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Quarleri J, Delpino MV. The interplay of aging, adipose tissue, and COVID-19: a potent alliance with implications for health. GeroScience 2024; 46:2915-2932. [PMID: 38191833 PMCID: PMC11009220 DOI: 10.1007/s11357-023-01058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
Obesity has emerged as a significant public health challenge. With the ongoing increase in life expectancy, the prevalence of obesity is steadily growing, particularly among older age demographics. The extension of life expectancy frequently results in additional years of vulnerability to chronic health issues associated with obesity in the elderly.The concept of SARS-CoV-2 directly infecting adipose tissue stems from the fact that both adipocytes and stromal vascular fraction cells express ACE2, the primary receptor facilitating SARS-CoV-2 entry. It is noteworthy that adipose tissue demonstrates ACE2 expression levels similar to those found in the lungs within the same individual. Additionally, ACE2 expression in the adipose tissue of obese individuals surpasses that in non-obese counterparts. Viral attachment to ACE2 has the potential to disturb the equilibrium of renin-angiotensin system homeostasis, leading to an exacerbated inflammatory response.Consequently, adipose tissue has been investigated as a potential site for active SARS-CoV-2 infection, suggesting its plausible role in virus persistence and contribution to both acute and long-term consequences associated with COVID-19.This review is dedicated to presenting current evidence concerning the presence of SARS-CoV-2 in the adipose tissue of elderly individuals infected with the virus. Both obesity and aging are circumstances that contribute to severe health challenges, heightening the risk of disease and mortality. We will particularly focus on examining the mechanisms implicated in the long-term consequences, with the intention of providing insights into potential strategies for mitigating the aftermath of the disease.
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Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Universidad de Buenos Aires, CONICET, Paraguay 2155, Piso 11, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina.
| | - M Victoria Delpino
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Universidad de Buenos Aires, CONICET, Paraguay 2155, Piso 11, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina.
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2
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Troyer BS, Kovacic Scherrer N, Garavaglia J. Tocilizumab Versus Baricitinib for the Treatment of COVID-19 in Patients With Obesity. J Pharm Pract 2024; 37:632-636. [PMID: 36803310 PMCID: PMC9941001 DOI: 10.1177/08971900231158931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Background: Tocilizumab and baricitinib have emerged as potential treatments for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following the findings of the Recovery Group and the results of the COV-BARRIER study. Unfortunately, there is a lack of guidance regarding the use of these agents in high-risk patients, such as those with obesity. Objective: To compare the outcomes of tocilizumab and baricitinib as potential treatments for obese patients infected with SARS-CoV-2. Methods: This was a multi-center retrospective analysis comparing outcomes of obese patients who received the standard of care plus tocilizumab or baricitinib for the treatment of SARS-CoV-2. Included patients had a BMI >30 kg/m2, needed ICU level care, and required non-invasive or invasive ventilatory support. Results: This study included 64 patients who received tocilizumab and 69 patients who received baricitinib. When examining the primary outcome, patients who received tocilizumab had a shorter duration of ventilatory support (10.0 vs 15.0 days, P = .016) than patients who received baricitinib. Our secondary outcome of in-hospital mortality was lower in the tocilizumab group as well (23.4% vs 53.6%, P < .001). Tocilizumab was also associated with a non-significant reduction in new positive blood cultures (13.0% vs 3.1%, P = .056) and new invasive fungal infection (7.3% vs 1.6%, P = .210). Conclusions: This retrospective review showed a reduced duration of ventilatory support in obese patients who received tocilizumab vs baricitinib. In the future, additional studies should be conducted to further examine and confirm these results.
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Affiliation(s)
- Bradley S. Troyer
- Department of Pharmacy Practice, University of Charleston School of Pharmacy, Charleston, WV, USA
| | | | - Jeffrey Garavaglia
- Critical Care Pharmacy Department, West Virginia University Hospitals, Morgantown, WV, USA
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Herbert C, Manabe YC, Filippaios A, Lin H, Wang B, Achenbach C, Kheterpal V, Hartin P, Suvarna T, Harman E, Stamegna P, Rao LV, Hafer N, Broach J, Luzuriaga K, Fitzgerald KA, McManus DD, Soni A. Differential Viral Dynamics by Sex and Body Mass Index During Acute SARS-CoV-2 Infection: Results From a Longitudinal Cohort Study. Clin Infect Dis 2024; 78:1185-1193. [PMID: 37972270 PMCID: PMC11093673 DOI: 10.1093/cid/ciad701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There is evidence of an association of severe coroanavirus disease (COVID-19) outcomes with increased body mass index (BMI) and male sex. However, few studies have examined the interaction between sex and BMI on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics. METHODS Participants conducted RT-PCR testing every 24-48 hours over a 15-day period. Sex and BMI were self-reported, and Ct values from E-gene were used to quantify viral load. Three distinct outcomes were examined using mixed-effects generalized linear models, linear models, and logistic models, respectively: all Ct values (model 1), nadir Ct value (model 2), and strongly detectable infection (at least 1 Ct value ≤28 during their infection) (model 3). An interaction term between BMI and sex was included, and inverse logit transformations were applied to quantify the differences by BMI and sex using marginal predictions. RESULTS In total, 7988 participants enrolled in this study and 439 participants (model 1) and 309 (models 2 and 3) were eligible for these analyses. Among males, increasing BMI was associated with lower Ct values in a dose-response fashion. For participants with BMIs greater than 29 kg/m2, males had significantly lower Ct values and nadir Ct values than females. In total, 67.8% of males and 55.3% of females recorded a strongly detectable infection; increasing proportions of men had Ct values <28 with BMIs of 35 and 40 kg/m2. CONCLUSIONS We observed sex-based dimorphism in relation to BMI and COVID-19 viral load. Further investigation is needed to determine the cause, clinical impact, and transmission implications of this sex-differential effect of BMI on viral load.
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Affiliation(s)
- Carly Herbert
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yukari C Manabe
- Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreas Filippaios
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Biqi Wang
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Chad Achenbach
- Division of Infectious Disease, Department of Medicine, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Paul Hartin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Pamela Stamegna
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Nathaniel Hafer
- UMass Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Program in Molecular Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - John Broach
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine Luzuriaga
- UMass Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Program in Molecular Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine A Fitzgerald
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - David D McManus
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Division of Cardiology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Division of Health System Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Oshakbayev K, Durmanova A, Zhankalova Z, Idrisov A, Bedelbayeva G, Gazaliyeva M, Nabiyev A, Tordai A, Dukenbayeva B. Weight loss treatment for COVID-19 in patients with NCDs: a pilot prospective clinical trial. Sci Rep 2024; 14:10979. [PMID: 38744929 PMCID: PMC11094141 DOI: 10.1038/s41598-024-61703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
COVID-19 comorbid with noncommunicable chronic diseases (NCDs) complicates the diagnosis, treatment, and prognosis, and increases the mortality rate. The aim is to evaluate the effects of a restricted diet on clinical/laboratory inflammation and metabolic profile, reactive oxygen species (ROS), and body composition in patients with COVID-19 comorbid with NCDs. We conducted a 6-week open, pilot prospective controlled clinical trial. The study included 70 adult patients with COVID-19 comorbid with type 2 diabetes (T2D), hypertension, or nonalcoholic steatohepatitis (NASH). INTERVENTIONS a restricted diet including calorie restriction, hot water drinking, walking, and sexual self-restraint. PRIMARY ENDPOINTS COVID-19 diagnosis by detecting SARS-CoV-2 genome by RT-PCR; weight loss in Main group; body temperature; C-reactive protein. Secondary endpoints: the number of white blood cells; erythrocyte sedimentation rate; adverse effects during treatment; fasting blood glucose, glycosylated hemoglobin A1c (HbA1c), systolic/diastolic blood pressure (BP); blood lipids; ALT/AST, chest CT-scan. In Main group, patients with overweight lost weight from baseline (- 12.4%; P < 0.0001); 2.9% in Main group and 7.2% in Controls were positive for COVID-19 (RR: 0.41, CI: 0.04-4.31; P = 0.22) on the 14th day of treatment. Body temperature and C-reactive protein decreased significantly in Main group compared to Controls on day 14th of treatment (P < 0.025). Systolic/diastolic BP normalized (P < 0.025), glucose/lipids metabolism (P < 0.025); ALT/AST normalized (P < 0.025), platelets increased from baseline (P < 0.025), chest CT (P < 0.025) in Main group at 14 day of treatment. The previous antidiabetic, antihypertensive, anti-inflammatory, hepatoprotective, and other symptomatic medications were adequately decreased to completely stop during the weight loss treatment. Thus, the fast weight loss treatment may be beneficial for the COVID-19 patients with comorbid T2D, hypertension, and NASH over traditional medical treatment because, it improved clinical and laboratory/instrumental data on inflammation; glucose/lipid metabolism, systolic/diastolic BPs, and NASH biochemical outcomes, reactive oxygen species; and allowed patients to stop taking medications. TRIAL REGISTRATION ClinicalTrials.gov NCT05635539 (02/12/2022): https://clinicaltrials.gov/ct2/show/NCT05635539?term=NCT05635539&draw=2&rank=1 .
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Affiliation(s)
- Kuat Oshakbayev
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan.
- ANADETO Medical Center, St. Kerey, Zhanibek Khans, 22, 010000, Astana, Republic of Kazakhstan.
| | - Aigul Durmanova
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan
| | - Zulfiya Zhankalova
- Department of General Medical Practice, Asfendiyarov Kazakh National Medical University, #1, Street Tole Bi, 94, 050000, Almaty, Republic of Kazakhstan
| | - Alisher Idrisov
- Department of Endocrinology, Astana Medical University, Street Beibitshilik St 49/A, Astana, Republic of Kazakhstan
| | - Gulnara Bedelbayeva
- Faculty of Postgraduate Education, Asfendiyarov Kazakh National Medical University, Street Tole Bi, 94, 050000, Almaty, Republic of Kazakhstan
| | - Meruyert Gazaliyeva
- Faculty of Internal Medicine, Astana Medical University, Street Beibitshilik St 49/A, Astana, Republic of Kazakhstan
| | - Altay Nabiyev
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan
| | - Attila Tordai
- Department of Transfusion Medicine, Semmelweis University, Vas U. 17, Budapest, 1088, Hungary
| | - Bibazhar Dukenbayeva
- Faculty of Pathology and Forensic Medicine, Astana Medical University, Astana, Republic of Kazakhstan
- ANADETO Medical Center, St. Kerey, Zhanibek Khans, 22, 010000, Astana, Republic of Kazakhstan
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Feghaly Z, Aoun R, Mouawad C, Chamaa B, Dahboul H, Kassar S, Osseis M, Noun R, Chakhtoura G. The Role of Obesity in the Poor Prognosis of COVID-19 Infection: A Review of 192 Patients. Interdiscip Perspect Infect Dis 2024; 2024:7212355. [PMID: 38770046 PMCID: PMC11105959 DOI: 10.1155/2024/7212355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Methods We performed a retrospective study on all patients having COVID-19 infection and admitted to our institution between March 2020 and June 2021. Inclusion criteria included any patient over the age of 18 admitted to our institution's COVID-19 unit, or intensive care unit, with a positive COVID-19 PCR or positive COVID-19 serology (IgM). Results 192 patients met the inclusion criteria, with an average age of 62.68 years and a slight male predominance (64.58%). 76.04% of hospitalized patients and 80% of those admitted to the ICU were either overweight or obese. No statistically significant difference was found regarding the risk of in-hospital mortality and invasive ventilation. The same applies to the length of stay, admission to intensive care, O2 needs, and for the various complications (all p values were >0.05). Patients with obesity type II and III have an increased risk of cardiac arrests and need for intubation and mechanical ventilation. Conclusion Obesity tends to be a major risk factor for a pejorative evolution in the COVID-19 infection.
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Affiliation(s)
- Ziad Feghaly
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Rany Aoun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bilal Chamaa
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michael Osseis
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Jung S. Associations between COVID-19 incidence, weight status, and social participation restrictions in the U.S.: evidence from the national population, cross-sectional study. BMC Public Health 2024; 24:1066. [PMID: 38632562 PMCID: PMC11022407 DOI: 10.1186/s12889-024-18566-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND To explore the associations between coronavirus infection incidence and weight status and social participation restrictions among community-dwelling adults in the United States. METHODS We analyzed data from the 2021 National Health Interview Survey (NHIS), which included a representative sample of 29,394 individuals (Coronavirus disease 2019 (COVID-19): 3,205) and a weighted total of 252,461,316 individuals (COVID-19: 31,697,404), considering the complex sampling design used in the survey. RESULTS Age, race/ethnicity, education level, family income index, body mass index (BMI), and smoking status were significantly associated with COVID-19 infection. Weight status was significantly correlated with social participation restrictions and strongly associated with COVID-19 infection, particularly among individuals who were overweight or obese. CONCLUSION Weight status was shown to be associated not only with social participation restrictions but also with COVID-19 infection among U.S. adults. Understanding the complex interplay between weight status, social participation, and COVID-19 is crucial for developing effective preventive measures and promoting overall well-being in the community population.
