The effects of obesity and metabolic abnormalities on severe COVID-19-related outcomes after vaccination: A population-based study

• Published in: Cell metabolism Vol. 35; no. 4; pp. 585 - 600.e5
• Main Authors: Fan, Xiude, Han, Junming, Zhao, Enfa, Fang, Jiansong, Wang, Dawei, Cheng, Yiping, Shi, Yingzhou, Wang, Zhen, Yao, Zhenyu, Lu, Peng, Liu, Tianbao, Li, Qihang, Poulsen, Kyle L., Yuan, Zhongshang, Song, Yongfeng, Zhao, Jiajun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 04.04.2023
• Subjects: breakthrough SARS-CoV-2 infections; Clinical and Translational Report; COVID-19; health management; Humans; metabolic abnormalities; Obesity; Risk Factors; SARS-CoV-2; Vaccination; breakthrough SARS-CoV-2 infections; metabolic abnormalities; obesity; health management
• ISSN: 1550-4131; 1932-7420
• DOI: 10.1016/j.cmet.2023.02.016

Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until October 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia, and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (all p < 0.05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (all p < 0.05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive [adjusted hazard ratio (aHR) 0.64, 95% CI 0.48–0.86; p = 0.003], glucose-lowering [aHR 0.55, 95% CI 0.36–0.83; p = 0.004], and lipid-lowering treatments [aHR 0.50, 95% CI 0.37–0.68; p < 0.001]) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination. [Display omitted] •Obesity and metabolic abnormalities are highly prevalent in patients with severe COVID-19•Obesity and metabolic abnormalities are associated with an increased risk of severe COVID-19•In vaccinated patients, metabolic abnormalities are risk factors for severe COVID-19•Interventions targeting metabolic abnormalities may reduce the risk of severe COVID-19 Fan et al. show that obesity and metabolic abnormalities were modifiable risk factors for severe COVID-19 events in vaccinated patients. When metabolic abnormalities (namely, hyperglycemia, hyperlipidemia, or hypertension) were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal people. Moreover, pharmacological interventions targeting such abnormalities were significantly associated with a reduced risk for this outcome.