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Obesity could shift severe COVID-19 disease to younger ages

23 May, 2020 - 00:05 0 Views
Obesity could shift severe COVID-19 disease to younger ages

The Herald

Roselyne Sachiti
Young obese people are at a higher risk of getting Covid -19, a Lancet report published on May 4 has warned.

The paper was co- authored by David A Kass, Priya Duggal and Oscar Cingolani of the Johns Hopkins University School of Medicine.

According to the authors, the largest study of 1591 ICU patients from Italy reported a median age of 63 years, with only 203 patients (13 percent) younger than 51 years.

Common comorbidities identified included hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (42 [4 percent] of 1043), obstructive pulmonary disease.

Similar data have been reported from China.

“When the COVID-19 epidemic began in the USA, we anticipated a similar ICU population. News reports and communications from the US Federal Government had emphasised that COVID-19 was a particular problem for older people, and a resistance to social distancing and sheltering in place by younger people might have been informed by this idea,” outlined the paper.

However, as the pandemic hit the Johns Hopkins Hospital in late March, 2020, younger patients began to be admitted to the ICU, many of whom were also obese.

“An informal survey of colleagues directing ICUs at other hospitals around the country yielded similar findings. At this time, news editorials were noting obesity as an underappreciated risk factor for COVID-19,” it further says.

This risk is particularly relevant in the USA because the prevalence of obesity is around 40 percent, versus a prevalence of 6·2 percent in China, 20 percent in Italy, and 24 percent in Spain.

“With use of least squares univariate and multivariate linear regression, we examined the correlation between body-mass index (BMI) and age in patients with COVID-19 admitted to ICU at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania (appendix),” the paper adds.

Acquisition of the de-identified data for this analysis was approved by the Johns Hopkins University Institutional Review Board.

“In our dataset of 265 patients (58 percent male patients), we found a significant inverse correlation between age and BMI, in which younger individuals admitted to hospital were more likely to be obese (figure).

“There was no difference by sex (p=0·9). The median BMI was 29·3 kg/m², with only 25 percent of individuals having a BMI of less than 26 kg/m², and 25 percent exceeding a BMI of 34·7 kg/m².”

Why we should worry

According to the Lancet paper, obesity can restrict ventilation by impeding diaphragm excursion, impairs immune responses to viral infection, is pro-inflammatory, and induces diabetes and oxidant stress to adversely affect cardiovascular function.

“We conclude that in populations with a high prevalence of obesity, COVID-19 will affect younger populations more than previously reported. Public messaging to younger adults, reducing the threshold for virus testing in obese individuals, and maintaining greater vigilance for this at-risk population should reduce the prevalence of severe COVID-19 disease,” adds the paper.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 was first reported in China in late December, 2019, and has since evolved into a global pandemic. As of May 15, 2020, COVID-19 has been confirmed in 4 405 680 cases individuals in 185 countries and regions.

As at May 15, 2020, Zimbabwe had 42 confirmed cases, including 13 recoveries and four deaths.

Severe disease involves bilateral interstitial pneumonia requiring intensive care unit (ICU) ventilatory support and can evolve into adult respiratory distress syndrome with high mortality.

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