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Affiliation(s)
- SuJung Jung
- School of Nursing, California State University Long Beach, Long Beach, USA.
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7
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Kim J, Jang JH, Kim K, Park S, Lee SH, Park O, Kim TH, yeo HJ, Cho WH. Functional Aspects of the Obesity Paradox in Patients with Severe Coronavirus Disease-2019: A Retrospective, Multicenter Study. Tuberc Respir Dis (Seoul) 2024; 87:176-184. [PMID: 38147721 PMCID: PMC10990606 DOI: 10.4046/trd.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Results of studies investigating the association between body mass index (BMI) and mortality in patients with coronavirus disease-2019 (COVID-19) have been conflicting. METHODS This multicenter, retrospective observational study, conducted between January 2020 and August 2021, evaluated the impact of obesity on outcomes in patients with severe COVID-19 in a Korean national cohort. A total of 1,114 patients were enrolled from 22 tertiary referral hospitals or university-affiliated hospitals, of whom 1,099 were included in the analysis, excluding 15 with unavailable height and weight information. The effect(s) of BMI on patients with severe COVID-19 were analyzed. RESULTS According to the World Health Organization BMI classification, 59 patients were underweight, 541 were normal, 389 were overweight, and 110 were obese. The overall 28-day mortality rate was 15.3%, and there was no significant difference according to BMI. Univariate Cox analysis revealed that BMI was associated with 28-day mortality (hazard ratio, 0.96; p=0.045), but not in the multivariate analysis. Additionally, patients were divided into two groups based on BMI ≥25 kg/m2 and underwent propensity score matching analysis, in which the two groups exhibited no significant difference in mortality at 28 days. The median (interquartile range) clinical frailty scale score at discharge was higher in nonobese patients (3 [3 to 5] vs. 4 [3 to 6], p<0.001). The proportion of frail patients at discharge was significantly higher in the nonobese group (28.1% vs. 46.8%, p<0.001). CONCLUSION The obesity paradox was not evident in this cohort of patients with severe COVID-19. However, functional outcomes at discharge were better in the obese group.
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Affiliation(s)
- Jeongsu Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kipoong Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Onyu Park
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Pusan National University College of Nursing, Yangsan, Republic of Korea
| | - Tae Hwa Kim
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hye Ju yeo
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - On behalf of Korean Intensive Care Study Group
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Pusan National University College of Nursing, Yangsan, Republic of Korea
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Sardinha TG, Lajos GJ, Souza RT, Cecatti JG, Luz AG, Oppermann MLR, Pacagnella RC, Ribeiro-Do-Valle CC, Nobrega GM, Griggio TB, Charles CM, Silveira C, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa SH, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Candreucci CB, Guida JP, Correa Junior MD, Dias MA, Oliveira LG, Melo Junior EF, Da Luz MG, Costa ML. The effect of body mass index on maternal and perinatal outcomes in COVID-19 infection during pregnancy and postpartum: Secondary analysis from the REBRACO cohort study. Int J Gynaecol Obstet 2024; 164:1019-1027. [PMID: 38009566 DOI: 10.1002/ijgo.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum. METHOD Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes. RESULTS Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P = 0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08). CONCLUSION Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.
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Affiliation(s)
- Thais G Sardinha
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Adriana G Luz
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina C Ribeiro-Do-Valle
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | | | | | - Evelyn Traina
- Federal University of São Paulo-UNIFESP/EPM, São Paulo, São Paulo, Brazil
| | | | - Janete Vettorazzi
- Clinics Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Moinhos de Vento Hospital-HMV, Porto Alegre, Brazil
| | - Samira M Haddad
- Jorge Rossmann Regional Hospital-Sócrates Guanaes Institute, Itanhaém, São Paulo, Brazil
| | | | - José P Guida
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Sumaré State Hospital-HES, Sumaré, São Paulo, Brazil
| | | | - Marcos Ab Dias
- Fernandes Figueira Institute-IFF/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro G Oliveira
- São Paulo State University School of Medicine, Botucatu, São Paulo, Brazil
| | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Pavlidou E, Poulios E, Papadopoulou SK, Fasoulas A, Dakanalis A, Giaginis C. Clinical Evidence on the Potential Beneficial Effects of Diet and Dietary Supplements against COVID-19 Infection Risk and Symptoms' Severity. Med Sci (Basel) 2024; 12:11. [PMID: 38390861 PMCID: PMC10885051 DOI: 10.3390/medsci12010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diet and dietary supplements aim to add trace elements, vitamins, and minerals to the body to improve human health and boost the immune system. In the previous few years, the new SARS-CoV-2 coronavirus strain has been threatening the health of individuals and public health more broadly, with rates of intensive care unit cases on the rise, while long-term COVID-19 complications are persisting until today. In the peculiar circumstances of the COVID-19 pandemic, in combination with disease prevention techniques, the strengthening of the immune system is considered particularly important to enable it to effectively respond to and eliminate the SARS-CoV-2 viral pathogen in the event of infection. The purpose of the current literature review is to thoroughly summarize and critically analyze the current clinical data concerning the potential beneficial effects of diet and dietary supplements against COVID-19 infection risk and symptoms' severity. The micronutrients/supplements examined in this study in relation to COVID-19 infection are vitamins A, B, C, and D, zinc, selenium, magnesium, iron, omega-3 fatty acids, glutamine, resveratrol, beta-glucans, and probiotics. The potential effects of dietary patterns such as the Mediterranean diet against SARS-CoV-2 infection risk and symptoms' severity were also analyzed. Our literature review suggests that micro- and macronutrient supplementation and a healthy diet and lifestyle may provide support to immune system function, with beneficial effects both before and during SARS-CoV-2 infection. However, additional studies are recommended to draw safe conclusions and formulate dietary recommendations concerning dietary supplements and their possible effects on preventing and co-treating COVID-19 disease.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (E.P.); (A.F.)
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (E.P.); (A.F.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Aristeidis Fasoulas
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (E.P.); (A.F.)
| | - Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, MB, Italy;
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, MB, Italy
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (E.P.); (A.F.)
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10
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Li S, Fu Z, Zhang W, Liu H. Impact of obesity on intensive care unit outcomes in older patients with critical illness: A cohort study. PLoS One 2024; 19:e0297635. [PMID: 38354125 PMCID: PMC10866459 DOI: 10.1371/journal.pone.0297635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Although the paradoxical association between obesity and improved survival has been reported in a variety of clinical settings, its applicability to intensive care unit (ICU) outcomes in older critically ill patients remains unclear. We sought to examine the association between obesity and 30-day mortality and other adverse outcomes in this population. METHODS We analyzed data of older patients (≥ 60 years) in the eICU Collaborative Research Database. Body mass index (BMI) was stratified according to the World Health Organization obesity classification. Logistic regression model was used to estimate adjusted odds ratios (ORs), and cubic spline curve was used to explore the nonlinear association between BMI and 30-day ICU outcomes. Stratified analysis and sensitivity analysis were also performed. RESULTS Compared with class I obesity, under- and normal-weight were associated with higher all-cause, cardiovascular and noncardiovascular mortality, and class III obesity was associated with greater all-cause and cardiovascular mortality (OR, 1.18 [95% CI, 1.06-1.32], 1.28 [1.08-1.51]). Obesity classes II and III were associated with higher composite all-cause mortality, mechanical ventilation, or vasoactive drug usage risks (OR, 1.12 [95% CI, 1.04-1.20], 1.33 [1.24-1.43]). Mechanical ventilation was strongly positively associated with BMI. A significant BMI-by-sex interaction was observed for cardiovascular mortality, such that the association between severe obesity and mortality was more pronounced among older men than older women. CONCLUSIONS The obesity paradox does not appear to apply to short-term ICU outcomes in older patients with critical illness, mainly due to increased all-cause and cardiovascular mortality in severely obese patients, particularly in men.
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Affiliation(s)
- Shan Li
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhiqing Fu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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11
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Varghese JS, Guo Y, Ali MK, Troy Donahoo W, Chakkalakal RJ. Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.12.24302697. [PMID: 38405934 PMCID: PMC10888974 DOI: 10.1101/2024.02.12.24302697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective To study body mass index (BMI) changes among individuals aged 18-99 years with and without SARS-CoV-2 infection. Subjects/Methods Using real-world data from the OneFlorida+ Clinical Research Network of the National Patient-Centered Clinical Research Network, we compared changes over time in BMI in an Exposed cohort (positive SARS-CoV-2 test between March 2020 - January 2022), to a contemporary Unexposed cohort (negative SARS-CoV-2 tests), and an age/sex-matched Historical control cohort (March 2018 - January 2020). Body mass index (kg/m2) was retrieved from objective measures of height and weight in electronic health records. We used target trial approaches to estimate BMI at baseline and change per 100 days of follow-up for Unexposed and Historical cohorts relative to the Exposed cohort by categories of sex, race-ethnicity, age, and hospitalization status. Results The study sample consisted of 44,436 (Exposed cohort), 164,118 (Unexposed cohort), and 41,189 (Historical cohort). Cumulatively, 62% were women, 21.5% Non-Hispanic Black, 21.4% Hispanic and 5.6% Non-Hispanic Other. Patients had an average age of 51.9 years (SD: 18.9). At baseline, relative to the Exposed cohort (mean BMI: 29.3 kg/m2 [95%CI: 29.0, 29.7]), the Unexposed (-0.07 kg/m2 [95%CI; -0.12, -0.01]) and Historical controls (-0.27 kg/m2 [95%CI; -0.34, -0.20]) had lower BMI. Relative to no change in the Exposed over 100 days (0.00 kg/m2 [95%CI; -0.03,0.03]), the BMI of those Unexposed decreased (-0.04 kg/m2 [95%CI; -0.06, -0.01]) while the Historical cohort's BMI increased (+0.03 kg/m2 [95%CI;0.00,0.06]). BMI changes were consistent between Exposed and Unexposed cohorts for most population groups, except at start of follow-up period among Males and those 65 years or older, and in changes over 100 days among Males and Hispanics. Conclusions In a diverse real-world cohort of adults, mean BMI of those with and without SARS-CoV2 infection varied in their trajectories. The mechanisms and implications of weight retention following SARS-CoV-2 infection remain unclear.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA
| | - W. Troy Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine University of Florida Gainesville FL USA
| | - Rosette J. Chakkalakal
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, USA
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12
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Oh DS, Kim E, Lu G, Normand R, Shook LL, Lyall A, Jasset O, Demidkin S, Gilbert E, Kim J, Akinwunmi B, Tantivit J, Tirard A, Arnold BY, Slowikowski K, Goldberg MB, Filbin MR, Hacohen N, Nguyen LH, Chan AT, Yu XG, Li JZ, Yonker L, Fasano A, Perlis RH, Pasternak O, Gray KJ, Choi GB, Drew DA, Sen P, Villani AC, Edlow AG, Huh JR. SARS-CoV-2 infection elucidates unique features of pregnancy-specific immunity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.05.24301794. [PMID: 38370801 PMCID: PMC10871456 DOI: 10.1101/2024.02.05.24301794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Pregnancy is a risk factor for increased severity of SARS-CoV-2 and other respiratory infections. The mechanisms underlying this risk have not been well-established, partly due to a limited understanding of how pregnancy shapes immune responses. To gain insight into the role of pregnancy in modulating immune responses at steady state and upon perturbation, we collected peripheral blood mononuclear cells (PBMC), plasma, and stool from 226 women, including 152 pregnant individuals (n = 96 with SARS-CoV-2 infection and n = 56 healthy controls) and 74 non-pregnant women (n = 55 with SARS-CoV-2 and n = 19 healthy controls). We found that SARS-CoV-2 infection was associated with altered T cell responses in pregnant compared to non-pregnant women. Differences included a lower percentage of memory T cells, a distinct clonal expansion of CD4-expressing CD8 + T cells, and the enhanced expression of T cell exhaustion markers, such as programmed cell death-1 (PD-1) and T cell immunoglobulin and mucin domain-3 (Tim-3), in pregnant women. We identified additional evidence of immune dysfunction in severely and critically ill pregnant women, including a lack of expected elevation in regulatory T cell (Treg) levels, diminished interferon responses, and profound suppression of monocyte function. Consistent with earlier data, we found maternal obesity was also associated with altered immune responses to SARS-CoV-2 infection, including enhanced production of inflammatory cytokines by T cells. Certain gut bacterial species were altered in pregnancy and upon SARS-CoV-2 infection in pregnant individuals compared to non-pregnant women. Shifts in cytokine and chemokine levels were also identified in the sera of pregnant individuals, most notably a robust increase of interleukin-27 (IL-27), a cytokine known to drive T cell exhaustion, in the pregnant uninfected control group compared to all non-pregnant groups. IL-27 levels were also significantly higher in uninfected pregnant controls compared to pregnant SARS-CoV-2-infected individuals. Using two different preclinical mouse models of inflammation-induced fetal demise and respiratory influenza viral infection, we found that enhanced IL-27 protects developing fetuses from maternal inflammation but renders adult female mice vulnerable to viral infection. These combined findings from human and murine studies reveal nuanced pregnancy-associated immune responses, suggesting mechanisms underlying the increased susceptibility of pregnant individuals to viral respiratory infections.
