Body Mass Index and Prognosis of COVID-19 Infection. A Systematic Review

The association between excess weight and COVID-19 outcomes: An umbrella review

This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death.

Effects of the pre-existing coronary heart disease on the prognosis of COVID-19 patients: A systematic review and meta-analysis

Although studies have shown severe Coronavirus disease 2019 (COVID-19) outcomes in patients with pre-existing coronary heart disease (CHD), the prognosis of COVID-19 patients with pre-existing CHD remains uncertain primarily due to the limited number of patients in existing studies. This study aimed to investigate the impacts of pre-existing CHD on the prognosis of COVID-19 patients. Five electronic databases were searched for eligible studies. This article focused on cohort and case-control studies involving the prognosis of COVID-19 patients with pre-existing CHD. The meta-analysis was performed using a random effects model. The odds ratios (ORs) and 95% confidence intervals (CIs) were used as valid indicators. The study was registered in PROSPERO with the identifier: CRD42022352853. A total of 81 studies, involving 157,439 COVID-19 patients, were included. The results showed that COVID-19 patients with pre-existing CHD exhibited an elevated risk of mortality (OR = 2.45; 95%CI: [2.04, 2.94], P < 0.001), severe/critical COVID-19 (OR = 2.57; 95%CI: [1.98, 3.33], P < 0.001), Intensive Care Unit or Coronary Care Unit (ICU/CCU) admission: (OR = 2.75, 95%CI: [1.61, 4.72], P = 0.002), and reduced odds of discharge/recovery (OR = 0.43, 95%CI: [0.28, 0.66], P < 0.001) compared to COVID-19 patients without pre-existing CHD. Subgroup analyses indicated that the prognosis of COVID-19 patients with pre-existing CHD was influenced by publication year, follow-up duration, gender, and hypertension. In conclusion, pre-existing CHD significantly increases the risk of poor prognosis in patients with COVID-19, particularly in those male or hypertensive patients.

The Influence of COVID-19 in Endocrine Research: Critical Overview, Methodological Implications and a Guideline for Future Designs

The COVID-19 pandemic has changed many aspects of people's lives, including not only individual social behavior, healthcare procedures, and altered physiological and pathophysiological responses. As a result, some medical studies may be influenced by one or more hidden factors brought about by the COVID-19 pandemic. Using the literature review method, we are briefly discussing the studies that are confounded by COVID-19 and facemask-induced partiality and how these factors can be further complicated with other confounding variables. Facemask wearing has been reported to produce partiality in studies of ophthalmology (particularly dry eye and related ocular diseases), sleep studies, cognitive studies (such as emotion-recognition accuracy research, etc.), and gender-influenced studies, to mention a few. There is a possibility that some other COVID-19 related influences remain unrecognized in medical research. To account for heterogeneity, current and future studies need to consider the severity of the initial illness (such as diabetes, other endocrine disorders), and COVID-19 infection, the timing of analysis, or the presence of a control group. Face mask-induced influences may confound the results of diabetes studies in many ways.

OBESITY AND OUTCOME AMONG PATIENTS HOSPITALIZED FOR SARS-COV-2: A HOSPITAL-BASED STUDY IN INDONESIA

Background

Patients with obesity who have SARS-CoV-2 are at significant risk for developing serious clinical problems that need intensive care and have a bad prognosis.

Aim

The aim of this study was to determine obesity and outcome among patients hospitalized for SARS-CoV-2 at the Indonesia's national referral hospital.

Methods

This study used a retrospective cohort. The study samples were SARS-CoV-2 patients who were treated by pulmonary specialists in the intensive room of Dr. M. Djamil Hospital Padang. The number of samples in this study was 106 subjects. Data analysis was performed using the Chi-square test, Kaplan-Meier, and Cox regression. P < 0.05 was significant, and the data were analyzed using the SPSS version 21.0 program.

Results

The results of this study found obesity was associated with the outcome of SARS-CoV-2 patients treated at Indonesia's national referral hospital (p<0.05, OR=3.55 (95% CI 1.44-8.71)). The mortality rate among patients hospitalized with SARS-CoV-2 at Indonesia's national referral hospital with obesity was higher than non-obese; 82.7% and 57.4% respectively. The length of stay in patients with obesity was also shorter; 12 days compared to 19 days in non-obese.

