The Lancet: If vaccination is not active, fat people are more prone to problems!

Lancet Reg Health Am.
: Why should obese youth be prioritized for COVID-19 vaccination programs? A nationwide retrospective study , 012,150 infections and 612,587 deaths
.

The lack of proportional mass vaccination in Brazilian states partly explains the high transmission rate of the SARS-CoV-2 virus 18 months after the country's first case was reported
.

When Brazil finally began vaccinating against COVID-19, the number of vaccines available was low and unevenly distributed between states and cities
.

Similar to the situation in other counties, the federal government needs to establish priority groups to receive vaccines first
.

Early in the pandemic, age was defined as one of the important risk factors for severe COVID-19
.

Therefore, the elderly population is the first to be vaccinated against COVID-19
.

This measure is critical to reducing the number of deaths in this age group
.

The relationship between various cardiovascular risk factors and the risk of poor prognosis in hospitalized patients with COVID-19 has also been described
.

In Brazil, priority is given to vaccinating people with these comorbidities, even if they are young
.

Given that the vaccine is only available to a small portion of the population, it is unclear whether prioritizing young adults with comorbidities will be effective
.

Obesity was epidemic in Brazil before COVID-19
.

The prevalence of obesity among adults aged 20 and older in Brazil increased from 12.
2 in 2003 to 26.
8% in 2019.
7
.

Such high obesity rates in Brazil create a high health and economic burden
.

It is predicted that the prevalence of obesity-related diseases such as stroke, hypertension, coronary heart disease, osteoarthritis and diabetes could double by 2050
.

We hypothesized that being overweight in young adults may be associated with a greater risk of severe COVID-19 disease compared with young adults of normal weight
.

Starting from 1120,767 unvaccinated individuals registered in the Brazilian surveillance system, this study selected 313,898 hospitalized COVID- 19 patients, and individuals without risk factors associated with severe COVID-19
.

Patient data were stratified according to age, obesity, BMI, and comorbidities, followed by crude and adjusted odds ratios, hazard ratios, and Kaplan-Meier curves
.

Disease outcomes were invasive and non-invasive ventilatory support, intensive care unit (ICU) admission, and death
.

The study population included 313,898 Brazilian adults (20-89 years old) who were hospitalized with COVID-19 between February 16, 2020 and January 17, 2021
.

These dates cover the time between the first case of COVID-19 in Brazil and the start of vaccination for the disease
.

COVID-19 patients were mainly male (60%), white (40%), 60-89 years old (50%), high school education (12%), and from the southeastern region of Brazil (51%)
.

We performed four independent analyses with the primary outcome of: (i) ICU admission, (ii) use of non-invasive support, (iii) use of invasive ventilatory support, and (iv) death
.

Patients identified as obese (N = 8, 834), CVD (N = 56, 079), diabetic (N = 24, 535), CVD + diabetes (N = 41, 646), obese + CVD were then compared Adjusted odds ratios for each primary outcome in patients with obesity (N=8,759), obesity+diabetes (N=2,178), and obesity+CVD+diabetes (N=7,748)
.

The reference group included patients without other risk factors (N = 164, 119)
.

Initially, we assessed the interaction between age and obesity using a multiple logistic regression model with BMI/age as a concurrent variable, and the association with the primary outcome remained, thus justifying the age-stratified analysis
.

Obesity is undoubtedly an aggravating factor in the severity of COVID-19, given ICU admissions, ventilatory support, and deaths
.

In fact, obese-only patients had a higher risk of dying from COVID-19 than CVD-only patients at all ages (P < 0.
0001)
.

Furthermore, for patients in the 20-39 and 40-59 age groups, the risk was comparable to that of patients with diabetes alone (P > 0.
05)
.

The risk of death in obese patients was more pronounced in younger patients: OR 3.
70, CI 3.
13 - 4.
37 for 20-39 years; OR 2.
41, CI 2.
14 to 2.
72, OR 1.
41, CI 1.
19 to 1.
66 when y≥60)
.

Younger patients with obesity and diabetes or cardiovascular disease had a 7.
24-fold higher risk of death from COVID-19 than younger patients without comorbidities (CI 5.
14–10.
18)
.

Obesity was identified as a risk factor using crude or adjusted odds ratios or hazard ratios
.

Kaplan-Meier survival analysis was used to investigate the median survival time, the minimum time at which the probability of survival fell to 50% or less
.

For hospitalized patients aged 20-39 years, estimates were 180 days for patients without risk factors, 39 days for obesity, 49 days for CVD, 34 days for CVD + obesity, 55 days for diabetes, and 29 days for diabetes + obesity
.

These effects, although less pronounced, persisted in the 40-59 age group: median survival time was 45 days in patients without risk factors; 36 days in obesity; 40 days in patients with cardiovascular disease; 33 days in CVD + obesity; 35 days in diabetes 32 days in diabetic + obese patients
.

For the elderly population, the median survival time for all diseases was equal and ranged from 25 to 28 days
.

Next, patients were stratified according to BMI information (N = 3,772) as overweight (N = 178 cases), class I obesity (N = 1,738), class II obesity (N = 984), and class III obesity ( N = 872) (Fig.
3)
.

Obesity grade had no significant effect on severity and death in elderly patients (type I obesity compared with type II or III, P>0.
05)
.

However, in the youngest population, obesity class was significantly associated with increased mortality (P<0.
0001 for obesity class I vs.
III; P = 0.
008 for class II vs.
III)
.

The median survival time for patients aged 20-39 years was estimated to be 180 days for patients without risk factors, 63 days for patients with class I obesity, 35 days for patients with class II obesity, and 38 days for patients with class III obesity
.

Severity was not associated with obesity for patients 40-59y and ≥60y
.

Taken together, obesity alone, or in association with cardiovascular disease and diabetes, significantly increases the risk of COVID-19 severity in young adults
.

Obesity itself is a risk factor for in-hospital mortality, more so than cardiovascular disease and diabetes
.

In addition, obesity, cardiovascular disease, and diabetes increase the severity of COVID-19 and the risk of death more significantly in younger adults than in older adults
.

When patients were classified by obesity category, obesity severity was found to be associated with a higher risk of ICU admission and death from COVID-19 compared with the non-obese young or elderly population
.

However, it is important to emphasize that the findings of this study cannot be extrapolated to those patients with COVID-19 who remain in the outpatient unit and do not require hospitalization
.

Obesity, cardiovascular disease and diabetes are major public health problems in Brazil
.

Cardiovascular disease has been the leading cause of hospitalization and death since the 1960s, and rising rates of obesity and diabetes are a concern
.

In addition, even before the COVID-19 pandemic, studies had shown that both all-cause and cause-specific mortality were higher in young, overweight individuals than in older adults of similar weight
.

As SARS-CoV-2 may become a recurring seasonal infection, future COVID-19 vaccinations may prioritize obese young adults
.

Reference: Michelle G.
Discacciati, et al.
Why should obese youth be prioritized in COVID-19 vaccination programs? A nationwide retrospective study.
Lancet Reg Health Am.
2022 Mar; 7: 100167.
Published online 2022 Jan 1.
doi: 10.
1016 /j.
lana.
2021.
100167.
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