Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Sarra Smati, Blandine Tramunt, Matthieu Wargny, Cyrielle Caussy, Bénédicte Gaborit, Camille Vatier, Bruno Vergès, Deborah Ancelle, Coralie Amadou, Leila A Bachir, Olivier Bourron, Christine Coffin-Boutreux, Sara Barraud, Anne Dorange, Bénédicte Fremy, Jean-François Gautier, Natacha Germain, Etienne Larger, Stéphanie Laugier-Robiolle, Laurent Meyer, Arnaud Monier, Isabelle Moura, Louis Potier, Nadia Sabbah, Dominique Seret-Bégué, Patrice Winiszewski, Matthieu Pichelin, Pierre-Jean Saulnier, Samy Hadjadj, Bertrand Cariou, Pierre Gourdy, CORONADO investigators, Sarra Smati, Blandine Tramunt, Matthieu Wargny, Cyrielle Caussy, Bénédicte Gaborit, Camille Vatier, Bruno Vergès, Deborah Ancelle, Coralie Amadou, Leila A Bachir, Olivier Bourron, Christine Coffin-Boutreux, Sara Barraud, Anne Dorange, Bénédicte Fremy, Jean-François Gautier, Natacha Germain, Etienne Larger, Stéphanie Laugier-Robiolle, Laurent Meyer, Arnaud Monier, Isabelle Moura, Louis Potier, Nadia Sabbah, Dominique Seret-Bégué, Patrice Winiszewski, Matthieu Pichelin, Pierre-Jean Saulnier, Samy Hadjadj, Bertrand Cariou, Pierre Gourdy, CORONADO investigators

Abstract

Aim: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D).

Methods: From the CORONAvirus-SARS-CoV-2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19-related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.

Results: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2 , reference group), 726 (36.9%) overweight (25-29.9 kg/m2 ) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2 ) and 314 (16.0%) with class II/III obesity (≥35 kg/m2 ). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.

Conclusions: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.

Keywords: COVID-19, elderly, mechanical ventilation, obesity, prognosis, type 2 diabetes.

Conflict of interest statement

C.C. reports personal fees from Novo Nordisk, Gilead, MSD, Eli Lilly and Astra Zeneca and grant support from Gilead. L.P. reports personal fees and non‐financial support from Sanofi, personal fees and non‐financial support from Eli Lilly, personal fees and non‐financial support from Novo Nordisk and personal fees and non‐financial support from MSD. B.F. reports personal fees and non‐financial support from Sanofi, Orkyn, Isis, MSD, NHC, Pfizer, Vitalair, Eli Lilly, Novo Nordisk, Merck and Servier. J.‐F.G. reports personal fees and non‐financial support from Eli Lilly, personal fees and non‐financial support from Novo Nordisk, personal fees and non‐financial support from Gilead and personal fees and non‐financial support from Astra Zeneca. A.M. reports personal fees support from Novo Nordisk. D.S.‐B. reports non‐financial support from Novo Nordisk, Sanofi, MSD and Lilly. M.P. reports personal fees and non‐financial support from Novo Nordisk, non‐financial support from Sanofi and non‐financial support from Amgen. S.H. reports personal fees and non‐financial support from Astra Zeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from Dinno Santé, personal fees from Eli Lilly, non‐financial support from LVL, personal fees and non‐financial support from Merck Sharpe Dome, personal fees from Novartis, grants from Pierre Fabre Santé, personal fees and non‐financial support from Sanofi, personal fees and non‐financial support from Servier and personal fees from Valbiotis. B.C. reports grants and personal fees from Amgen, personal fees from Astra‐Zeneca, personal fees from Akcea, personal fees from Genfit, personal fees from Gilead, personal fees from Eli Lilly, personal fees from Novo Nordisk, personal fees from Merck (MSD), grants and personal fees from Sanofi and grants and personal fees from Regeneron. P.G. reports personal fees from Abbott, personal fees from Amgen, personal fees from Astra‐Zeneca, personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, personal fees from Merck Sharp and Dohme, personal fees from Mundipharma, grants and personal fees from Novo Nordisk, personal fees from Sanofi and personal fees from Servier. All of the other authors declare no competing interests.

© 2020 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Flowchart. BMI, body mass index; IMV, intubation for mechanical ventilation; T2D, type 2 diabetes
FIGURE 2
FIGURE 2
Distribution of COVID‐19‐related outcomes by day 7 per age and body mass index (BMI) subgroups: A) Primary outcome; B) IMV; C) Death; D) Hospital discharge

