# ent

id: cord-267505-4tw7kfek
type: WORK_OF_ART
entity:
  The ABCD of Obesity An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications


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  adipokines monocyte chemoattractant protein 1 MCP1 C X C motif chemokine ligand 5 hemostatic proteins proteins


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  transforming growth factor β adipokines monocyte chemoattractant protein 1 MCP1 C X C motif chemokine ligand 5 hemostatic proteins proteins


id: cord-329308-ipui7lo6
type: ORG
entity:
  Epidemiology Working Group for NCIP Epidemic Response Chinese Center for Disease Control and Prevention


id: cord-319580-awtp0mpg
type: ORG
entity:
  Adipose Tissue Critical Players in Immunometabolism Obesity Expands a Distinct Population of T Cells


id: cord-311535-ppkwd1kp
type: GGP
entity:
  IL 6 IL 8 monocyte chemoattractant protein 1 MCP 1 CCL2 leptin and plasminogen activator inhibitor 1 PAI 1


id: cord-316260-1t3ifsfi
type: DISEASE
entity:
  comorbidities chronic kidney and lung diseases malignancies diabetes obesity sickle cell anemia immune disorders chromosomal abnormalities heart disease


id: cord-333368-kjrk8nn9
type: ORG
entity:
  Monocyte Macrophage Drive Chronic Inflammation and Impair Wound Healing in Diabetes Mellitus Upregulation


id: cord-333368-kjrk8nn9
type: WORK_OF_ART
entity:
  Metabolic Syndrome and Risk of Cervical Human Papillomavirus Incident and Persistent Infection Morbid


id: cord-288255-p8uzrsbd
type: PROTEIN
entity:
  Lille COVID 19 and Obesity study group High prevalence of obesity in severe acute respiratory syndrome coronavirus 2 SARS CoV 2


id: cord-288255-p8uzrsbd
type: ORG
entity:
  the European Association for the Study of Obesity on Immunological Perturbations Therapeutic Challenges and Opportunities in Obesity


id: cord-277803-7p1qu2rf
type: DISEASE
entity:
  acute respiratory syndrome coronavirus 2 SARS CoV 2 Upper gastrointestinal endoscopy another aerosol


id: cord-351223-nnuoadh6
type: GGP
entity:
  disease 7 2 4 1 0 0 0 0 5 9 3 0 08 significant after Bonferroni correction for multiple comparisons p 0 0038 Asthma chronic obstructive pulmonary disease bronchitis sarcoidosis obstructive sleep apnea Coronary artery disease heart failure valvular heart disease arrhythmia Abbreviations BMI body mass index SD standard deviation VTE venous thromboembolism This article is protected by copyright All rights reserved This article is protected by copyright All rights reserved Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID 19


id: cord-351223-nnuoadh6
type: ORG
entity:
  Retrospective Observational Study Epidemiologic Features and Clinical Course of Patients Infected with


id: cord-012493-pwbzffo9
type: ORG
entity:
  WHOQOL Measuring Quality of Life International Classification of Impairments Disabilities and Handicaps Constitution of WHO


id: cord-012493-pwbzffo9
type: ORG
entity:
  The Effect of Bariatric Surgery on Mobility Health Related Quality of Life Healthcare Resource Utilization and Employment Status Wordsworth S


id: cord-012493-pwbzffo9
type: ORG
entity:
  Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain


id: cord-012493-pwbzffo9
type: ORG
entity:
  Energy Metabolism after Continuous Positive Airway Pressure for Obstructive Sleep Apnea Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea


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type: GGP
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  Syndr DOI 10 1016 j dsx 2020 07 030 sha 2b999410f2e2264ae977f7af498bbcf81a98d60a doc_id 291627 cord_uid 5dqwyd9r


id: cord-290551-a02tueuu
type: DISEASE
entity:
  Asthma ischemic heart diseases heart failure pulmonary heart diseases cerebrovascular diseases chronic kidney disease fatty liver cirrhosis


id: cord-034066-fsp7e5x5
type: ORG
entity:
  the Maternal and Child Health Bureau of the Health Resources and Services Administration HRSA Department of Health and Human Services


id: cord-034066-fsp7e5x5
type: ORG
entity:
  Electronic Media Branch Division of News and Electronic Media Office of the Associate Director of Communication


id: cord-325138-riu4jdc2
type: WORK_OF_ART
entity:
  Body Mass Index in Elementary School Children Metropolitan Area Food Prices and Food Outlet Density Public Health Food Prices and Weight Gain during Elementary School 5 Year Update Food Insecurity and Child Health Maternal Depression Changing Public Assistance Food Security and Child Health Status Poverty


id: cord-325138-riu4jdc2
type: ORG
entity:
  Childhood Expert Committee Recommendations Regarding the Prevention Assessment and Treatment of Child and Adolescent Overweight and


id: cord-325138-riu4jdc2
type: ORG
entity:
  WIC Eligible Women A Longitudinal Study of WIC Participation on Household Food Insecurity Identifying the


id: cord-325138-riu4jdc2
type: WORK_OF_ART
entity:
  A Summer Nutrition Benefit Pilot Program and Low income Children s Food Security US Burden of Disease Collaborators


id: cord-277074-1emlkii0
type: GGP
entity:
  Syndr DOI 10 1016 j dsx 2020 05 047 sha c031acce0ef21abf941da47c7a5c800e0149ba4a doc_id 277074 cord_uid 1emlkii0 N A


id: cord-318391-2s0rjfn8
type: WORK_OF_ART
entity:
  Prevalence of Obesity and Severe Obesity Among Adults United States COVID 19 Related School Closings and Risk of Weight Gain Among Children DQ A Impact of COVID 19


id: cord-354928-brliql4d
type: ORG
entity:
  World Health Organization Novel Coronavirus COVID 19 Situation Clinical Characteristics of Coronavirus Disease 2019


# bib

id: cord-011333-yyhwtnza
title: Childhood obesity, cardiovascular and liver health: a growing epidemic with age
author: Faienza, Maria Felicia
date: 2020-02-04
txt: ./txt/cord-011333-yyhwtnza.txt
cache: ./cache/cord-011333-yyhwtnza.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224053/
doi: 10.1007/s12519-020-00341-9
summary:
  Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, cardiovascular diseases, and diabetes risk during adulthood. The raising prevalence of obesity, metabolic syndrome together with insulin resistance [43] , worldwide is associated with liver abnormalities encompassing the clinical spectrum of nonalcoholic fatty liver disease (NAFLD). Physical inactivity affects a vast majority of children and adolescents who become prone to high obesity rates and related diseases, including CVD and NAFLD. Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, CVD, and diabetes risk during adulthood. The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis

abstract:
  BACKGROUND: The frequency of childhood obesity has increased over the last 3 decades, and the trend constitutes a worrisome epidemic worldwide. With the raising obesity risk, key aspects to consider are accurate body mass index classification, as well as metabolic and cardiovascular, and hepatic consequences. DATA SOURCES: The authors performed a systematic literature search in PubMed and EMBASE, using selected key words (obesity, childhood, cardiovascular, liver health). In particular, they focused their search on papers evaluating the impact of obesity on cardiovascular and liver health. RESULTS: We evaluated the current literature dealing with the impact of excessive body fat accumulation in childhood and across adulthood, as a predisposing factor to cardiovascular and hepatic alterations. We also evaluated the impact of physical and dietary behaviors starting from childhood on cardio-metabolic consequences. CONCLUSIONS: The epidemic of obesity and obesity-related comorbidities worldwide raises concerns about the impact of early abnormalities during childhood and adolescence. Two key abnormalities in this context include cardiovascular diseases, and nonalcoholic fatty liver disease. Appropriate metabolic screenings and associated comorbidities should start as early as possible in obese children and adolescents. Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, cardiovascular diseases, and diabetes risk during adulthood.