Conclusion

There was an association between obesity with mortality of SARS-CoV-2 patients in a national referral hospital in Indonesia. This study can provide input in the therapeutic management of patients with obesity so as to reduce the poor prognosis.

Antibody responses to COVID-19 vaccination in people with obesity: A systematic review and meta-analysis

COVID-19 vaccine is critical in preventing SARS-CoV-2 infection and transmission. However, obesity's effect on immune responses to COVID-19 vaccines is still unknown. We performed a meta-analysis of the literature and compared antibody responses with COVID-19 vaccines among persons with and without obesity. We used Pubmed, Embase, Web of Science, and Cochrane Library to identify all related studies up to April 2022. The Stata.14 software was used to analyze the selected data. Eleven studies were included in the present meta-analysis. Five of them provided absolute values of antibody titers in the obese group and non-obese group. Overall, we found that the obese population was significantly associated with lower antibody titers (standardized mean difference [SMD] = -0.228, 95% CI [-0.437, -0.019], P < 0.001) after COVID-19 vaccination. Significant heterogeneity was present in most pooled analyses but was reduced after subgroup analyses. No publication bias was observed in the present analysis. The Trim and Fill method did not change the results in the primary analysis. The present meta-analysis suggested that obesity was significantly associated with decreased antibody responses to SARS-CoV-2 vaccines. Future studies should be performed to unravel the mechanism of response to the COVID-19 vaccine in obese individuals.

Recent Advance Analysis of Recovery in Hospitalized People with COVID-19: A Systematic Review

INTRODUCTION

COVID-19 is a public health emergency all around the world. Severe illness occurred in about 14% of patients and 5% of patients developed critical illness, but the prognosis for these patients remains unclear.

OBJECTIVE

To describe the prognosis in hospitalized adults with COVID-19.

METHODS

The MEDLINE, EMBASE, AMED, and COCHRANE databases were searched for studies published up to 28 June 2021 without language restrictions. Descriptors were related to "COVID-19" and "prognosis". Prospective inception cohort studies that assessed morbidity, mortality and recovery in hospitalized people over 18 years old with COVID-19 were included. Two independent reviewers selected eligible studies and extracted the available data. Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOFS) were considered as outcomes for morbidity and discharge was considered for recovery. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Analyses were performed using Comprehensive Meta-Analysis (version 2.2.064).

RESULTS

We included 30 inception cohort studies investigating 13,717 people hospitalized with COVID-19 from different countries. The mean (SD) age was 60.90 (21.87) years, and there was high proportion of males (76.19%) and people with comorbidities (e.g., 49.44% with hypertension and 29.75% with diabetes). Findings suggested a high occurrence of morbidity, mainly related to ARDS. Morbidity rates varied across studies from 19% to 36% in hospital wards, and from 13% to 90% in Intensive Care Units-ICU. Mortality rates ranged from 4% to 38% in hospital wards and from 8% to 51% in ICU. Recovery rates ranged up to 94% and 65% in hospital wards and ICU, respectively. The included studies had high risk of bias in the confounding domain.

CONCLUSIONS

The prognosis of people hospitalized with COVID-19 is an issue for the public health system worldwide, with high morbidity and mortality rates, mainly in ICU and for patients with comorbidities. Its prognosis emphasizes the need for appropriate prevention and management strategies.

Body-mass index COVID-19 severity: A systematic review of systematic reviews

Objectives

Conflicting studies have resulted in several systematic reviews and meta-analyses on the relationship between COVID-19 and body mass index (BMI).

Methods

This systematic review of systematic reviews followed an umbrella review design, and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines; Medical literature analysis and retrieval system online (MEDLINE) and SCOPUS databases were searched for systematic reviews on the topic. A predefined screening and selection procedure was done for the retrieved results based on the population, intervention/interest, comparator, outcome, study (PICOS) framework.

Results

The search strategy yielded 6334 citations. With the predefined selection and screening process, 23 systematic reviews were retrieved for inclusion in the present study. Twenty-three (n = 23) systematic reviews met the inclusion criteria. As expected, there was overlap across the reviews in the included primary studies. Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. It is difficult to draw a firm conclusion about Class I and Class II obesity due to conflicting outcomes of metanalyses. Increased obesity was consistently associated with increased risk of invasive mechanical ventilation (IMV) in all the reviews with low to moderate heterogeneity.

