The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium

Bette Loef; Jolanda M A Boer; Marian Beekman; Sophie L Campman; Emiel O Hoogendijk; Floris Huider; Demi M E Pagen; Marije J Splinter; Jeroen H P M van der Velde; Dorret I Boomsma; Pieter C Dagnelie; Jenny van Dongen; Eco J C de Geus; Martijn Huisman; M Arfan Ikram; Annemarie Koster; Silvan Licher; Jochen O Mierau; Renée de Mutsert; H Susan J Picavet; Frits R Rosendaal; Miranda T Schram; P Eline Slagboom; Evie van der Spoel; Karien Stronks; W M Monique Verschuren; Saskia W van den Berg; Lifelines Corona Research initiative

doi:10.1038/s41366-024-01660-x

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium

Int J Obes (Lond). 2024 Oct 31. doi: 10.1038/s41366-024-01660-x. Online ahead of print.

Authors

Bette Loef¹, Jolanda M A Boer², Marian Beekman³, Sophie L Campman^{4

5

6}, Emiel O Hoogendijk⁷, Floris Huider⁸, Demi M E Pagen^{9

10}, Marije J Splinter¹¹, Jeroen H P M van der Velde¹², Dorret I Boomsma⁸, Pieter C Dagnelie¹³, Jenny van Dongen⁸, Eco J C de Geus^{8

14}, Martijn Huisman^{7

15}, M Arfan Ikram¹¹, Annemarie Koster⁹, Silvan Licher¹¹, Jochen O Mierau^{16

17

18}, Renée de Mutsert¹², H Susan J Picavet², Frits R Rosendaal¹², Miranda T Schram^{11

13}, P Eline Slagboom³, Evie van der Spoel³, Karien Stronks¹⁹, W M Monique Verschuren^{2

20}, Saskia W van den Berg²; Lifelines Corona Research initiative

Affiliations

¹ Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. bette.loef@rivm.nl.
² Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
³ Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
⁴ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
⁵ Amsterdam UMC location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands.
⁶ Amsterdam Institute for Immunology & Infectious Diseases, Amsterdam, the Netherlands.
⁷ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁸ Netherlands Twin Register, Vrije Universiteit Amsterdam; Amsterdam Reproduction and Development (AR&D) and Amsterdam Public Health (APH) Research Institutes, Amsterdam, the Netherlands.
⁹ Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
¹⁰ Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands.
¹¹ Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
¹² Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
¹³ Department of Internal Medicine and Heart and Vascular Center, Maastricht University Medical Centre+ (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
¹⁴ Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁵ Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands.
¹⁶ Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands.
¹⁷ Lifelines Cohort Study and Biobank, Groningen, the Netherlands.
¹⁸ Team Strategy and External Relations, University Medical Center Groningen, Groningen, the Netherlands.
¹⁹ Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.
²⁰ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

PMID: 39482451
DOI: 10.1038/s41366-024-01660-x

Abstract

Background: Obesity may affect an individual's immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection.

Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements.

Results: Individuals with overweight (25 ≤ BMI < 30 kg/m²) (odds ratio (OR) = 1.08, 95%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m²) (OR = 1.43, 95%-CI 1.18-1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95%-CI 1.04-1.14, I² = 0%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95%-CI 0.999-1.55, I² = 57%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk.

Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.