According to prior studies, people with diabetes and obesity are not more likely to contract COVID-19, but they are more likely to develop severe illness and eventually pass away from it. Uncertainty persists regarding the underlying mechanisms and their contribution to the extended post-COVID-19 symptoms (long COVID).
A study found that a higher incidence of COVID-19 infection and protracted COVID was linked to a high body mass index (BMI) rather than high blood sugar levels.
At this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden, Dr. Anika Knuppel and colleagues from the MRC Unit for Lifelong Health and Aging at University College London, UK, will present their findings (19-23 Sept).
“Early in the pandemic research identified diabetes and obesity as risk factors for becoming severely ill with COVID-19. And we know that many people living with type 2 diabetes are also carrying excess weight. Our early findings support the idea that obesity-related mechanisms may be responsible for the excess risks of COVID-19 associated with diabetes, rather than high blood sugar per se,” says Dr Knuppel.
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 symptoms.
In order to learn more, researchers looked for correlations between self-reported COVID infection and long COVID in nine ongoing UK cohort studies [1]. These correlations included 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 and, when possible, questions on the period of persistent COVID-related symptoms.
Participants who had a positive test or a strong suspicion of having COVID-19 reported having it. In order to compare individuals reporting symptoms for less than four weeks to those reporting symptoms lasting longer than four weeks, the term “long COVID” was used.
In some cases, relationships were corrected for at the time of assessment for sex, smoking, ethnicity, income, and education.
A total of 5,806 participants reported having COVID-19 between May 2020 and September 2021, and 584 of those participants (or about 7% of COVID-19 cases with information on symptoms length) reported having protracted COVID.
Higher BMI was found to be associated with increased odds of COVID infection, with the risk increasing by 7% for every 5 kg/m2 increase in BMI, according to an analysis of data from 31,252 participants in nine trials. Obesity (BMI 30 kg/m2 or above) and overweight (BMI 25-29.9 kg/m2) were associated with 10% and 16% higher probabilities of COVID-19 infection, respectively, than healthy weight (BMI less than 25 kg/m2; see the graph in the notes to editors).
Similar findings were seen for extended COVID (4,243 participants, six studies), where the risk increased by 20% for every kilogram/m2 increase in BMI. Obesity and overweight individuals exhibited risks of protracted COVID that were correspondingly 20% and 36% higher. However, not all relationships between COVID infection and long-term COVID and BMI categories were statically important (thus we cannot be sure that they are not due to chance).
Inconclusive results came from analyses looking into the association with WHR.
Notably, research concentrating on average blood sugar level (HbA1c) and diabetes (1,917 participants in long COVID and 15,795 participants overall) found no correlation with COVID-19 or long-COVID.
The researchers stress the need for further research to explore the mechanisms underpinning these associations and to reduce the excess risk associated with high BMI. “Our early findings suggest a link of adiposity with COVID infection and long COVID 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”, says Knuppel.
The authors acknowledge that the study was observational and that it cannot demonstrate that having a higher BMI increases the risk of contracting COVID. They also admit that they 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. They further note that COVID-19 was based on suspicion rather than a positive test and that some of the studies included may have used clinical assessments that were conducted prior to the pandemic. Finally, they mention that the study’s participants were in better health than the general public, which may constrain the conclusions that may be made.
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