id: cord-012493-pwbzffo9
author: Alligier, Maud
date: 2020-01-16
txt: ./txt/cord-012493-pwbzffo9.txt
cache: ./cache/cord-012493-pwbzffo9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098277/
doi: 10.1159/000505342
summary:
  • It provided information that made it likely to impact treatment response, according to the relevant literature (especially studies that aimed to stratify patients) • It was feasible: Given that each clinical trial has limits on budget and time as well as research team expertise, the OBEDIS group aimed to minimize the burden of including each variable in future trials. Data for the minimal core set should include: the number of attempts, whether the patient has undertaken individual/group behavioral interventions (pertaining to nutrition/PA/psychology), whether treatment included obesity drugs or bariatric surgery, and the maximal weight loss and weight regain as a result of these attempts. A measure of muscle strength, as an important component of muscular fitness, is therefore also recommended for the minimal core set, since the evidence in aggregate shows that muscle strength is associated with reduced mortality in all BMI categories and that resistance training (designed to increase muscle strength), even without weight loss, improves health risk [53] .

title:
  OBEDIS Core Variables Project: European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions

abstract:
  Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing − focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity − ultimately leading to better patient care and improved obesity outcomes.


id: cord-034066-fsp7e5x5
title: Treatment of children and adolescents who are overweight or obese
author: Di Figlia-Peck, Stephanie
date: 2020-10-21
txt: ./txt/cord-034066-fsp7e5x5.txt
cache: ./cache/cord-034066-fsp7e5x5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576185/
doi: 10.1016/j.cppeds.2020.100871
abstract: nan
summary:
  2 And in 2008, the Agency for Healthcare Research and Quality of the HHS came out with an Evidence-Based/Technology Assessment entitled "The Effectiveness of Weight Management Programs in Children and Adolescents." 3 In addition to these government-sponsored guidelines, recommendations for management of overweight and obesity in this population have been issued by multiple other organizations. One 12month technology-based program for adolescents with Type 2 diabetes "was not sufficient to produce weight loss with the combination of web intervention and group sessions and telephone follow up, but improvements in sedentary behavior and use of behavior change strategies expected to lead to behavior change was evidenced." 32 Telemedicine, in theory, should be able to compensate for some of the barriers that prevent access to and utilization of family based comprehensive behavioral interventions for child and adolescent obesity.


id: cord-261891-yiiz9s53
author: Czernichow, Sébastien
date: 2020-08-20
txt: ./txt/cord-261891-yiiz9s53.txt
cache: ./cache/cord-261891-yiiz9s53.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32815621/
doi: 10.1002/oby.23014
summary:
  8 Preliminary data from different cohorts of patients infected by COVID-19 of small sample size (lower than 400 patients), with short follow-up or with poorly described BMI indicate poorer prognosis in people with obesity compared to other patients. However, it is not possible to conclude from these results that obesity is an independent factor of mortality for patients infected with COVID-19 due to the small sample sizes of these studies, neither to have a precise estimate of obesity size effect due to the absence of BMI categories and incomplete follow-up. We imputed missing BMI category using predictive mean matching considering as the following as explaining variables: comorbidities (hypertension, diabetes, sleep apnea, dyslipidemia, chronic kidney disease, heart failure, cancer), smoking status, sex, age and indirect information regarding BMI value (obesity from free-text reports, variables extracted from 4-digits E66 ICD-10 codes and malnutrition ICD-10 codes).

title:
  Obesity doubles mortality in patients hospitalized for SARS‐CoV‐2 in Paris hospitals, France: a cohort study on 5795 patients

abstract:
  BACKGROUND: Preliminary data from different cohorts of small sample size or with short follow‐up indicate poorer prognosis in people with obesity compared to other patients. This study aims to precisely describe the strength of association between obesity in patients hospitalised with Covid‐19 and mortality and clarify the risk according to usual cardiometabolic risk factors in a large cohort. METHODS: This is a prospective cohort study including 5795 patients aged 18‐79 years hospitalized from 1(st) February 2020 to 30 April 2020 in Paris area, with confirmed infection by SARS‐CoV‐2. Adjusted regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for mortality rate at 30 days across BMI classes, without and with imputation for missing BMI. RESULTS: 891 deaths occurred at 30 days. Mortality was significantly raised in people with obesity with the following OR in BMI 30‐35, 35‐40 and >40 kg/m(2): 1.89 (95%CI 1.45‐2.47), 2.79 (1.95‐3.97) and 2.55 (1.62‐3.95), respectively (18.5‐25 kg/m(2), as the reference class). This increase holds for all age classes. CONCLUSION: Obesity doubles mortality in patients hospitalized with Covid‐19.


id: cord-265139-x7g3jcjm
title: The Emerging Role and Promise of Circular RNAs in Obesity and Related Metabolic Disorders
author: Zaiou, Mohamed
date: 2020-06-16
txt: ./txt/cord-265139-x7g3jcjm.txt
cache: ./cache/cord-265139-x7g3jcjm.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/cells9061473
doi: 10.3390/cells9061473
summary:
  There is also growing evidence that circRNAs are closely linked to non-alcoholic fatty liver disease (NAFLD), a disorder that is caused by a plethora of factors including hepatic lipid accumulation, adipose tissue and mitochondrial dysfunction, a high-fat diet, obesity, a chronic inflammatory state, insulin resistance (IR), and genetic and epigenetic factors [48, 55] . In addition to classical epigenetic modifications, a variety of ncRNAs have been uncovered in different cells and organs including adipose tissues, many of which are involved in the regulation of adipogenesis and other metabolic processes implying their role in the etiology of obesity [69] . Emerging evidence from in vitro and in vivo animal studies suggest that circRNAs are expressed in adipose tissues and may modulate adipogenesis and lipid metabolism. Collectively, the results from the above studies demonstrate that several circRNAs are differentially expressed in adipose tissue and support a significant role of these RNA species in the regulatory networks of adipogenesis.

abstract:
  Circular RNAs (circRNAs) are genome transcripts that are produced from back-splicing of specific regions of pre-mRNA. These single-stranded RNA molecules are widely expressed across diverse phyla and many of them are stable and evolutionary conserved between species. Growing evidence suggests that many circRNAs function as master regulators of gene expression by influencing both transcription and translation processes. Mechanistically, circRNAs are predicted to act as endogenous microRNA (miRNA) sponges, interact with functional RNA-binding proteins (RBPs), and associate with elements of the transcriptional machinery in the nucleus. Evidence is mounting that dysregulation of circRNAs is closely related to the occurrence of a range of diseases including cancer and metabolic diseases. Indeed, there are several reports implicating circRNAs in cardiovascular diseases (CVD), diabetes, hypertension, and atherosclerosis. However, there is very little research addressing the potential role of these RNA transcripts in the occurrence and development of obesity. Emerging data from in vitro and in vivo studies suggest that circRNAs are novel players in adipogenesis, white adipose browning, obesity, obesity-induced inflammation, and insulin resistance. This study explores the current state of knowledge on circRNAs regulating molecular processes associated with adipogenesis and obesity, highlights some of the challenges encountered while studying circRNAs and suggests some perspectives for future research directions in this exciting field of study.


