If at the beginning of the pandemic, it was stated that the hardest coronavirus infection occurs in older people, now in the first ranks of high-risk groups left people of all ages suffering from obesity. Almost 90% of patients admitted with severe SARS-CoV-2 in the US hospitals had concomitant diseases such as arterial hypertension (49.7 per cent), obesity (48.3 percent), chronic lung disease (34.6 per cent), diabetes mellitus type 2 (28.3 per cent), cardiovascular diseases (27.8 percent). “We see that obesity was the second in the frequency of occurrence of the state and surpassed even lung disease that determines the severity of the condition,” says head of the Department of endocrinology of the medical faculty rnsmu. Pirogov Tatiana DEMIDOVA. Tatiana Yulevna told “MK” about how connected COVID and obesity.
– The problem of obesity is a global and extremely relevant in the world – one in three adults and one in eight children are overweight, says Tatiana Yulevna. – The prevalence of obesity among adults has risen sharply in the last decade, and without significant interventions will grow even more rapidly in the near future. According to forecasts, by 2025 the global prevalence of obesity reaches 18% among men and will exceed 21% among women. Moreover, it is expected a rapid increase in people with severe obesity (with a body mass index above 34.9 kg/m2), the number of which in 2025 will reach 207 million among adults (6% of men and 9% women). For comparison: in 2014, the world was 173 million. this is why obesity is a real non-communicable pandemic, and she’s probably terrible coronavirus. It is a chronic, permanent, progressive disease associated with the violation of the energy balance, hormonal regulation, metabolism, and hemodynamics associated with pathological accumulation of adipose tissue of different localization, leading to the development of disabling complications. Overweight people have lowered immunity, increased risk of cardiovascular, endocrinological, oncological diseases, joint diseases, psychological disorders and reproductive abilities. People with obesity are at risk for the development of diabetes mellitus type 2, atherosclerosis, heart attacks, strokes and heart failure. Today’s pandemic COVID-19 particularly drew our attention to the vulnerability of certain categories of patients, which, as it turned out, had the highest risks of severe disease, need for hospitalization, especially in intensive care and had an extremely high chance to die due to multiple organ failure. If the first data received from China, has focused our attention on the elderly and already suffering from serious chronic diseases, the latest information from colleagues in Europe and the USA switch the attention to the people with obesity, expanding the obvious risk. Given the high prevalence of obesity in these countries, the percentage of such people among the sick and hospitalized due to coronavirus has been extremely high.
– What is more difficult for new infections in people with obesity?
Today we can see that patients with obesity are not only more likely to get sick COVID-19, but also demonstrate a more severe course and outcome of the violation they have immune response and reduce the protective cardio-respiratory reserve. It turned out that people with obesity after exposure to the virus is more persistent penetration into the cell, the virus replicates much faster and longer creates a lot of copies, hitting the large “square” that almost inevitably causes an acute inflammatory response, which received the name “cytokine storm”. It is this phenomenon, according to experts, starts severe respiratory distress, thrombotic disorders and multiple organ failure. Cytokines is a special biologically active molecules that are involved in the normal functioning of the immune system, providing both inflammatory and anti-inflammatory response. A cytokine storm – an acute specific protective reaction of the body, accompanied by a powerful release of cytokines. However, this process becomes uncontrolled due to the volume of lung lesions on a background of viral attack. In the power of distorted reactions, in the end is good, it does more damage to healthy cells and organs. The key effects of the cytokine storm becomes severe respiratory failure and acute respiratory distress syndrome, which are the most frequent cause of death in patients with SARS-CoV-2.
Visceral adipose tissue (located in the abdomen) is a highly active organ that affect the immune, endocrine and metabolic homeostasis in the body. In people with obesity-secreting fat cells naturally much larger, and they emit significantly more than a dozen types of hormones and inflammatory cytokines, among them interleukin-6 and interleukin-1 and tumor necrosis factor, and others. Thus, many viral infections and especially COVID-19 to amplify the effects of cytokines that compromised on and generalized nonspecific inflammation. It is proved that adipose tissue serves as a reservoir for some viruses, such as influenza, HIV, and cytomegalovirus and, according to the latest data, it also can be activated and COVID-19. Fat cells are a critical source of interleukin-6 and its receptors, for which “clings” virus. Apparently, interleukin-6 and possibly other cytokines provide a cascading viral transmission signals and effects. Today this discovery has enabled the development of a new direction in the treatment of patients with SARS-CoV-2 – attempts to use a targeted anti-inflammatory drugs to improve outcomes in severe manifestations.
