Sarcopenic obesity and the risk of hospitalization or death from coronavirus disease 2019: findings from UK Biobank

Thomas J Wilkinson; Thomas Yates; Luke A Baker; Francesco Zaccardi; Alice C Smith

doi:10.1002/rco2.47

Sarcopenic obesity and the risk of hospitalization or death from coronavirus disease 2019: findings from UK Biobank

JCSM Rapid Commun. 2022 Jan-Jun;5(1):3-9. doi: 10.1002/rco2.47. Epub 2021 Jul 3.

Authors

Thomas J Wilkinson^{1

2}, Thomas Yates^{2

3}, Luke A Baker^{1

2}, Francesco Zaccardi^{3

4

5}, Alice C Smith^{1

2}

Affiliations

¹ Leicester Kidney Lifestyle Team, Department of Health Sciences University of Leicester Leicester UK.
² Leicester NIHR Biomedical Research Centre Leicester UK.
³ Leicester Diabetes Research Centre Leicester UK.
⁴ Leicester Real World Evidence Unit University of Leicester Leicester UK.
⁵ NIHR Applied Research Collaboration (ARC) East Midlands, Diabetes Research Centre Leicester UK.

PMID: 34541518
PMCID: PMC8441916
DOI: 10.1002/rco2.47

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. The role of skeletal muscle mass in modulating immune response is well documented. Whilst obesity is well established as a key factor in COVID-19 and outcome, no study has examined the influence of both sarcopenia (low muscle mass) and obesity, termed 'sarcopenic obesity' on the risk of severe COVID-19.

Methods: This study uses data from UK Biobank. Probable sarcopenia was defined as low handgrip strength. Sarcopenic obesity was mutually exclusively defined as the presence of obesity and low muscle mass [based on two established criteria: appendicular lean mass (ALM) adjusted for either (i) height or (ii) body mass index]. Severe COVID-19 was defined by a positive severe acute respiratory syndrome coronavirus 2 test result in a hospital setting and/or death with a primary cause reported as COVID-19. Fully adjusted logistic regression models were used to analyse the associations between sarcopenic status and severe COVID-19. This work was conducted under UK Biobank Application Number 52553.

Results: We analysed data from 490 301 UK Biobank participants (median age 70.0 years, 46% male); 2203 (0.4%) had severe COVID-19. Individuals with probable sarcopenia were 64% more likely to have had severe COVID-19 (odds ratio 1.638; P < 0.001). Obesity increased the likelihood of severe COVID-19 by 76% (P < 0.001). Using either ALM index or ALM/body mass index to define low muscle mass, those with sarcopenic obesity were 2.6 times more likely to have severe COVID-19 (odds ratio 2.619; P < 0.001). Sarcopenia alone did not increase the risk of COVID-19.

Conclusions: Sarcopenic obesity may increase the risk of severe COVID-19, over that of obesity alone. The mechanisms for this are complex but could be a result of a reduction in respiratory functioning, immune response, and ability to respond to metabolic stress.

Keywords: Coronavirus disease 2019; Obesity; Sarcopenia; Sarcopenic obesity.

Abstract

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