The association between body mass index and severity of Coronavirus Disease 2019 (COVID-19): A cohort study
Kulapong Jayanama1, Sirawat Srichatrapimuk1, Kanin Thammavaranucupt1
1Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
Insights
Obesity (body mass index ≥25.0 kg/m2) in patients with coronavirus disease 2019 (COVID-19) is linked to severe pneumonia. Underweight patients (BMI <18.5 kg/m2) require monitoring for acute kidney injury (AKI).
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) presents diverse clinical manifestations, ranging from asymptomatic cases to fatal outcomes.
- Understanding risk factors associated with COVID-19 severity is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the association between body mass index (BMI) categories and the severity of COVID-19.
- To identify specific clinical outcomes related to different BMI levels in COVID-19 patients.
Main Methods:
- A cohort study involving 147 adult COVID-19 patients.
- Patients were classified into four BMI groups: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), and obese (≥25.0 kg/m2).
- Logistic regression analysis was employed to assess the relationship between BMI and severe pneumonia, controlling for confounding factors.
Main Results:
- Higher BMI levels were associated with increased rates of pneumonia and severe pneumonia.
- Underweight and obese patients exhibited higher rates of acute kidney injury (AKI) and intensive care unit (ICU) stay compared to normal-weight patients.
- Obesity (BMI ≥25.0 kg/m2) significantly increased the risk of severe pneumonia (OR 4.73; p = 0.003) after adjusting for covariates.
- Elevated hemoglobin and alanine aminotransferase levels were linked to higher BMI, while rising serum creatinine was observed in underweight patients.
Conclusions:
- Obesity is a significant risk factor for severe pneumonia and adverse outcomes, including AKI, transaminitis, and ICU admission in COVID-19 patients.
- Underweight individuals with COVID-19 require close monitoring for the development of AKI.
- Further research into body composition is needed to elucidate the mechanisms linking adiposity to COVID-19 pathogenesis.
Objectives:
The coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19.
Methods And Study Design:
A cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5-22.9 (normal weight), 23.0-24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia.
Results:
Of the totals, patients having a BMI <18.5, 18.5-22.9, 23.0-24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50-14.94; p = 0.003) compared to having a BMI 18.5-22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness.
Conclusions:
Obesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.
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