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13
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Maharat M, Rahimlou M, Sioofi A, Sajjadi SF, Moosavian SP. Association of major dietary patterns with socioeconomic status, obesity, and contracting COVID-19 among Iranian adults. Front Nutr 2024; 11:1301634. [PMID: 38347959 PMCID: PMC10859857 DOI: 10.3389/fnut.2024.1301634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic clearly affected the lifestyle and dietary habits of millions of people worldwide. The purpose of this study was to evaluate the association of major dietary patterns with socioeconomic status, obesity, and contracting COVID-19. Methods We conducted a cross-sectional study using an online survey for data collection with a total of 1,187 participants (over the age of 18 years) who reported their sociodemographic details, anthropometric index (weight and height), and dietary intake. Multivariable logistic regression models were applied to assess the association between major dietary patterns and study outcomes. Results A total of 1,106 adults were included in the current analysis. We identified three major dietary patterns (plant-based, meat, and Western dietary patterns). The mean age of participants was significantly higher in the upper tertile of plant-based dietary patterns (DPs) compared to the first tertile, while it was lower in the top tertile of meat and Western DPs. The percentage of participants who lived in urban areas was significantly higher in the third tertile of meat DP than in the first tertile (p < 0.001). Moderate adherence to Western DP was significantly associated with increased odds of obesity (OR: 1.79; 95% CI: 1.17, 2.74). In addition, high adherence to Western DP was significantly related to increased odds of obesity after controlling for confounders. Subjects in the second tertile of the Western DP had higher odds (95% Cl: 1.04, 1.92) for COVID-19 infection than the first tertile. Conclusion This study showed that moderate and high adherence to a Western dietary pattern was associated with a higher risk of obesity and COVID-19 infection during the pandemic. Future studies are needed to confirm these findings.
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Affiliation(s)
- Maryam Maharat
- Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ali Sioofi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Forough Sajjadi
- Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Parisa Moosavian
- Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Covill LE, Sendel A, Campbell TM, Piiroinen I, Enoksson SL, Borgström EW, Hansen S, Ma K, Marits P, Norlin AC, Smith CIE, Kåhlin J, Eriksson LI, Bergman P, Bryceson YT. Evaluation of Genetic or Cellular Impairments in Type I IFN Immunity in a Cohort of Young Adults with Critical COVID-19. J Clin Immunol 2024; 44:50. [PMID: 38231281 PMCID: PMC10794435 DOI: 10.1007/s10875-023-01641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Several genetic and immunological risk factors for severe COVID-19 have been identified, with monogenic conditions relating to 13 genes of type I interferon (IFN) immunity proposed to explain 4.8% of critical cases. However, previous cohorts have been clinically heterogeneous and were not subjected to thorough genetic and immunological analyses. We therefore aimed to systematically investigate the prevalence of rare genetic variants causing inborn errors of immunity (IEI) and functionally interrogate the type I IFN pathway in young adults that suffered from critical COVID-19 yet lacked comorbidities. We selected and clinically characterized a cohort of 38 previously healthy individuals under 50 years of age who were treated in intensive care units due to critical COVID-19. Blood samples were collected after convalescence. Two patients had IFN-α autoantibodies. Genome sequencing revealed very rare variants in the type I IFN pathway in 31.6% of the patients, which was similar to controls. Analyses of cryopreserved leukocytes did not indicate any defect in plasmacytoid dendritic cell sensing of TLR7 and TLR9 agonists in patients carrying variants in these pathways. However, lymphocyte STAT phosphorylation and protein upregulation upon IFN-α stimulation revealed three possible cases of impaired type I IFN signaling in carriers of rare variants. Together, our results suggest a strategy of functional screening followed by genome analyses and biochemical validation to uncover undiagnosed causes of critical COVID-19.
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Affiliation(s)
- L E Covill
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - A Sendel
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T M Campbell
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - I Piiroinen
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - S Lind Enoksson
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Wahren Borgström
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Hansen
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - K Ma
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - P Marits
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - A C Norlin
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - C I E Smith
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Kåhlin
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - L I Eriksson
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - P Bergman
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y T Bryceson
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
- Broegelmann Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway.
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15
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Zhao Y, Araki T. Diet quality and its associated factors among adults with overweight and obesity: findings from the 2015-2018 National Health and Nutrition Examination Survey. Br J Nutr 2024; 131:134-142. [PMID: 37462503 DOI: 10.1017/s0007114523001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
The rate of adult severe obesity has been continually rising in the USA. While improving diet quality has been shown to reduce the risk of obesity, few studies have explored the differences in diet quality among adults with overweight and obesity by different weight statuses along with socio-demographic factors and physical activity using data from a nationally representative survey in the USA. The main goal of the study is to assess the diet quality of adults with overweight and obesity by examining differences in the Healthy Eating Index-2015 (HEI-2015) scores, using data from the 2015-2018 National Health and Nutrition Survey. Among 6746 adults with overweight and obesity (aged ≥ 20 years), severe obesity was prevalent (27 %), particularly among females, non-Hispanic Blacks and those with lower education and income. Compared to adults with overweight, adults with severe obesity had lower HEI-2015 total scores as well as component scores for total fruits, whole fruits, greens and beans, refined grains, sodium and saturated fats. Among adults with overweight and obesity, non-Hispanic Blacks had lower diet quality than non-Hispanic Asians; females had better diet quality than males; older adults had better diet quality than younger adults; adults with a college degree and above had better diet quality than those with less than a high school degree. Socio-demographic differences in diet quality and weight status should be considered in future obesity interventions to reduce adult severe obesity in the USA.
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Affiliation(s)
- Yajie Zhao
- International Agro-Informatics Laboratory, Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Japan
| | - Tetsuya Araki
- International Agro-Informatics Laboratory, Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Japan
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16
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Kapinos KA, Peters RM, Murphy RE, Hohmann SF, Podichetty A, Greenberg RS. Inpatient Costs of Treating Patients With COVID-19. JAMA Netw Open 2024; 7:e2350145. [PMID: 38170519 PMCID: PMC10765267 DOI: 10.1001/jamanetworkopen.2023.50145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies. Objective To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics. Design, Setting, and Participants This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US. Main Outcomes and Measures Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices. Results The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284). Conclusions and Relevance In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.
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Affiliation(s)
| | - Richard M. Peters
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Robert E. Murphy
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Ankita Podichetty
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | - Raymond S. Greenberg
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas
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17
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Patel H, Burgner D, Whittaker E. Multisystem inflammatory syndrome in children: a longitudinal perspective on risk factors and future directions. Pediatr Res 2024; 95:15-17. [PMID: 37667033 DOI: 10.1038/s41390-023-02803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatrics, Imperial College, London, UK
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - Elizabeth Whittaker
- Department of Infectious Disease, Section of Paediatrics, Imperial College, London, UK
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
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18
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Douda L, Hasnat H, Schwank J, Nassar S, Jackson NM, Flynn JC, Gardiner J, Misra DP, Sankari A. Predictors of Intensive Care Unit Admissions in Patients Presenting with Coronavirus Disease 2019. Avicenna J Med 2024; 14:45-53. [PMID: 38694135 PMCID: PMC11057900 DOI: 10.1055/s-0043-1778068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Increased mortality rates among coronavirus disease 2019 (COVID-19) positive patients admitted to intensive care units (ICUs) highlight a compelling need to establish predictive criteria for ICU admissions. The aim of our study was to identify criteria for recognizing patients with COVID-19 at elevated risk for ICU admission. Methods We identified patients who tested positive for COVID-19 and were hospitalized between March and May 2020. Patients' data were manually abstracted through review of electronic medical records. An ICU admission prediction model was derived from a random sample of half the patients using multivariable logistic regression. The model was validated with the remaining half of the patients using c-statistic. Results We identified 1,094 patients; 204 (18.6%) were admitted to the ICU. Correlates of ICU admission were age, body mass index (BMI), quick Sequential Organ Failure Assessment (qSOFA) score, arterial oxygen saturation to fraction of inspired oxygen ratio, platelet count, and white blood cell count. The c-statistic in the derivation subset (0.798, 95% confidence interval [CI]: 0.748, 0.848) and the validation subset (0.764, 95% CI: 0.706, 0.822) showed excellent comparability. At 22% predicted probability for ICU admission, the derivation subset estimated sensitivity was 0.721, (95% CI: 0.637, 0.804) and specificity was 0.763, (95% CI: 0.722, 0.804). Our pilot predictive model identified the combination of age, BMI, qSOFA score, and oxygenation status as significant predictors for ICU admission. Conclusion ICU admission among patients with COVID-19 can be predicted by age, BMI, level of hypoxia, and severity of illness.
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Affiliation(s)
- Lahib Douda
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Heraa Hasnat
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Jennifer Schwank
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Sarien Nassar
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Nancy M. Jackson
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Jeffrey C. Flynn
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Abdulghani Sankari
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
- Department of Medicine, Wayne State University, Detroit, Michigan, United States
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19
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Mukhopadhyay S. The effects of the COVID-19 pandemic on the mental health of people with obesity. Stress Health 2023. [PMID: 38126550 DOI: 10.1002/smi.3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Obesity is a risk factor for anxiety and depression. Obesity is also a risk factor for severe COVID-19 disease and therefore may have contributed to adverse mental health outcomes in this vulnerable population during the COVID-19 pandemic. We compare the trajectory of mental health outcomes of people with obesity with normal-weight people before and during the COVID-19 pandemic using nationally representative individual-level longitudinal data from the National Health Interview Survey and Difference-in-Difference regressions. Our results indicate that severe anxiety increased by 2.75 (95% CI: 0.0056-0.0494; p-value 0.014) percentage points, representing a 31.3% relative increase, and anxiety-related prescription drug usage increased by 2.75 (95% CI: 0.0076-0.0473; p-value<0.01) percentage points, representing a 19.2% relative increase among people with obesity, compared to normal-weight people. We conclude that people with obesity experienced an increase in the incidence of severe anxiety and anxiety-related prescription drug usage during the COVID-19 pandemic, which was not observed among normal-weight individuals. Furthermore, women, less-educated, and rural residents with obesity disproportionately bore the burden of the pandemic.
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20
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Harding JL, Doucet N, Patel SA, Davis T, McDonald B, Goldberg B, Patzer RE, Walker-Williams D, Jagannathan R, Teunis L, Gander JC. The Association Between Black vs. White Race and 30-Day Hospitalization Among People Diagnosed with COVID-19 Within an Integrated Care Setting: a Cohort Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01894-x. [PMID: 38110800 DOI: 10.1007/s40615-023-01894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Black Americans are more likely to experience hospitalization from COVID-19 compared with White Americans. Whether this excess risk differs by age, sex, obesity, or diabetes, key risk factors for COVID hospitalization, among an integrated population with uniform healthcare access, are less clear. METHODS We identified all adult members (≥ 18 years) of Kaiser Permanente Georgia (KPGA) diagnosed with COVID-19 between January 1, 2020, and September 30, 2021 (N = 24,564). We restricted the analysis to members of Black or White race identified from electronic medical records. Our primary outcome was first hospitalization within 30 days of COVID-19 diagnosis. To assess the association between race and 30-day hospitalization, we performed multivariable logistic regression adjusting for several member and neighborhood-level characteristics, and tested for interactions of race with age, sex, diabetes, and obesity. A regression-based decomposition method was then used to estimate how much of the observed race disparity in 30-day hospitalization could be explained by member and neighborhood-level factors. RESULTS Overall, 11.27% of Black KPGA members were hospitalized within 30 days of a COVID diagnosis, as compared with 9.44% of White KPGA members. Black (vs. White) KPGA members had a 34% (aOR: 1.32 [95% CI: 1.19-1.47]) higher odds of 30-day hospitalization following COVID-19 after accounting for clinical differences. The odds of 30-day hospitalization in Black vs. White KPGA members did not differ significantly by sex (men: 1.46 [1.25-1.70]; women: 1.24 [1.07-1.43]), by age (18-29 years: 1.33 [0. 841-2.10]; 30-49 years: 1.26 [1.02-1.56]; ≥ 50 years: 1.24 [1.10-1.41]); by diabetes status (with diabetes: 1.38 [1.16-1.66]; without diabetes: 1.26 [1.11-1.44]), or by obesity (with obesity: 1.31 [1.15-1.50]; without obesity: 1.28 [1.06-1.53]). Factors that, if Black and White KPGA members had the same level of exposure, would be most likely to reduce the Black-White disparity in 30-day hospitalization from COVID-19 were obesity, history of flu vaccine, and neighborhood-level income and social vulnerability. CONCLUSIONS Early in the pandemic, Black (vs. White) members of an integrated health system had higher odds of being hospitalized within 30 days of COVID-19 diagnosis and this excess risk was similar by sex, age, and comorbidities. Factors that explained the largest proportions of race-based disparities were obesity, receipt of flu vaccine, and neighborhood-level social determinants of health. These findings suggest that social determinants of health, or other unmeasured factors, may be drivers of racial disparities in COVID-19 outcomes.