Conclusions

Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. Increased BMI is positively associated with the risk of IMV and the severity of COVID- care.

Risk factors for severity and mortality in adults testing positive for COVID-19 in the VI Health Area of Albacete

OBJECTIVES

There are several retrospective studies that establish a relationship between some risk factors (cardiovascular risks mainly) and the development of COVID-19 and a severe outcome. Thus, our aim with this study is to find out the former relationship among the population within our basic health area METHOD: Cohort study. The study sample consisted of 372 patients aged 14 or older who had tested positive for COVID-19 in our health centre by consecutive sampling. Data collected from medical records will be analysed using Frequencies, X2 with a Confidence interval of 95% and those carrying out the study will have prior experience/training in research and will be specifically trained for the aim of this research.

RESULTS

A worse outcome in patients aged 76 years old on average was found versus patients aged 48.7. Regarding high blood pressure patients, X2 was <0.001 and OR between 3.975 and 21.425 with confidence interval of 95%, finding a worse outcome in these patients. With regard to Diabetes Mellitus (DM), X2 was <0.001 and OR rated between 2.766 and 12.690 with a confidence interval of 95%, also resulting in a worse outcome in these patients. No significant differences regarding a worse outcome were found in Body Mass Index, gender, or toxic habits.

CONCLUSIONS

Older patients had a worse outcome from COVID-19, as well as patients with high blood pressure or DM. We found no differences regarding gender and neither could we find any differences regarding BMI.

[Risk factors for severity and mortality in adults testing positive for COVID-19 in the VI Health Area of Albacete]

Objectives

There are several retrospective studies that establish a relationship between some risk factors (cardiovascular risks mainly) and the development of COVID-19 and a severe outcome. Thus, our aim with this study is to find out the former relationship among the population within our basic health area.

Method

Cohort study. The study sample consisted of 372 patients aged 14 or older who had tested positive for COVID-19 in our health centre by consecutive sampling. Data collected from medical records will be analysed using Frequencies, X2 with a Confidence interval of 95% and those carrying out the study will have prior experience/training in research and will be specifically trained for the aim of this research.

Results

A worse outcome in patients aged 76 years old on average was found versus patients aged 48.7. Regarding high blood pressure patients, X2 was < .001 and OR between 3.975 and 21.425 with confidence interval of 95%, finding a worse outcome in these patients. With regard to Diabetes Mellitus (DM), X2 was < .001 and OR rated between 2.766 and 12.690 with a confidence interval of 95%, also resulting in a worse outcome in these patients. No significant differences regarding a worse outcome were found in Body Mass Index, gender, or toxic habits.

Conclusions

Older patients had a worse outcome from COVID- 19, as well as patients with high blood pressure or DM. We found no differences regarding gender and neither could we find any differences regarding BMI.

Obesity augments the disease burden in COVID-19: Updated data from an umbrella review

The ongoing coronavirus disease 2019 (COVID-19) pandemic calls for identification of risk factors, which may help to identify people at enhanced risk for severe disease outcomes to improve treatment and, if possible, establish prophylactic measures. This study aimed to determine whether individuals with obesity compared to individuals with normal weight have an increased risk for severe COVID-19. We conducted a systematic literature search of PubMed, Embase and Cochrane Library and critically reviewed the secondary literature using AMSTAR-2. We explored 27 studies. Findings indicate that individuals with obesity (body mass index ≥ 30 kg/m2 ), as compared to individuals without obesity, experience an increased risk for hospitalization (odds ratio [OR]: 1.40-2.45), admission to the intensive care unit (OR: 1.30-2.32), invasive mechanical ventilation (OR: 1.47-2.63), and the composite outcome 'severe outcome' (OR or risk ratio: 1.62-4.31). We found diverging results concerning death to COVID-19, but data trended towards increased mortality. Comparing individuals with obesity to individuals without obesity, findings suggested younger individuals (<60 years) experience a higher risk of severe disease compared to older individuals (≥60 years). Obesity augments the severity of COVID-19 including a tendency to increased mortality and, thus, contributes to an increased disease burden, especially among younger individuals.

