Excess weight, no hyperglycemia, associated

A high body mass index (BMI), rather than high blood sugar, is associated with excessive risks of COVID-19 infection and long COVID, according to a meta-analysis of more than 30,000 UK adults from nine large prospective cohort studies.

The findings of Dr Anika Knuppel from the MRC Unit for Lifelong Health and Aging, University College London, UK, and her colleagues are being presented at this year’s annual meeting of the European Association for Diabetes Study (EASD) in Stockholm, Sweden (19-23 September).

“Early in the pandemic, research identified diabetes and obesity as risk factors for becoming seriously ill with COVID-19. And we know that many people with type 2 diabetes are also overweight. Our early findings support the idea that obesity-related mechanisms may be responsible for the excess COVID-19 risks associated with diabetes, rather than hyperglycemia per se,” says Dr. Knuppel.

Previous research has shown that people with diabetes and obesity are more likely to become seriously ill and die if they catch COVID-19, but are not more likely to contract it. However, the underlying mechanisms and their role in prolonged post-COVID-19 (long COVID) symptoms remain unclear.

To find out more, the researchers looked for associations between a range of clinical characteristics measured before the pandemic – HbA1c (average blood sugar level), self-reported or drug-induced diabetes, body mass index (BMI) and waist-to-hip ratio. . (WHR) – and self-reported and long COVID-19 infection in nine ongoing UK cohort studies [1].

Analyzes included the most recent measurements (taken between 2002 and 2019) of HbA1c, weight, height, waist circumference and hips from each study as well as information from health and lifestyle questionnaires. of life.

All eligible participants (maximum 31,252, ages 19-75, 57% female) had data on previous measures and completed at least one questionnaire during the COVID-19 pandemic (May 2020 to September 2021) covering questions about COVID-19 and, if possible, questions about the duration of persistent symptoms related to COVID-19.

Participants reported having COVID-19 based on a positive test or strong suspicion. Long COVID was defined as symptoms that persisted or affected functioning for more than four weeks after infection and were compared to those reporting symptoms for less than four weeks.

Where possible, associations were adjusted for gender, smoking status, ethnicity, income, and education at the time of measurement.

Between May 2020 and September 2021, 5,806 participants reported ever having had COVID-19, and 584 reported having long COVID (approximately 7% of COVID-19 cases with symptom duration information).

Analysis of data from 31,252 participants in nine studies found that higher BMI was associated with a greater likelihood of COVID-19 infection, with a 7% higher risk for every 5 kg/m2 increase in BMI. Overweight people (BMI 25-29.9kg/m2) and obesity (30 kg/m2 or more) were 10% and 16% more likely to be infected with COVID-19, respectively, than individuals of healthy weight (less than 25 kg/m2; see figure in Notes to Editors).

Similar results were seen for long COVIDs (4243 participants, six studies) — with a 20% higher risk for every 5 kg/m2 increase in BMI. Overweight and obese people had a 20% and 36% higher chance of long COVID, respectively. However, both for COVID infection and for long associations of COVID with BMI categories were not all statistically significant (so we cannot be sure that they are not due to chance).

Analyzes of association with WHR were inconclusive.

Notably, studies looking at mean blood glucose (HbA1c) and diabetes (15,795 participants and 1,917 for long COVID) found no association with COVID-19 or long COVID (see figure in notes to editors).

The researchers stress the need for further research to explore the mechanisms underlying these associations and reduce the excess risk associated with high BMI. “Our early results suggest a link between adiposity and COVID-19 infection and long COVID-19 even after controlling for socio-demographic factors and smoking. We need to explore more what makes people in overweight and obese at risk for worse outcomes and how this relates to severe cases,” says Knuppel.

The authors acknowledge that the study was observational and cannot prove that a higher BMI increases the risk of COVID-19 infection, and they cannot rule out the possibility that other unmeasured factors (e.g., underlying conditions) or missing data may have affected the results. They also point out that COVID-19 was based on suspicion rather than a positive test, and that clinical measures taken before the pandemic may be outdated for some of the included studies. Finally, they note that study participants were healthier than the general population, which may limit the conclusions that can be drawn.

For interviews with the authors of the report, please contact Dr Anika Knuppel, MRC Unit for Lifelong Health and Ageing, University College London, UK E) [email protected] T) +44(0)2076705719 or +44(0)7474873564

Alternate contact in the EASD press room: Tony Kirby T) + 44(0)7834 385827 E) [email protected]

Notes to Editors:

[1] Preliminary analyzes included data from up to 9 prospective UK cohort studies:

  • The British Cohort Study of 1970 (BCS70)
  • Born in Bradford (BiB)*
  • The English Longitudinal Study of Aging (ELSA)*
  • Generation Scotland (GS)
  • The Millennium Cohort Study (MCS)
  • The National Child and Development Study (NCDS)
  • MRC’s National Survey of Health and Development (NSHD)*
  • Avon Longitudinal Study of Parents and Children (ALSPAC G1)
  • Understanding Society (USoc), the longitudinal study of British households.

*Not included in long COVID analyses.

The study was funded by Characterization, Determinants, Mechanisms, and Consequences of the Long-Term Effects of COVID-19: Providing the Evidence Base for Health Care Services (CONVALESCENCE) funded by the National Institute for Health Research and care.

The authors declare no conflict of interest.

For the figure, see the full abstract

This press release is based on Abstract 363 from the European Association for the Study of Diabetes (EASD) Annual Meeting. All accepted abstracts have been carefully reviewed by the conference selection committee. There is no complete article at this stage, but the authors are happy to answer your questions. No poster is available with this presentation.



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Edward L. Robinett