Coronavirus and Obesity: Could Insulin Resistance Mediate the Severity of Covid-19 Infection?

摘要

The rapidly evolving global epidemic of coronavirus disease 2019 (COVID-19) (1), caused by thenovel severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), presents with variableclinical severity, being fatal in some and asymptomatic in others (2). Preliminary indications fromthe UK (3), China (4), and the USA (5) suggest that patients with obesity, at least in hospital,have a worse prognosis. This is consistent with long-established observations that patients withacute respiratory distress syndrome (ARDS) who have obesity do worse, for several reasons (6).Obesity causes atelectasis, particularly in the posterior dependant lung zones (7) and this, alongwith collapse of alveolar capillary units because of raised pleural pressures (8) leads to diminishedrecruitability of lung tissue. Also, parenchymal heterogeneity leads to high lung shear forces, evenwhen applied ventilatory pressures are low and without well-established lung injury (9). This isconsistent with population-based observations that obesity adversely affects lung function (10).