Editor's note:
Global COVID-19 is still raging, and my country's COVID-19 is also a wave of unresolved one after another. Vaccination with COVID-19 is one of the important means to win this sniper battle. A recent study published in Lancet Diabetes Endocrinology shows that the COVID-19 vaccine can effectively reduce the risk of hospitalization and death in all body mass index (BMI) groups. However, compared with those with normal weight, those with BMI who are too high or too low are at higher risk of adverse outcomes after receiving the COVID-19 vaccine.
Dr. Carmen Piernas, Honorary Fellow of the University of Oxford, UK, and Ramóny, Researcher of the University of Granada, Spain, , Researcher of Ramóny, Researcher of the University of Granada, Spain. Dr. Cajal said: "Given the previous research evidence on influenza vaccines, we are concerned that the COVID-19 vaccine may have a poor effect on obese people. When comparing people vaccinated with COVID-19 vaccination with those who were not vaccinated, it was found that the COVID-19 vaccine can effectively reduce the risk of hospitalization or death in COVID-19, and each BMI group can benefit (Figure 1). However, among people vaccinated with COVID-19 vaccine, although the risk of severe illness in all BMI groups was significantly reduced, compared with those with normal weight, the risk of severe illness in patients with excessive or low BMI was significantly higher."
Figure 1. COVID-19 vaccine can effectively reduce the risk of hospitalization or death in the new crown, and each BMI group can benefit
Research Overview and Design
In this population-based cohort study in the UK, , the researchers included 9,171,524 adults aged 18 and above registered between December 8, 2020 (the date of the first COVID-19 vaccination in the UK) to November 17, 2021. According to the classification standards of the World Health Organization and the UK National Institute of Health Care and Clinical Optimization, the researchers divided the different BMIs into four groups: wasting, normal weight, overweight, and obesity; and calculated the vaccination rate of 1, 2 and 3 doses of COVID-19 in each group. Taking into account the dose and time period of vaccination, a nested matching case control design was used to evaluate the effectiveness of the COVID-19 vaccine, and the odds ratio (OR) of the severe outcomes of COVID-19 (hospitalization and death) of vaccinated people were estimated. The researchers estimated the effect of BMI (reference BMI of 23kg/㎡) on the outcome of COVID-19 disease in vaccinated populations through a multivariable Cox proportional hazard model.
Main research results
Overall situation
9 171 524 subjects in this study cohort, with an average age of 52±19 years and an average BMI of 26.7±5.6 kg/㎡. During the follow-up period, 566,461 subjects were positive for SARS-CoV-2, of which 32,808 were hospitalized and 14,389 were dead.
1 758 689 subjects (19.2%) in this study cohort were not vaccinated with COIVD-19 vaccine, 287 246 subjects (3.1%) received 1 dose of COIVD-19 vaccine, 4 828 327 subjects (52.6%) received 2 doses of COIVD-19 vaccine, and 2 297 262 subjects (25.1%) received 3 doses of COIVD-19 vaccine. Among them, more than 80% of overweight or obese adults aged 40 and above have received 2 to 3 doses of COIVD-19 vaccine.
