Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1897-1904. doi: 10.1016/j.dsx.2020.09.029. Epub 2020 Sep 28.


Background and aims: Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients.

Methods: We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality.

Results: Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m2). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67-1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25-2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension.

Conclusion: Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.

Keywords: Body mass index; Covid-19; Obesity; Poor outcome.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Age Factors
  • Body Mass Index
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • COVID-19 / therapy
  • Diabetes Mellitus, Type 2 / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypertension / epidemiology
  • Intensive Care Units / statistics & numerical data
  • Obesity / epidemiology*
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Distress Syndrome / epidemiology*
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy
  • SARS-CoV-2
  • Severity of Illness Index
  • Sex Factors