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Affiliation(s)
- Jessica L Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nicole Doucet
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shivani A Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Teaniese Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Bennett McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Benjamin Goldberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel E Patzer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | | | - Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Larissa Teunis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer C Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
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21
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Gallagher C, Ording J. A Comprehensive Obesity Benefit as a Guide for Employers on the Core Components of Obesity Care: Guidance From the American College of Occupational and Environmental Medicine (ACOEM) Roundtable on Obesity. J Occup Environ Med 2023; 65:e808-e811. [PMID: 37800332 DOI: 10.1097/jom.0000000000002987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage. METHODS In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees. RESULTS Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care. CONCLUSION Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees.
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Affiliation(s)
- Christine Gallagher
- George Washington University, Washington, DC; and American College of Occupational and Environmental Medicine, Elk Grove Village, IL
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22
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Aldiabat M, Kilani Y, Arshad I, Rana T, Aleyadeh W, Al Ta'ani O, Aljabiri Y, Alsakarneh S, Abdelfattah T, Alhuneafat L, Manvar A. Determinants and outcomes of acute pancreatitis in patients hospitalized for COVID-19: Early pandemic experience. Pancreatology 2023; 23:926-934. [PMID: 37865613 DOI: 10.1016/j.pan.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES To examine the predictors and outcomes associated with the development of acute pancreatitis (AP) in patients hospitalized with Coronavirus Disease 2019 (COVID-19). METHODS This is an observational analysis of the 2020 National Inpatient Sample Database. The study includes adult patients who were admitted with a confirmed diagnosis of COVID-19 and stratifies them based on the presence or absence of AP during their hospitalization. Predictors of AP development between the two groups and differences in outcomes are examined. Multivariate logistic regression analysis using Stata/BE 17.0 is conducted, with adjustments made for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical significance is determined at a p-value of <0.05. RESULTS Significant factors associated with an increased risk of AP in COVID-19 patients include Hispanic ethnicity, higher Charlson Comorbidity Index (CCI) score, residence in states located in the southern region, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use. COVID-19 patients who developed AP were also found to be at higher risk of adverse outcomes, including mortality, acute coronary syndrome, acute kidney injury, sepsis, septic shock, in-hospital cardiac arrest, invasive mechanical ventilation, upper gastrointestinal bleeding, prolonged length of stay, and increased healthcare cost. CONCLUSIONS In hospitalized patients with COVID-19, the presence of AP is associated with increased mortality and morbidity. Risk factors for developing AP in this population include Hispanic ethnicity, residence in the southern region, higher Charlson Comorbidity Index (CCI) score, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use.
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Affiliation(s)
- Mohammad Aldiabat
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weil Cornell Medicine, Bronx, NY, USA.
| | - Iqra Arshad
- Department of Medicine, Lincoln Medical Center/Weil Cornell Medicine, Bronx, NY, USA.
| | - Tabeer Rana
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Wesam Aleyadeh
- Department of Medicine, Cleveland Clinic Akron General, Akron, OH, USA.
| | - Omar Al Ta'ani
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Yazan Aljabiri
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, 64108, USA.
| | - Thaer Abdelfattah
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Amar Manvar
- Division of Gastroenterology, NYU Langone Health, Mineola, NY, USA.
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23
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Marchesi F, Dalmonte G, Riccò M, Martines G, Dibra R, Bernante P, Balsamo F, Anzolin F, Gagliardi S, Conti L, Rampulla A, Prioriello C, Ballabeni L, Tartamella F, Del Rio P, Valente M. Bariatric Surgery and COVID-19: a Change of Perspective in a New Phase of the Pandemic. Obes Surg 2023; 33:4049-4057. [PMID: 37897638 DOI: 10.1007/s11695-023-06923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE The protective role of bariatric surgery (BS) against COVID-19 has been reported by several studies, showing, in the first pandemic waves, better outcome of the infection in patients that had undergone BS. With the virus progressive endemicity, BS benefits on COVID-19 clinical course could appear less evident, while COVID-19 effects on BS outcomes must be investigated. In this national multicentric cross-sectional study, we compared COVID-19 incidence and clinical course between a cohort of patients that had undergone BS (OP) and a cohort of candidates to BS (WS); moreover, we analyzed BS outcomes based on SARS-CoV-2 positivity/negativity. METHODS From June to December 2021, 522 patients from five Italian referral centers were administered an 87-item telephonic questionnaire completing the analysis of electronic medical records. Demographics, COVID-19 "tested" incidence, suggestive symptoms and clinical outcome parameters of OP and WS were compared. BS outcomes parameters were compared between OP that developed the disease or not. RESULTS COVID-19 incidence was the same in OP and WS, while symptoms and clinical course seemed milder in OP, with no data individually reaching statistical significance. OP who developed SARS-CoV-2 infection had higher excess weight loss than negative OP (66.8% ± 22.1 vs. 57.7% ± 22.8, p = 0.029). Positive OP had had gastric-bypass (RYGB/OAGB) more frequently than negative ones (38.4% vs. 18.2%, p = 0.025). CONCLUSION With the disease becoming endemic, BS protective role against COVID-19 seems clinically less relevant. BS outcomes can be affected by COVID-19, thus imposing careful follow-up for positive patients, especially if undergoing gastric-bypass.
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Affiliation(s)
- Federico Marchesi
- Unit of General Surgery, Department of Surgery, Parma University Hospital, Parma, Italy.
| | - Giorgio Dalmonte
- Unit of General Surgery, Parma University Hospital, Parma, Italy
| | - Matteo Riccò
- Dipartimento di Sanità Pubblica/Public Health, AUSL-IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Gennaro Martines
- Unit of General Surgery "M. Rubino", Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Rigers Dibra
- Unit of General Surgery "M. Rubino", Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Paolo Bernante
- Centro di Chirurgia Metabolica e dell'Obesità, IRCCS Azienda Ospedaliera Universitaria di Bologna Policlinico di Sant Orsola, Bologna, Italy
| | - Francesca Balsamo
- Centro di Chirurgia Metabolica e dell'Obesità, IRCCS Azienda Ospedaliera Universitaria di Bologna Policlinico di Sant Orsola, Bologna, Italy
| | | | - Stefano Gagliardi
- Centro di Chirurgia Metabolica e dell'Obesità Ausl-Aosp, Bologna, Italy
| | - Luigi Conti
- UO Chirurgia Generale, Vascolare e Toracica, Dipartimento Chirurgico, Ospedale G. Da Saliceto, AUSL, Piacenza, Italy
| | - Alessandro Rampulla
- UO Medicina Interna, Malattia Metaboliche e DCA, Ospedale G. Da Saliceto, AUSL, Piacenza, Italy
| | - Concetta Prioriello
- Unit of General Surgery, Department of Surgery, Parma University Hospital, Parma, Italy
| | - Lucia Ballabeni
- Unit of General Surgery, Department of Surgery, Parma University Hospital, Parma, Italy
| | | | - Paolo Del Rio
- Unit of General Surgery, Department of Surgery, Parma University Hospital, Parma, Italy
| | - Marina Valente
- Unit of General Surgery, Parma University Hospital, Parma, Italy
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24
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Johnson RM, Ardanuy J, Hammond H, Logue J, Jackson L, Baracco L, McGrath M, Dillen C, Patel N, Smith G, Frieman M. Diet-induced obesity and diabetes enhance mortality and reduce vaccine efficacy for SARS-CoV-2. J Virol 2023; 97:e0133623. [PMID: 37846985 PMCID: PMC10688338 DOI: 10.1128/jvi.01336-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 10/18/2023] Open
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a wide spectrum of diseases in the human population, from asymptomatic infections to death. It is important to study the host differences that may alter the pathogenesis of this virus. One clinical finding in coronavirus disease 2019 (COVID-19) patients is that people with obesity or diabetes are at increased risk of severe illness from SARS-CoV-2 infection. We used a high-fat diet model in mice to study the effects of obesity and type 2 diabetes on SARS-CoV-2 infection as well as how these comorbidities alter the response to vaccination. We find that diabetic/obese mice have increased disease after SARS-CoV-2 infection and they have slower clearance of the virus. We find that the lungs of these mice have increased neutrophils and that removing these neutrophils protects diabetic/obese mice from disease. This demonstrates why these diseases have increased risk of severe disease and suggests specific interventions upon infection.
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Affiliation(s)
- Robert M. Johnson
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeremy Ardanuy
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Holly Hammond
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James Logue
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lian Jackson
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lauren Baracco
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marisa McGrath
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carly Dillen
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Matthew Frieman
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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25
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Ripoll JG, Chang MC, Nabzdyk CS, Balakrishna A, Ortoleva J, Bittner EA. Should Obesity Be an Exclusion Criterion for Extracorporeal Membrane Oxygenation Support? A Scoping Review. Anesth Analg 2023:00000539-990000000-00664. [PMID: 38009837 DOI: 10.1213/ane.0000000000006745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Obesity is often considered a contraindication to extracorporeal membrane oxygenation (ECMO) candidacy due to technical challenges with vascular access, higher cardiac output requirements, and known associations between obesity and overall increased morbidity and mortality due to chronic health conditions. However, a growing body of literature suggests that ECMO may be as safe and efficacious in both obese and nonobese patients. This scoping review provides a synthesis of the available literature on the outcomes of obese patients supported with (1) venovenous (VV)-ECMO in acute respiratory distress syndrome (ARDS) not due to coronavirus disease 2019 (COVID-19), (2) VV-ECMO in ARDS due to COVID-19, (3) venoarterial (VA)-ECMO for all indications, and (4) studies combining data of patients supported with VA- and VV-ECMO. A librarian-assisted search was performed using 4 primary electronic medical databases (PubMed, Web of Science, Excerpta Medica database [Embase], and Cochrane Library) from January 2003 to March 2023. Articles that reported outcomes of obese patients requiring ECMO support were included. Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. A total of 354 publications were imported for screening on titles and abstracts, and 30 studies were selected for full-text review. A total of 26 publications met the inclusion criteria: 7 on VV-ECMO support in non-COVID-19 ARDS patients, 6 on ECMO in COVID-19 ARDS patients, 8 in patients supported with VA-ECMO, and 5 combining both VA- and VV-ECMO data. Although the included studies are limited to retrospective analyses and display a heterogeneity in definitions of obesity and comparison groups, the currently available literature suggests that outcomes and complications of ECMO therapy are equivalent in obese patients as compared to nonobese patients. Hence, obesity as measured by body mass index alone should not be considered an exclusion criterion in the decision to initiate ECMO.
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Affiliation(s)
- Juan G Ripoll
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marvin C Chang
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christoph S Nabzdyk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aditi Balakrishna
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts
| | - Edward A Bittner
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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26
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Chenchula S, Sharma S, Tripathi M, Chavan M, Misra AK, Rangari G. Prevalence of overweight and obesity and their effect on COVID-19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta-analysis. Obes Rev 2023; 24:e13616. [PMID: 37574901 DOI: 10.1111/obr.13616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
Cohort studies have shown that both overweight and obesity have their impact by increasing hospitalization with COVID-19. We conducted a systematic literature search in PubMed, Google Scholar, and MedRxiv databases following the PRISMA guidelines. Statistical analyses were performed using STATA software version 16 MP (Stata Corp, College Station, TX, USA) and Med Calc software version 22.009(Med Calc software Ltd, Ostend, Belgium). The primary outcome was to measure the prevalence of overweight and obesity and their impact on the risk of hospitalization among COVID-19 patients under and above 50 years of age. In total, 184 studies involving 2,365,377 patients were included. The prevalence of overweight was highest among those younger than 50 years of age over those older than 50 years of age, (26.33% vs. 30.46%), but there was no difference in obesity (36.30% vs. 36.02%). Overall, the pooled prevalence of overweight and obesity among hospitalized COVID-19 patients was 31.0% and 36.26%, respectively. Compared with normal weight, the odds of hospitalization with overweight (odds ratio [OR] 2.186, 95% confidence interval [CI] [1.19, 3.99], p < 0.01) and obesity (OR 3.069, 95% CI [1.67, 5.61], p < 0.001) in those younger than 50 years and obesity (OR 3.977, 95% CI [2.75, 5.73], p < 0.001) in the older than 50 years age group were significantly high. The increased prevalence of overweight and obesity among the under 50 years age group and obesity among the older than 50 years age group significantly increased the rate of COVID-19 infections, severity and hospitalization.
