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Overweight and obesity as risk factors for COVID-19-associated hospitalisations and death: systematic review and meta-analysis.
Sawadogo, W, Tsegaye, M, Gizaw, A, Adera, T
BMJ nutrition, prevention & health. 2022;5(1):10-18
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A novel coronavirus named SARS-CoV-2, causing COVID-19, emerged in late 2019. The prognosis of COVID-19 has been consistently reported to worsen with older age, male sex and comorbidities. The aim of this study was to quantify the association between overweight or obesity and COVID-19-related hospitalisations and death, and to assess the magnitude of the association and the potential dose–response relationships. This study is a systematic review and meta-analysis of 208 studies. A total of 3 550 977 participants from over 32 countries were included in this study. Results indicate that being overweight increases the risk of COVID-19-related hospitalisations but not death while obesity and extreme obesity increase the risk of both COVID-19-related hospitalisations and death. In addition, there was a linear dose–response association between obesity categories and COVID-19 outcomes. However, the strength of the association has weakened over time following the pattern of the first wave of COVID-19. Authors conclude that their findings suggest the importance of increased vigilance towards people with excess adiposity. Some preventative measures for this vulnerable group include prompt access to COVID-19 testing and healthcare, as well as prioritisation for COVID-19 vaccination.
Abstract
Objective: To quantify the current weight of evidence of the association between overweight and obesity as risk factors for COVID-19-related hospitalisations (including hospital admission, intensive care unit admission, invasive mechanical ventilation) and death, and to assess the magnitude of the association and the potential dose-response relationships. Design: PubMed, Embase, Cochrane, Web of Sciences, WHO COVID-19 database and Google Scholar were used to identify articles published up to 20 July 2021. Peer-reviewed studies reporting adjusted estimates of the association between overweight or obesity and COVID-19 outcomes were included. Three authors reviewed the articles and agreed. The quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis was used to estimate the combined effects. Results: A total of 208 studies with 3 550 997 participants from over 32 countries were included in this meta-analysis. Being overweight was associated with an increased risk of COVID-19-related hospitalisations (OR 1.19, 95% CI 1.12 to 1.28, n=21 studies), but not death (OR 1.02, 95% CI 0.92 to 1.13, n=21). However, patients with obesity were at increased risk of both COVID-19-related hospitalisations (OR 1.72, 95% CI 1.62 to 1.84, n=58) and death (OR 1.25, 95% CI 1.19 to 1.32, n=77). Similarly, patients with extreme obesity were at increased risk of COVID-19-related hospitalisations (OR 2.53, 95% CI 1.67 to 3.84, n=12) and death (OR 2.06, 95% CI 1.76 to 3.00, n=19). There was a linear dose-response relationship between these obesity categories and COVID-19 outcomes, but the strength of the association has decreased over time. Conclusion: Being overweight increases the risk of COVID-19-related hospitalisations but not death, while obesity and extreme obesity increase the risk of both COVID-19-related hospitalisations and death. These findings suggest that prompt access to COVID-19 care, prioritisation for COVID-19 vaccination and other preventive measures are warranted for this vulnerable group.
2.
Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis.
Anum, EA, Adera, T
Annals of epidemiology. 2004;(9):705-21
Abstract
PURPOSE To determine whether hypercholesterolemia is an independent risk factor for CHD morbidity and mortality in persons aged 65 years and above, and to quantify the magnitude of the association, if any, using data from follow-up studies. METHODS A MEDLINE search of all published studies that evaluated the association between high cholesterol levels and CHD in persons aged 65 years and above, and the relevant articles referenced in these studies, were used as sources of selected articles. RESULTS In men aged 65 years and above who were followed from middle age, the RR for CHD incidence associated with 1.0 mmol/L increase in total cholesterol was 1.28 (CI: 1.17-1.39). The RR for CHD mortality associated with a similar increase in total cholesterol was 1.22 (CI: 1.18-1.27). In elderly men followed from age 65 and above, the RR was 1.24 (CI: 1.1-1.37) for CHD incidence, and 1.22(CI: 1.15-1.28) for CHD mortality. In elderly women followed after age 65, the association between total cholesterol and CHD mortality was not significant. For men aged 80 years and above at entry, total cholesterol showed an inverse relationship with all-cause mortality. CONCLUSION Serum total cholesterol shows a positive association with CHD morbidity and mortality in men aged 65 years and above. This may, however, not hold true for persons aged 80 years and above.
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Effect of HMG-CoA reductase inhibitors (statins) on bone mineral density.
Funkhouser, HL, Adera, T, Adler, RA
Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2002;(2):151-8
Abstract
Recent studies have suggested that 3-hydroxy-3-methylglutaryl - coenzyme A (HMG-CoA) reductase inhibitors (statins) can increase the bone mineral density (BMD). Our objective was to determine if patients on statin drugs were more likely to have a greater bone mineral density and lower risk of osteoporosis than patients not taking these drugs. A computerized pharmacy system provided complete medication dispensing records for the 983 patients (697 men and 286 women) referred for bone mineral density testing at a single Veterans Affairs Medical Center. In an analysis of covariance model that adjusted for age, body mass index, race, and vitamin use, men using statin drugs were more likely to have a greater BMD of the spine (p < 0.005). The mean difference (effect size) was 0.05 g/cm2 (95% confidence interval of [CL] 0.02-0.09), about 5.3% greater BMD. In women, the association was not significant. The risk of osteoporosis (defined as a T-score < or = -2.5) was determined using logistic regression analysis after adjustment for potential confounding variables. Although not statistically significant, men who received statin drugs for more than 2 yr were approximately half as likely to develop osteoporosis (odds ratio [OR] =.55, 95% CI = 0.28-1.08). A similar effect was observed in women taking statins for any length of time (OR = 0.36, 95% CI = 0.12-1.07). This study suggests that statin drugs may decrease osteoporosis risk, warranting a randomized controlled trial.