Obesity could shift severe COVID-19 disease to younger ages (Lancet 2020.05.16)

.... The largest study of 1591 ICU patients from Italy reported a median age of 63 years, with only 203 patients (13%) younger than 51 years. Common comorbidities are hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (42 [4%] of 1043), obstructive pulmonary disease. Similar data have been reported from China.

When the COVID-19 epidemic began in the USA, we anticipated a similar ICU population. News reports and communications from the US Federal Government had emphasised that COVID-19 was a particular problem for older people, and a resistance to social distancing and sheltering in place by younger people might have been informed by this idea. However, as the pandemic hit the Johns Hopkins Hospital in late March, 2020, younger patients began to be admitted to our ICU, many of whom were also obese. An informal survey of colleagues directing ICUs at other hospitals around the country yielded similar findings. At this time, news editorials were noting obesity as an underappreciated risk factor for COVID-19. This risk is particularly relevant in the USA because the prevalence of obesity is around 40%, versus a prevalence of 6·2% in China, 20% in Italy, and 24% in Spain.

With use of least squares univariate and multivariate linear regression, we examined the correlation between body-mass index (BMI) and age in patients with COVID-19 admitted to ICU at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania (appendix).Acquisition of the de-identified data for this analysis was approved by the Johns Hopkins University Institutional Review Board.

In our dataset of 265 patients (58% male patients), we found a significant inverse correlation between age and BMI, in which younger individuals admitted to hospital were more likely to be obese (figure). There was no difference by sex (p=0·9). The median BMI was 29.3 kg/m2, with only 25% of individuals having a BMI of less than 26 kg/m2, and 25% exceeding a BMI of 34·7 kg/m2.

Obesity can restrict ventilation by impeding diaphragm excursion, impairs immune responses to viral infection, is pro-inflammatory, and induces diabetes and oxidant stress to adversely affect cardiovascular function. We conclude that in populations with a high prevalence of obesity, COVID-19 will affect younger populations more than previously reported. Public messaging to younger adults, reducing the threshold for virus testing in obese individuals, and maintaining greater vigilance for this at-risk population should reduce the prevalence of severe COVID-19 disease.

肥満は重度のCOVID-19(新型コロナウイルス感染症)疾患を若年層にシフトさせる可能性がある (Lancet 2020.05.16)

.... イタリアのICU患者1591人を対象とした最大規模の研究では、年齢中央値が63歳と報告されており、51歳未満の患者は203人(13%)のみであった。一般的な併存疾患は、高血圧、心血管疾患、2型糖尿病、そしてまれに(1043人中42人[4%])、閉塞性肺疾患である。同様のデータが中国から報告されている。

米国でCOVID-19の流行が始まったときには、同様のICU患者群を予想していた。米国連邦政府からのニュース報道や通信では、COVID-19は高齢者にとって特別な問題であることが強調されており、若年者によるソーシャルディスタンスの実施や隔離への抵抗感がこの考えに通じていたのかもしれない。しかし、2020年3月下旬にパンデミックがジョンズ・ホプキンス病院を襲うと、若い患者が当院のICUに入院するようになり、その多くは肥満でもあった。全国の他の病院でICUを指揮している同僚の非公式な調査でも、同様の結果が得られた。この頃、ニュースの社説では、COVID-19の危険因子として肥満が十分に評価されていないことが指摘されていた 。




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