id: cord-266380-lu6hj3a2
title: Management of obesity in Saudi Arabia during the era of COVID‐19: A clash of two pandemics
author: Alfaris, Nasreen
date: 2020-10-01
txt: ./txt/cord-266380-lu6hj3a2.txt
cache: ./cache/cord-266380-lu6hj3a2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/oby.23055
doi: 10.1002/oby.23055
summary:
  In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, 2 but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection. In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, 2 but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection. Key challenges that were specific for obesity care, included reduced access to healthcare resources, isolating patients, limiting their physical activity, and causing disruptions in eating habits with irregular mealtimes, frequent snacking, more processed meals, and increased anxiety and depression. 5 At a time when the focus is only the immediate COVID-19 pandemic, our patients with obesity should not be lost, nor forgotten.

abstract:
  Obesity remains one of the world’s most challenging pandemics. The Kingdom of Saudi Arabia carries one of the highest burdens of obesity with a prevalence of 35 %. Unfortunately, . COVID‐19 has arisen as an added challenge shifting focus and valuable resources to managing this emerging threat. In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection.


id: cord-267505-4tw7kfek
title: European Association for the Study of Obesity Position Statement on the Global COVID-19 Pandemic
author: Frühbeck, Gema
date: 2020-04-27
txt: ./txt/cord-267505-4tw7kfek.txt
cache: ./cache/cord-267505-4tw7kfek.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32340020/
doi: 10.1159/000508082
abstract: nan
summary:
  However, people with obesity have an elevated risk of hospitalization, serious illness, and mortality, likely due to chronic lowgrade inflammation [1] , an altered immune response to infection, as well as related cardiometabolic comorbidities [2] , and the COVID-19 pandemic is likely to have a significant impact on people with obesity. Given that obesity is a prevalent, persistent, serious, complex, chronic, and relapsing disease among the general population [3] , it is important that we pay special attention to these challenges especially during the COVID-19 pandemic and when planning management of the aftermath to avoid placing an even greater burden on individuals, health systems, and society over the short, medium, and long term. The role of EASO is crucial in (1) identifying the particular needs of healthcare providers and persons living with obesity during the COVID-19 pandemic, (2) disseminating sciencebased information, and (3) sharing knowledge, evidence-based recommendations, and guidance toward the clinical, patient, and policy communities using social and other media, which allow us to reach millions of people across Europe.


id: cord-277074-1emlkii0
title: Relationship between COVID-19 and obesity
author: Ekiz, Timur
date: 2020-06-02
txt: ./txt/cord-277074-1emlkii0.txt
cache: ./cache/cord-277074-1emlkii0.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S187140212030165X
doi: 10.1016/j.dsx.2020.05.047
abstract: N/A.
summary:
  From this point of view, we determined the obesity prevalence of the top 20 ranked countries by total deaths due to COVID-19. The data regarding the obesity prevalence of countries were obtained from global health services data of the World Health Organization [1, 2] . Herein, we believe that cardiovascular and metabolic effects, sleep apnea, vitamin D deficiency, dysregulation of the renin-angiotensin-aldosterone system (RAAS) as well as sarcopenia should be taken into account as obesity-related confounders to COVID-19. The adipose tissue can manifest as a reservoir for a wider viral spread with increased shedding, immune activation, and cytokine amplification in relevant patients as well [4, 5] . First of all, obesity is a predominant risk factor for OSA (obesity hypoventilation syndrome), and OSA patients may be vulnerable to COVID-19. The dysregulation/increase of the RAAS has been shown in OSA patients, likewise in obesity [6] . Is Adipose Tissue a Reservoir for Viral Spread, Immune Activation and Cytokine Amplification in COVID-19.


id: cord-277803-7p1qu2rf
author: Rubino, Francesco
date: 2020-05-07
txt: ./txt/cord-277803-7p1qu2rf.txt
cache: ./cache/cord-277803-7p1qu2rf.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2213858720301571
doi: 10.1016/s2213-8587(20)30157-1
summary:
  Given the uncertainty regarding the effects and duration of the COVID-19 outbreak, combined with the progressive nature of obesity, diabetes, and related conditions, delaying bariatric and metabolic surgery could increase the risks for morbidity and mortality in surgical candidates.

title:
  Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery

abstract:
  The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.


id: cord-288255-p8uzrsbd
author: Goossens, Gijs H.
date: 2020-08-13
txt: ./txt/cord-288255-p8uzrsbd.txt
cache: ./cache/cord-288255-p8uzrsbd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32791497/
doi: 10.1159/000510719
summary:
  authors: Goossens, Gijs H.; Dicker, Dror; Farpour-Lambert, Nathalie J.; Frühbeck, Gema; Mullerova, Dana; Woodward, Euan; Holm, Jens-Christian Evidence from studies in humans indicates that people with obesity are characterized by systemic low-grade inflammation, higher susceptibility to infections, dampened immune response to infectious agents, as well as higher morbidity and mortality associated with infections, and demonstrate an impaired immune response to vaccinations and antimicrobial treatment [25] [26] [27] [28] . Together, these findings imply that evaluation of cytokine profiles and immune cell subsets in patients with SARS-CoV-2 infection, and a deeper understanding of the underlying processes, will significantly contribute to better treatment strategies and clinical management of COVID-19 [37] . At the same time, the rapidly emerging clinical data require ongoing scrutiny to understand not only the risks and benefits of single drugs to tackle COVID-19, but also the interaction with pharmacological agents commonly used in people with obesity and related NCDs, including type 2 diabetes and cardiovascular diseases, who are especially at risk of or hospitalized with SARS-CoV-2 infection.

title:
  Obesity and COVID-19: A Perspective from the European Association for the Study of Obesity on Immunological Perturbations, Therapeutic Challenges, and Opportunities in Obesity

abstract:
  Accumulating evidence suggests that obesity is a major risk factor for the initiation, progression, and outcomes of coronavirus disease 2019 (COVID-19). The European Association for the Study of Obesity (EASO), as a scientific and medical society dedicated to the promotion of health and well-being, is greatly concerned about the concomitant obesity and COVID-19 pandemics and their impact on health and society at large. In this perspective, we will address the inherent immunological perturbations and alterations in the renin-angiotensin-aldosterone system in patients with obesity and COVID-19, and discuss how these impairments may underlie the increased susceptibility and more detrimental outcomes of COVID-19 in people with obesity. Clearly, this has important implications for preventive measures, vaccination, and future therapeutic strategies to combat COVID-19. Furthermore, we will highlight important knowledge gaps and provide suggestions for future research and recommendations for policy actions. Since many new reports on COVID-19 rapidly appear, the present perspective should be seen as a focus for discussion to drive forward further understanding, research initiatives, and clinical management of COVID-19.