COIVD-19 vaccine reduces the risk of severe COVID-19
Compared with unvaccinated adults, the risk of hospitalization for thin people who received 2 doses of COIVD-19 vaccine is reduced by 49% after 14 days of vaccination (OR=0.51; 95% credibility range: 0.41~0.63), and the risk of hospitalization for people with normal weight is reduced by 66 after 14 days of vaccination for 66 after 14 days of vaccination for people with normal weight is reduced by 66 after 14 days of vaccination for people with normal weight is reduced by 66 after 14 days of vaccination for people with normal weight is vaccinated for 66 days of vaccination for people with normal weight is reduced by 66 after 14 days of vaccination for people with normal weight is vaccinated for 66 days of vaccination for people with normal weight is vaccinated for 14 days of vaccination for people with normal weight is reduced by 66 after 14 days of vaccination for people with normal weight is vaccinated for 66 days of vaccination for people with normal weight is vaccinated for 66 days of vaccination for people with normal weight is vaccinated for 14 days of vaccination for people with normal weight is reduced by 66 after 14 days of vaccination for people with normal weight is vaccinated for 66 days of vaccination for people with normal weight is vaccinated for 68 days of vaccination for people with normal weight is reduced by 20% after 14 days of vaccination for people with normal weight is reduced by 20% after 14 days of vaccination for people with normal weight is reduced by 20% after 14 days of vaccination for people with normal weight is reduced by 20% after 14 days of vaccination for people with normal weight is reduced %(OR=0.34; 95% confidence interval: 0.32~0.36), the risk of hospitalization for overweight patients was reduced by 68% after 14 days of vaccination (OR=0.32; 95% confidence interval: 0.3~0.34), and the risk of severe disease in obese people was reduced by 68% (OR=0.32; 95% confidence interval: 0.3~0.34); this risk was further reduced by those who received 3 doses of COIVD-19 vaccine.
Compared with unvaccinated adults, the risk of death in thin people who received 2 doses of COIVD-19 vaccine was reduced by 40% after 14 days of vaccination (OR=0.6; 95% confidence interval: 0.36~0.98), the risk of death in normal weight was reduced by 61% after 14 days of vaccination (OR=0.39; 95% confidence interval: 0.33~0.47), the risk of death in overweight people was reduced by 70% after 14 days of vaccination (OR=0.3; 95% confidence interval: 0.25~0.35), and the risk of death in obese people was reduced by 72% after 14 days of vaccination (OR=0.26; 95% confidence interval: 0.22~0.3).
In vaccinated adults, those with low or high BMI have the highest risk of severe COVID-19 infection
In adults who received one dose of COVID-19 vaccine, compared with those with BMI=23kg/㎡, the risk of hospitalization or death among those with BMI=30kg/㎡ is linearly related to BMI, and there is no evidence that the risk of hospitalization or death among those with BMI30kg/㎡ increases. Among adults who received 2 doses of COVID-19 vaccine, BMI is associated with the risk of hospitalization and death in COVID-19 - compared with those with BMI=23kg/㎡, the risk of hospitalization or death in patients with BMI18kg/㎡ or 40kg/㎡ is significantly higher. Among adults who received 3 doses of COVID-19 vaccine, the number of hospitalization and deaths decreased significantly, but there was no evidence that BMI was associated with the risk of hospitalization or death (Figure 2).
Figure 2. Among the different COVID-19 vaccination doses, the relationship between BMI and COVID-19 hospitalization and death risk
Dr Piernas said: "Last year we reported that BMI was closely related to the severity of COVID-19 disease, and those with low or high BMI were at a higher risk of severe COVID-19. We originally hoped that this correlation would disappear after vaccination, but it was not the case. Fortunately, given the effectiveness of the vaccine, the absolute number of severe cases has been greatly reduced. But among the few severe cases, those with low or high BMI were at a higher risk than those with normal weight."
Researcher Review
In a related comment, Annelies Wilder, head of the Institute of Social and Preventive Medicine, University of Bern, Switzerland, head of the Institute of Social and Preventive Medicine, Switzerland. Dr. Smith and Dr. Annika Frahsa said, “These findings not only emphasize the importance of vaccination, but also the importance of reducing the incidence of obesity. This large-scale cohort study highlights the key role of obesity in the COVID-19 pandemic. However, due to the impact of lockdown measures during the COVID-19 pandemic, people have increased unhealthy behaviors of overeating, reduced physical activity levels, and weight management faces multiple obstacles, resulting in an upward trend in obesity rates. Therefore, treating obesity as a social problem and working hard may alleviate the disastrous consequences of the COVID-19 pandemic and its pandemic.”
References:
Wilder Smith A, et al. Lancet Diabetes Endocrinol. 2022;doi:10.1016/S2213~8587(22)00170~X.
(Source: Editorial Department of "International Diabetes")
