The Study: Obesity and the increased risk for COVID-19: mechanisms and nutritional management

 Overview- Prior to the Covid-19 outbreak, obesity was considered the main pandemic of our time. We are now seeing the clear overlap of obesity with its many associated comorbidities such as diabetes, insulin resistance, hypertension, and cardiovascular disease, and increased risk of mortality in COVID-19 patients.

Key Points: 

a)      From the outset, obesity has been recognized as a risk factor for COVID-19 complications and morbidity. 

b)      Obesity alters many different components of the innate and adaptive immune responses, creating a chronic and low-grade state of inflammation and “consequently worse prognosis for viral infections, and this seems to be the same for SARS-CoV-2.”  

c)      “Low-grade chronic inflammation, characterised by a higher concentration, in basal levels, of the pro-inflammatory cytokines TNF-α, IL-1β, monocyte chemoattractant protein-1 (MCP-1) and IL-6, is an obesity hallmark.”  

d)     They specifically note that the hyperglycemia and/or Type 2 diabetes which often accompany obesity are associated with increased inflammation and the release of inflammatory cytokines and suggest these as potential “triggering factors” for the cytokine storm which has been so prevalent in many of theCovid-19 fatalities.  

e)      The authors also cite prior studies stating that “Impaired immune response in individuals with obesity is not a novel feature, and this has been evidenced by high vaccine failure and more complications from infections.”  

f)       Abdominal obesity increases pressure in the diaphragm, impairing the lung ventilation in and resulting in reduced blood-oxygen levels. 

g)      Other more specific nutritional considerations in obese patients include decreased levels of fat soluble vitamins such as Vitamins A, C and Zinc, all of which are supportive of immune function. 

h)      They also point out that confinement and quarantine procedures may exacerbate poor nutrition by reducing the ability to access high quality, fresh foods and consequently increase consumption of highly processed foods, thereby exacerbating the problems associated with obesity. 

Take Home: “Obesity and its co-morbidities create an unfavourable inflammatory environment that enhances the risk of severe COVID-19.” 

Reviewer's Comments: Interesting article highlighting the many complicating factors in COVID-19 and their common relationship to the most fundamental health problem facing modern society…obesity. Fortunately, for those willing to make the effort, obesity is a problem which can almost always be managed effectively by changes in lifestyle.

Reviewer:  Mark R. Payne DC 

Reference:  Morais AHA, Passos TS, de Lima Vale SH, da Silva Maia JK, Maciel BLL. Obesity and the increased risk for COVID-19: mechanisms and nutritional management. Nutr Res Rev. 2020 Nov 13:1-13. doi: 10 

Link to Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737140/ 

Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737140/pdf/S095442242000027Xa.pdf