id: cord-290551-a02tueuu
author: Singh, Shailendra
date: 2020-08-21
txt: ./txt/cord-290551-a02tueuu.txt
cache: ./cache/cord-290551-a02tueuu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32835663/
doi: 10.1053/j.gastro.2020.08.028
abstract: nan
summary:
  title: Impact of Obesity on Outcomes of Patients with COVID-19 in United States: A Multicenter Electronic Health Records Network Study. We performed a retrospective cohort study using TriNetX (Cambridge, MA, USA), a global federated health research network that provided access to electronic medical records of patients from multiple large member healthcare organizations (HCOs) in United States. Our study using a large nationally representative database showed that COVID-19 patients with any degree of obesity had a significantly higher risk of hospitalization and intubation or death compared to patients without obesity. An analysis of a larger group of selected patients using diagnostic criteria of obesity as any time before the index event (after PSM n=9769) showed a higher risk for composite outcomes in the obesity group ( J o u r n a l P r e -p r o o f

title:
  Impact of Obesity on Outcomes of Patients with COVID-19 in United States: A Multicenter Electronic Health Records Network Study.


id: cord-291627-5dqwyd9r
title: SARS-CoV-2-host dynamics: Increased risk of adverse outcomes of COVID-19 in obesity
author: Yadav, Rakhee
date: 2020-07-21
txt: ./txt/cord-291627-5dqwyd9r.txt
cache: ./cache/cord-291627-5dqwyd9r.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1871402120302782
doi: 10.1016/j.dsx.2020.07.030
summary:
  11 Many recent studies are now reporting obesity as one of the risk factors for severity of COVID-19 in USA, Brazil, UK, Italy, Spain and France [12] [13] [14] [15] [16] [17] [18] 67 (summarised in the In the current scenario, since USA has become the epi-centre of the COVID-19 pandemic; the dynamics of patient characteristics in terms of associated complications is showing a difference from the initial data put out by China. During the present pandemic, till now, it has been well established that cardiovascular diseases and diabetes are the major risk factors for poor outcomes but considering a higher BMI to be a forerunner for both these co-morbidities, the inclusion of obesity and overweight individuals as candidates for poor COVID-19 outcomes becomes very important. 58 Thus, the interaction between ACE2-RAS system, adipose tissue and the SARS-CoV-2 could, at least partially, explain the higher morbidity and mortality risk of COVID-19 in obese patients.

abstract:
  BACKGROUND AND AIM: The pandemic of COVID-19 has put forward the public health system across countries to prepare themselves for the unprecedented outbreak of the present time. Recognition of the associated risks of morbidity and mortality becomes not only imperative but also fundamental to determine the prevention strategies as well as targeting the high-risk populations for appropriate therapies. METHODS: We reviewed, collated and analysed the online database i.e. Pubmed, Google scholar, Researchgate to highlight the demographic and mechanistic link between obesity and associated risks of severity in COVID-19. RESULTS: We observed a changing dynamic in the reporting from the time of initial pandemic in China to currently reported research. While, initially body mass index (BMI) did not find a mention in the data, it is now clearly emerging that obesity is one of the profound risk factors for complications of COVID-19. CONCLUSION: Our review will help clinicians and health policy makers in considering the importance of obesity in making the prevention and therapeutic strategies of COVID-19. An extra attention and precaution for patients with obesity in COVID-19 pandemic is recommended.


id: cord-300991-ipy24zxp
title: Obesity and COVID-19: Oro-Naso-Sensory Perception
author: Khan, Amira Sayed
date: 2020-07-08
txt: ./txt/cord-300991-ipy24zxp.txt
cache: ./cache/cord-300991-ipy24zxp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/jcm9072158
doi: 10.3390/jcm9072158
summary:
  Through a recent upsurge of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, the clinical assessment of most of the coronavirus disease 19 (COVID-19) patients clearly presents a health condition with the loss of oro-naso-sensory (ONS) perception, responsible for the detection of flavor and savor. Hence, obesity represents a great risk factor for SARS-CoV-2 infection, as it may hide the viral-associated altered ONS symptoms, thus leading to a high mortality rate in these subjects. Moreover, the number of immunosuppressive T-regulatory, Treg (CD4 + CD25 + Foxp3 + ) cells and concentrations of IL-6, IL-10, and C-reactive protein (CRP) were upregulated in patients with severe COVID-19 [18] , suggesting that SARS-CoV-2 infection may lead to "over-immunosuppression" in the case of obesity ( Figure 1 ). SARS-CoV-2 infection may further aggravate the ONS functions; mask the obesity-induced inflammation, including loss of taste and smell; and render the obese subjects more vulnerable and prone to severe pathophysiological consequences such as RTI, leading to death.

abstract:
  Through a recent upsurge of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, the clinical assessment of most of the coronavirus disease 19 (COVID-19) patients clearly presents a health condition with the loss of oro-naso-sensory (ONS) perception, responsible for the detection of flavor and savor. These changes include anosmia and dysgeusia. In some cases, these clinical manifestations appear even before the general flu-like symptoms, e.g., sore throat, thoracic oppression and fever. There is no direct report available on the loss of these chemical senses in obese COVID-19 patients. Interestingly, obesity has been shown to be associated with low ONS cues. These alterations in obese subjects are due to obesity-induced altered expression of olfacto-taste receptors. Besides, obesity may further aggravate the SARS-CoV-2 infection, as this pathology is associated with a high degree of inflammation/immunosuppression and reduced protection against viral infections. Hence, obesity represents a great risk factor for SARS-CoV-2 infection, as it may hide the viral-associated altered ONS symptoms, thus leading to a high mortality rate in these subjects.


id: cord-301423-stod75j2
title: Health behaviours during the coronavirus disease 2019 pandemic: implications for obesity
author: Parekh, Niyati
date: 2020-08-04
txt: ./txt/cord-301423-stod75j2.txt
cache: ./cache/cord-301423-stod75j2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1017/s1368980020003031
doi: 10.1017/s1368980020003031
summary:
  DESIGN: We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. Sheltering-in-place has significantly altered health behaviours and the food environment by limiting opportunities for daily physical activities, encouraging screen time and sedentary behaviours, disturbing sleep and promoting consumption of ultraprocessed foods and alcohol. The average American adult spends 7·2-9·5 h/d engaged in sedentary behaviours, such as sitting while working, Higher alcohol intake Fig. 1 (colour online) Interrelationships of behavioural risk factors for weight gain that have been affected by the COVID pandemic; the confluence of these behavioural changes is hypothesised to exacerbate the national prevalence of obesity that is a threat for disease severity and mortality reading, watching television and using computers, smartphones or other devices (9) .

abstract:
  OBJECTIVE: Obesity is a risk factor for severe complications and death from the coronavirus disease 2019 (COVID-19). Public health efforts to control the pandemic may alter health behaviors related to weight gain, inflammation, and poor cardiometabolic health, exacerbating the prevalence of obesity, poor immune health, and chronic diseases. DESIGN: We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. RESULTS: At the community level and higher, public health and health care professionals need to advocate for intervention strategies and policy changes that address these behaviors, such as increasing nutrition assistance programs and creating designated areas for recreation and active transportation, to reduce disparities among vulnerable populations. CONCLUSIONS: The long-lasting impact of the pandemic on health behaviors, and the possibility of a second COVID-19 wave, emphasize the need for creative and evolving, multi-level approaches to assist individuals in adapting their health behaviors to prevent both chronic and infectious diseases.


