Abstract
Objective: Obesity has been shown to be associated with adverse outcomes in viral
infections such as influenza, but previous studies on coronavirus disease 2019
(COVID-19) had mixed results. The aim of this systematic review is to investigate the
relationship between COVID-19 and obesity.
Methods: We performed a systematic review and meta-analysis. A literature search of
MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL, OpenGrey and preprint
servers medRxiv and bioRxiv was performed, with no restriction on language or date of
publication. Primary outcomes of this study were intensive care unit (ICU) admission
or critical disease, severe disease and mortality. Secondary outcome was a positive
COVID-19 test. Meta-analysis was performed using OpenMeta-Analyst software, and
heterogeneity was tested using Cochran’s Q test and I2 statistic. The study protocol was
registered on PROSPERO (CRD42020184953).
Results: A total of 1,493 articles were identified and 61 studies on 270,241 patients
were included. The pooled prevalence of obesity was 27.6% (95% confidence interval
[CI] 22.0–33.2) in hospitalised patients. Obesity was not significantly associated with
increased ICU admission or critical illness (odds ratio [OR] 1.25, 95% CI 0.99–1.58,
P=0.062, I2=31.0) but was significantly associated with more severe disease (OR 3.13,
95% CI 1.41–6.92, P=0.005, I2=82.6), mortality (OR 1.36, 95% CI 1.09–1.69, P=0.006,
I2=88.5) and a positive COVID-19 test (OR 1.50, 95% CI 1.25–1.81, P<0.001).
Conclusion: Obesity increased the risk of severe disease, mortality and infection with
COVID-19. Higher body mass index was associated with ICU admission and critical
disease. Patients who are obese may be more susceptible to severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection, and infected patients should be
monitored closely for adverse outcomes.
Keywords: Body mass index, coronavirus, intensive care, mortality, prognosis
Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta‐Analysis and Systematic Review