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Affiliation(s)
- Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
| | - Sushil Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
| | - Mukesh Tripathi
- Department of Anaesthesia and Critical care Medicine, All India Institute of Medical Sciences, Mangalagiri, India
| | - Madhavrao Chavan
- Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
| | - Arup Kumar Misra
- Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
| | - Gaurav Rangari
- Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
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27
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Calder PC. Nutrition and immunity: lessons from coronavirus disease-2019. Proc Nutr Soc 2023:1-16. [PMID: 37886807 DOI: 10.1017/s0029665123004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.
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Affiliation(s)
- Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
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28
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Velez T, Wang T, Garibaldi B, Singman E, Koutroulis I. Identification and Prediction of Clinical Phenotypes in Hospitalized Patients With COVID-19: Machine Learning From Medical Records. JMIR Form Res 2023; 7:e46807. [PMID: 37642512 PMCID: PMC10589836 DOI: 10.2196/46807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There is significant heterogeneity in disease progression among hospitalized patients with COVID-19. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response that in some patients unpredictably and rapidly leads to "hyperinflammation" associated with increased risk of mortality. The early identification of patients at risk of progression to hyperinflammation may help inform timely therapeutic decisions and lead to improved outcomes. OBJECTIVE The primary objective of this study was to use machine learning to reproducibly identify specific risk-stratifying clinical phenotypes across hospitalized patients with COVID-19 and compare treatment response characteristics and outcomes. A secondary objective was to derive a predictive phenotype classification model using routinely available early encounter data that may be useful in informing optimal COVID-19 bedside clinical management. METHODS This was a retrospective analysis of electronic health record data of adult patients (N=4379) who were admitted to a Johns Hopkins Health System hospital for COVID-19 treatment from 2020 to 2021. Phenotypes were identified by clustering 38 routine clinical observations recorded during inpatient care. To examine the reproducibility and validity of the derived phenotypes, patient data were randomly divided into 2 cohorts, and clustering analysis was performed independently for each cohort. A predictive phenotype classifier using the gradient-boosting machine method was derived using routine clinical observations recorded during the first 6 hours following admission. RESULTS A total of 2 phenotypes (designated as phenotype 1 and phenotype 2) were identified in patients admitted for COVID-19 in both the training and validation cohorts with similar distributions of features, correlations with biomarkers, treatments, comorbidities, and outcomes. In both the training and validation cohorts, phenotype-2 patients were older; had elevated markers of inflammation; and were at an increased risk of requiring intensive care unit-level care, developing sepsis, and mortality compared with phenotype-1 patients. The gradient-boosting machine phenotype prediction model yielded an area under the curve of 0.89 and a positive predictive value of 0.83. CONCLUSIONS Using machine learning clustering, we identified and internally validated 2 clinical COVID-19 phenotypes with distinct treatment or response characteristics consistent with similar 2-phenotype models derived from other hospitalized populations with COVID-19, supporting the reliability and generalizability of these findings. COVID-19 phenotypes can be accurately identified using machine learning models based on readily available early encounter clinical data. A phenotype prediction model based on early encounter data may be clinically useful for timely bedside risk stratification and treatment personalization.
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Affiliation(s)
- Tom Velez
- Computer Technology Associates, Cardiff, CA, United States
| | - Tony Wang
- Imedacs, Ann Arbor, MI, United States
| | - Brian Garibaldi
- Biocontainment Unit, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric Singman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ioannis Koutroulis
- Division of Emergency Medicine, Childrens National Hospital, Washington, DC, United States
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Zhang J, Wen J, Wan X, Luo P. The causal relationship between air pollution, obesity, and COVID-19 risk: a large-scale genetic correlation study. Front Endocrinol (Lausanne) 2023; 14:1221442. [PMID: 37867515 PMCID: PMC10585274 DOI: 10.3389/fendo.2023.1221442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/10/2023] [Indexed: 10/24/2023] Open
Abstract
Objective Observational evidence reported that air pollution is a significant risk element for numerous health problems, such as obesity and coronavirus disease 2019 (COVID-19), but their causal relationship is currently unknown. Our objective was to probe the causal relationship between air pollution, obesity, and COVID-19 and to explore whether obesity mediates this association. Methods We obtained instrumental variables strongly correlated to air pollutants [PM2.5, nitrogen dioxide (NO2) and nitrogen oxides (NOx)], 9 obesity-related traits (abdominal subcutaneous adipose tissue volume, waist-to-hip ratio, body mass index, hip circumference, waist circumference, obesity class 1-3, visceral adipose tissue volume), and COVID-19 phenotypes (susceptibility, hospitalization, severity) from public genome-wide association studies. We used clinical and genetic data from different public biological databases and performed analysis by two-sample and two-step Mendelian randomization. Results PM2.5 genetically correlated with 5 obesity-related traits, which obesity class 1 was most affected (beta = 0.38, 95% CI = 0.11 - 0.65, p = 6.31E-3). NO2 genetically correlated with 3 obesity-related traits, which obesity class 1 was also most affected (beta = 0.33, 95% CI = 0.055 - 0.61, p = 1.90E-2). NOx genetically correlated with 7 obesity-related traits, which obesity class 3 was most affected (beta = 1.16, 95% CI = 0.42-1.90, p = 2.10E-3). Almost all the obesity-related traits genetically increased the risks for COVID-19 phenotypes. Among them, body mass index, waist circumference, hip circumference, waist-to-hip ratio, and obesity class 1 and 2 mediated the effects of air pollutants on COVID-19 risks (p < 0.05). However, no direct causal relationship was observed between air pollution and COVID-19. Conclusion Our study suggested that exposure to heavy air pollutants causally increased risks for obesity. Besides, obesity causally increased the risks for COVID-19 phenotypes. Attention needs to be paid to weight status for the population who suffer from heavy air pollution, as they are more likely to be susceptible and vulnerable to COVID-19.
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Affiliation(s)
- Jingwei Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Wan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Raffoul A, Beccia AL, Jackson DA, Sarda V, Hart JE, Chavarro JE, Austin SB. Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States. Soc Sci Med 2023; 335:116232. [PMID: 37708694 PMCID: PMC10567056 DOI: 10.1016/j.socscimed.2023.116232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m2 and 30-34.9 kg/m2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic.
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Affiliation(s)
- Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Destiny A Jackson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Elsayed S, Cabrera A, Ouellette D, Jones PM, Dhami R, Hanage W. Association of body mass index with COVID-19-related neurologic sequelae: a retrospective cohort study. Clin Exp Med 2023; 23:2239-2251. [PMID: 36525126 PMCID: PMC9755765 DOI: 10.1007/s10238-022-00965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
We sought to explore the relationship between body mass index (BMI) and neurologic outcomes following acute COVID-19 infection. We conducted a retrospective electronic medical record-based cohort study enrolling adults with laboratory-confirmed acute COVID-19 infection who presented to 1 of 12 academic and community hospitals in Southwestern Ontario, Canada between April 1, 2020 and July 31, 2021. Primary subjective (anosmia, dysgeusia, and/or headache) and objective (aseptic meningitis, ataxia, delirium, encephalopathy, encephalitis, intracranial hemorrhage, ischemic stroke, and/or seizure) composite neurologic outcomes were assessed, comparing obese and overweight individuals to those with underweight/normal BMI indices, adjusting for baseline characteristics. Secondary outcomes (severity of illness, length of hospital stay, SARS-CoV-2 viral load, mortality) were similarly analyzed. A total of 1437 enrolled individuals, of whom 307 (21%), 456 (32%), and 674 (47%) were underweight/normal, overweight, and obese, respectively. On multivariable analysis, there was no association between BMI category and the composite outcome for subjective (odds ratio [OR] 1.17, 95% CI 0.84-1.64, Bonferroni p = 1.00 for obese; OR 1.02, 95% CI 0.70-1.48; Bonferroni p = 1.00 for overweight) and objective (OR 0.74, 95% CI 0.42-1.30, p = 0.29 for obese; OR = 0.80, 95% CI 0.45-1.43, p = 0.45 for overweight) neurologic manifestations. There was no association between BMI category and any secondary outcome measure and no evidence of effect modification by age or sex. This study demonstrates the absence of an association between BMI and neurologic manifestations following acute COVID-19 illness. Prospective studies using standardized data collection tools and direct measures of body fat are warranted to obtain more valid effect estimates.
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Affiliation(s)
- Sameer Elsayed
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ana Cabrera
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danielle Ouellette
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Phil M Jones
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita Dhami
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - William Hanage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sheean P, O'Connor P, Joyce C, Wozniak A, Vasilopoulos V, Formanek P. Applying the Global Leadership Initiative on Malnutrition criteria in patients admitted with SARS-CoV-2 infection using computed tomography imaging. Nutr Clin Pract 2023; 38:1009-1020. [PMID: 37312258 DOI: 10.1002/ncp.11024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patients with low muscle mass and acute SARS-CoV-2 infection meet the Global Leadership Initiative on Malnutrition (GLIM) etiologic and phenotypic criteria to diagnose malnutrition, respectively. However, available cut-points to classify individuals with low muscle mass are not straightforward. Using computed tomography (CT) to determine low muscularity, we assessed the prevalence of malnutrition using the GLIM framework and associations with clinical outcomes. METHODS A retrospective cohort was conducted gathering patient data from various clinical resources. Patients admitted to the COVID-19 unit (March 2020 to June 2020) with appropriate/evaluable CT studies (chest or abdomen/pelvis) within the first 5 days of admission were considered eligible. Sex- and vertebral-specific skeletal muscle indices (SMI; cm2 /m2 ) from healthy controls were used to determine low muscle mass. Injury-adjusted SMI were derived, extrapolated from cancer cut-points and explored. Descriptive statistics and mediation analyses were completed. RESULTS Patients (n = 141) were 58.2 years of age and racially diverse. Obesity (46%), diabetes (40%), and cardiovascular disease (68%) were prevalent. Using healthy controls and injury-adjusted SMI, malnutrition prevalence was 26% (n = 36/141) and 50% (n = 71/141), respectively. Mediation analyses demonstrated a significant reduction in the effect of malnutrition on outcomes in the presence of Acute Physiology and Chronic Health Evaluation II, supporting the mediating effects of severity of illness intensive care unit (ICU) admission, ICU length of stay, mechanical ventilation, complex respiratory support, discharge status (all P values = 0.03), and 28-day mortality (P = 0.04). CONCLUSIONS Future studies involving the GLIM criteria should consider these collective findings in their design, analyses, and implementation.
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Affiliation(s)
- Patricia Sheean
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Paula O'Connor
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Cara Joyce
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Amy Wozniak
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Vasilios Vasilopoulos
- Department of Radiology (3D lab), Loyola University Medical Center, Maywood, Illinois, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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Parker J, Kaur S, Medalla JM, Imbert-Sanchez A, Bautista J. Dietary trends among young adults during the COVID-19 lockdown: socioeconomic and gender disparities. BMC Nutr 2023; 9:107. [PMID: 37749620 PMCID: PMC10519054 DOI: 10.1186/s40795-023-00759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Healthy eating is vital to well-being and during the COVID-19 pandemic, it was especially important for boosting immunity and protecting against viral infections. Yet, by many accounts, keeping a nutritious diet was a casualty of the pandemic rather than a means to fight it. Young adults experienced disproportionate pandemic-related disruptions during a formative stage of development while little is still known about dietary outcomes. METHODS We employed a cross-sectional design to examine dietary disparities targeting young adults (ages 18-28) during the COVID-19 lockdown period. Participants (N = 254) responded to a 15-20-min online survey with questions related to food composition and sources of food, perceptions of healthy eating, weight change, physical activity, and food insecurity. Comparisons were made by household income and gender. Multiple regression analyses were conducted to investigate factors that predicted perceptions of healthy eating behaviors while controlling for other sociodemographic factors. RESULTS A clear overall trend toward unhealthy behaviors was found while positive changes were also identified. Consumption of junk food significantly increased (+ 3%), 40% gained weight, a third were less active, and 5-8% were food insecure on a regular basis. Meanwhile, eating food from restaurants declined and, for some, home-based cooking increased. Lower income participants were overly represented in unhealthy changes and higher income participants were disproportionately represented in healthy changes. Males reported more changes in dietary composition while females reported more fluctuation in weight. Reduced activity, weight gain, and food insecurity predicted unhealthy eating behaviors. Living with friend(s)/roommate(s) predicted healthier eating, but only among lower income participants. CONCLUSIONS It is recommended that pandemic minded public health interventions account for negative dietary trends with particular attention to low-income young adults. Solutions should be geared toward reshaping fiscal, social and physical environments, rather than relying solely on behavioral interventions.
