Meta-Analysis the Effects of Obesity and Type 2 Diabetes Mellitus on Covid-19 Mortality

Oktaviana Kurniawati, Hanung Prasetya, Bhisma Murti

Abstract

Background: COVID-19 is a disease caused by a new coronavirus called SARS-CoV-2. In more severe cases, COVID-19 can cause death. The most severe COVID-19 patient mortality is associated with underlying health conditions. The most common associated comorbidities are pulmonary disease, diabetes, obesity, and old age. However, the effects of obesity and T2DM disease on the 2019 coronavirus disease (COVID-19) pandemic are controversial. This study aims to analyze the magnitude of the influence of obesity and T2DM on COVID-19 mortality.

Subjects and Method: This study uses a systematic review and meta-analysis research design. The time of the selected test results is between January 2020 to January 2021. The search for articles is carried out for 1 month. Research data was searched from databases: PubMed, Google Scholar, JAMA, Willey, and Science Direct. Using search keywords: (Type 2 diabetes mellitus OR diabetic) AND (mortality OR death) AND (COVID-19 /OR Coronavirus OR SARS-CoV-2) AND ("adjusted odds ratio" OR "aOR"), (obesity OR obese) AND (mortality OR death) AND (COVID-19 OR Coronavirus OR SARS-CoV-2) AND ("adjusted odds ratio" OR "aOR"). The inclusion criteria in this study were full-text articles in English, observational study designs were collected using PRISMA, and analyzed using the Review Manager application (RevMan 5.3).

Results: A total of 15 articles were reviewed in this study. A meta-analysis of 10 cohort studies showed that people with COVID19 who had comorbid obesity were 1.50 times more likely to die from COVID-19 compared to those without obesity (aOR = 1.50; 95% CI = 1.17 to 1.93; p = 0.001). A meta-analysis of 6 cohort studies showed people with COVID-1919 who had comorbid T2DM 1.93 times to die from COVID-19 compared with those without T2DM (aOR = 1.93; 95% CI = 1.28 to 2.90; p = 0.002).

Conclusion: Obesity and T2DM are predictors of COVID19 mortality.

 

Keywords: obesity, type 2 diabetes mellitus, mortality, COVID 19

 

Correspondence: Oktaviana Kurniawati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: oktaniawati94@gmail.com. Mobile: 085865463742.

Journal of Epidemiology and Public Health (2021), 06(02): 177-191

https://doi.org/10.26911/jepublichealth.2021.06.02.05

 

 

 

Full Text:

PDF

References

Abaci A, Oguzhan A, Kahraman S, Eryol NK, Ünal S (1999). Effect of Diabetes Mellitus on Formation of. Am Health Assoc J. 99(17): 2239–2242. https://doi.org/10.1161/01.CIR.99.17.2239


AHA (2014). Body mass index in adult. American Health Association Journal.


Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA (2017). Contribution of established stroke risk factors to the burden of stroke in young adults. AHA Journal. 48: 1–9. https://doi.org/10.1161/STROKEAHA.117.016599.


Al-Benna S (2020). Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients. Obes Med. 19: 100283. https://doi.org/10.1016/j.obmed.2020.100283.


Barron E, Bakhai C, Kar P, Weaver A, Bradley D, Ismail H, Knighton P, et al. (2020). Associations of type 1 and type 2 diabetes with COVID-19 related mortality in England: a wholepopulation study. The Lancet Diabetes Endocrinol. 8(10): 813–822. https://doi.org/10.1016/S2213-8587-(20)30272-2


Bloomgarden ZT (2020). Diabetes and COVID-19. J Diabetes. 12(4): 347–348. https://doi.org/10.1111/1753-04-07.13027.


Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, Wang T, et al. (2020). Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 130(5): 2620–2629. https://doi.org/10.1172-/JCI137244.


Czernichow S, Beeker N, Rives-Lange C, Guerot E, Diehl JL, Katsahian S, Hulot JS, et al. (2020). Obesity doubles mortality in patients hospitalized for severe acute respiratory syn-drome coronavirus 2 in Paris Hospi-tals, France: A cohort study on

,795 patients. Obesity (Silver Spring). 28 (12): 2282–2289. https://doi.org/10.1002/oby.23014


Lima CMAO (2020). Information about the new coronavirus disease (COVID-19). Radiol Bras. 53(2): vvi. https://doi.org/10.1590/0100-3984.2020.53.2e1.


Diaz JH (2021). Hypothesis: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. 27(3): 1–7. https://doi.org/10.1093/JTM/TA-AA041.


Dixon JB (2010). The effect of obesity on health outcomes. Mol Cell Endocrinol. 316(2): 104–108. https://doi.org/10.1016/j.mce.2009.07.008.


Flack JM, Ferdinand KC, Nasser SA (2003). Epidemiology of hypertension and cardiovascular disease in African Americans. J Clin Hypertens (Green-wich). 5(1): 5-11. https://doi.org/10.-1111/j.1524-6175.2003.02152.x.


