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September 30, 2020
On March 11, 2020, the World Health Organization declared COVID-19 a pandemic. The disease caused by SARS-CoV-2 has inflamed about 20 million people worldwide, with a global death rate of 3. 7%. Unusually, symptoms range from 0 to severe respiratory failure with diffuse lung damage and death. Given these various effects, understanding the threats of the most serious demonstrations was especially important from the beginning. Early reports from China and Italy, where the pandemic first took hold, knew a wide variety of things – old age, autoimmune diseases, high blood pressure and heart disease – as threats of worse outcomes. However, when the pandemic hit the United States, another thing that was not unusual among severely affected patients was obesity. The United States has a severe obesity rate of 20% and a morbid obesity rate of 10%, the highest rates in the industrialized world. More than 40% of Americans are thought to be obese. One option was that, given this peak prevalence, one would expect to localize more obesity in COVID-19 patients. However, as of early April, studies contradicted this hypothesis, appearing that COVID-19 patients in the intensive care unit were more likely to be obese than older ICU patients without COVID-19 and those who were obese. . who had COVID-19 were more likely to be obese. require hospitalization and treatment in an intensive care unit. Unlike other known threats, obesity was prevalent even in other people under the age of 50, and this peak prevalence predicted a shift from severe COVID-19 disease to younger populations.
In recent months, nearly three hundred articles have reported an arrangement between severe obesity and increased COVID-19 morbidity and mortality. The concentrate is mainly in hospitalized patients and levels, from small single-center studies to in-depth retrospective analysis of thousands of patients. They used the era from March 2020, when the pandemic first erupted in New York, until May 2020, when it had spread to the rest of the United States. The effects are consistent: there is a dose-dependent obesity arrangement with more severe COVID-19 morbidity that requires hospitalization and extensive and mortality care. This applies to patients under 50 to 60 years of age.
In their article, Tartof and his colleagues contribute research for a giant network population: the patients of the Kaiser Permanente Southern California system. They retrospectively reviewed the records of another 5,652 people with SARS-CoV-2, with the number one end result being death within 3 weeks of diagnosis. Two thirds of the patients were hospitalized and 43% ventilated. Patients with a BMI greater than 40 kg / m2 generally had higher mortality rates, and those with a BMI greater than 45 kg / m2 had a threat rate of 4. 18. However, what is most surprising is that those under 60 had higher threat rates of 12 to 17 compared to 1 to 3 if they were older; a high BMI increases the threat more in men than in women. More importantly, the threat of obesity has been adjusted for non-unusual comorbidities, adding diabetes, hypertension, central failure, myocardial infarction, and chronic lung or kidney disease. The study also took into account when SARS-CoV-2 was detected. Interestingly, with each week that followed, the death threat dropped dramatically. This would possibly reflect the development of social consciousness with evolving policies to decrease the spread and practice of medicine.
This test follows two recent reports in Annals that examine something similar but only in hospitalized patients. Goyal and his colleagues reported 1,687 hospitalized patients at 2 hospitals in New York City, and found that those with a BMI greater than 40 kg/m2 were at higher risk However, 69% of their cohort had a BMI of less than 30 kg/m2, and only 5% had a BMI greater than 40 kg/m2. At one point under review, Anderson and his colleagues reported 2,466 patients with COVID-19 who had at least 47 days in the hospital. They found that children under the age of 65 with a BMI greater than 40 kg/m2 had a twice as high threat to intubation; however, BMI was no longer a significant threat in older patients.
The coherence of this new review and previous studies deserve to be said that obesity is not unusual in severe COVID-19s, as it is not unusual in the population. Obesity is a vital independent threat to severe COVID-19 disease. are superior in younger patients because obesity is especially harmful in this age group; Other serious comoordities that evolve later in life are more likely to become dominant threats. Men who are affected may reflect their greater visceral adiposity than women, as these fats are pro-inflammatory and contribute to metabolic and vascular diseases.
The main mechanisms come with a restrictive lung body structure and sleep apnea, diabetes and dyslipidemia, immune disorder with depressed anti-inflammatory signaling (eg, Adiponectin) and increased pro-inflammatory signaling (eg, Leptin, interleukin-6, and factor tumor necrosis-α), endothelial disorder and renin-angiotensin stimulation that stimulates high blood pressure and worsens lung inflammation and alveolar damage. Fat deposited in skeletal muscle is possibly sought after in high-end steakhouses, but, in vivo, it compromises muscle metabolic efficiency, nutrient absorption, and performance. Then there is Newton’s law of moment: force = mass × acceleration. It takes more muscle strength to move the diaphragm down when there is a giant fat frame underneath. Abdominal obesity also makes it more difficult to breathe while mendacity decreases, which is promoted to ventilation in COVID-19 patients. The most expressed mechanisms are the expression of the angiotensin-converting enzyme two proteins in adipose tissue. This is the anchor protein that allows SARS-CoV-2 to enter a cell, and the fat is above the lungs and can serve as a safe haven for the virus and replication site, thus prolonging the spread of the virus.
Perhaps the hardest question to answer is: what to do?Severe and morbid obesity is not unusual enough in the United States to be a component of our social fabric. Knowledge constantly shows significant hazards for a BMI greater than 35 kg/m2, and at this level, weight relief is complicated and in fact not achieved quickly. Therefore, social estating, conversion of behaviors to decrease exposure and viral transmission, such as dresses in masks; and the progression of fitness care policies and approaches that recognize the potential effects of obesity. These movements help and are in fact achievable.
Ref: https://www. acpjournals. org/doi/10. 7326/M20-5677
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