OBJECTIVE: Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear . In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes . RESEARCH
DESIGN AND METHODS: We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries . We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities . Subgroup analysis was performed on patients with preexisting diabetes . Site-specific estimates were combined in a meta-analysis .
RESULTS: Among 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15-1.80) and invasive mechanical ventilatory support (aOR , 1.22; 95% CI 1.03-1.46). There was no association between overweight and in-hospital mortality (aOR , 0.88; 95% CI 0.74-1.04). Similar effects were observed in patients with obesity or diabetes . In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity .
CONCLUSIONS: In adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death . In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.