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  1. Article ; Online: Obesity and Critical Illness in COVID-19: Respiratory Pathophysiology.

    Wolf, Molly / Alladina, Jehan / Navarrete-Welton, Allison / Shoults, Benjamin / Brait, Kelsey / Ziehr, David / Malhotra, Atul / Hardin, C Corey / Hibbert, Kathryn A

    Obesity (Silver Spring, Md.)

    2021  Volume 29, Issue 5, Page(s) 870–878

    Abstract: ... in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness ... Conclusions: In this cohort of critically ill patients with COVID-19, obesity was not associated ... in COVID-19, the association of BMI with baseline demographic and intensive care unit (ICU) parameters ...

    Abstract Objective: Recent cohort studies have identified obesity as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness in COVID-19, the association of BMI with baseline demographic and intensive care unit (ICU) parameters, laboratory values, and outcomes in a critically ill patient cohort was examined.
    Methods: In this retrospective study, the first 277 consecutive patients admitted to Massachusetts General Hospital ICUs with laboratory-confirmed COVID-19 were examined. BMI class, initial ICU laboratory values, physiologic characteristics including gas exchange and ventilatory mechanics, and ICU interventions as clinically available were measured. Mortality, length of ICU admission, and duration of mechanical ventilation were also measured.
    Results: There was no difference found in respiratory system compliance or oxygenation between patients with and without obesity. Patients without obesity had higher initial ferritin and D-dimer levels than patients with obesity. Standard acute respiratory distress syndrome management, including prone ventilation, was equally distributed between BMI groups. There was no difference found in outcomes between BMI groups, including 30- and 60-day mortality and duration of mechanical ventilation.
    Conclusions: In this cohort of critically ill patients with COVID-19, obesity was not associated with meaningful differences in respiratory physiology, inflammatory profile, or clinical outcomes.
    MeSH term(s) Aged ; Body Mass Index ; COVID-19/complications ; COVID-19/epidemiology ; Critical Illness ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Massachusetts ; Middle Aged ; Obesity/complications ; Respiration, Artificial ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2021-03-31
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2230457-5
    ISSN 1930-739X ; 1071-7323 ; 1930-7381
    ISSN (online) 1930-739X
    ISSN 1071-7323 ; 1930-7381
    DOI 10.1002/oby.23142
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4061: Show issues Location:
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    Zs.MG 87: Show issues

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  2. Article ; Online: Impact of Obesity in Critical Illness.

    Anderson, Michaela R / Shashaty, Michael G S

    Chest

    2021  Volume 160, Issue 6, Page(s) 2135–2145

    Abstract: ... may deepen our understanding of how obesity impacts critical illness pathophysiology. ... these risks. Obesity is associated with improved critical illness survival in some studies. It is unclear ... The prevalence of obesity is rising worldwide. Adipose tissue exerts anatomic and ...

    Abstract The prevalence of obesity is rising worldwide. Adipose tissue exerts anatomic and physiological effects with significant implications for critical illness. Changes in respiratory mechanics cause expiratory flow limitation, atelectasis, and V̇/Q̇ mismatch with resultant hypoxemia. Altered work of breathing and obesity hypoventilation syndrome may cause hypercapnia. Challenging mask ventilation and peri-intubation hypoxemia may complicate intubation. Patients with obesity are at increased risk of ARDS and should receive lung-protective ventilation based on predicted body weight. Increased positive end expiratory pressure (PEEP), coupled with appropriate patient positioning, may overcome the alveolar decruitment and intrinsic PEEP caused by elevated baseline pleural pressure; however, evidence is insufficient regarding the impact of high PEEP strategies on outcomes. Venovenous extracorporeal membrane oxygenation may be safely performed in patients with obesity. Fluid management should account for increased prevalence of chronic heart and kidney disease, expanded blood volume, and elevated acute kidney injury risk. Medication pharmacodynamics and pharmacokinetics may be altered by hydrophobic drug distribution to adipose depots and comorbid liver or kidney disease. Obesity is associated with increased risk of VTE and infection; appropriate dosing of prophylactic anticoagulation and early removal of indwelling catheters may decrease these risks. Obesity is associated with improved critical illness survival in some studies. It is unclear whether this reflects a protective effect or limitations inherent to observational research. Obesity is associated with increased risk of intubation and death in SARS-CoV-2 infection. Ongoing molecular studies of adipose tissue may deepen our understanding of how obesity impacts critical illness pathophysiology.
    MeSH term(s) COVID-19/complications ; COVID-19/mortality ; COVID-19/therapy ; Critical Illness ; Humans ; Obesity/complications ; Obesity/physiopathology ; Respiration, Artificial
    Language English
    Publishing date 2021-08-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2021.08.001
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  3. Article: Obesity as a Risk Factor for Severe Illness From COVID-19 in the Pediatric Population.

    Agarwal, Ankit / Karim, Farida / Fernandez Bowman, Adriana / Antonetti, Callah R

    Cureus

    2021  Volume 13, Issue 5, Page(s) e14825

    Abstract: ... severity, and clinical outcome attributed to obesity and COVID-19 infections in children. ... paramount, to anticipate and provide appropriate clinical care specific to the pediatric population. Obesity ... In this current outbreak of coronavirus disease 2019 (COVID-19) caused ...

