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COVID-19: One Reason So Many People Have Been Hit Hard By The Virus

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Early on in the COVID-19 pandemic, scientists recognized obesity and diabetes as risk factors for developing a serious illness. Furthermore, we are aware that many individuals with type 2 diabetes are overweight. 

According to a meta-analysis of more than 30,000 UK individuals from nine sizable prospective cohort studies, having a high body mass index (BMI) is more closely linked to an increased risk of COVID-19 infection and a long COVID than having high blood sugar levels.

Dr. Anika Knuppel of the MRC Unit for Lifelong Health and Ageing at University College London, UK, and colleagues to present their findings at the European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden, this year (19-23 Sept).

COVID-19: One Reason So Many People Have Been Hit Hard By The Virus
COVID-19: One Reason So Many People Have Been Hit Hard By The Virus

Early on in the COVID-19 pandemic, scientists recognized obesity and diabetes as risk factors for developing a serious illness. Furthermore, we are aware that many individuals with type 2 diabetes are overweight. 

Dr. Knuppel explains that preliminary findings support the theory that obesity-related mechanisms may be responsible for the elevated risk of COVID-19 linked with diabetes, rather than high blood sugar levels.

Previous studies revealed that while patients with diabetes and obesity are not more likely to get COVID-19, they are more likely to experience severe illness and eventually pass away. Uncertainty surrounds the underlying mechanisms and their contribution to the long-lasting post-COVID-19 symptoms.

In order to learn more, researchers examined relationships between self-reported COVID-19 infection and chronic COVID in nine ongoing UK cohort studies, including HbA1c (average blood sugar level), self-reported or medication-based diabetes, body mass index (BMI), and waist-to-hip ratio (WHR).

The analyses included data from questionnaires on health and lifestyle, as well as the most recent measurements of HbA1c, weight, height, waist, and hip circumference from each study (taken between 2002 and 2019).

During the COVID-19 pandemic (May 2020 to September 2021), all eligible participants (maximum 31,252, aged 19 to 75, 57% female) completed at least one questionnaire covering questions on COVID-19 and, when possible, questions on the period of persistent COVID-19-related symptoms.

Based on a positive test result or high suspicion, participants reported having COVID-19. Long COVID was defined as symptoms that persisted or impaired function for longer than four weeks following infection and was compared to individuals who reported symptoms for less than four weeks.

When feasible, correlations were adjusted for gender, smoking, ethnicity, income, and level of education at the time of measurement.

Between May 2020 and September 2021, 5,806 people said they had ever had COVID-19, and 584 said they had long COVID. This is about 7% of COVID-19 cases for which the length of symptoms was known.

Diabetics With This Condition Have A Greater Risk Of Infection And Long-covid

An increased risk of COVID-19 infection was found to be associated with a higher BMI in an analysis that included data from 31,252 persons who took part in nine research. The risk increased by 7% for every 5kg/m2 rise in BMI. Overweight (BMI 25-29.9kg/m2) and obese (30 kg/m2 or more) people had 10% and 16% higher COVID-19 infection probabilities than healthy weight people (less than 25 kg/m2.

Similar findings were seen for long COVID (4,243 participants, six studies), with the risk increasing by 20% for every kilogram of BMI over the baseline. Long COVID was more likely in people who were overweight or obese by 20% and 36%, respectively. However, not all relationships between COVID infection and long-term COVID and BMI categories were statistically significant (so we cannot be sure they are not due to chance).

The results of the studies done on the link to WHR were inconclusive.

Notably, research concentrating on diabetes and average blood sugar level (HbA1c) (15,795 participants and 1,917 for long COVID) found no correlation between COVID-19 or long-COVID.

The study’s authors emphasize the need for additional study to better understand the processes underlying these relationships and to lower the excess risk brought on by high BMI. 

“Our early findings suggest a link of adiposity with COVID-19 infection and long COVID-19 even after taking into account socio-demographic factors and smoking. We need to further explore what makes people with overweight and obesity at risk of worse outcomes and how this relates to severe cases,” adds Knuppel.

The study was observational, the authors acknowledge, and they cannot prove that having a higher BMI increases the risk of contracting COVID-19.

They also cannot completely rule out the possibility that other unmeasured factors (such as underlying conditions) or missing data may have had an impact on the findings.

Additionally, they point out that some of the included studies may use clinical data that are no longer valid because COVID-19 was based on suspicion rather than a positive test.

Lastly, they say that the people who took part in the study were healthier than the average person, which may make it harder to draw conclusions.

Image Credit: Getty

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