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COVID-19 and Obesity: Dangerous Liaisons

Internal Medicine, Luzerner Kantonsspital, LUKS, 6000 Luzern 16, Switzerland
Scientific and Technology Pole, IRCCS MultiMedica, 20138 Milan, Italy
Traslational Medicine Department, Eastern Piedmont University (UPO), 13100 Novara, Italy
Respiratory Unit, St. Andrea Hospital, 13100 Vercelli, Italy
Center of Excellence for the acceleration of HArm Reduction (CoEHAR), University of Catania, 95124 Catania, Italy
Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
Dipartimento di Medicina Clinica e Sperimentale, University of Catania, 95124 Catania, Italy
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(8), 2511;
Received: 9 July 2020 / Revised: 22 July 2020 / Accepted: 28 July 2020 / Published: 4 August 2020
(This article belongs to the Special Issue COVID-19: From Pathophysiology to Clinical Practice)
Besides advanced age and the presence of multiple comorbidities as major contributors to increased risk of severe disease and fatal outcome from Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19), there is now emerging evidence that overweight and obesity predispose to severe symptoms and negative prognosis. Remarkably, the severity of COVID-19 appears to rise with increasing body mass index (BMI). The association between COVID-19 outcomes and overweight/obesity has biological and physiological plausibility. Potential pathophysiological mechanisms that may explain this strong association include the chronic pro-inflammatory state, the excessive oxidative stress response, and the impaired immunity that is commonly reported in these individuals. The role of cytokines, mammalian target of rapamycin (mTOR), and altered natural killer cell polarization in the dangerous liaison between COVID-19 and obesity are discussed here. These pathways can favor and accelerate the deleterious downstream cellular effects of SARS-CoV-2. Moreover, obesity is well known to be associated with reduced lung function and poor response to mechanical ventilation, thus placing these individuals at high risk of severe illness and mortality from COVID-19. Furthermore, obesity may lead to other complications, such as renal failure, cardiovascular dysfunction, hypertension, and vascular damage, which in turn can further accelerate negative clinical outcomes from COVID-19. Obese individuals should be shielded against any potential viral exposure to SARS-CoV-2 with consequential considerations for compulsory protection devices and social distancing. Health care providers should be aware that obesity predisposes to severe symptoms and negative prognosis in COVID-19 patients. View Full-Text
Keywords: obesity; ACE2; renin–angiotensin system (RAS) pathway; COVID-19; SARS-CoV-2; cytokine storm; adipokines; IL-6 pathway obesity; ACE2; renin–angiotensin system (RAS) pathway; COVID-19; SARS-CoV-2; cytokine storm; adipokines; IL-6 pathway
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MDPI and ACS Style

Caci, G.; Albini, A.; Malerba, M.; Noonan, D.M.; Pochetti, P.; Polosa, R. COVID-19 and Obesity: Dangerous Liaisons. J. Clin. Med. 2020, 9, 2511.

AMA Style

Caci G, Albini A, Malerba M, Noonan DM, Pochetti P, Polosa R. COVID-19 and Obesity: Dangerous Liaisons. Journal of Clinical Medicine. 2020; 9(8):2511.

Chicago/Turabian Style

Caci, Grazia, Adriana Albini, Mario Malerba, Douglas M. Noonan, Patrizia Pochetti, and Riccardo Polosa. 2020. "COVID-19 and Obesity: Dangerous Liaisons" Journal of Clinical Medicine 9, no. 8: 2511.

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