Document Type : Original Article

Authors

1 Department of Clinical Nutrition and Dietetics, School of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

2 Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship between obesity and COVID-19 morbidity and outcomes in Iranian patients with MS still remains unclear.
Methods: A cross-sectional study was conducted in Sina Hospital, Tehran, Iran. Patients with MS were asked to complete an online questionnaire in the Google Form format. Demographic information, clinical information including MS disease-related factors, COVID-19-related factors, and anthropometric information were recorded. Totally, 492 patients filled the questionnaire during two weeks in November 2021, by the response rate of 21.6%. Body mass index (BMI) was categorized based on the standard classification of the World Health Organization (WHO). The logistic regression was used to examine the risk of morbidity and chi-square test/one-way analysis of variance (ANOVA) was employed to determine the difference regarding severity and symptoms among groups.
Results: In the fully adjusted model, the odds ratio (OR) of COVID-19 morbidity in class II obese participants was significantly 5.41 times higher than that in the normal BMI group [OR: 5.41, 95% confidence interval (CI): 1.00-29.09]. COVID-19 severity was significantly different among BMI groups (P = 0.024). Respiratory symptoms (P = 0.05) as well as gastrointestinal (GI) symptoms (P < 0.01) of COVID-19 were more prevalent among class I and class II obese patients compared with overweight, normal weight, and underweight groups. 
Moreover, no one in the class I and class II obesity groups reported COVID-19 morbidity without any symptoms (P = 0.04).
Conclusion: The results of the current study support the view that obesity could play a key role in susceptibility to COVID-19 morbidity and severity of the symptoms in patients with MS. The findings recommended that neurologists pay more attention to patients' BMI during this pandemic. 

Keywords

  1. Baloch S, Baloch MA, Zheng T, Pei X. The coronavirus disease 2019 (COVID-19) pandemic. Tohoku J Exp Med 2020; 250(4): 271-8.
  2. Centers for Disease Control and Prevention. Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals [Online]. [cited 2022 Dec 5]; Available from: URL: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html
  3. Yu H, Feng Z, Uyeki TM, Liao Q, Zhou L, Feng L, et al. Risk factors for severe illness with 2009 pandemic influenza A (H1N1) virus infection in China. Clin Infect Dis 2011; 52(4): 457-65.
  4. Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Can Respir J 2006; 13(4): 203-10.
  5. Andersen CJ, Murphy KE, Fernandez ML. Impact of obesity and metabolic syndrome on immunity. Adv Nutr 2016; 7(1): 66-75.
  6. Albashir AAD. The potential impacts of obesity on COVID-19. Clin Med (Lond) 2020; 20(4): e109-e113.
  7. Holt H, Talaei M, Greenig M, Zenner D, Symons J, Relton C, et al. Risk factors for developing COVID-19: A population-based longitudinal study (COVIDENCE UK). Thorax 2022; 77(9): 900-12.
  8. Centers for Disease Control and Prevention. Obesity, Race/Ethnicity, and COVID-19 [Online]. [cited 2022 Sep 27]; Available from: URL: https://www.cdc.gov/obesity/data/obesity-and-covid-19.html
  9. Louapre C, Collongues N, Stankoff B, Giannesini C, Papeix C, Bensa C, et al. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol 2020; 77(9): 1079-88.
  10. Simpson-Yap S, De BE, Kalincik T, Rijke N, Hillert JA, Walton C, et al. Associations of disease-modifying therapies with COVID-19 severity in multiple sclerosis. Neurology 2021; 97(19): e1870-e1885.
  11. Reder AT, Centonze D, Naylor ML, Nagpal A, Rajbhandari R, Altincatal A, et al. COVID-19 in patients with multiple sclerosis: Associations with disease-modifying therapies. CNS Drugs 2021; 35(3): 317-30.
  12. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162-73.
  13. World Health Organization. A healthy lifestyle - WHO recommendations [Online]. [cited 2010 May 6]; Available from: URL: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations
  14. The OpenSAFELY Collaborative, Williamson E, Walker AJ, Bhaskaran K, Bacon S, Bates C, et al. OpenSAFELY: Factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv 2020; 2020.
  15. Zheng C, Kar I, Chen CK, Sau C, Woodson S, Serra A, et al. Multiple sclerosis disease-modifying therapy and the COVID-19 pandemic: Implications on the risk of infection and future vaccination. CNS Drugs 2020; 34(9): 879-96.
  16. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al. Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City. medRxiv 2020; 2020.
  17. Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev 2020; 21(11): e13128.
  18. Karlsson EA, Sheridan PA, Beck MA. Diet-induced obesity in mice reduces the maintenance of influenza-specific CD8+ memory T cells. J Nutr 2010; 140(9): 1691-7.
  19. Maier HE, Lopez R, Sanchez N, Ng S, Gresh L, Ojeda S, et al. Obesity Increases the Duration of Influenza A Virus Shedding in Adults. J Infect Dis 2018; 218(9): 1378-82.
  20. Milner JJ, Rebeles J, Dhungana S, Stewart DA, Sumner SC, Meyers MH, et al. Obesity increases mortality and modulates the lung metabolome during pandemic H1N1 influenza virus infection in mice. J Immunol 2015; 194(10): 4846-59.
  21. Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev 2020; 21(6): e13034.
  22. Cheng WA, Turner L, Marentes Ruiz CJ, Tanaka ML, Congrave-Wilson Z, Lee Y, et al. Clinical manifestations of COVID-19 differ by age and obesity status. Influenza Other Respir Viruses 2022; 16(2): 255-64.
  23. Eslick GD. Gastrointestinal symptoms and obesity: A meta-analysis. Obes Rev 2012; 13(5): 469-79.