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Severe COVID-19: The Younger the Patient, the More Obesity | Instant News

MAY 13 2020 – The younger an ICU patient is, the worse it is COVID-19 is, more and more fat patients are less likely, according to new analysis published in Lancet.

“Automatically, obesity “seems to be a sufficient risk factor to start seeing young people land in ICU,” said the study’s lead author, David Kass, MD, a professor of cardiology and medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland.

“In that case, there is a simple message: If you are very, very obesity, don’t think that if you are 35 you are much safer[severely[fromsevere[dariparah[fromsevereCOVID-19]”from your mother or grandparents or other people in their 60s or 70s,” Kass said Medscape Medical News.

The findings, which Kass described as a “2-week snapshot” of 265 patients (58% men) at the end of March and early April in several university hospitals in the United States reinforce other recent research showing that obesity is one of the biggest risk factors for severe COVID-19 disease, especially among younger patients. In addition, a large study in the United Kingdom showed that, after adjusting for comorbidity, obesity was a significant factor associated with hospital mortality in COVID-19.

But this new analysis stands out as the only dataset to date that specifically “asks questions relative to age” whether severe COVID-19 the disease correlates with ICU care, he said.

The average age of the ICU patient study population was 55, Kass said, “and that’s still young, not what we expected.”

“Even with the first 20 patients, we’ve seen younger people and they are clearly heavier, with many patients with BMI more than 35 kg / m2, “he added.” The relationship is quite close, fast enough. “

“Just don’t make the assumption that some of us are too young to be vulnerable if, in fact, this is an aspect of our body,” he said.

Steven Heymsfield, MD, past president and spokesman for The Obesity Society, agreed with Kass’s conclusion.

“One thing we have in our minds is that the prototype of someone with this disease is older … but now if we get it [a patient] who is asymptomatic and 40 and fat“We shouldn’t assume they have some other disease,” Heymsfield said Medscape Medical News.

“We have to think of them as a vulnerable population.”

Kass and his partner agreed. “Public messaging for younger adults, reducing the threshold for testing viruses in obese people, and maintaining greater vigilance for populations at risk should reduce the prevalence of severe COVID-19 disease [among those with obesity], “they declared.

“I think this is a mental adjustment from a health perspective, which hopefully can help target people at higher risk before they get into trouble,” Kass said. Medscape Medical News.

Trio of Mechanisms Explaining Obesity, Extra COVID-19 Risks

Kass and his co-authors wrote that, in analyzing their data, they anticipated results similar to the largest study of 1,591 ICU patients from Italy where only 203 were younger than 51 years. Common comorbidities among patients include hypertension, cardiovascular disease, and type 2 diabetes, with similar data reported from China.

When the COVID-19 epidemic spread in the United States, older age was also identified as a risk factor. Obesity hasn’t been added to this list, Kass said. But after informal discussions with colleagues at other ICUs across the country, he decided to investigate further whether it was an undervalued risk factor.

Kass and colleagues conducted a rapid evaluation of the relationship between the two BMI and age of patients with COVID-19 who were treated at the ICU at Johns Hopkins, University of Cincinnati, University of New York, University of Washington, Florida Health, and University of Pennsylvania.

“Significant inverse correlation between age and BMI” shows that ICU patients who are younger are more likely to be obese, without differences based on sex.

The average BMI among study participants was 29.3 kg / m2, with only a quarter having a BMI lower than 26 kg / m2 and the other 25% have a BMI higher than 34.7 kg / m2.

Kass acknowledged that it was not possible with this simple dataset to explain other potential confounders, but he said Medscape Medical News “Meanwhile diabetes, cardiovascular disease, and hypertension, for example, can occur with obesity, this is generally less common in younger populations because it takes time to develop other comorbidities. “


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He said several mechanisms could explain why obesity affects patients with COVID-19 in severe illness.

For one, obesity puts extra pressure on diaphragm while lying on your back, limit breathing.

“Abnormal obesity itself is a kind of proinflammation,” he continued.

“Here we have a viral infection where preliminary reports indicate that cytokine storms and handling of immunity to the virus are why it’s far more severe than other forms of coronavirus we’ve seen before. So if you have someone with a virus that already underlies the state of proinflammation, this could be the reason there is a higher risk. “

In addition, the angiotensin-converting enzyme-2 (ACE-2) receptor where SARSThe CoV-2 virus that causes COVID-19 to attach is expressed in higher amounts in adipose tissue than lungs, Said Kass.

“This could turn into a kind of repository for viruses,” he explained. “You might make more viruses as a component of obesity.”

Sensitivity Required in Public Messaging About Risks, But a Rapid Test

With an obesity rate of around 40% in the United States, the results are very relevant for Americans, said Kass and Heymsfield, noting that the country’s “obesity belt” crosses the South.

Heymsfield, who was not part of the new analysis, noted that sending public messages around the risk of severe COVID-19 in younger adults with obesity was “complicated,” especially because the virus “is still quite common in people who are not strangers.”

Kass agreed, noting, “it’s hard to turn to 40% of the population and say, ‘You have to watch it.'”

But increasing research findings require linking obesity to severe COVID-19 disease and possibly testing patients in this category for the virus more quickly before symptoms become severe.

And for the record, since hard to breathe is common among people with obesity regardless of the disease, similar symptoms of COVID-19 may make these people unconscious, suggests Heymsfield, who is also a professor in the Metabolism and Body Composition Lab at Pennington Biomedical Research Center at Louisiana State University , Baton Rouge.

“They might find themselves really unable to breathe, and the concern is that they waited too long to come” for treatment, he said. Usually, people can get worse between the 7th and 10th day of COVID-19 infection.

Obese people “need to be educated to recognize the serious complications of COVID-19 which often appear suddenly, even though the virus sometimes works through the body for a long time,” he concluded.


Source: Lancet. Published online. Full text

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