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Prevalence of obesity and hypovitaminosis D in elderly with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Take Home Message

In elderly patients in Brazil testing positive for COVID-19 admitted to an ICU there was a high prevalence of obesity and low vitamin D levels. Whether or not the obesity and vitamin D levels are directly related to COVID-19 status is difficult to determine but warrants further investigation.

 

Results

  • The BMI showed the prevalence rate of obesity (BMI ≥ 30 kg/m2) in 68.7% of the elderly and median BMI of 30.5 (IQR 28.1–33) kg/m2. The findings show that 15.3% of all elderly patients in ICU with SARS-CoV-2 had BMI ≥35 kg/m2.
  • The serum dosage of 25 OHD performed at the admission to the ICU showed a median value of 16 (IQR 10–21) ng/mL.
  • The prevalence of 25 OHD <30 ng/mL was 93.8%, 25 OHD <20 ng/mL was 65.9% and 25 OHD <10 ng/mL (severe deficiency) was 21%.
  • The prevalence of 25 OHD <30 ng/mL among the obese elderly was 94.2%.
  • There was a significant negative correlation between BMI and the serum dosage of 25 OHD with statistical significance.
  • There was no correlation between serum 25 OHD and SAPS III and CRP.
  • As for the presence of comorbidities, arterial hypertension (72.2%), diabetes mellitus (40.9%), heart disease (27.3%) and lung diseases like asthma or chronic obstructive pulmonary disease (27.3%) showed the highest prevalence among patients admitted to ICU. Chronic kidney disease (13.1%), neurological diseases (17%) and oncological diseases (7.4%) had a lower prevalence.

 

Who

Patients (176) 60 or older admitted to the ICU who received a diagnosis of acute respiratory distress syndrome defined as a ratio of arterial oxygen tension over fractional inspired oxygen – PaO2/FiO2 < 300; positive swab from the nasal cavity and oropharynx for detection of viral RNA (ribonucleic acid) for COVID-19 using the reverse-transcription polymerase chain reaction (RT-PCR) technique; computed tomography (CT) scan of the chest showing bilateral interstitial infiltrate pulmonary with a typical “ground-glass” pattern.

Things to Keep in Mind

  • This is a descriptive single center study over just one month.
  • There is no COVID-19 negative comparison group therefore, similar vitamin D levels and similar rates of obesity may be common in this group regardless of COVID-19 status.
  • The population included in this study is limited to elderly people with conditions other than obesity, making it difficult to determine if obesity and vitamin D levels are directly related.
  • The study design and small limited sample size make it very difficult to make any conclusions.

 

Author’s Conclusions

There is a high prevalence of hypovitaminosis D and obesity among elderly patients and these factors should be investigated in the evolution of severe cases of COVID-19 requiring ICU admission and mechanical ventilation assisted by ARDS. In addition, further investigations are needed to stablish an association between obesity and hypovitaminosis D and clinical outcomes in this specific population.

Study Design

  • A cross-sectional descriptive study composed of elderly (age ≥ 60 years) in the first 24 hours upon admission to the ICU at Sancta Maggiore Hospital Prevent Senior Private Operative, São Paulo, Brazil.
  • Data collected included demographic data (sex, age); anthropometric data such as weight (kilograms) and height (meters); severity score in the ICU such as SAPS III (Simplified Acute Physiology Score III); measurement of the PaO2/FiO2 ratio after orotracheal intubation and mechanical ventilation; the presence of comorbidities (systemic arterial hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, asthma, heart diseases, neurological, oncological and immunosuppressed diseases or who use immunosuppressants); CRP (C-reactive protein) measurement in the first day of hospitalization.
  • The data on weight and height were obtained from a survey with the family member or companion who lived with the elderly. From these data, body mass index (BMI) was calculated by dividing weight by height squared (kg/m2).
  • The BMI was stratified according to the cutoff points suggested by the Pan American Health Organization for the elderly: BMI ≤ 23 kg/m2 (low weight), 23–28 kg/m2 (normal weight), 28 to 30 kg/m2 (overweight) and ≥30 kg/m2 (obesity).
  • The test requested for the analysis of vitamin D levels was the serum dosage of 25-hydroxy vitamin D (25 OHD), measured by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS).
  • The definition of hypovitaminosis D was standardized according to the criteria of the Brazilian Society of Endocrinology and Metabolism (SBEM) defined by a serum level < 20 ng/mL for general population and <30 ng/mL for individuals at risk.
  • The cutoff level defined in the study for hypovitaminosis was 25 OHD <30 ng/mL. Severe deficiency was defined by 25 OHD <10 ng/mL.

Reference

Gonçalves TJM, Gonçalves SEAB, Guarnieri A, Risegato RC, Guimarães MP, de Freitas DC, Razuk-Filho A, Benedito Junior PB, Parrillo EF. Prevalence of obesity and hypovitaminosis D in elderly with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Nutr ESPEN. 2020 Dec;40:110-114. doi: 10.1016/j.clnesp.2020.10.008. Epub 2020 Oct 13. PMID: 33183522; PMCID: PMC7552968.

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