key: cord-0815466-eoiov5fb authors: Zeng, Jing; Liu, Xiong; Wang, Shengshu; Yang, Shanshan; Jia, Wangping; Han, Ke; Wang, Changjun; Liu, Miao; Chen, Yong; He, Yao title: The Association Between BMI and Metabolically Unhealthy Status With COVID-19 Mortality: Based On 3019 Inpatients From Wuhan, China date: 2021-08-05 journal: Nutr Metab Cardiovasc Dis DOI: 10.1016/j.numecd.2021.07.030 sha: e91fc67554d6919110d0d1caa71ace293ec7f874 doc_id: 815466 cord_uid: eoiov5fb Background and aims Patients with multiple metabolic diseases are at high risk for the occurrence and death of COVID-19. Little is known about patients with underweight and metabolically healthy obesity. The aim of this study is to evaluate the impact of BMI and COVID-19 mortality in hospitalized patients, and also explore the association in different metabolically healthy (MHS) and unhealthy status (MUS). Methods and results A retrospective cohort study based on 3019 inpatients from Wuhan was conducted. Included patients were classified into four groups according the BMI level (underweight, normal weight, overweight and obesity), and patients with at least one of the metabolic abnormalities (diabetes, hypertension, dyslipidemia) was defined as MUS. Multiple Cox model was used to calculate the hazard ratio (HR). Compared to patients with normal weight, the HRs of overweight and obesity for COVID-19 mortality were 1.91 (95%CI:1.02-3.58) and 2.54 (95%CI:1.22-5.25) respectively in total patients, and 2.58 (95%CI:1.16-5.75) and 3.89 (95%CI:1.62-9.32) respectively in the elderly. And the HR of underweight for COVID-19 mortality was 4.58 (95%CI:1.56-13.48) in the elderly. For different metabolic statuses, both underweight, overweight and obesity had obviously negative association with COVID-19 mortality in total and elderly patients with MUS. However, no significance was found in non-elderly and patients with MHS. Conclusion Not only overweight or obesity, but also underweight can be associated with the COVID-9 mortality, especially in the elderly and patients with MUS. More large-scale studies are needed for patients with underweight and metabolically healthy overweight or obesity. Obesity, as the cause of many chronic diseases, is also observed to be closely associated 64 to similar risks of COVID- 19 The database was from medical records on hospitalization system of our hospital, with 94 complete records of admission, diagnosis, treatment process and discharge. All related 95 data including demographic information, medical history, computed tomography (CT) 96 description, blood pressure, symptoms, height, weight and laboratory test were for data analysis and a two-sided P value <0.05 was considered statistically significant. Clinical laboratory characteristics of each BMI group 165 The laboratory characteristics in the four BMI groups presented in Table 2 , and mostly 166 revealed significant difference in addition to lymphocyte and neutrophil percentage, 172 Table 3 showed the HRs and 95% CI of BMI for mortality with COVID-19. After HRs of BMI for mortality in metabolically healthy and unhealthy patients. 186 We ascertained the association of BMI for follow-up COVID-19 mortality among 187 patients with different metabolic statuses in Table 4 . Adjusted for age, gender, disease The linear dose-response association between overweight or obesity and COVID-19 223 mortality basically reach a consensus [19, 20] , but the impact of underweight is still 224 controversial. Our result presented that underweight was also associated with COVID- 225 19 mortality in the elderly, that is to say, the association between BMI and COVID-19 226 mortality in elderly is not a simple linear but a U-shaped curve. The elderly with BMI The database of the current study is not publicly available. Global perspective of COVID-19 epidemiology for a full-cycle pandemic Prevalence of co-morbidities and their 296 association with mortality in patients with COVID-19: A systematic review and meta-analysis Impact of obesity on COVID-19 patients Trends in the prevalence of overweight, obesity, and abdominal 301 obesity among Chinese adults between 1993 and 2015 Forecasting the Populations of Overweight and Obese Chinese Harmonizing the metabolic 316 syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and 317 Prevention International Atherosclerosis Society; and International Association for the Study of Obesity COVID-19 and Obesity: Dangerous Liaisons Obesity Is a Risk Factor for Greater Obesity in patients with COVID-19: a systematic 325 review and meta-analysis Obesity and mortality of COVID-19 Body Mass Index and Risk 329 for Intubation or Death in SARS-CoV-2 Infection : A Retrospective Cohort Study Obesity, and Metabolic Inflammation Create the Perfect Storm for 332 COVID-19 Sexual Dimorphism of Coronavirus 19 Morbidity and Lethality Body mass index and outcome in 336 patients with COVID-19: A dose-response meta-analysis Association of body mass index (BMI) with critical COVID-19 and in-338 hospital mortality: A dose-response meta-analysis BMI as a Risk Factor for Clinical Outcomes in 340 Patients Hospitalized with COVID-19 in New York With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry With COVID-19: Results From an Integrated Health Care Organization Body Mass Index and Risk AST(IU/L), median(IQR) 7-45 19.60(15.30-25.60) TBIL(IU/L), median(IQR)