Gerwen MV, Alsen M, Little C, Barlow, J., Genden E, Naymagon L, Tremblay, D (2021.). Risk factors and outcomes of COVID- 19 in New York City: A retrospective cohort study. J Med Virol. 93(2): 907-915. https://doi.org/10.1002/jmv.26337.


Giacomelli A, De Falco T, Oreni L, Pedroli A, Ridolfo AL, Calabrò E, Carrozzo G et al. (2021). Impact of gender on patients hospitalized for SARS- COV- 2 infection: A prospective observational study. J Med Virol. 93(7): 4597-4602. https://doi.org/10.1002/jmv.2-6933.


Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, Liu L, et al. (2020). Clinical characte-ristics of Coronavirus disease 2019 in China. N Engl J Med. 382(18): 1708–1720. https://doi.org/10.1056/nejmo-a2002032.

Hamzah FAB, Lau CH, Nazri H, Ligot DC, Lee G,Tan CL, Shaib MKBM et al. (2020). Corona Tracker: World-wide Covid-19 outbreak data analysis and prediction. Bulletin of the World Health Organization, March, Submitted.


Holman N, Knighton P, Kar P, O’Keefe J, Curley M, Weaver A, Barron E, et al. (2020). Risk factors for COVID-19 related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endo. 8(10): 823–833.https://doi.org/10.1016/S2213-8587(20)30271-0.


Holman N, Knighton P, Kar P, O’Keefe J, Curley M, Weaver A, Barron E, et al. (2020). Type 1 and type 2 diabetes and COVID-19 related mortality in England: A cohort study in people with diabetes. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.36-05226.


Huang I, Lim MA, Pranata R (2020). Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and metaregression. Diabetes Metab Syndr. 14(4): 395–403. https://dx.doi.org/10.1016%2Fj.dsx.2020.04.018.


Id TWL, Hassen IS, Ayele BT, Tsegay YG, Abebe S, Edo MG, Maru EH, et al. (2021). Laboratory biomarkers of COVID-19 disease severity and out-come: Findings from a developing country. PLoS One. 16(3): e0246087. https://doi.org/10.1371/journal.pone.0246087.


Jannah PI, Pamungkasari EP, Prasetya H (2021). The effect of sleep duration on overweight or obesity in female adolescents: A meta-analysis study. Indones J Med. 6(1): 52–61. https://doi.org/10.26911/theijmed.2021.06.01.06.


Jayawardena R, Jeyakumar DT, Misra A, Hills AP, Ranasinghe P (2020). Obesity: A potential risk factor for infec-tion and mortality in the current COVID-19 epidemic. Diabetes Meta-bolic Synd. 14(6): 2199–2203. https:-//doi.org/10.1016/j.dsx.2020.11.001.


Kassir R (2020). Risk of COVID-19 for patients with obesity. Obes Rev. 21(6): 10–11. https://doi.org/10.1111/obr.13034.


Weston S, Frieman MB (2020). COVID-19: Knowns, unknowns, and questions. mSphere. 5(2): e00203-20. https://doi.org/10.1128/msphere.00203-20.


Kruger HS, Puoane T, Senekal M, van Der MM (2005). Obesity in South Africa: challenges for government and health professionals. Public Health Nutr. 8 (5): 491-500. https://doi.org/10.107-9/PHN2005785.


Kumar A, Arora A, Sharma P, Anil S (2020). Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr: Clin Res Rev. 14(4): 535-545. https://doi.org/10.1016/j.dsx.2020.04.044.


Moreno L, Mesana M, Gonza´lez-Gross M, Gil CM, Ortega FB, Fleta J, Wärnberg J, et al. (2008). Body fat distribution reference standards in Spanish ado-lescents: The AVENA Body fat distribution reference standards in Spanish adolescents: the AVENA

Study. Int J Obes (Lond). 31(12): 1798-805. https://doi.org/10.1038/sj.ijo.0803670.


Nakeshbandi M, Maini R, Daniel P, Rosengarten S, Parmar P, Wilson C, Kim JM, et al. (2020). The impact of obesity on COVID-19 complications: a retrospective cohort study. Int J Obes. 44(9): 1832–1837. https://doi.org/10.1038/s41366-020-0648-x.


Nasraway Jr SA, Albert M, Donnelly A M, Ruthazer R, Shikora SA, Saltzman E (2006). Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med. 34(4): 964-70. https://doi.org/10.1097/01.CCM.0000205758.18891.70.


Palaiodimos L, Kokkinidis DG, Li W, Kara-manis D, Ognibene J, Arora S, South-ern WN, Mantzoros CS (2020). Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 108:154262.

https://doi.org/10.1016/j.metabol.2020.154262.