id: cord-301833-q8jiep32
title: Body Mass Index and Prognosis of COVID-19 Infection. A Systematic Review
author: Peres, Karina Colombera
date: 2020-08-14
txt: ./txt/cord-301833-q8jiep32.txt
cache: ./cache/cord-301833-q8jiep32.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3389/fendo.2020.00562
doi: 10.3389/fendo.2020.00562
summary:
  Nine studies (two prospective cohorts, four retrospective cohorts and three cross-sectional) were included and assessed the relationship between obesity and COVID-19 prognosis. Most of the included studies showed some degree of association to: (a) higher BMI and worse clinical presentation and (b) obesity and need of hospitalization. Based on limited methodological quality studies, obesity seems to predict poor clinical evolution in patients with COVID-19. Herein, we perform a systematic review in order to evaluate if overweight and obesity may predict poor outcome in patients with COVID-19. We reviewed data from 17,568 patients with SARS-CoV-2 infection, included in nine studies. Most of these studies highlighted some level of association between obesity and disease severity, encompassing hospitalization rate, admission to ICU, invasive ventilation need and mortality. Once younger patients generally do not represent higher risk for a severe presentation of COVID-19, authors suggest that obesity may be an unrecognized risk factor for hospital care.

abstract:
  A better understanding of the SARS-CoV-2 virus behavior and possible risk factors implicated in poor outcome has become an urgent need. We performed a systematic review in order to investigate a possible association between body weight and prognosis among patients diagnosed with COVID-19. We searched in Cochrane Library, EMBASE, MEDLINE, WHO-Global Literature on Coronavirus Disease, OpenGrey, and Medrxiv. We used the ROBINS-I tool or Cross-Sectional/Prevalence Study Quality tool from AHRQ, to evaluate the methodological quality of included studies. Nine studies (two prospective cohorts, four retrospective cohorts and three cross-sectional) were included and assessed the relationship between obesity and COVID-19 prognosis. Risk of bias of the included studies ranged from moderate to critical. Clinical and methodological heterogeneity among them precluded meta-analyses. Most of the included studies showed some degree of association to: (a) higher BMI and worse clinical presentation and (b) obesity and need of hospitalization. The results were inconsistent about the impact of obesity on mortality. Based on limited methodological quality studies, obesity seems to predict poor clinical evolution in patients with COVID-19. Further studies with appropriate prospective design are needed to reduce the uncertainty on this evidence.


id: cord-311535-ppkwd1kp
author: Korakas, Emmanouil
date: 2020-07-01
txt: ./txt/cord-311535-ppkwd1kp.txt
cache: ./cache/cord-311535-ppkwd1kp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1152/ajpendo.00198.2020
doi: 10.1152/ajpendo.00198.2020
summary:
  The production of increased amounts of cytokines such as TNFα, IL-1, IL-6, and monocyte chemoattractant protein (MCP-1) lead to oxidative stress and defective function of innate and adaptive immunity, whereas the activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome seems to play a crucial role in the pathogenesis of the infection. Endothelial dysfunction and arterial stiffness could favor the recently discovered infection of the endothelium by SARS-CoV-2, whereas alterations in cardiac structure and function and the prothrombotic microenvironment in obesity could provide a link for the increased cardiovascular events in these patients. Chronic inflammation and oxidative stress, hypercytokinemia, immune dysregulation, endothelial dysfunction, and cardiovascular abnormalities are all possible mechanisms through which the excess in adipose tissue could lead to the acute hyperinflammatory state that characterizes severe SARS-CoV-2 infections and is responsible for its complications.

title:
  Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes

abstract:
  Recent reports have shown a strong association between obesity and the severity of COVID-19 infection, even in the absence of other comorbidities. After infecting the host cells, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause a hyperinflammatory reaction through the excessive release of cytokines, a condition known as “cytokine storm,” while inducing lymphopenia and a disrupted immune response. Obesity is associated with chronic low-grade inflammation and immune dysregulation, but the exact mechanisms through which it exacerbates COVID-19 infection are not fully clarified. The production of increased amounts of cytokines such as TNFα, IL-1, IL-6, and monocyte chemoattractant protein (MCP-1) lead to oxidative stress and defective function of innate and adaptive immunity, whereas the activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome seems to play a crucial role in the pathogenesis of the infection. Endothelial dysfunction and arterial stiffness could favor the recently discovered infection of the endothelium by SARS-CoV-2, whereas alterations in cardiac structure and function and the prothrombotic microenvironment in obesity could provide a link for the increased cardiovascular events in these patients. The successful use of anti-inflammatory agents such as IL-1 and IL-6 blockers in similar hyperinflammatory settings, like that of rheumatoid arthritis, has triggered the discussion of whether such agents could be administrated in selected patients with COVID-19 disease.


id: cord-316260-1t3ifsfi
title: COVID-19 and obesity in childhood and adolescence: A clinical review()()
author: Nogueira-de-Almeida, Carlos Alberto
date: 2020-08-04
txt: ./txt/cord-316260-1t3ifsfi.txt
cache: ./cache/cord-316260-1t3ifsfi.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32768388/
doi: 10.1016/j.jped.2020.07.001
summary:
  In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. 3--6 The present review aims to identify the factors that contribute to the increase in the susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences, to collaborate for better clinical care of these patients. The three main risk factors that link obesity to COVID-19 demonstrated for adults 52 are also present among children and adolescents: chronic subclinical inflammation, impaired immune response, and underlying cardiorespiratory diseases. In conclusion, obesity in childhood and adolescence can be considered a risk factor for greater susceptibility and severity of COVID-19 and is associated with nutritional, cardiac, respiratory, renal, and immunological alterations, which may potentiate the complications of SARS-CoV-2 infection.

abstract:
  OBJECTIVE: To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. SOURCES: Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. SUMMARY OF FINDINGS: Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. CONCLUSIONS: The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.


id: cord-318391-2s0rjfn8
title: Tackling Obesity During the COVID‐19 Pandemic
author: Akirov, Amit
date: 2020-08-14
txt: ./txt/cord-318391-2s0rjfn8.txt
cache: ./cache/cord-318391-2s0rjfn8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32797666/
doi: 10.1002/dmrr.3393
abstract: nan
summary:
  A study to assess the effects of lockdown during COVID-19 epidemic on lifestyle in patients with type 2 diabetes in north India reported carbohydrate consumption and frequency of snacking increased in 21% and 23% of study participants, respectively, while exercise duration decreased in 42% and weight gain was documented in 23% of patients [14] . Furthermore, obesity class I (BMI>30 kg/m2) and obesity class II (BMI>35 kg/m2) have been associated with an increased risk for need of invasive mechanical ventilation in patients hospitalized for COVID-19, independent of age, sex, diabetes mellitus and hypertension [9, 13] . A study from China reported similar findings, noting the association of obesity with high mortality risk in young patients with COVID-19 [3] . Data from England reported that patients with type 1 or type 2 diabetes were at increased risk for COVID-19 associated mortality, and there was a U-shaped relationship with BMI. Obesity is clearly a pivotal risk factor associated with severe disease -including greater rate of hospital admission, ICU admission, need for ventilation and excess mortality.


