• Yanbin Du, Yuan Lv, Wenting Zha, Nan Zhou, and Xiuqin Hong.
• MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, Hunan Province 410081, China.
• Metab. Clin. Exp. 2021 Apr 1; 117: 154373.

Background And PurposeThe coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented health crisis to the entire world. As reported, the body mass index (BMI) may play an important role in COVID-19; however, this still remains unclear. The aim of this study was to explore the association between BMI and COVID-19 severity and mortality.MethodsThe Medline, PubMed, Embase and Web of science were systematically searched until August 2020. Random-effects models and dose-response meta-analysis were used to synthesize the results. Combined odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated, and the effect of covariates were analyzed using subgroup analysis and meta-regression analyses.ResultsA total of 16 observational studies involving 109,881 patients with COVID-19 were included in the meta-analysis. The pooled results showed that patients with a BMI ≥ 30 kg/m2 had a 2.35-fold risk (OR = 2.35, 95%CI = 1.64-3.38, P < 0.001) for critical COVID-19 and a 2.68-fold risk for COVID-19 mortality (OR = 2.68, 95%CI = 1.65-4.37, P < 0.001) compared with patients with a BMI <30 kg/m2. Subgroup analysis results showed that patients with obesity and age > 60 years was associated with a significantly increased risk of critical COVID-19 (OR = 3.11, 95%CI = 1.73-5.61, P < 0.001) and COVID-19 mortality (OR = 3.93, 95%CI = 2.18-7.09, P < 0.001). Meta-regression analysis results also showed that age had a significant influence on the association between BMI and COVID-19 mortality (Coef. = 0.036, P = 0.048). Random-effects dose-response meta-analysis showed a linear association between BMI and both critical COVID-19(Pnon-linearity = 0.242) and mortality (Pnon-linearity = 0.116). The risk of critical COVID-19 and mortality increased by 9%(OR = 1.09, 95%CI = 1.04-1.14, P < 0.001) and 6%(OR = 1.06, 95%CI = 1.02-1.10, P = 0.002) for each 1 kg/m2 increase in BMI, respectively.ConclusionsEvidence from this meta-analysis suggested that a linear dose-response association between BMI and both COVID-19 severity and mortality. Further, obesity (BMI ≥ 30 kg/m2) was associated with a significantly increased risk of critical COVID-19 and in-hospital mortality of COVID-19.Copyright © 2020. Published by Elsevier Inc.

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