    Abstract In this current outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many studies have been published to determine the spectrum of illness, risk factors, prevention, and treatment strategies. Due to relatively fewer cases among children as compared to adults, there is a paucity of clinical data available to fully understand the risk factors and disease course in the pediatric population. Our understanding is evolving with limited data showing an increased risk of severe or critical disease in children less than one year of age and those with certain underlying medical conditions. Recognition of emerging risk factors for morbidity and mortality is now paramount, to anticipate and provide appropriate clinical care specific to the pediatric population. Obesity has only recently been identified as a risk factor for severe COVID-19 disease in children. Case reports such as this are essential in understanding the pathophysiologic association, associated disease severity, and clinical outcome attributed to obesity and COVID-19 infections in children.
    Language English
    Publishing date 2021-05-03
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.14825
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  4. Article ; Online: COVID-19 and obesity: fighting two pandemics with intermittent fasting.

    Ealey, Kafi N / Phillips, Joy / Sung, Hoon-Ki

    Trends in endocrinology and metabolism: TEM

    2021  Volume 32, Issue 9, Page(s) 706–720

    Abstract: ... metabolic health and immunity and thus reduce the impact of obesity on COVID-19 morbidity and mortality. ... Obesity is strongly and independently associated with an increased risk of severe illness and death ... which increase vulnerability to severe illness from COVID-19. While vaccination strategies are under way across ...

    Abstract Obesity is strongly and independently associated with an increased risk of severe illness and death from coronavirus disease 2019 (COVID-19). The pathophysiological changes that result from elevated body weight lead to metabolic dysfunction, chronic inflammation, impaired immunological responses, and multisystem disorders, which increase vulnerability to severe illness from COVID-19. While vaccination strategies are under way across the world, the second and third waves of the pandemic, along with the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains, continue to threaten the stability of medical systems worldwide. Furthermore, evidence from previous pandemics suggests that vaccines are less effective in obese individuals than in their healthy-weight counterparts over the long term. Therefore, a consideration of lifestyle changes that can boost metabolic health and immunity is critical to reduce the risk of complications and severe illness from viral infection. In this review, we discuss the potential mechanisms linking excess body weight with COVID-19 morbidity. We also present evidence that intermittent fasting (IF), a dietary program that has gained popularity in recent years, may be an effective strategy to improve metabolic health and immunity and thus reduce the impact of obesity on COVID-19 morbidity and mortality.
    MeSH term(s) COVID-19/diet therapy ; COVID-19/prevention & control ; Fasting ; Humans ; Obesity/complications ; Obesity/diet therapy
    Language English
    Publishing date 2021-06-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1042384-9
    ISSN 1879-3061 ; 1043-2760
    ISSN (online) 1879-3061
    ISSN 1043-2760
    DOI 10.1016/j.tem.2021.06.004
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    Zs.A 2999: Show issues Location:
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  5. Book ; Online: Evidence summary

    National Health Library & Knowledge Service (NHLKS) / Morgan, Margaret / Lynch, Dympna / Burgess, Leona / Quinn, Emma / Leen, Brendan

    Covid-19 and obesity [v1.0]

    2020  

    Abstract: ... IL-6 secretion22. Mortality in patients with COVID-19 and obesity is also reviewed. Severe obesity is ... other groups hypothesise that obesity could predispose to serious COVID-19 complications ... that “obesity mediates 45.5% of the effect of diabetes on COVID-19 lethality”. ...

    Abstract Obesity is a medical condition with complex pathophysiology which is a significant risk factor for increased prevalence, morbidity, and mortality in the context of COVID-1911. According to the US CDC, severe obesity is associated with multiple serious chronic diseases and underlying health conditions that can increase the risk of severe illness from COVID-193. Severe COVID-19 infection can be defined as tachypnoea of ≥30 breaths per minute, oxygen saturation ≤93% at rest, or PaO2/FiO2 ratio <300 mm Hg. Critical infection involves respiratory failure requiring mechanical ventilation, septic shock, or other organ dysfunction or failure requiring intensive care9. International literature includes various studies looking at the vulnerability of people with obesity. Obese individuals show diminished protection from influenza immunization: despite vaccination, obese recipients are 2–3 times more prone to infection compared to non-obese15. Simonnett et al and Kalligeros et al report a high frequency of obesity among patients admitted to intensive care for SARS-CoV-2, showing an increase in disease severity with increased BMI18, 19. The Intensive Care National Audit and Research Centre, UK reports a correlation between patients with COVID-19 receiving advanced respiratory support and BMI between 30-40+49. Obesity in Metabolic Associated Fatty Liver Disease was associated with a ~6-fold increased risk of severe COVID-19 illness12. Watanabe et al and other groups hypothesise that obesity could predispose to serious COVID-19 complications through several mechanisms: immune dysregulation, reduced cardiorespiratory reserve, systemic chronic inflammation, endothelial dysfunction, related comorbidities such as diabetes, increased complement system activation, and IL-6 secretion22. Mortality in patients with COVID-19 and obesity is also reviewed. Severe obesity is associated with higher in-hospital mortality even after adjusting for confounding factors in an early cohort of hospitalized patients in New York16. An Italian study links obesity as a risk factor for higher mortality in patients with COVID-1926. A Mexican study to devise a clinical score to predict COVID-19 mortality found that “obesity mediates 45.5% of the effect of diabetes on COVID-19 lethality”.
    Keywords CORONAVIRUS ; COVID-19 ; OBESITY ; CO-MORBIDITY ; covid19
    Subject code 610 ; 616
    Language English
    Publishing date 2020-06-23
    Publisher Health Service Executive
    Publishing country ie
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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