Pangestu U, Lanti Y, Dewi R, Prasetya H (2021). The effect of ear acupuncture in reducing body weight in obesity patients: A meta-analysis. Indones J Med. 06(01): 23-31.


Pettit NN, MacKenzie EL, Ridgway JP, Pursell K, Ash D, Patel B, Pho MT (2020). Obesity is associated with increased risk for mortality among hospitalized patients with COVID-19. Obesity. 28(10): 1806–1810. https://doi.org/10.1002/oby.22941.


Prasiska DI (2014). Analisis faktor risiko berat badan lahir pada kematian perinatal menggunakan meta analysis. Jurnal Biometrika Kependudukan. 3(1): 28–33.


Rajpal A, Rahimi L, Ismail-Beigi F (2020). Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes. J Diabet. 12(12): 895–908. https://doi.org/10.1111/17-53-0407.13085.


Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, Elkind MSV, et al. (2013). AHA / ASA expert consensus document an updated definition of stroke for the 21st century. Am Health Assoc J. 44(7): 2064–2089. https://doi.org/10.1161/STR.0-b013e318296aeca.


Satman I, Demirci I, Haymana C, Tasci I, Salman S, Ata N, Dagdelen S, et al. (2021). Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul. Diabet Res Clin Prac. 174: 108753. https://doi.org/10.1016/j.diabres.2021.108753.


Seiglie J, Platt J, Cromer SJ, Bunda B, Foulkes AS, Bassett IV, Hsu J, Meigs JB (2020). Diabetes as a risk factor for poor early outcomes in patients hospitalized with COVID-19. 43(12): 2938–2944. https://doi.org/10.2337/dc20-1506.


Setiati S, Azwar MK (2020). COVID-19 and Indonesia. Acta Med Indones. 52(1): 84-89.


Shi Q, Zhang X, Jiang F, Zhang X, Hu N, Bimu C, Feng J, et al. (2020). Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: A two-center, retrospective study. Diabet Care. 43(7): 1382–1391. https://doi.org/10.2337/dc20-0598.


Soetjipto HP (1955). Aplikasi meta-analisis dalam pengujian validitas aitem (Vol. 2). Buletin Psikologi. 3(2). https://doi.org/10.22146/bpsi.13392.


Sonmez A (2021). Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes. 13(7): 585-595. https://doi.org/10.1111/17530407.13171.


Ssentongo P, Sentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM (2020). Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS ONE. 15(8): 1–16. https://doi.org/10.1371/journal.pone.0238215.


Suresh S, Siddiqui M, Abu M, Jou J, Simmer S, Mendiratta V, Russell S, et al. (2021). Obesity research & clinical practice association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study. Obesity

Res Clin Prac. 15(2): 172–176. https://doi.org/10.10-16/j.orcp.2021.02.006.


Susilo A, Rumende CM, Pitoyo CW, San-toso WD, Yulianti M, Herikurniawan H, Sinto R, et al. (2020). Coronavirus disease 2019: Tinjauan literatur terkini. Jurnal Penyakit Dalam Indonesia. 7(1): 45. https://doi.org/10.7454/jpdi.v7i1.415.


Ullah W, Roomi S, Nadeem N, Saeed R, Tariq S, Ellithi M (2021). Impact of body mass index on COVID-19-related in- hospital outcomes and mortality. J Clin Med Res. 13(4): 230–236. https://doi.org/10.14740/jocmr4239.


Wang X, Liu Z, Li J, Zhang J, Tian S, Lu S, Qi M, Ma J, Qiu B, Dong W, Xu Y (2020). Impacts of Type 2 diabetes on disease severity, therapeutic effect, and mortality of patients with COVID-19. J Clin Endocrinol Metab. 105(12): 1–11. https://doi.org/10.121-0/clinem/dgaa535.


WHO (2007). National Diabetes Fact Sheet, 2007.


WHO (2016). Global report on diabetes.


WHO (2018). Fact sheets obesity and over-weight. WHO.


WHO (2019). Key fact. WHO.


Widhiastuti H (2002). Studi meta-analisis tentang hubungan (meta-Analysis study on relationship). Jurnal Psiko-logi. 1: 28–42.


You JH, Lee SA, Chun S, Song SO, Lee B, Kim DJ (2020). Original article clinical outcomes of COVID-19 patients with type 2 diabetes: A population-based study in Korea. 901–908.


Zhao R, Sun Y, Zhang Y, Wang W, Wang S, Wang C, Liu J, Gao L, Hu Z, Fei J, Hou X, Zheng H, Chen L (2020). Distinguishable immunologic characteristics of COVID-19 patients with comorbid type 2 diabetes compared with nondiabetic individuals. Mediators

of Inflammation. https://doi.org/10.1155/2020/6914878.


Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, Lei F, et al. (2020). Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 31(6): 1068-1077.e3. https://doi.org/10.1016/j.cmet.2020.04.021.




Refbacks

  • There are currently no refbacks.