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Affiliation(s)
- Jennifer Parker
- Pennsylvania State University, 2809 Saucon Valley Road, Center Valley, Pa, 18034, USA.
| | - Simranpreet Kaur
- Bachelor of Science Student in Biobehavioral Health, Pennsylvania State University, 2809 Saucon Valley Road, Center Valley, Pa, 18034, USA
| | - John Marlo Medalla
- Bachelor of Science Student in Biobehavioral Health, Pennsylvania State University, 2809 Saucon Valley Road, Center Valley, Pa, 18034, USA
| | - Anairobi Imbert-Sanchez
- Bachelor of Science Student in Biobehavioral Health, Pennsylvania State University, 2809 Saucon Valley Road, Center Valley, Pa, 18034, USA
| | - Jeanette Bautista
- Bachelor of Science Student in Biobehavioral Health, Pennsylvania State University, 2809 Saucon Valley Road, Center Valley, Pa, 18034, USA
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Kastner L, Suenkel U, Eschweiler GW, Dankowski T, von Thaler AK, Mychajliw C, Brockmann K, Maetzler W, Berg D, Fallgatter AJ, Heinzel S, Thiel A. Older adults' coping strategies during the COVID-19 pandemic - a longitudinal mixed-methods study. Front Psychol 2023; 14:1209021. [PMID: 37744579 PMCID: PMC10512280 DOI: 10.3389/fpsyg.2023.1209021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Older age is a main risk factor for severe COVID-19. In 2020, a broad political debate was initiated as to what extent older adults need special protection and isolation to minimize their risk for SARS-CoV-2 infection. However, isolation might also have indirect negative psychological (e.g., loneliness, stress, fear, anxiety, depression) or physical (e.g., lack of exercise, missing medical visits) consequences depending on individual strategies and personality traits to cope longitudinally with this crisis. Methods To examine the impact of individuals' coping with the pandemic on mental health, a large sample of 880 older adults of the prospective longitudinal cohort TREND study were surveyed six times about their individual coping strategies in the COVID-19 pandemic between May 2020 (05/2020: Mage = 72.1, SDage = 6.4, Range: 58-91 years) and November 2022 in an open response format. The relevant survey question was: "What was helpful for you to get through the last months despite the COVID-19 pandemic? E.g., phone calls, going for a walk, or others." Results and Discussion In total, we obtained 4,561 records containing 20,578 text passages that were coded and assigned to 427 distinct categories on seven levels based on qualitative content analysis using MAXQDA. The results allow new insights into the impact of personal prerequisites (e.g., value beliefs, living conditions), the general evaluation of the pandemic (e.g., positive, irrelevant, stressful) as well as the applied coping strategies (e.g., cognitive, emotional- or problem-focused) to deal with the COVID-19 pandemic by using an adapted Lazarus stress model. Throughout the pandemic emotional-focused as well as problem-focused strategies were the main coping strategies, whereas general beliefs, general living conditions and the evaluation were mentioned less frequently.
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Affiliation(s)
- Lydia Kastner
- Institute for Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Ulrike Suenkel
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
| | - Gerhard W. Eschweiler
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Theresa Dankowski
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Anna-Katharina von Thaler
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christian Mychajliw
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Andreas J. Fallgatter
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Ansgar Thiel
- Institute for Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Lead Graduate School and Research Network, Eberhard Karls University of Tübingen, Tübingen, Germany
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Ederer DJ, Lee SH, Belay B, Boutelle K, Park S. Associations between comfort eating and weight change during the COVID-19 pandemic among U.S. adults. HUMAN NUTRITION & METABOLISM 2023; 33:10.1016/j.hnm.2023.200212. [PMID: 38618183 PMCID: PMC11010443 DOI: 10.1016/j.hnm.2023.200212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Objective To examine associations between comfort eating in response to loneliness or stress and weight change during the COVID-19 pandemic among U.S. adults. Design Quantitative, cross-sectional study. Setting The 2021 SummerStyles survey data. Subjects U.S. adults (≥18 years; N = 4068). Measures The outcome was reported weight changes since the start of the COVID-19 pandemic with four responses: lost weight, weight remained the same, gained weight, and don't know. The exposure variable was frequency of comfort eating in response to loneliness or stress during the past year with three responses: never/ rarely, sometimes, or often/always. Analysis We used chi-square analysis to examine the independence of survey variables related to weight changes, and comfort eating in response to loneliness or stress during the COVID-19 pandemic. Next, we used a multinomial logistic regression to estimate adjusted odds ratios for weight changes by comfort eating in response to loneliness or stress frequency. Results Overall, 20.1% of adults reported losing weight, 39.9% remained about the same weight, 30.4% gained weight, and 9.4% did not know about their weight change during the COVID-19 pandemic. Taking comfort by eating in response to loneliness or stress was reported by over 33% of participants (often/always = 8.3%; sometimes = 25.3%). Weight change and comfort eating during the COVID-19 pandemic significantly varied by sociodemographic factors. Respondents that sometimes or often/always reported taking comfort by eating in response to loneliness or stress were more likely to report losing weight (Adjusted Odds Ratio ranges: 1.62-2.99) or gaining weight (Adjusted Odds Ratio ranges: 3.10-4.61) than those who never/rarely took comfort by eating in response to loneliness or stress. Conclusions Taking comfort by eating when stressed/lonely was significantly associated with reported weight changes during the COVID-19 pandemic. Weight changes may lead to additional health complications. Implementing evidence-based strategies to reduce loneliness or stress and support healthy eating during the COVID-19 pandemic may benefit weight management and future well-being.
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Affiliation(s)
- David J. Ederer
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, USA
| | - Seung Hee Lee
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
| | - Brook Belay
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
| | - Kerri Boutelle
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA
| | - Sohyun Park
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
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Kompaniyets L, Freedman DS, Belay B, Pierce SL, Kraus EM, Blanck HM, Goodman AB. Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity. JAMA Netw Open 2023; 6:e2327358. [PMID: 37548978 PMCID: PMC10407685 DOI: 10.1001/jamanetworkopen.2023.27358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/24/2023] [Indexed: 08/08/2023] Open
Abstract
Importance Information on the probability of weight loss among US adults with overweight or obesity is limited. Objective To assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race. Design, Setting, and Participants This cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years. Exposures Initial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity). Main Outcomes and Measures The 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9). Results The 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category. Conclusions and Relevance Results of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight.
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Affiliation(s)
- Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David S. Freedman
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brook Belay
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samantha L. Pierce
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily M. Kraus
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Informatics Institute, Taskforce for Global Health, Atlanta, Georgia
- Kraushold Consulting, Denver, Colorado
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B. Goodman
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Elhouderi E, Elsawalhy E, Al-Sudani N, Mahmood I, Sengstock D. The Association Between COVID-19 Mortality and ICU Admission Rates and Prior History of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hospitalized COVID-19 Patients With Hypertension in Michigan. Cureus 2023; 15:e43980. [PMID: 37746496 PMCID: PMC10516143 DOI: 10.7759/cureus.43980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Importance There are conflicting data regarding the safety of the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) medications in hypertensive patients who are susceptible to COVID-19. Objective Our study assesses the association between COVID-19 severity and mortality and the use of ACEIs/ARBs among hospitalized patients with hypertension. Research design, setting, and participants This was a retrospective cohort study. Using the EPIC system of Beaumont Health, Dearborn, Michigan, we identified 5490 patients with COVID-19 who were admitted to the eight Beaumont hospitals. After excluding subjects who have no hypertension and those with missing data, we included 2129 COVID-19 patients who have hypertension. Logistic regression and Cox proportional hazards models were used to analyze the association between history of ACEI/ARB use, intensive care unit (ICU) admission rate, and COVID-19 mortality. Exposure Exposure refers to the use of ACEIs/ARBs as documented in the medical records before admission to the hospitals. Main outcome The main outcome was 30-day COVID-19 mortality and ICU admission rates. Results There were 1281 subjects (60%) with prior ACEI/ARB use and 848 subjects (40%) with no ACEI/ARB use. There was no significant association between ICU admission and the use of ACEIs/ARBs (odds ratio {OR} = 0.95, 95% CI = {0.76, 1.19}, p-value = 0.6). Although the unadjusted logistic regression model demonstrated a statistically significant association between history of ACEI/ARB use and COVID-19 mortality (odds ratio = 1.31, 95% CI = {1.05, 1.66}, p-value = 0.02), the adjusted logistic regression model failed to show this statistically significant association (odds ratio = 1.20, 95% CI = {0.93, 1.54}, p-value = 0.14). Moreover, we were not able to reveal a statistically significant association between 30-day COVID-19 survival and prior use of ACEI/ARB in the adjusted Cox proportional hazards model (hazard ratio {HR} = 1.11, 95% CI = {0.91, 1.40}, p-value = 0.14). Conclusion In this large retrospective study, we conclude that there was no statistically significant association between prior history of ACEI/ARB use and COVID-19 ICU admission rates or mortality in hypertensive patients hospitalized with COVID-19.
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Affiliation(s)
| | | | | | - Irum Mahmood
- Internal Medicine, Beaumont Health, Dearborn, USA
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Nadimpalli G, O’Hara LM, Magder LS, Johnson JK, Haririan A, Pineles L, Goodman KE, Baghdadi JD, Pineles BL, Harris AD. Comorbidities associated with 30-day readmission following index coronavirus disease 2019 (COVID-19) hospitalization: A retrospective cohort study of 331,136 patients in the United States. Infect Control Hosp Epidemiol 2023; 44:1325-1333. [PMID: 36189788 PMCID: PMC11018251 DOI: 10.1017/ice.2022.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission. DESIGN, SETTING, AND PARTICIPANTS We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital. RESULTS Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17-1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09-1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58-2.19), renal failure (aOR, 1.32; 95% CI, 1.25-1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24-1.34) were most associated with readmission for COVID-19. CONCLUSIONS Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.
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Affiliation(s)
- Gita Nadimpalli
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Lyndsay M. O’Hara
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Laurence S. Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - J. Kristie Johnson
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
- Department of Pathology, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Abdolreza Haririan
- Division of Nephrology, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Lisa Pineles
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine E. Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D. Baghdadi
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Beth L. Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
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Ghimire B, Pour SK, Middleton E, Campbell RA, Nies MA, Aghazadeh-Habashi A. Renin-Angiotensin System Components and Arachidonic Acid Metabolites as Biomarkers of COVID-19. Biomedicines 2023; 11:2118. [PMID: 37626615 PMCID: PMC10452267 DOI: 10.3390/biomedicines11082118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Through the ACE2, a main enzyme of the renin-angiotensin system (RAS), SARS-CoV-2 gains access into the cell, resulting in different complications which may extend beyond the RAS and impact the Arachidonic Acid (ArA) pathway. The contribution of the RAS through ArA pathways metabolites in the pathogenesis of COVID-19 is unknown. We investigated whether RAS components and ArA metabolites can be considered biomarkers of COVID-19. We measured the plasma levels of RAS and ArA metabolites using an LC-MS/MS. Results indicate that Ang 1-7 levels were significantly lower, whereas Ang II levels were higher in the COVID-19 patients than in healthy control individuals. The ratio of Ang 1-7/Ang II as an indicator of the RAS classical and protective arms balance was dramatically lower in COVID-19 patients. There was no significant increase in inflammatory 19-HETE and 20-HETE levels. The concentration of EETs was significantly increased in COVID-19 patients, whereas the DHETs concentration was repressed. Their plasma levels were correlated with Ang II concentration in COVID-19 patients. In conclusion, evaluating the RAS and ArA pathway biomarkers could provide helpful information for the early detection of high-risk groups, avoid delayed medical attention, facilitate resource allocation, and improve patient clinical outcomes to prevent long COVID incidence.