id: cord-319580-awtp0mpg
title: Obesity as a contributor to immunopathology in pregnant and non‐pregnant adults with COVID‐19
author: McCartney, Stephen A.
date: 2020-08-11
txt: ./txt/cord-319580-awtp0mpg.txt
cache: ./cache/cord-319580-awtp0mpg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32779790/
doi: 10.1111/aji.13320
summary:
  The synergistic effects of obesity‐associated delays in immune control of COVID‐19 with mechanical stress of increased adipose tissue may contribute to a greater risk of pulmonary compromise in obese pregnant women. The expression of ACE2 by adipocytes and immune cells also suggests the possibility that adipose tissue may represent a potential reservoir for viral infection and may lead to increased viral burden or persistence; however, no studies to date have demonstrated that adipocytes can be directly infected with SARS-CoV-2. Maternal obesity has emerged as a key risk factor increasing susceptibility of pregnant women to severe COVID-19 disease. There is also an urgent need to focus research on how risk factors, like obesity, alter the immune response to SARS-CoV-2 and influence disease pathogenesis of COVID-19 (Box 1). What is the mechanism of increased risk for severe COVID-19 disease in obese nonpregnant and pregnant women?

abstract:
  The ongoing coronavirus disease 2019 (COVID‐19) pandemic has led to a global public health emergency with the need to identify vulnerable populations who may benefit from increased screening and healthcare resources. Initial data suggests that overall, pregnancy is not a significant risk factor for severe coronavirus disease 2019 (COVID‐19). However, case series have suggested that maternal obesity is one of the most important co‐morbidities associated with more severe disease. In obese individuals, suppressors of cytokine signaling are upregulated and type I and III interferon responses are delayed and blunted leading to ineffective viral clearance. Obesity is also associated with changes in systemic immunity involving a wide range of immune cells and mechanisms that lead to low‐grade chronic inflammation, which can compromise antiviral immunity. Macrophage activation in adipose tissue can produce low levels of pro‐inflammatory cytokines (TNF‐α, IL‐1β, IL‐6). Further, adipocyte secretion of leptin is pro‐inflammatory and high circulating levels of leptin have been associated with mortality in patients with acute respiratory distress syndrome. The synergistic effects of obesity‐associated delays in immune control of COVID‐19 with mechanical stress of increased adipose tissue may contribute to a greater risk of pulmonary compromise in obese pregnant women. In this review, we bring together data regarding obesity as a key co‐morbidity for COVID‐19 in pregnancy with known changes in the antiviral immune response associated with obesity. We also describe how the global burden of obesity among reproductive age women has serious public health implications for COVID‐19.


id: cord-321997-3dkl6iha
author: Hussain, Abdulzahra
date: 2020-04-29
txt: ./txt/cord-321997-3dkl6iha.txt
cache: ./cache/cord-321997-3dkl6iha.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0026049520301207?v=s5
doi: 10.1016/j.metabol.2020.154256
abstract: nan
summary:
  title: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Not only, NASH and NAFLD are important predictive factors for the outcomes in acute and chronic disease processes but also the obesity surgery and its complications [7] . We believe more powerful studies are needed to confirm why obesity is a risk factor for critical illness and or mortality in Covid-19. Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Effect of Body Mass Index, Metabolic Health and Adipose Tissue Inflammation on the Severity of Non-alcoholic Fatty Liver Disease in Bariatric Surgical Patients: a Prospective Study Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity Anand U 3 .Non-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations Nonalcoholic Steatohepatitis Is Associated With Increased Mortality in Obese Patients Undergoing Bariatric Surgery Risk of COVID-19 for patients with obesity

title:
  Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease


id: cord-325055-todb1d4x
title: Should patients with obesity be more afraid of COVID‐19?
author: Rychter, Anna Maria
date: 2020-06-24
txt: ./txt/cord-325055-todb1d4x.txt
cache: ./cache/cord-325055-todb1d4x.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/obr.13083
doi: 10.1111/obr.13083
summary:
  Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID‐19 infection. Although the data regarding the impact of SARS-CoV-2 in individuals with obesity are limited and their association has not been fully defined yet, it has been observed that people suffering from excessive body weight may experience a more serious COVID-19 infection. 68 Whether the obesity paradox will be present among COVID-19 patients remains to be seen, nevertheless, the phenomenon was reported among other respiratory diseases, such as COPD or ARDS. 53, 69 Its pathophysiological basis remains unknown; however, an increased BMI seems to be associated with a better survival and a slower decline in the lung function in patients with a mild course of chronic obstructive pulmonary disease. Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Association of obesity with disease severity among patients with COVID-19.

abstract:
  COVID‐19 crisis has lasted since the late 2019 to the present day. The severity of the disease is positively correlated with several factors, such as age and coexisting diseases. Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID‐19 infection. On the basis of current research, in our nonsystematic review, we have investigated the extent to which obesity can affect the SARS‐CoV‐2 course and identify the potential mechanisms of the disease. We have also described the role of proper nutrition, physical activity and other aspects relevant to the management of obesity.


id: cord-325138-riu4jdc2
title: Obesity and Hunger Threaten the Foundations of Child Health
author: Hassink, Sandra G.
date: 2020-08-13
txt: ./txt/cord-325138-riu4jdc2.txt
cache: ./cache/cord-325138-riu4jdc2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32798724/
doi: 10.1016/j.acap.2020.08.010
abstract: nan
summary:
  29 Specific federal programs which "serve as critical supports for the physical and mental health and academic competence of children " are SNAP, WIC, Child and Adult Care Food Program, School breakfast and lunch program, and the Summer Food Service Program 26 Food programs like these are opportunities to provide healthy food for children most at risk for food insecurity and obesity. WIC provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and nonbreastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. Making WIC widely accessible to families hit hard by COVID-19 is crucial because WIC has been shown to both reduce the prevalence of food insecurity 42, 43 and obesity 44 and is an important contributor to early childhood health.


id: cord-329308-ipui7lo6
title: Proper Management of People with Obesity during the COVID-19 Pandemic
author: Lim, Soo
date: 2020-06-30
txt: ./txt/cord-329308-ipui7lo6.txt
cache: ./cache/cord-329308-ipui7lo6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32544885/
doi: 10.7570/jomes20056
summary:
  During the COVID-19 pandemic, people have tended to gain weight because of environmental factors imposed by quarantine policies, such as decreased physical activity and increased consumption of unhealthy food. The common medications used to treat people with obesity, such as glucagon-like peptide-1 analogues, statins, and antiplatelets agents, should be continued because these agents have anti-inflammatory properties and play protective roles against cardiovascular and all-cause mortality. 54 A cumulative effect of chronic inflammation and hypercytokinemia seems to bring about a hyperinflammatory response through macrophage active syndrome, especially in patients with severe COVID-19 (Fig. 2) . Letter to the Editor: obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Letter to the Editor: obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease

abstract:
  Since December 2019, countries around the world have been struggling with a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case series have reported that people with obesity experience more severe coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic, people have tended to gain weight because of environmental factors imposed by quarantine policies, such as decreased physical activity and increased consumption of unhealthy food. Mechanisms have been postulated to explain the association between COVID-19 and obesity. COVID-19 aggravates inflammation and hypoxia in people with obesity, which can lead to severe illness and the need for intensive care. The immune system is compromised in people with obesity and COVID-19 affects the immune system, which can lead to complications. Interleukin-6 and other cytokines play an important role in the progression of COVID-19. The inflammatory response, critical illness, and underlying risk factors may all predispose to complications of obesity such as diabetes mellitus and cardiovascular diseases. The common medications used to treat people with obesity, such as glucagon-like peptide-1 analogues, statins, and antiplatelets agents, should be continued because these agents have anti-inflammatory properties and play protective roles against cardiovascular and all-cause mortality. It is also recommended that renin–angiotensin system blockers are not stopped during the COVID-19 pandemic because no definitive data about the harm or benefits of these agents have been reported. During the COVID-19 pandemic, social activities have been discouraged and exercise facilities have been closed. Under these restrictions, tailored lifestyle modifications such as home exercise training and cooking of healthy food are encouraged.