References

    1. Singh AK, Gillies CL, Singh R, et al. Prevalence of co‐morbidities and their association with mortality in patients with COVID‐19: a systematic review and meta‐analysis. Diabetes Obes Metab. 2020;22:1915‐1924.
    1. Vas PRJ, Hopkins D, Feher MD, Rubino F, Martin MB. Diabetes, obesity and COVID‐19: a complex interplay. Diabetes Obes Metab. 2020;22:1892‐1896.
    1. Sun Y, Wang Q, Yang G, Lin C, Zhang Y, Yang P. Weight and prognosis for influenza a(H1N1)pdm09 infection during the pandemic period between 2009 and 2011: a systematic review of observational studies with meta‐analysis. Infect Dis. 2016;48(11‐12):813‐822.
    1. Fezeu L, Julia C, Henegar A, et al. Obesity is associated with higher risk of intensive care unit admission and death in influenza a (H1N1) patients: a systematic review and meta‐analysis. Obes Rev. 2011;12(8):653‐659.
    1. Alqahtani FY, Aleanizy FS, Ali El Hadi Mohamed R, et al. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study. Epidemiol Infect. 2019;147:e35.
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID‐19 in the New York City area. JAMA. 2020;323:2052‐2059.
    1. ICNARC . Report on COVID‐19 in critical care. Intensive Care National Audit & Research Centre. 2020. . Accessed July 10, 2020.
    1. Caussy C, Pattou F, Wallet F, et al. Prevalence of obesity among adult inpatients with COVID‐19 in France. Lancet Diabetes Endocrinol. 2020;8(7):562‐564.
    1. Cai Q, Chen F, Wang T, et al. Obesity and COVID‐19 severity in a designated hospital in Shenzhen, China. Diabetes Care. 2020;43(7):1392–1398.
    1. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity is associated with higher in‐hospital mortality in a cohort of patients with COVID‐19 in the Bronx, New York. Metabolism. 2020;108:154262.
    1. Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID‐19 disease to younger ages. Lancet. 2020;395(10236):1544‐1545.
    1. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID‐19 infection are at higher risk of ICU admission and poor short‐term outcome. J Clin Virol. 2020;127:104354.
    1. Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID‐19 and diabetes: the CORONADO study. Diabetologia. 2020;63(8):1500–1515.
    1. Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity. 2020;28(7):1195–1197.
    1. Caussy C, Wallet F, Laville M, Disse E. Obesity is associated with severe forms of COVID‐19. Obesity (Silver Spring). 2020;28(7):1175.
    1. Tartof SY, Qian L, Hong V, et al. Obesity and mortality among patients diagnosed with COVID‐19: results from an integrated health care organization. Ann Intern Med. 2020;M20‐3742.
    1. Druet C, Bourdel‐Marchasson I, Weill A, et al. Type 2 diabetes in France: epidemiology, trends of medical care, social and economic burden. Entred 2007. Presse Med. 2013;42(5):830‐838.
    1. Pornet C, Bourdel‐Marchasson I, Lecomte P, et al. Trends in the quality of Care for Elderly People with Type 2 diabetes: the need for improvements in safety and quality (the 2001 and 2007 ENTRED surveys). Diabetes Metab. 2011;37(2):152‐161.
    1. Lovejoy JC, Sainsbury A. Sex differences in obesity and the regulation of energy homeostasis: etiology and pathophysiology. Obes Rev. 2009;10(2):154‐167.
    1. Logue J, Walker JJ, Colhoun HM, et al. Do men develop type 2 diabetes at lower body mass indices than women? Diabetologia. 2011;54(12):3003‐3006.
    1. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years a randomized clinical trial. JAMA. 2016;315(24):2673‐2682.
    1. Hartholt KA, Lee R, Burns ER, Van Beeck EF. Mortality from falls among US adults aged 75 years or older, 2000–2016. JAMA. 2019;321(21):2131‐2133.
    1. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid‐19 hospital admission. Clin Infect Dis. 2020;71(15):896–897.
    1. Anderson MR, Geleris J, Anderson DR, et al. Body mass index and risk for intubation or death in SARS‐CoV‐2 infection. Ann Intern Med. 2020;M20–3214.
    1. Zoppini G, Verlato G, Leuzinger C, et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int J Obes. 2003;27(2):281‐285.
    1. Hainer V, Aldhoon‐Hainerová I. Obesity paradox does exist. Diabetes Care. 2013;36((Suppl. 2)):S281.
    1. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short‐term and long‐term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39(4):578‐584.
    1. Romero‐Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368(9536):666‐678.
    1. Tate J, Knuiman M, Davis WA, Davis TME, Bruce DG. A comparison of obesity indices in relation to mortality in type 2 diabetes: the Fremantle diabetes study. Diabetologia. 2020;63(3):528‐536.
    1. Zheng KI, Gao F, Wang XB, et al. Obesity as a risk factor for greater severity of COVID‐19 in patients with metabolic associated fatty liver disease. Metabolism. 2020;108:154244.
    1. Targher G, Mantovani A, Byrne CD, et al. Risk of severe illness from COVID‐19 in patients with metabolic dysfunction‐associated fatty liver disease and increased fibrosis scores. Gut. 2020;69(8):1545–1547.
    1. Calori G, Lattuada G, Piemonti L, et al. Prevalence, metabolic features, and prognosis of metabolically healthy obese italian individuals: the Cremona study. Diabetes Care. 2011;34(1):210‐215.
    1. Sattar N, McInnes IB, McMurray JJV. Obesity a risk factor for severe COVID‐19 infection: multiple potential mechanisms. Circulation. 2020;142:4‐6.
    1. Ryan PMD, Caplice NM. Is adipose tissue a reservoir for viral spread, immune activation and cytokine amplification in COVID‐19. Obesity (Silver Spring). 2020;28:1191‐1194.
    1. Wang Z, Aguilar EG, Luna JI, et al. Paradoxical effects of obesity on T cell function during tumor progression and PD‐1 checkpoint blockade. Nat Med. 2019;25(1):141‐151.
    1. Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in metropolitan Detroit. JAMA Netw Open. 2020;3(6):e2012270.

Source: PubMed

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