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Affiliation(s)
- Biwash Ghimire
- College of Pharmacy, Idaho State University, Pocatello, ID 83209, USA; (B.G.)
| | - Sana Khajeh Pour
- College of Pharmacy, Idaho State University, Pocatello, ID 83209, USA; (B.G.)
| | - Elizabeth Middleton
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Robert A. Campbell
- Department of Internal Medicine, Division ofHematology, University of Utah, Salt Lake City, UT 84112, USA
| | - Mary A. Nies
- College of Health, School of Nursing, Idaho State University, Pocatello, ID 83209, USA
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Dueñas-Espín I, Echeverría-Mora M, Montenegro-Fárez C, Baldeón M, Chantong Villacres L, Espejo Cárdenas H, Fornasini M, Ochoa Andrade M, Solís C. Development and validation of a scoring system to predict mortality in patients hospitalized with COVID-19: A retrospective cohort study in two large hospitals in Ecuador. PLoS One 2023; 18:e0288106. [PMID: 37459312 PMCID: PMC10351692 DOI: 10.1371/journal.pone.0288106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To develop and validate a scoring system to predict mortality among hospitalized patients with COVID-19. METHODS Retrospective cohort study. We analyzed 5,062 analyzed hospitalized patients with COVID-19 treated at two hospitals; one each in Quito and Guayaquil, from February to July 2020. We assessed predictors of mortality using survival analyses and Cox models. We randomly divided the database into two sets: (i) the derivation cohort (n = 2497) to identify predictors of mortality, and (ii) the validation cohort (n = 2565) to test the discriminative ability of a scoring system. After multivariate analyses, we used the final model's β-coefficients to build the score. Statistical analyses involved the development of a Cox proportional hazards regression model, assessment of goodness of fit, discrimination, and calibration. RESULTS There was a higher mortality risk for these factors: male sex [(hazard ratio (HR) = 1.32, 95% confidence interval (95% CI): 1.03-1.69], per each increase in a quartile of ages (HR = 1.44, 95% CI: 1.24-1.67) considering the younger group (17-44 years old) as the reference, presence of hypoxemia (HR = 1.40, 95% CI: 1.01-1.95), hypoglycemia and hospital hyperglycemia (HR = 1.99, 95% CI: 1.01-3.91, and HR = 1.27, 95% CI: 0.99-1.62, respectively) when compared with normoglycemia, an AST-ALT ratio >1 (HR = 1.55, 95% CI: 1.25-1.92), C-reactive protein level (CRP) of >10 mg/dL (HR = 1.49, 95% CI: 1.07-2.08), arterial pH <7.35 (HR = 1.39, 95% CI: 1.08-1.80) when compared with normal pH (7.35-7.45), and a white blood cell count >10 × 103 per μL (HR = 1.76, 95% CI: 1.35-2.29). We found a strong discriminative ability in the proposed score in the validation cohort [AUC of 0.876 (95% CI: 0.822-0.930)], moreover, a cutoff score ≥39 points demonstrates superior performance with a sensitivity of 93.10%, a specificity of 70.28%, and a correct classification rate of 72.66%. The LR+ (3.1328) and LR- (0.0981) values further support its efficacy in identifying high-risk patients. CONCLUSION Male sex, increasing age, hypoxemia, hypoglycemia or hospital hyperglycemia, AST-ALT ratio >1, elevated CRP, altered arterial pH, and leucocytosis were factors significantly associated with higher mortality in hospitalized patients with COVID-19. A statistically significant Cox regression model with strong discriminatory power and good calibration was developed to predict mortality in hospitalized patients with COVID-19, highlighting its potential clinical utility.
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Affiliation(s)
- Iván Dueñas-Espín
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - María Echeverría-Mora
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Camila Montenegro-Fárez
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Manuel Baldeón
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Luis Chantong Villacres
- Hospital General Norte de Guayaquil, IESS Ceibos, Instituto Ecuatoriano de Seguridad Social (IESS), Guayaquil, Ecuador
| | | | - Marco Fornasini
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Miguel Ochoa Andrade
- Hospital General del Sur de Quito, Instituto Ecuatoriano de Seguridad Social (IESS), Quito, Ecuador
| | - Carlos Solís
- Hospital General Norte de Guayaquil, IESS Ceibos, Instituto Ecuatoriano de Seguridad Social (IESS), Guayaquil, Ecuador
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Nabi AHMN, Ebihara A, Shekhar HU. Impacts of SARS-CoV-2 on diabetes mellitus: A pre and post pandemic evaluation. World J Virol 2023; 12:151-171. [PMID: 37396707 PMCID: PMC10311579 DOI: 10.5501/wjv.v12.i3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 06/21/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel beta coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) crippled the whole world and has resulted in large number of morbidity and mortality. The origin of the SARS-CoV-2 is still disputed. The risk of infection with SARS-CoV-2 is dependent on several risk factors as observed in many studies. The severity of the disease depends on many factors including the viral strain, host immunogenetics, environmental factors, host genetics, host nutritional status and presence of comorbidities like hypertension, diabetes, Chronic Obstructive Pulmonary Disease, cardiovascular disease, renal impairment. Diabetes is a metabolic disorder mainly characterized by hyperglycemia. Diabetic individuals are intrinsically prone to infections. SARS-CoV-2 infection in patients with diabetes result in β-cell damage and cytokine storm. Damage to the cells impairs the equilibrium of glucose, leading to hyperglycemia. The ensuing cytokine storm causes insulin resistance, especially in the muscles and liver, which also causes a hyperglycemic state. All of these increase the severity of COVID-19. Genetics also play pivotal role in disease pathogenesis. This review article focuses from the probable sources of coronaviruses and SARS-CoV-2 to its impacts on individuals with diabetes and host genetics in pre- and post-pandemic era.
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Affiliation(s)
- A H M Nurun Nabi
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Akio Ebihara
- Faculty of Applied Biological Sciences, Gifu University, Gifu 501-1193, Japan
| | - Hossain Uddin Shekhar
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
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Kowal M, Morgiel E, Winiarski S, Gieysztor E, Madej M, Sebastian A, Madziarski M, Wedel N, Proc K, Madziarska K, Wiland P, Paprocka-Borowicz M. Effect of COVID-19 on Musculoskeletal Performance in Gait and the Timed-Up and Go Test. J Clin Med 2023; 12:4184. [PMID: 37445219 DOI: 10.3390/jcm12134184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The total number of confirmed cases of COVID-19 caused by the SARS-CoV-2 virus infection is over 621 million in the world. In approximately 63% of cases, the patient still experiences persistent symptoms 30 days after the onset of symptoms or hospitalisation, and 45.9% of patients have experienced or will experience symptoms for at least three months. Despite the prevalence of chronic symptoms and pathological changes that may affect gait and functional mobility in people with a history of COVID-19, there are few publications investigating the impact of these abnormalities. This study aims to determine the long-term effects of COVID-19 on gait and the Timed-Up and Go Task. MATERIAL AND METHODS A total of 30 individuals took part in the experiment. The subjects in the study group were infected with the COVID-19 virus and required hospital treatment. Prior to the study, the subjects had no chronic diseases or other conditions affecting the musculoskeletal system. The non-infected by COVID-19 group was a healthy population with no history of COVID-19 disease. The study used the inertial system wireless motion analysis system based on 15 inertial sensors (inertial measurement units, IMUs). IMU sensors were placed on the following body segments: head, sternum, middle and lower spine, shoulder, arm, forearm, hand, shank, for the left and right limb. Movement task reports generated from the recording were created using myoRESEARCH 3.10. The subjects in the study group were asked to perform a movement task test-the Timed-Up and Go Test (TUG): sit-to-stand, walk (3 m) without change in direction, walk termination, and stand-to-sit. RESULTS It took 46% longer for those infected by COVID-19 (participants) to complete the entire movement task compared to those in the not-infected by COVID-19 group. Sit-to-Stand Time [s] was greater in the infected by COVID-19 group and was 2.1 ± 0.7. Mean Walking Speed [m/s] was lower than in the not-infected by COVID-19 group and was 0.26 ± 0.07. Walking cadence [steps/min] was lower and was 21.2 ± 1.2. Infected by COVID-19 participants achieved a smaller anterior pelvic tilt angle (p < 0.001) and a smaller hip flexion angle (p = 0.025), with an increase in knee (p < 0.001) and ankle (p < 0.001) flexion angles. CONCLUSIONS Individuals in the infected by COVID-19 group present changes in the ranges of motion and the time to complete the TUG task, despite the fact that at least eight weeks passed after hospital discharge.
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Affiliation(s)
- Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, T. Chałubińskiego 3, 50-556 Wrocław, Poland
| | - Ewa Morgiel
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Sławomir Winiarski
- Biomechanics Department, Wroclaw University of Health and Sport Sciences, Paderewskiego 35, 51-612 Wrocław, Poland
| | - Ewa Gieysztor
- Department of Physiotherapy, Wroclaw Medical University, T. Chałubińskiego 3, 50-556 Wrocław, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Marcin Madziarski
- Department of Rheumatology and Internal Medicine, University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Nicole Wedel
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave., New York, NY 10461, USA
| | - Krzysztof Proc
- Department of Rheumatology and Internal Medicine, University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Katarzyna Madziarska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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Kim A, Ortega-Ribera M, McMullen MR, Bellar A, Taiwo M, Pathak V, Streem D, Dasarathy J, Welch N, Dasarathy S, Vachharajani V, Nagy LE. Altered Anti-Viral Immune Responses in Monocytes in Overweight Heavy Drinkers. iScience 2023; 26:107133. [PMID: 37361874 PMCID: PMC10268809 DOI: 10.1016/j.isci.2023.107133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Alcohol abuse causes increased susceptibility to respiratory syndromes like bacterial pneumonia and viral infections like SARS-CoV-2. Heavy drinkers (HD) are at higher risk of severe COVID-19 if they are also overweight, yet the molecular mechanisms are unexplored. Single-cell RNA-seq (scRNA-seq) was performed on peripheral blood mononuclear cells from lean or overweight HD and healthy controls (HC) after challenge with a dsRNA homopolymer (PolyI:C) to mimic a viral infection and/or with lipopolysaccharide (LPS). All monocyte populations responded to both PolyI:C and LPS with pro-inflammatory gene expression. However, expression of interferon stimulated genes, essential for inhibiting viral pathogenesis, was greatly reduced in overweight patients. Interestingly, the number of upregulated genes in response to PolyI:C challenge was far greater in monocytes from HD compared to HC, including much stronger pro-inflammatory cytokine and interferon-γ signaling responses. These results suggest increased body weight reduced anti-viral responses while heavy drinking increased pro-inflammatory cytokines.
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Affiliation(s)
- Adam Kim
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
- - Department of Medicine, University of Connecticut Health Center, Farmington, CT
| | - Martí Ortega-Ribera
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
| | - Megan R McMullen
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
| | - Annette Bellar
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
| | - Moyinoluwa Taiwo
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
| | - Vai Pathak
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
| | - David Streem
- - Lutheran Hospital, Cleveland Clinic, Cleveland, OH
| | | | - Nicole Welch
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
- - Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
- - Department of Molecular Medicine, Case Western Reserve University, Cleveland, OH
| | - Srinivasan Dasarathy
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
- - Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
- - Department of Molecular Medicine, Case Western Reserve University, Cleveland, OH
| | - Vidula Vachharajani
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
- - Department of Critical Care Medicine Cleveland Clinic Respiratory Institute, Cleveland, OH
| | - Laura E Nagy
- - Northern Ohio Alcohol Center, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH
- - Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
- - Department of Molecular Medicine, Case Western Reserve University, Cleveland, OH
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Hsieh YH, Chang HT, Wang PH, Chang MY, Hsu HS. Mortality in patients with COVID-19 versus non-COVID-19- related acute respiratory distress syndrome: A single center retrospective observational cohort study. PLoS One 2023; 18:e0286564. [PMID: 37267339 DOI: 10.1371/journal.pone.0286564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) varies from other pneumonia-related ARDS. We evaluated whether the mortality rates differed for COVID-19 and non-COVID-19-related ARDS in the Asian population in 2021. This single center retrospective observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included hospital length of stay, ICU length of stay, duration of mechanical ventilation, and ventilator-free days (VFDs) during the first 28 days. A 1:1 propensity score matching was performed to correct potential confounders by age, obesity or not, and ARDS severity. One-hundred-and-sixty-four patients fulfilled the inclusion criteria. After 1:1 propensity score matching, there were 50 patients in each group. The all-cause in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non-COVID-19-related ARDS (17 [34%) vs. 21 [42%], p = 0.410). Both groups had length of stay (30.0 [20.0-46.0] vs. 27.0 [13.0-45.0] days, p = 0.312), ICU length of stay (19.0 [13.0-35.0] vs. 16.0 [10.0-32.0] days, p = 0.249), length of mechanical ventilation (19.0 [10.0-36.0] vs. 14.0 [9.0-29.0] days, p = 0.488), and ventilator-free days during the first 28 days (5.5 [0.0-17.0] vs. 0.0 [0.0-14.0] days, p = 0.320). Immunocompromised status (Hazard ratio: 3.63; 95% CI: 1.51-8.74, p = 0.004) and progress to severe ARDS (Hazard ratio: 2.92; 95% CI: 1.18-7.22, p = 0.020) were significant in-hospital mortality-related confounders. There were no significant difference in mortality among both groups. Immunocompromised status and progression to severe ARDS are two possible risk factors for patients with ARDS; COVID-19 is not a mortality-related risk exposure.
