The negative impact of obesity on the occurrence and prognosis of the 2019 novel coronavirus (COVID-19) disease: a systematic review and meta-analysis

Abstract

PURPOSE: The 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality. METHODS: The study protocol was registered in PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted from 31 December 2019 to 1 June 2020 to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95 confidence intervals (CIs) were calculated to assess the associations. RESULTS: The prevalence of obesity was 33 (95 CI 30.0-35.0) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR = 2.42, 95 CI 1.58-3.70; moderate certainty) and COVID-19 severity (OR = 1.62, 95 CI 1.48-1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR = 1.75, 95 CI 1.47-2.09; very low certainty), mechanical ventilation (OR = 2.24, 95 CI 1.70-2.94; low certainty), intensive care unit (ICU) admission (OR = 1.75, 95 CI 1.38-2.22; low certainty), and death (OR = 1.23, 95 CI 1.06-1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. CONCLUSION: Obesity is associated with COVID-19, need for hospitalization, mechanical ventilation, ICU admission, and death due to COVID-19. LEVEL OF EVIDENCE: Level I, systematic reviews and meta-analyses.