The Severity of the Co-infection of Mycoplasma pneumoniae in COVID-19 Patients

Background and objective

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 2019 (COVID-19) infection, with symptoms ranging from mild upper respiratory illness to multisystem organ failure, and even death. Since its discovery in December 2019, the SARS-CoV-2 virus has led to a global pandemic, rapidly spreading to countries around the world, with millions of reported deaths to date. As researchers around the world continue to analyze and interpret the data gathered regarding the novel virus, it is evident that its co-infection with various bacterial pathogens is associated with a worse overall prognosis. One such bacterial pathogen, Mycoplasma pneumoniae (M. pneumoniae), has been associated with an increase in inpatient mortality, length of hospital stay, and need for mechanical ventilation. The aim of this study was to evaluate the characteristics and outcomes of patients co-infected with SARS-CoV-2 and M. pneumoniae. We sought to determine if this co-infection led to increased incidence of ventilatory support, intensive care unit (ICU) stay, and mortality.

Materials and Methods

A multi-center retrospective study was conducted involving patients aged 18 years and older. We compared the incidence of in-hospital mortality, ICU stay, and mechanical ventilation support between COVID-19-positive patients with and without M. pneumoniae co-infection. Based on the collected data, a binary logistic regression model was implemented to assess the correlation between mortality and ventilatory support, while linear regression was used to study the length of stay (LOS) independent variable.

Results

A total of 1,208 patients with a positive SARS-CoV-2 test were identified. Among them, 604 (50%) had an M. pneumoniae co-infection. LOS (95% CI for the coefficient estimate [0.86, 1.05], p<0.001), need for mechanical ventilation (95% CI for the odds ratio [2.60, 6.02], p<0.001), and inpatient mortality (95% CI for the odds ratio [1.43, 2.97], p<0.001) among those co-infected were significantly higher compared to COVID-19 patients without concomitant M. pneumoniae infection.

Conclusion

COVID-19 with a concomitant M. pneumoniae infection was found to have worse outcomes and overall prognosis when compared to individuals with independent disease states. Based on retrospective data gathered from a large multicenter database, the rates of mortality, ventilatory support, and length of hospital stay were significantly worse in patients with a co-infection of SARS-CoV-2 and M. pneumoniae.

Association of Patient Characteristics, Diabetes, BMI, and Obesity With Severe COVID-19 in Metropolitan Detroit, MI

Identification of specific risk factors for severe coronavirus disease 2019 (COVID-19) is crucial for prevention of poor outcomes and mortality. This retrospective cohort study of patients hospitalized with COVID-19 demonstrated that older age, male sex, Black race, diabetes, elevated BMI, and elevated inflammatory markers were correlated with critical illness in COVID-19. Older age, male sex, diabetes, and inflammatory markers, but not elevated BMI, were associated with mortality. Despite having greater odds of critical illness, Black patients had lower odds of death than White patients. Older age, male sex, diabetes, and elevated inflammatory markers were significantly associated with venous thromboembolism. These findings suggest a need to aggressively identify and manage modifiable risk factors (i.e., diabetes and elevated BMI) and encourage vaccination of at-risk individuals to prevent poor outcomes from COVID-19.

‘You Owe It to Yourself, Everyone You Love and to Our Beleaguered NHS to Get Yourself Fit and Well’: Weight Stigma in the British Media during the COVID-19 Pandemic—A Thematic Analysis

The portrayal of obesity in the media can impact public health by guiding peoples’ behaviours and furthering stigma. Individual responsibility for body weight along with negative portrayals of obesity have frequently dominated UK media discourses on obesity. This study aims to explore how the media has represented obesity during the COVID-19 pandemic through a thematic analysis of 95 UK online newspaper articles published in The Sun, The Mail Online, and The Guardian. The first theme, lifestyle recommendations, accounts for media coverage providing ‘expert’ advice on losing weight. The second theme, individual responsibility, emphasises media appeals to self-governance to tackle obesity and protect the NHS during the pandemic. The third theme, actors of change, explores how celebrities and politicians are presented as examples of weight management. These results suggest that individuals are held responsible for their weight and accountable for protecting the NHS during the COVID-19 pandemic. Stigma can be furthered by the decontextualisation of lifestyle recommendations and exacerbated by the actors of change presented: Celebrity profiles reveal gendered goals for weight management, and politicians exemplify self-governance, which consolidates their power. In conclusion, individualising and stigmatising discourses around obesity have taken new forms during the pandemic that link health responsibility to protecting the NHS and invokes celebrities and politicians to foster action.

