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Journal of Clinical Medicine Research

Editorial

Volume 12, Number 5, May 2020, pages 273-275

Serious Conditions in COVID-19 Accompanied With a Feature of Metabolic Syndrome

At the time of this writing, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain of coronavirus has reached pandemic levels, threatening human life and limiting activity worldwide. For the past several months, the clinical characteristics of patients who are likely to develop a serious condition or die from COVID-19 have been gradually revealed from the evidence accumulated by great efforts of frontline health professionals and investigators worldwide [1-3].

Retrospective research has shown that COVID-19 is frequently observed in people with obesity, diabetes, and hypertension [1-13], which are pivotal components of metabolic syndrome (MetS), a cluster of cardiometabolic risks based on excess visceral fat. In addition, the condition and mortality of patients infected with SARS-CoV-2 are likely to be more serious in cases that involve a feature of MetS compared with cases that do not [1, 4-6, 8, 10-13]. Hospitalization, admission to intensive care unit (ICU), and usage of mechanical ventilation are much more prevalent in patients with obesity [4, 5, 14] and diabetes [10, 13], which are the fundamental components of MetS [15].

These facts are undeniable, and yet they may go unperceived by frontline health professionals and the general population alike. One plausible reason for this is that each component of MetS (obesity, diabetes, and hypertension) has been paid attention sporadically and separately in different fields, and not argued comprehensively even in the updated literature.

In recent decades, many investigators have convincingly shown that people with obesity, prediabetes, diabetes and MetS are at increased risk for impaired lung function, and especially impaired restrictive lung pattern [16-22], which is primarily determined by reduced predicted forced vital capacity. Chronic obstructive pulmonary disease, which is familiar to physicians and the general population, and usually determined by reduced forced expiratory volume in 1 s, might play only a minor role in the physiology of impaired lung function observed in patients with MetS or diabetes [16-22].

Consistently, overweight and MetS have been shown to be associated with the severity of influenza A (H1N1) [23-25], although the precise mechanism has not been explored. Therefore, it is reasonable to expect serious condition and high mortality in cases of COVID-19 accompanied by features of MetS because the main target organ of SARS-CoV-2 is the lung.

It is well established that the prevalence rates of MetS and obesity are higher in Americans and Europeans than in Asians [26, 27], which may explain some proportion of the observed differences in severity, hospitalization, and mortality rates of COVID-19 between Western and Asian countries. On the other hand, MetS is far more prevalent in men than in women [1, 2], is associated with chronic kidney disease [28, 29], and may be attributable to the same unknown mechanism mentioned above.

In patients with any of the specific metabolic abnormalities of MetS, pre-existing impaired lung function can predispose them to SARS-CoV-2 infection and even accelerate it, potentially worsening the condition. Plausible pathophysiology for this phenomenon includes impaired immune function, elevated inflammation, insulin resistance, restrictive pattern/reduced lung volume, and elevated expression of receptors of angiotensin converting enzyme 2 (ACE2) and dipeptidyl peptidase 4 (DPP-4) [2, 6-8, 10, 12, 14, 30]. The latter two of these may be particularly notable because the expression of ACE2, a receptor for the entry of SARS-CoV-2 into target cells, and DPP-4 are both increased in patients with obesity and diabetes [6, 12]. Although it has not been definitively established that inhibitors of ACE and DPP-4 influence the predisposition and/or severity of SARS-CoV-2 [31, 32], this possibility deserves further study.

Taken together, the predisposition to infection with viruses including SARS-CoV-2 may represent a serious complication when accompanied by any of the features of MetS, which are mostly preventable or modifiable by diet, exercise, and other aspects of a healthy lifestyle.

Urgent COVID-19 studies are required to confirm the association between serious condition and obesity and diabetes, investigate the fundamental features of MetS in terms of causality, and explore potential treatments for the multitude of patients all around the world.

Acknowledgments

We thank Michelle Kahmeyer-Gabbe, PhD, from Edanz Group (www.edanz.com/ac) for editing a draft of this manuscript.

Financial Disclosure

None to declare.

Conflict of Interest

None to declare.

Data Availability

The author declares that data supporting the findings of this study are available within the article.

1. Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity (Silver Spring). 2020.
   doi pubmed
2. Balla M, Merugu GP, Patel M, Koduri NM, Gayam V, Adapa S, Naramala S. COVID-19, modern pandemic: a systematic review from front-line health care providers' perspective. J Clin Med Res. 2020;12(4):215-229.
   doi pubmed
3. Puig-Domingo M, Marazuela M, Giustina A. COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine. 2020;68(1):2-5.
   doi pubmed
4. Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the patient with obesity - the editors speak out. Obesity (Silver Spring). 2020;28(5):847.
   doi pubmed
5. Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, Stachel A. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis. 2020.
   doi pubmed
6. Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020.
   doi pubmed
7. Maddaloni E, Buzzetti R. Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020:e33213321.
   doi pubmed
8. Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab. 2020;318(5):E736-E741.
   doi pubmed
9. Klonoff DC, Umpierrez GE. COVID-19 in patients with diabetes: risk factors that increase morbidity. Metabolism. 2020:154224.
   doi pubmed
10. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14(4):303-310.
    doi pubmed
11. Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142.
    doi pubmed
12. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.
    doi
13. Drucker DJ. Coronavirus Infections and Type 2 Diabetes-Shared Pathways with Therapeutic Implications. Endocr Rev. 2020;41(3).
    doi pubmed
14. Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020.
    doi pubmed
15. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-2752.
    doi pubmed
16. Nakajima K, Kubouchi Y, Muneyuki T, Ebata M, Eguchi S, Munakata H. A possible association between suspected restrictive pattern as assessed by ordinary pulmonary function test and the metabolic syndrome. Chest. 2008;134(4):712-718.
    doi pubmed
17. Paek YJ, Jung KS, Hwang YI, Lee KS, Lee DR, Lee JU. Association between low pulmonary function and metabolic risk factors in Korean adults: the Korean National Health and Nutrition Survey. Metabolism. 2010;59(9):1300-1306.
    doi pubmed
18. Yoshimura C, Oga T, Chin K, Takegami M, Takahashi K, Sumi K, Nakamura T, et al. Relationships of decreased lung function with metabolic syndrome and obstructive sleep apnea in Japanese males. Intern Med. 2012;51(17):2291-2297.
    doi pubmed
19. Li Y, Saito M, Tobimatsu S, Oshida H, Hori Y, Fuchigami H, Munakata H, et al. Prediabetes and impaired lung function in asymptomatic adults. Diabetes Res Clin Pract. 2013;100(2):e51-54.
    doi pubmed
20. Scarlata S, Fimognari FL, Cesari M, Giua R, Franco A, Pasqualetti P, Pastorelli R, et al. Lung function changes in older people with metabolic syndrome and diabetes. Geriatr Gerontol Int. 2013;13(4):894-900.
    doi pubmed
21. Kim CH, Kim HK, Kim EH, Bae SJ, Jung YJ, Choi J, Park JY. Association of restrictive ventilatory dysfunction with the development of prediabetes and type 2 diabetes in Koreans. Acta Diabetol. 2015;52(2):357-363.
    doi pubmed
22. Godfrey MS, Jankowich MD. The vital capacity is vital: epidemiology and clinical significance of the restrictive spirometry pattern. Chest. 2016;149(1):238-251.
    doi pubmed
23. Bijani B, Pahlevan AA, Qasemi-Barqi R, Jahanihashemi H. Metabolic syndrome as an independent risk factor of hypoxaemia in influenza A (H1N1) 2009 pandemic. Infez Med. 2016;24(2):123-130.
    doi
24. Morgan OW, Bramley A, Fowlkes A, Freedman DS, Taylor TH, Gargiullo P, Belay B, et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010;5(3):e9694.
    doi pubmed
25. Martin V, Castilla J, Godoy P, Delgado-Rodriguez M, Soldevila N, Fernandez-Villa T, Molina AJ, et al. High body mass index as a risk factor for hospitalization due to influenza: a case-control study. Arch Bronconeumol. 2016;52(6):299-307.
    doi pubmed
26. Patel A, Huang KC, Janus ED, Gill T, Neal B, Suriyawongpaisal P, Wong E, et al. Is a single definition of the metabolic syndrome appropriate? A comparative study of the USA and Asia. Atherosclerosis. 2006;184(1):225-232.
    doi pubmed
27. Pan WH, Yeh WT, Weng LC. Epidemiology of metabolic syndrome in Asia. Asia Pac J Clin Nutr. 2008;17(Suppl 1):37-42.
28. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Arch Acad Emerg Med. 2020;8(1):e35.
29. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020.
    doi pubmed
30. Carter SJ, Baranauskas MN, Fly AD. Considerations for obesity, vitamin D, and physical activity amidst the COVID-19 pandemic. Obesity (Silver Spring). 2020.
    doi pubmed
31. Sommerstein R, Kochen MM, Messerli FH, Grani C. Coronavirus disease 2019 (COVID-19): do angiotensin-converting enzyme inhibitors/angiotensin receptor blockers have a biphasic effect? J Am Heart Assoc. 2020;9(7):e016509.
    doi pubmed
32. Guo J, Huang Z, Lin L, Lv J. Coronavirus disease 2019 (COVID-19) and cardiovascular disease: a viewpoint on the potential influence of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on onset and severity of severe acute respiratory syndrome coronavirus 2 infection. J Am Heart Assoc. 2020;9(7):e016219.
    doi

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Journal of Clinical Medicine Research is published by Elmer Press Inc.