The Association between High Body Mass Index and Mortality Risk in Hospitalized Patients Diagnosed with COVID-19: A Meta-Analysis

Yuzana Maung, Eti Poncorini Pamungkasari, Bhisma Murti


Background: COVID-19, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), emerged as a global pandemic with confirmed death cases of more than 1.27 million worldwide. Since the past pandemic, several studies discovered the adverse effects of excess fat accumulation on the severity of viral infections. This study aimed to investigate the association between high body mass index (BMI) and mortality risk in hospitalized COVID-19 patients based on four categories of high BMI ranges.
Subjects and Method: A systematic review and Meta-Analysis was conducted using search articles from electronic databases including PubMed, Google Scholar, and Scopus, published from 2019 to 2021. The keywords used to retrieve articles were "Body Mass Index" OR BMI OR Obesity OR Overweight) AND (Mortality OR Death) AND COVID-19 OR SARS-CoV-2. The included studies were full-text articles published in the English language, reporting adjusted odds ratios from multivariate analysis. The eligibility criteria were defined using PICO model. The article selection was conducted using PRISMA flow chart. The included studies were analyzed by the Review Manager 5.3 application.
Results: A total of nine cohort studies involving 12,907 COVID-19 patients with high BMI conducted from America, Europe, and Georgia regions was included in qualitative synthesis and Meta-Analysis. The pooled estimate showed hospitalized COVID-19 patients with morbid/ class III obesity had a higher risk of mortality (aOR= 1.77; 95% CI= 1.27 to 2.47; p= 0.001) than overweight (aOR= 1.10; 95% CI= 1.00 to 1.21; p= 0.060), class I (aOR= 1.16; 95% CI= 0.87 to 1.55; p= 0.300), and class II obesity (aOR= 1.54; 95% CI= 1.11 to 2.13; p= 0.009).
Conclusion: High BMI increases the risk of mortality in hospitalized COVID-19 patients. A potential dose-response relationship may exist between different categories of high BMI range and mortality risk in COVID-19 patients.

Keywords: BMI, obesity, mortality, COVID-19, SARS-CoV-2

Correspondence: Yuzana Maung. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: +6281295346614.

Journal of Epidemiology and Public Health (2021)­/jepublic­health.2021.06.01.08

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Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y et al. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 395(10223): 507-513. DOI: 10.1016/S0140-6736(20)30211-7.

Chiappetta S, Sharma A, Bottino V, Stier C (2020). COVID-19 and the role of chronic inflammation in patients with obesity. Int J Obes. 44: 1790-1792. DOI: 10.1038/s41366-020-0597-4

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, Holden KA, et al. (2020). Features of 20,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study.BMJ. 369:1985. DOI: 10.1136/bmj.m1985.

Giacomelli A, Ridolfo AL, Milazzo L, Oreni L, Bernacchia D, Siano M, Bonazzetti C, et al. (2020). 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study. Pharmacol Res. 158:104931.DOI: 10.1016/j.phrs.2020.1049-31.

Guglielmi V, Colangeli L, Adamo MD, Sbraccia P (2021). Susceptibility and Severity of Viral Infections in Obesity: Lessons from Influenza to COVID-19. Does Leptin Play a Role? Int. J. Mol. Sci, 22: 3183.

Hajifathalian K, Kumar S, Newberry C, Shah S, Fortune B, Krisko T, Pujols SO, et al. (2020). Obesity is Associated with Worse Outcomes in COVID-19: Analysis of Early Data from New York City. Obesity. 28(9): 1606–1612. doi: 10.1002/oby.22923.

Hendren N, Lemos J, Ayers C, Das S, Rao A, Carter S, Rosenblatt A, et al. (2021). Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19. Circulation. 143: 135-144. DOI: 10.1161/CIRCULATIONAHA.120.051936

Jain S, Chaves S (2011). Obesity and Influenza. Clin. Infect. Dis. 53(5): 422–424. DOI: 10.1093/cid/cir448f

Mafort TT,Rufino R, Costa CH, Lopes AJ (2016). Obesity: Systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med. 11(28): 1–11. DOI: 10.1186/s40248-016-0066-z.

Mehanna O, El Askary A, El Esawy B, FathAlla T, Gharib AF (2021). Impact of Obesity and Its Associated Comorbid Conditions on COVID-19 Presentation. Diabetes Metab Syndr Obes. 14: 409-415. DOI: org/10.2147/DMSO.S287779

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ (2020). COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet. 395(10229): 1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.

Palaidimos L, Kokkinidis D, Li W, Kara-manis D, Ognibene J, Arora S, Southern W, et al. (2020). Severe obesity, increasing age and male sex are independently associated with worse in hospital outcomes, and higher in hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metab.: Clin. Exp.108: 154262. DOI: org/10.1016/j.metabol.2020.154262

Petrilli CM, Jones SA, Yang J, Rajagopalan H, Donnell LO,Chernyak Y, Tobin KA et al. (2020). Factors associated with hospital admission and critical illness among 5,279 people with coronavirus disease 2019 in New York City: Prospective cohort study.BMJ. 369. DOI: 10.1136/bmj.m1966.

Seidu S, Gillies C, Zaccardi F, Kunutsor S, Boyce J, Yates T, Singh A, et al. (2020). The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis. Endocrinol Diabetes Metab. 4(1): e00176.DOI: 10.1002/edm2.176

Tartof S, Qian L, Hong V, Wei R, Nadjafi R, Fischer H, Li Z, et al. (2020). Obesity and mortality among patients diagnosed with COVID-19: Results from an Integrated Health Care Organization. Ann Intern Med. DOI:10.7326-/M20-3742.

Tsai PH, Lai W, Lin Y, Luo Y, Lin Y, Chen H, Chen Y et al. (2021). Clinical manifestation and disease progression in COVID-19 infection. J Chin Med Assoc. 84(1): 3-8. DOI: 10.1097/JCMA.0000000000000463.

WHO (2020). COVID-19 Weekly Epidemiological Update 22. World Health Organization. 1–3. Retrieved from

WHO (2021). WHO Coronavirus (COVID-19) Dashboard. World Health Organization. Retrieved from

Wilding J, Ralston J (2021). COVID-19 and Obesity: The 2021 Atlas. Worldobesityday. 1–227. Landon: World Obesity Federation.


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