The impact of behavioural risk factors on communicable diseases: a systematic review of reviews

Background

The coronavirus (COVID-19) pandemic has highlighted that individuals with behavioural risk factors commonly associated with non-communicable diseases (NCDs), such as smoking, harmful alcohol use, obesity, and physical inactivity, are more likely to experience severe symptoms from COVID-19. These risk factors have been shown to increase the risk of NCDs, but less is known about their broader influence on communicable diseases. Taking a wide focus on a range of common communicable diseases, this review aimed to synthesise research examining the impact of behavioural risk factors commonly associated with NCDs on risks of contracting, or having more severe outcomes from, communicable diseases.

Methods

Literature searches identified systematic reviews and meta-analyses that examined the association between behavioural risk factors (alcohol, smoking, illicit drug use, physical inactivity, obesity and poor diet) and the contraction/severity of common communicable diseases, including infection or associated pathogens. An a priori, prospectively registered protocol was followed (PROSPERO; registration number CRD42020223890).

Results

Fifty-three systematic reviews were included, of which 36 were also meta-analyses. Reviews focused on: tuberculosis, human immunodeficiency virus, hepatitis C virus, hepatitis B virus, invasive bacterial diseases, pneumonia, influenza, and COVID-19. Twenty-one reviews examined the association between behavioural risk factors and communicable disease contraction and 35 examined their association with communicable disease outcomes (three examined their association with both contraction and outcomes). Fifty out of 53 reviews (94%) concluded that at least one of the behavioural risk factors studied increased the risk of contracting or experiencing worse health outcomes from a communicable disease. Across all reviews, effect sizes, where calculated, ranged from 0.83 to 8.22.

Conclusions

Behavioural risk factors play a significant role in the risk of contracting and experiencing more severe outcomes from communicable diseases. Prevention of communicable diseases is likely to be most successful if it involves the prevention of behavioural risk factors commonly associated with NCDs. These findings are important for understanding risks associated with communicable disease, and timely, given the COVID-19 pandemic and the need for improvements in future pandemic preparedness. Addressing behavioural risk factors should be an important part of work to build resilience against any emerging and future epidemics and pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12148-y.

A Clinical Monitoring Program of COVID-19 Outpatients: A Prospective Cohort Study

Purpose

Coronavirus disease 2019 (COVID-19) has been associated with a high rate of mortality and morbidity. While a high portion of COVID-19 patients have mild symptoms, a limited number of clinical trials have evaluated the clinical course of this large group of patients. This study was designed to investigate the demographics and clinical characteristics and comorbidity of nonhospitalized COVID-19 patients.

Methods

This prospective, observational cohort study was performed on nonhospitalized adult patients (≥18 years) with COVID-19. Pharmacotherapy service was responsible for patients' assessment for up to 1 month. Demographic characteristics, the onset of symptoms, severity, duration, laboratory data, and hospitalization rate were evaluated by a pharmacist-based monitoring program.

Results

From 323 patients who had been referred to the emergency department, 105 individuals were recruited between April 26 and August 2, 2020. Most of the patients were female (66.7%) with a mean age of 39.39 years (SD: ± 15.82). The mean time of the symptom onset was 5.6 days (SD: ±1.79). The majority of patients suffered from fatigue (78.1%), sore throat (67.6%), cough (60%), and myalgia (55.2%). C-reactive protein, white blood cell, lymphocyte, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and hemoglobin levels were recovered significantly during the first two weeks (P < 0.001). Hydroxychloroquine, naproxen, diphenhydramine, azithromycin, and vitamin D3 were the most common medications administered (98%, 96%, 94%, 68%, and 57%, respectively). Forty patients were not symptom-free after the one-month follow-up, and 8 patients (7.6%) were required to revisit without the need for hospitalization. Anosmia (18.1%) and fatigue (17.1%) were the most common persisted symptoms. There were no significant differences between symptom-free and symptomatic patients.

Conclusion

Mild COVID-19 patients had a wide variety of symptoms and could be symptomatic even one month after the onset of symptoms. The pharmacist-based monitoring system can contribute beneficially to patients through the evaluation of symptoms, reduction of unnecessary visits, and provision of updated information to patients concerning the status of their illness.