id: cord-333368-kjrk8nn9
title: The Collision of Meta-Inflammation and SARS-CoV-2 Pandemic Infection
author: Huizinga, Gabrielle P
date: 2020-09-03
txt: ./txt/cord-333368-kjrk8nn9.txt
cache: ./cache/cord-333368-kjrk8nn9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1210/endocr/bqaa154
doi: 10.1210/endocr/bqaa154
summary:
  While obesity and diabetes may complicate the delivery of supportive care in critical illness regardless of the underlying disease, lessons learned from the interaction of obesity with other systemic inflammatory syndromes suggest that obesity modifies biologic factors related to SARS-CoV-2 infection and the COVID-19 syndrome. In seasonal and pandemic influenza, however, obese individuals may be more susceptible to severe viral respiratory disease even if they mount a serologic response to vaccination 25 A c c e p t e d M a n u s c r i p t 11 Along with possible impairments in pathogen clearance, obese hosts are more likely to experience the breakdown of respiratory epithelium during a pulmonary infection, which leads to increased fluid in the airway space.

abstract:
  The COVID-19 pandemic has forced us to consider the physiologic role of obesity in the response to infectious disease. There are significant disparities in morbidity and mortality by sex, weight and diabetes status. Numerous endocrine changes might drive these varied responses to SARS-CoV-2 infection including hormone and immune mediators, hyperglycemia, leukocyte responses, cytokine secretion, and tissue dysfunction. Studies of patients with severe COVID-19 disease have revealed the importance of innate immune responses in driving immunopathology and tissue injury. In this review we will describe the impact of the metabolically induced inflammation (meta-inflammation) that characterizes obesity on innate immunity. We consider that obesity-driven dysregulation of innate immune responses may drive organ injury in development of severe COVID-19 and impair viral clearance.


id: cord-338317-ro041w5l
title: When two pandemics meet: Why is obesity associated with increased COVID-19 mortality?
author: Lockhart, Sam M.
date: 2020-06-29
txt: ./txt/cord-338317-ro041w5l.txt
cache: ./cache/cord-338317-ro041w5l.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.medj.2020.06.005
doi: 10.1016/j.medj.2020.06.005
summary:
  Thus, the association of obesity with worse 105 outcomes in acute lung infection or widespread alveolar damage of other types, appears to be 106 strongest and most consistent with COVID-19 and pandemic H1N1 influenza. In addition to being lower in obesity and most insulin 168 resistant states it is worth noting that adiponectin levels have been reported to be significantly 169 lower in many of the COVID-19 "at risk" groups e.g. Male < Females 20 and South Asians < White 170 is secreted from adipose tissue, associated with insulin resistance and likely contributes to 197 thrombotic risk in obesity by impairing fibrinolysis 23 . In summary, we have applied insights into the pathophysiology of the adverse consequences of 279 obesity and emerging evidence regarding the pathological mechanisms in COVID-19 to suggest 280 possible routes whereby obesity can exacerbate the tissue damage associated with infection by the 281 SARS-CoV-2 virus.

abstract:
  Abstract A growing body of evidence indicates that obesity is strongly and independently associated with adverse outcomes of COVID-19 including death. By combining emerging knowledge of the pathological processes involved in COVID-19 with insights into the mechanisms underlying the adverse health consequences of obesity, we present some hypotheses regarding the deleterious impact of obesity on the course of COVID-19. These hypotheses are testable and could guide therapeutic and preventive interventions. As obesity is now almost ubiquitous and no vaccine for COVID-19 is currently available, even a modest reduction in the impact of obesity on mortality and morbidity from this viral infection could have profound consequences for public health.


id: cord-344614-5zcylf6k
author: Moriconi, Diego
date: 2020-06-04
txt: ./txt/cord-344614-5zcylf6k.txt
cache: ./cache/cord-344614-5zcylf6k.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.orcp.2020.05.009
doi: 10.1016/j.orcp.2020.05.009
summary:
  Partial least square regression analysis showed that BMI, age and CRP at admission were related to longer length of hospital stay, and time for negative swab. Our study shows that obesity is associated with a severer respiratory presentation of COVID-19 and severer elevation of inflammatory markers, likely leading to higher oxygen demands at admission, prolonged oxygen requirement during hospitalization, delayed viral clearance and extended hospital stay. For this reason, beyond the potential impact on the lung mechanics, obesity might influence the clinical presentation and evolution of SARS-COV-2 infection through J o u r n a l P r e -p r o o f exacerbation of the immune-inflammatory response related to the disease, as confirmed by the increased levels of several inflammatory markers detected in the peripheral blood of patients with obesity in our population.

title:
  Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding

abstract:
  INTRODUCTION: On the last three months the new SARS-COV-2 coronavirus has created a pandemic, rapidly spreading all around the world. The aim of the study is to investigate whether obesity impacts on COVID-19 morbidity. METHODS: One hundred consecutive patients with COVID-19 pneumonia admitted in our Medical Unit were evaluated. Anthropometric parameters and past medical history were registered. Nasopharyngeal swab samples and biochemical analysis were obtained at admission and during hospital stay. RESULTS: Patients with (OB, 29) and without obesity (N-OB, 71) were similar in age, gender and comorbidities, with the exception of hypertension that was more frequent in OB group. At admission, inflammatory markers were higher in OB than N-OB group. OB group showed a worse pulmonary clinical picture, with lower PaO2 (57 ± 15 vs. 68 ± 14 mmHg, p = 0.042), and SaO2 (88 ± 6 vs. 92 ± 5 %, p = 0.049) at admission consequently requiring higher volumes of oxygen (Fi02: 38 ± 15 vs. 29 ± 19%, p = 0.047) and a longer period to achieve oxygen weaning (10 ± 6 vs. 15 ± 7 days, p = 0.03). OB group also had positive swabs for longer time (19 ± 8 vs. 13 ± 7, days, p = 0.002), and required longer hospital stay (21 ± 8 vs. 13 ± 8, days, p = 0.0008). Partial least square regression analysis showed that BMI, age and CRP at admission were related to longer length of hospital stay, and time for negative swab. On the contrary, in this cohort, obesity did not predict higher mortality. CONCLUSIONS: Subjects with obesity affected by COVID-19 require longer hospitalization, more intensive and longer oxygen treatment, and they may have longer SARS-COV-2 shedding.