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Affiliation(s)
- Yu-Hsiang Hsieh
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hou-Tai Chang
- Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Ping-Huai Wang
- Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Mei-Yun Chang
- Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Do H, Nandi S, Putzel P, Smyth P, Zhong J. A joint fairness model with applications to risk predictions for underrepresented populations. Biometrics 2023; 79:826-840. [PMID: 35142367 PMCID: PMC9363518 DOI: 10.1111/biom.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
In data collection for predictive modeling, underrepresentation of certain groups, based on gender, race/ethnicity, or age, may yield less accurate predictions for these groups. Recently, this issue of fairness in predictions has attracted significant attention, as data-driven models are increasingly utilized to perform crucial decision-making tasks. Existing methods to achieve fairness in the machine learning literature typically build a single prediction model in a manner that encourages fair prediction performance for all groups. These approaches have two major limitations: (i) fairness is often achieved by compromising accuracy for some groups; (ii) the underlying relationship between dependent and independent variables may not be the same across groups. We propose a joint fairness model (JFM) approach for logistic regression models for binary outcomes that estimates group-specific classifiers using a joint modeling objective function that incorporates fairness criteria for prediction. We introduce an accelerated smoothing proximal gradient algorithm to solve the convex objective function, and present the key asymptotic properties of the JFM estimates. Through simulations, we demonstrate the efficacy of the JFM in achieving good prediction performance and across-group parity, in comparison with the single fairness model, group-separate model, and group-ignorant model, especially when the minority group's sample size is small. Finally, we demonstrate the utility of the JFM method in a real-world example to obtain fair risk predictions for underrepresented older patients diagnosed with coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Hyungrok Do
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Shinjini Nandi
- Department of Mathematical Sciences, Montana State University, Bozeman, MT, 59717, USA
| | - Preston Putzel
- Department of Computer Science, University of California, Irvine, CA, 92697, USA
| | - Padhraic Smyth
- Department of Computer Science, University of California, Irvine, CA, 92697, USA
| | - Judy Zhong
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
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46
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Jaisinghani P, Kumar R. Obesity and Viral Infections. Gastroenterol Clin North Am 2023; 52:393-402. [PMID: 37197881 DOI: 10.1016/j.gtc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The 2019 novel coronavirus disease (COVID-19) triggered a rapidly expanding global pandemic. The presence of obesity in patients with COVID-19 has been established as a risk factor for disease severity, hospital admission, and mortality. Thus, it is imperative those living with obesity be vaccinated against COVID-19. Although there is a timeframe COVID-19 vaccines are efficacious in those living with obesity, more studies need to be conducted to ensure that those long-lasting protection is maintained, as obesity has implications on the immune system.
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Affiliation(s)
- Priya Jaisinghani
- Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, USA.
| | - Rekha Kumar
- Division of Endocrinology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, NY, USA
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Çınar C, Kocakaya D, Olgun Yıldızeli S, Karakurt S. Lung Cavitation as a Long-Term Imaging Pattern of COVID-19. Cureus 2023; 15:e39825. [PMID: 37397682 PMCID: PMC10314721 DOI: 10.7759/cureus.39825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background A wide variety of radiological imaging findings, especially CT findings, have been reported in patients with COVID-19 pneumonia during the pandemic surge. Generally, on control chest imaging, individuals who have been cured of the disease usually show complete remission; however, in severe cases, residual pulmonary fibrosis, other abnormalities, and, rarely, lung cavitation can be observed. In this retrospective descriptive study, we aimed to describe the clinical, radiological, and laboratory characteristics of patients who developed lung cavitation in the course of SARS-CoV-2 disease recovery. Methodology Over a period of five months from March 1, 2021, to August 1, 2021, 15 consecutive patients who developed cavitary lesions on chest CT during the course of recovery from COVID-19 were recruited as the study population. All patients had a history of a SARS-CoV-2 infection diagnosed with a positive real-time polymerase chain reaction test. Patients who already had cavitary lesions in chest CT during the start of COVID-19 symptoms were excluded. Results In this study, 14 patients were male (93.3%). The only female patient was the only severely obese patient in the study population, with a body mass index was 40.4 kg/m2. The median (range) age of the patient population was 61 (42-79) years. Eight patients (53.3%) required intensive care unit admission during the hospitalization period. Three patients who required intensive care unit were intubated and needed invasive mechanical ventilation. Two patients died during hospitalization. Conclusions Lung cavitation remains a rare occurrence in the course of COVID-19. Bronchoscopic evaluation and scanning for pulmonary embolism should be done in appropriate patients to determine secondary reasons for cavitation. Although this descriptive study showed that cavitary lesions can develop in patients with severe disease, more comprehensive studies with a control group are needed to reach a definitive conclusion.
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Affiliation(s)
- Caner Çınar
- Pulmonology Department, Marmara University, Istanbul, TUR
| | - Derya Kocakaya
- Pulmonology Department, Marmara University School of Medicine, Istanbul, TUR
| | | | - Sait Karakurt
- Pulmonology Department, Marmara University School of Medicine, Istanbul, TUR
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M TE, MA RH, B GV, ME FF, V M, F P, P BP, C S, A N, C GP, M L. Clinical and economic impact of COVID-19 on people with obesity in a Spanish cohort during the first pandemic peak. Front Endocrinol (Lausanne) 2023; 14:1146517. [PMID: 37342262 PMCID: PMC10278591 DOI: 10.3389/fendo.2023.1146517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/09/2023] [Indexed: 06/22/2023] Open
Abstract
Introduction COVID-19 and obesity relationship has been extensively studied since the COVID-19 outbreak, proving obesity is a risk factor. This study aims to broaden the available information about this association and to evaluate the economic impact of obesity and the COVID-19 disease combination. Methods This retrospective study analyzed a sample of 3,402 patients admitted to a Spanish hospital with available body mass index (BMI) data. Results The prevalence of obesity was 33.4%. Patients with obesity showed a higher risk of hospitalization (OR 95% ConfidenceInterval [CI]=1.46; [1.24-1.73]; p < 0.001), which increased with the obesity degree (I: OR [95% CI]=1.28 [1.06-1.55], p =0.010; II: OR [95% CI]=1.58 [1.16-2.15], p =0.004; III: OR [95% CI] =2.09 [1.31-3.34], p =0.002). Patients with type III obesity had a significantly higher risk of intensive care unit (ICU) admission (OR [95% CI]= 3.30 [1.67-6.53]; p = 0.001) and invasive mechanical ventilation (IMV) need (OR [95% CI]= 3.98 [2.00-7.94]; p<0.001). The average cost per patient was remarkably higher in patients with obesity (p = 0.007), reaching an excess cost of 28.41% in the study cohort and rising to 56.5% in patients < 70 years. The average cost per patient increased significantly with the degree of obesity (p = 0.007). Discussion In conclusion, our results suggest a strong association between obesity and adverse COVID-19 outcomes and higher expenditures in patients with both conditions.
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Affiliation(s)
- Torrego-Ellacuría M
- Innovation Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Rubio-Herrera MA
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - González López-Valcárcel B
- Department of Quantitative Methods for Economics and Management, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fuentes-Ferrer ME
- Department of Preventive Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Martín V
- Department of Market Access and Public Affairs, Novo Nordisk Pharma, Sociedad Anónima (SA.), Madrid, Spain
| | - Poyato F
- Department of Clinical, Medical and Regulatory, Novo Nordisk Pharma, Sociedad Anònima (SA.), Madrid, Spain
| | - Barber-Pérez P
- Department of Quantitative Methods for Economics and Management, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Santucci C
- Department of Quantitative Methods for Economics and Management, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nuñez A
- Department of Critical Care, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - González-Pérez C
- Innovation Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Hospital Pharmacy, Hospital Clínico San Carlos, Instituto de Investigaciòn Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luaces M
- Innovation Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Tadayon Najafabadi B, Rayner DG, Shokraee K, Shokraie K, Panahi P, Rastgou P, Seirafianpour F, Momeni Landi F, Alinia P, Parnianfard N, Hemmati N, Banivaheb B, Radmanesh R, Alvand S, Shahbazi P, Dehghanbanadaki H, Shaker E, Same K, Mohammadi E, Malik A, Srivastava A, Nejat P, Tamara A, Chi Y, Yuan Y, Hajizadeh N, Chan C, Zhen J, Tahapary D, Anderson L, Apatu E, Schoonees A, Naude CE, Thabane L, Foroutan F. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database Syst Rev 2023; 5:CD015201. [PMID: 37222292 PMCID: PMC10207996 DOI: 10.1002/14651858.cd015201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection. OBJECTIVES To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed. SEARCH METHODS MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021. SELECTION CRITERIA We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. DATA COLLECTION AND ANALYSIS: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m2 increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. MAIN RESULTS: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m2) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m2), and II (BMI 35 to 40 kg/m2) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m2 and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation. AUTHORS' CONCLUSIONS Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients.
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Affiliation(s)
| | - Daniel G Rayner
- Faculty Health Sciences, McMaster University, Hamilton, Canada
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Shokraie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Paravaneh Rastgou
- School of Medicine, Tabriz University of Medical Sciences, Tehran, Iran
| | | | - Feryal Momeni Landi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pariya Alinia
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Parnianfard
- Research Center for Evidence-Based Medicine, Iranian Evidence-Based Medicine (EBM) Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nima Hemmati
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Banivaheb
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Society of Clinical Research Associates, Toronto, Canada
- Graduate division, Master of Advanced Studies in Clinical Research, University of California, San Diego, California, USA
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parmida Shahbazi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Elaheh Shaker
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Peyman Nejat
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alice Tamara
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Jakarta, Indonesia
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - Nima Hajizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Cynthia Chan
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Jamie Zhen
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Dicky Tahapary
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ontario, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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Pollack C, Gilbert-Diamond D, Onega T, Vosoughi S, O'Malley AJ, Emond JA. Obesity-Related Discourse on Facebook and Instagram Throughout the COVID-19 Pandemic: Comparative Longitudinal Evaluation. JMIR INFODEMIOLOGY 2023; 3:e40005. [PMID: 37191990 PMCID: PMC10203886 DOI: 10.2196/40005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND COVID-19 severity is amplified among individuals with obesity, which may have influenced mainstream media coverage of the disease by both improving understanding of the condition and increasing weight-related stigma. OBJECTIVE We aimed to measure obesity-related conversations on Facebook and Instagram around key dates during the first year of the COVID-19 pandemic. METHODS Public Facebook and Instagram posts were extracted for 29-day windows in 2020 around January 28 (the first US COVID-19 case), March 11 (when COVID-19 was declared a global pandemic), May 19 (when obesity and COVID-19 were linked in mainstream media), and October 2 (when former US president Trump contracted COVID-19 and obesity was mentioned most frequently in the mainstream media). Trends in daily posts and corresponding interactions were evaluated using interrupted time series. The 10 most frequent obesity-related topics on each platform were also examined. RESULTS On Facebook, there was a temporary increase in 2020 in obesity-related posts and interactions on May 19 (posts +405, 95% CI 166 to 645; interactions +294,930, 95% CI 125,986 to 463,874) and October 2 (posts +639, 95% CI 359 to 883; interactions +182,814, 95% CI 160,524 to 205,105). On Instagram, there were temporary increases in 2020 only in interactions on May 19 (+226,017, 95% CI 107,323 to 344,708) and October 2 (+156,974, 95% CI 89,757 to 224,192). Similar trends were not observed in controls. Five of the most frequent topics overlapped (COVID-19, bariatric surgery, weight loss stories, pediatric obesity, and sleep); additional topics specific to each platform included diet fads, food groups, and clickbait. CONCLUSIONS Social media conversations surged in response to obesity-related public health news. Conversations contained both clinical and commercial content of possibly dubious accuracy. Our findings support the idea that major public health announcements may coincide with the spread of health-related content (truthful or otherwise) on social media.
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Affiliation(s)
- Catherine Pollack
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Tracy Onega
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Soroush Vosoughi
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - A James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States
| | - Jennifer A Emond
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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