The Impact of Obesity and Lifestyle on the Immune System and Susceptibility to Infections Such as COVID-19

Daan L de Frel, Douwe E Atsma, Hanno Pijl, Jacob C Seidell, Pieter J M Leenen, Willem A Dik, Elisabeth F C van Rossum, Daan L de Frel, Douwe E Atsma, Hanno Pijl, Jacob C Seidell, Pieter J M Leenen, Willem A Dik, Elisabeth F C van Rossum

Abstract

Background: COVID-19 is a global challenge to healthcare. Obesity is common in patients with COVID-19 and seems to aggravate disease prognosis. In this review we explore the link between obesity, chronic disease, lifestyle factors and the immune system, and propose societal interventions to enhance global immunity. Search Strategy and Selection Criteria: We performed three literature searches using the keywords (1) coronavirus AND comorbidities, (2) comorbidities AND immune system, and (3) lifestyle factors AND immune system. Results were screened for relevance by the main author and a total of 215 articles were thoroughly analyzed. Results: The relationship between obesity and unfavorable COVID-19 prognosis is discussed in light of the impact of chronic disease and lifestyle on the immune system. Several modifiable lifestyle factors render us susceptible to viral infections. In this context, we make a case for fostering a healthy lifestyle on a global scale. Conclusions: Obesity, additional chronic disease and an unhealthy lifestyle interactively impair immune function and increase the risk of severe infectious disease. In adverse metabolic and endocrine conditions, the immune system is geared toward inflammation. Collective effort is needed to ameliorate modifiable risk factors for obesity and chronic disease on a global scale and increase resistance to viruses like SARS-CoV-2.

Keywords: COVID-19; diet; immune system; lifestyle; obesity.

Copyright © 2020 de Frel, Atsma, Pijl, Seidell, Leenen, Dik and van Rossum.

Figures

Figure 1
Figure 1
Schematic overview of factors contributing to obesity and/or impairing weight loss. Next to obesity, most of these factors are also directly related to alterations in the immune system leading to a pro-inflammatory state and subsequent comorbidities.
Figure 2
Figure 2
Positive and negative lifestyle factors influence obesity and the immune system. The negative lifestyle factors (red) can lead to a disbalance in immune homeostasis, trained innate immunity, inflammaging, and a decrease in infection resistance. Positive factors (green) can protect immune homeostasis and potentially increase resistance to infection. Trained innate immunity: long term functional reprogramming of innate immune cells, which is evoked by exogenous or endogenous stimuli and which leads to a usually enhanced response toward a second challenge after return to a non-activated state. Inflammaging: chronic low-grade inflammation that occurs with aging and is characterized by dysregulated inflammatory responses, in general resulting in increased inflammatory responses and diminished responses to pathogens like influenza or SARS-CoV-2.

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