Body mass index and severity/fatality from coronavirus disease 2019: A nationwide epidemiological study in Korea

OBJECTIVE

Obesity has been reported as a risk factor for severe coronavirus disease 2019 (COVID-19) in recent studies. However, the relationship between body mass index (BMI) and COVID-19 severity and fatality are unclear.

RESEARCH DESIGN AND METHODS

This study included 4,141 COVID-19 patients who were released from isolation or had died as of April 30, 2020. This nationwide data was provided by the Korean Centers for Disease Control and Prevention Agency. BMI was categorized as follows; < 18.5 kg/m2, 18.5-22.9 kg/m2, 23.0-24.9 kg/m2, 25.0-29.9 kg/m2, and ≥ 30 kg/m2. We defined a fatal illness if the patient had died.

RESULTS

Among participants, those with a BMI of 18.5-22.9 kg/m2 were the most common (42.0%), followed by 25.0-29.9 kg/m2 (24.4%), 23.0-24.9 kg/m2 (24.3%), ≥ 30 kg/m2 (4.7%), and < 18.5 kg/m2 (4.6%). In addition, 1,654 (41.2%) were men and 3.04% were fatalities. Multivariable analysis showed that age, male sex, BMI < 18.5 kg/m2, BMI ≥ 25 kg/m2, diabetes mellitus, chronic kidney disease, cancer, and dementia were independent risk factors for fatal illness. In particular, BMI < 18.5 kg/m2 (odds ratio [OR] 3.97, 95% CI 1.77-8.92), 25.0-29.9 kg/m2 (2.43, 1.32-4.47), and ≥ 30 kg/m2 (4.32, 1.37-13.61) were found to have higher ORs than the BMI of 23.0-24.9 kg/m2 (reference). There was no significant difference between those with a BMI of 18.5-22.9 kg/m2 (1.59, 0.88-2.89) and 23.0-24.9 kg/m2.

CONCLUSIONS

This study demonstrated a non-linear (U-shaped) relationship between BMI and fatal illness. Subjects with a BMI of < 18.5 kg/m2 and those with a BMI ≥ 25 kg/m2 had a high risk of fatal illness. Maintaining a healthy weight is important not only to prevent chronic cardiometabolic diseases, but also to improve the outcome of COVID-19.

COVID-19 lockdown consequences on body mass index and perceived fragility related to physical activity: A worldwide cohort study

Background

This paper is a follow‐up study continuing the COVISTRESS network previous research regarding health‐related determinants.

Objective

The aim was to identify the main consequences of COVID‐19 lockdown on Body MassIndex and Perceived Fragility, related to Physical Activity (PA), for different categories of populations, worldwide.

Design

The study design included an online survey, during the first wave of COVID‐19 lockdown, across different world regions.

Setting and participants

The research was carried out on 10 121 participants from 67 countries. The recruitment of participants was achieved using snowball sampling techniques via social networks, with no exclusion criteria other than social media access.

Main outcome measures

Body MassIndex, Physical Activity, Perceived Fragility and risk of getting infected items were analysed. SPSS software, v20, was used. Significance was set at P < .05.

Results

Body MassIndex significantly increased during lockdown. For youth and young adults (18‐35 years), PA decreased by 31.25%, for adults (36‐65 years) by 26.05% and for the elderly (over 65 years) by 30.27%. There was a high level of Perceived Fragility and risk of getting infected for female participants and the elderly. Correlations between BMI, Perceived Fragility and PA were identified.

Discussion and Conclusions

The research results extend and confirm evidence that the elderly are more likely to be at risk, by experiencing weight gain, physical inactivity and enhanced Perceived Fragility. As a consequence, populations need to counteract the constraints imposed by the lockdown by being physically active.

Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients

BACKGROUND

Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.

METHODS

Ninety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models.

RESULTS

Viral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92-0.99; P = .020) and body mass index (BMI) ≥25 kg/m2 (aHR, 0.37; 95% CI, 0.18-0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02-4.18; P = .044).

CONCLUSIONS

We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.

