk factor for the prognosis assessment of COVID-19. Special monitoring and earlier treatment should be implemented in patients with obesity and COVID-19.

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