The Journal of Clinical Endocrinology and Metabolism Journal Article

Body Mass Index and Risk of COVID-19 Outcomes

December 07, 2021
 

Martina Recalde, Andrea Pistillo, Sergio Fernandez-Bertolin, Elena Roel, Maria Aragon, Heinz Freisling, Daniel Prieto-Alhambra, Edward Burn, Talita Duarte-Salles
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 12, December 2021, Pages e5030–e5042
https://doi.org/10.1210/clinem/dgab546

Abstract

Context

A comprehensive understanding of the association between body mass index (BMI) and coronavirus disease 2019 (COVID-19) is still lacking.

Objective

To investigate associations between BMI and risk of COVID-19 diagnosis, hospitalization with COVID-19, and death after a COVID-19 diagnosis or hospitalization (subsequent death), accounting for potential effect modification by age and sex.

Design

Population-based cohort study.

Setting

Primary care records covering >80% of the Catalan population, linked to regionwide testing, hospital, and mortality records from March to May 2020.

Participants

Adults (≥18 years) with at least 1 measurement of weight and height.

Main outcome measures

Hazard ratios (HR) for each outcome.

Results

We included 2,524,926 participants. After 67 days of follow-up, 57,443 individuals were diagnosed with COVID-19, 10,862 were hospitalized with COVID-19, and 2,467 had a subsequent death. BMI was positively associated with being diagnosed and hospitalized with COVID-19. Compared to a BMI of 22 kg/m2, the HR (95% CI) of a BMI of 31 kg/m2 was 1.22 (1.19–1.24) for diagnosis and 1.88 (1.75–2.03) and 2.01 (1.86–2.18) for hospitalization without and with a prior outpatient diagnosis, respectively. The association between BMI and subsequent death was J-shaped, with a modestly higher risk of death among individuals with BMIs ≤ 19 kg/m2 and a more pronounced increasing risk for BMIs ≥ 40 kg/m2. The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients.

Conclusions

There is a monotonic association between BMI and COVID-19 diagnosis and hospitalization risks but a J-shaped relationship with mortality. More research is needed to unravel the mechanisms underlying these relationships.

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