Sex as a Prognostic Factor in Systematic Reviews: Challenges and Lessons Learned

Sex is a common baseline factor collected in studies that has the potential to be a prognostic factor (PF) in several clinical areas. In recent years, research on sex as a PF has increased; however, this influx of new studies frequently shows conflicting results across the same treatment or disease state. Thus, systematic reviews (SRs) addressing sex as a PF may help us to better understand diseases and further personalize healthcare. We wrote this article to offer insights into the challenges we encountered when conducting SRs on sex as a PF and suggestions on how to overcome these obstacles, regardless of the clinical domain. When carrying out a PF SR with sex as the index factor, it is important to keep in mind the modifications that must be made in various SR stages, such as modifying the PF section of CHARMS-PF, adjusting certain sections of QUIPS and extracting data on the sex and gender terms used throughout the studies. In this paper, we provide an overview of the lessons learned from carrying out our reviews on sex as a PF in different disciplines and now call on researchers, funding agencies and journals to realize the importance of studying sex as a PF.

Delayed rise of oral fluid antibodies, elevated BMI, and absence of early fever correlate with longer time to SARS-CoV-2 RNA clearance in an longitudinally sampled cohort of COVID-19 outpatients

Background

Sustained molecular detection of SARS-CoV-2 RNA in the upper respiratory tract (URT) in mild to moderate COVID-19 is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.

Methods

Ninety-five outpatients self-collected mid-turbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models.

Results

Viral RNA clearance, as measured by SARS-CoV-2 RT-PCR, in 507 URT samples occurred a median (IQR) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR positive samples tested. All participants but one with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (aHR 0.96, 95% CI 0.92-0.99, p=0.020) and BMI ≥ 25kg/m ² (aHR 0.37, 95% CI 0.18-0.78, p=0.009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as one of first three COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR 2.06, 95% CI 1.02-4.18, p=0.044).

Conclusions

We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.

MCH-R1 Antagonist GPS18169, a Pseudopeptide, Is a Peripheral Anti-Obesity Agent in Mice

Melanin-concentrating hormone (MCH) is a 19 amino acid long peptide found in the brain of animals, including fishes, batrachians, and mammals. MCH is implicated in appetite and/or energy homeostasis. Antagonists at its receptor (MCH-R1) could be major tools (or ultimately drugs) to understand the mechanism of MCH action and to fight the obesity syndrome that is a worldwide societal health problem. Ever since the deorphanisation of the MCH receptor, we cloned, expressed, and characterized the receptor MCH-R1 and started a vast medicinal chemistry program aiming at the discovery of such usable compounds. In the present final work, we describe GPS18169, a pseudopeptide antagonist at the MCH-R1 receptor with an affinity in the nanomolar range and a Ki for its antagonistic effect in the 20 picomolar range. Its metabolic stability is rather ameliorated compared to its initial parent compound, the antagonist S38151. We tested it in an in vivo experiment using high diet mice. GPS18169 was found to be active in limiting the accumulation of adipose tissues and, correlatively, we observed a normalization of the insulin level in the treated animals, while no change in food or water consumption was observed.

Impact of cancer on mortality and severity of corona virus disease 2019: A protocol for systematic review and meta-analysis

BACKGROUND

Cancer patients are in a state of systemic immunosuppression and are considered a highly vulnerable population in the Corona Virus Disease 2019 (COVID-19) epidemic. However, the relationship between cancer and the severity and mortality of patients with COVID-19 remains unclear. This study aims to evaluate whether cancer patients with COVID-19 may be at an increased risk of severe illness and mortality.

METHODS

We will perform comprehensive searches in PubMed, EMBASE.com, Web of Science, and the Cochrane Central Register of Controlled Trials to identify studies providing prevalence of cancer between patients with severe and non-severe illness or between non-survivors and survivors. We will use the Newcastle-Ottawa quality assessment scale to assess the quality of included studies. We will conduct pairwise meta-analyses to compute the odds ratio and 95% confidence interval using the Mantel Haenszel method with the random-effects model. The statistical heterogeneity will be assessed using the I statistic. Subgroup analyses, sensitivity analyses, and meta-regression analyses will be performed to explore the sources of heterogeneity.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

Our meta-analysis will systematically evaluate the association between cancer and the severity and mortality of patients with COVID-19. This study will provide evidence to help determine whether cancer patients should be provided with special precautions and advised to use stronger personal protection.

INPLASY REGISTRATION NUMBER

INPLASY202090093.