Another unexpected feature of SARS-CoV-2 in obesity was the ability of this virus quickly spread from the affected organ in their surrounding fatty tissue, such as hilar, hepatic, renal, pericardial, etc. and as a consequence, more difficult to damage vital organs. For this reason, these patients may stay longer carriers of the virus, require longer hospital stay and isolation, and also have a high risk of thrombosis of different localizations, which explains the link between heavy COVID-19 and lethal outcomes because of thromboembolism.
Began to be published about the ability COVID-19 to damage the pancreas damaged by the raise in enzyme levels (amylase and lipase) and glucose in plasma. It was reported that such a pattern was detected of not less than one-third of patients hospitalized with SARS-CoV-2-associated pneumonia in China, European countries and the USA. This is already more deep confirmation and even hypotheses that explain the intended relationship of the injury to the pancreas and SARS-CoV-2. This is a very disturbing development because it determines a high risk of developing diabetes type 2 diabetes in people with obesity, the original, after recovery from infection. In our country, epidemiological studies showed that about 20% of the population are prediabetic, which means that all they can be at risk in the case of SARS-CoV-2, and we can get an unexpected increase in the number of people with diabetes. To think about it.
Probably, patients with obesity are heavier are treatable, and because they are heavier to carry out various medical manipulations?
Yes, hospitals all over the world in terms of viral pandemic are faced with the fact that were not prepared for the treatment of severe SARS-CoV-2 patients with obesity. In the management of these patients is much more common in resuscitation, there are difficulties, because they are more difficult to intubate; like pregnant women, they are difficult to translate in a special position in the stomach for breathing; there are difficulties in conducting visual research methods (e.g. computer tomography) and weighing, since the devices have weight limitations. Moreover, they need special beds and equipment for positioning and transportation, which may not be widely available in ordinary hospitals and more.
– After the quarantine is probably a problem with the prevalence of obesity will only get worse…
– Unfortunately, the current pandemic may further increase the prevalence of obesity. The government has taken extensive measures to prevent the rapid spread of the virus, the restrictions on travel and personal contacts, playing sports. Not only in Russia but also in other countries, the population is also exposed to an increased risk of developing obesity in the context of the pandemic threatens the very negativity consequences. Overeating has become one of the main problems in the quarantine period and for many turned out to have been caused or exacerbated the weight problem. Being in isolation for pandemic COVID-19, many people were experiencing understandable stress and anxiety, boredom or excitement in connection with the situation. It is known that this palette of sensations and emotions associated with overeating. They are forced to consume mainly refined foods rich in fats and carbohydrates that bring pleasure and obesity. Of course, such food is the easiest and most affordable way to cope with stress, to feel better, but in the long term this measure is not effective, has dire consequences for physical and mental health. Overeating, though forced, may start a “cascade of dependency”, which only exacerbate the original problem, to create a “vicious circle” – food, depression, obesity, eating again. The stress becomes permanent, not allowing to find a way out, increasing the quantity and frequency of food, exacerbating the depression, and obesity. Of course, a major role in this process is played by the hormones that regulate eating behavior that affect mood, appetite, motivation and sleep, for example, serotonin – the pleasure hormone, cortisol – the stress hormone, and others.
People prone to depression are more likely to develop dependencies. In such situations, recommend sports, interesting Hobbies, meditation, professional counseling, therapist, nutritionist. Fortunately, the quarantine restrictions in the country have gradually abolished and now is the best time to return to normal life, to deal with health, to try to correct malnutrition and to normalize weight. This can help the following tips. In the store to buy only low-fat food, better on the list and only what is really necessary. Consume the most diverse food, rich in vitamins, minerals and fiber. This will contribute to the development of healthy intestinal microflora, which in turn will help in the absorption of nutrients and will improve metabolic processes. Avoid unusual diets, since many popular methods – such as interval fasting, keto diet is unbalanced and overly restrictive, which is not physiological and may cause health issues. To limit the consumption of sweets, fizzy drinks and alcohol. Sweet you can substitute fresh fruit or berries. To limit the consumption of animal fats. To cook with minimal oil or no (bake, boil, simmer), avoid TRANS fats. To increase the amount of dietary fiber in the diet to increase the consumption of vegetables, fruits (at least 400 g per day). Drinking more water – fluid intake is very important for the normal functioning of the body.