id: cord-351223-nnuoadh6
title: Obesity is Associated with Increased Risk for Mortality Among Hospitalized Patients with COVID‐19
author: Pettit, Natasha N.
date: 2020-06-26
txt: ./txt/cord-351223-nnuoadh6.txt
cache: ./cache/cord-351223-nnuoadh6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/oby.22941
doi: 10.1002/oby.22941
summary:
  [1] [2] [3] [4] [5] [6] [7] Early reports from Chinese series identified hypertension, diabetes, chronic pulmonary disease, and cardiovascular disease as the comorbidities most consistently associated with hospitalization, respiratory support, intensive care unit (ICU) admission, and death in COVID-19 patients. Subsequent reports from the United States and Europe suggested that patients with a higher body mass index (BMI) are at greater risk for hospital admission and severe disease requiring respiratory support. Secondary analyses included assessing the association of BMI group with oxygen requirement upon hospital admission, length of stay, ICU admission at any point, and mechanical ventilation at any point. Our study shows that amongst hospitalized patients with COVID-19 infection, obesity was significantly associated with mortality after adjusting for age, gender, and other comorbidities. This finding provides further evidence that obesity is a key comorbidity in COVID-19 that may not only predict severe disease requiring hospital admission, oxygen supplementation, or mechanical ventilation, but may also predict increased mortality.

abstract:
  OBJECTIVE: Obesity has been identified as a risk factor for severe COVID‐19 caused by the SARS‐CoV2 virus, however a direct association with mortality has not been reported. We sought to determine whether obesity is a risk factor for mortality among COVID‐19 patients. METHODS: The study was a retrospective cohort, including patients with COVID‐19 between March 1 and April 18, 2020. The primary objective was to determine if obesity is a predictor of mortality. RESULTS: A total of 238 patients were included, 218 patients (91.6%) were African American, 113 (47.5%) were male, and the mean age was 58.5 years. Of the included patients, 146 (61.3%) were obese (BMI >30kg/m(2)), with 63 (26.5%), 29 (12.2%), and 54 (22.7%) with class 1, 2, and 3 obesity, respectively. Obesity was identified as a predictor for mortality (OR 1.7(1.1‐2.8),p=0.016), as was male gender (OR 5.2(1.6‐16.5),p=0.01) and older age (OR 3.6(2.0‐6.3),p<0.0005). Obesity (OR 1.7(1.3‐2.1),p<0.0005) and older age (OR 1.3(1.0‐1.6),p=0.03) were also risk factors for hypoxemia. CONCLUSIONS: Obesity was found to be a significant predictor for mortality among inpatients with COVID‐19 after adjusting for age, gender, and other comorbidities. Patients with obesity were also more likely to present with hypoxemia.


id: cord-354805-5wnp02wd
title: COVID‐19 and obesity: The intersection between a pandemic and an epidemic in a developing country
author: Concepción‐Zavaleta, Marcio José
date: 2020-09-21
txt: ./txt/cord-354805-5wnp02wd.txt
cache: ./cache/cord-354805-5wnp02wd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32956554/
doi: 10.1002/oby.23027
summary:
  We have read with great interest the prospective cohort study published by Czernichow et al (1), wherein they found that obesity doubles mortality in patients hospitalized with coronavirus disease (COVID‐19), using as an indicator anthropometric, the body mass index (BMI). We have read with great interest the prospective cohort study published by Czernichow et al 1 , wherein they found that obesity doubles mortality in patients hospitalized with coronavirus disease (COVID-19), using as an indicator anthropometric, the body mass index (BMI). Excess mortality and severity of the COVID-19 disease in people with obesity is also prevalent in developing countries with constrained resources such as Peru, in which preliminary findings reported by the Ministry of Health show that among people with obesity died from COVID-19, 85.5% had obesity as assessed by BMI. 6 As studies have highlighted the association between this disease and its mortality and severity of SARS-CoV-2 infection, Peru and other countries are recognizing the importance of considering obesity as a disease and developing effective health system strategies and public health approaches.

abstract:
  We have read with great interest the prospective cohort study published by Czernichow et al (1), wherein they found that obesity doubles mortality in patients hospitalized with coronavirus disease (COVID‐19), using as an indicator anthropometric, the body mass index (BMI). Despite BMI being recognized as an anthropometric index of obesity and various studies confirming that it predicts cardiovascular events, the lack of information it provides on the distribution of body fat is considered its main limitation. The use of abdominal circumference and waist‐height ratio are better measures of visceral fat distribution, which is more closely associated with cardiometabolic risk;(2) however, those measures demand greater contact with COVID‐19 patients.


id: cord-354928-brliql4d
title: Overweight and obesity are risks factors of severe illness in patients with COVID‐19
author: Wang, Jian
date: 2020-07-31
txt: ./txt/cord-354928-brliql4d.txt
cache: ./cache/cord-354928-brliql4d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/oby.22979
doi: 10.1002/oby.22979
summary:
  CONCLUSION: Overweight and obesity were independent risk factors of severe illness in COVID‐19 patients. Old age and comorbidities, such as hypertension, diabetes, and chronic respiratory disease, were identified as risk factors of poor outcomes for COVID-19 patients according previous studies (3, 4) . Obesity was regarded as a common risk factor to aggravate the severity of respiratory diseases, which was associated with poor prognosis in influenza A (H1N1) pulmonary infection (5, 6) . A retrospective study enrolled 124 COVID-19 patients who were admitted to intensive care unit (ICU) showed more patients required invasive mechanical ventilation (IMV) therapy with increased body mass index (BMI) (12) . Several studies have demonstrated that the presence of type 2 diabetes was a significant risk factor of severe illness and fatal outcome of COVID-19 (24) (25) (26) .

abstract:
  OBJECTIVE: We aimed to observe the clinical characteristics of coronavirus disease 2019 (COVID‐19) patients with overweight and obesity. METHODS: Consecutive COVID‐19 patients from 10 hospitals of Jiangsu province, China were enrolled. RESULTS: 297 COVID‐19 patients were included. 39.39% and 13.47% of patients were overweight and obese, respectively. The proportions of bilateral pneumonia (92.50% vs. 73.57%, P=0.033) and type 2 diabetes (17.50% vs. 3.57%, P=0.006) were higher in patients with obesity than lean patients. The proportions of severe illness in patients with overweight (12.82% vs. 2.86%, P=0.006) and obesity (25.00% vs. 2.86%, P<0.001) were significantly higher than lean patients. More patients with obesity developed respiratory failure (20.00% vs. 2.86%, P<0.001) and acute respiratory distress syndrome (5.00% vs. 0%, P=0.024) than lean patients. The median days of hospitalization were longer in patients with obesity than lean patients (17.00 days vs. 14.00 days, P=0.029). Overweight (OR 4.222, 95%CI 1.322‐13.476, P=0.015) and obesity (OR 9.216, 95% CI 2.581‐32.903, P=0.001) were independent risk factors of severe illness. Obesity (HR 6.607, 95% CI 1.955‐22.329, P=0.002) was an independent risk factor of respiratory failure. CONCLUSION: Overweight and obesity were independent risk factors of severe illness in COVID‐19 patients. More attention should be paid to these patients.


