The Effects of Obesity and Metabolic Abnormalities on Severe COVID-19-related Outcomes after Vaccination: A Population-Based Study. Fan et al.

Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until Oct. 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (All P < .05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (All P < .05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive (adjusted hazard ratio (aHR) .64, 95% CI .48-.86; P = .003), glucose-lowering (aHR .55, 95% CI .36-.83; P = .004) and lipid-lowering treatments (aHR .50, 95% CI .37-.68; P < .001)) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination.

全球范围内已有多起接种新冠疫苗个体发生突破性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的病例报告，此类患者的住院与死亡风险均有所升高。因此，明确可能影响疫苗预防重症新型冠状病毒肺炎（COVID-19）保护效力的可改变危险因素，并据此启动早期临床干预，具有重要意义。本研究基于英国生物银行（UK Biobank）与2021年全国健康访谈调查（National Health Interview Survey, NHIS）数据库开展人群队列研究，共纳入两所数据库中SARS-CoV-2核酸检测阳性的受试者：其中50岁及以上受试者20362名，18岁及以上受试者2588名，两组分别有33.1%与67.7%的个体接种了至少1剂新冠疫苗。在英国生物银行队列中，随访起始时间为受试者接种疫苗之日，终止时间为2021年10月18日。本研究发现，肥胖与代谢异常（即高血糖、高脂血症及高血压）是接种疫苗个体发生重症COVID-19的可改变危险因素（所有P值均<0.05）。无论是否合并肥胖，存在代谢异常的受试者其重症COVID-19发病风险均高于代谢状态正常者（所有P值均<0.05）。此外，针对此类代谢异常的药物干预措施——即降压治疗（调整后风险比（adjusted hazard ratio, aHR）=0.64，95%置信区间（confidence interval, CI）：0.48~0.86；P=0.003）、降糖治疗（aHR=0.55，95%CI：0.36~0.83；P=0.004）与调脂治疗（aHR=0.50，95%CI：0.37~0.68；P<0.001）——均与重症COVID-19发病风险的显著降低相关。本研究结果表明，对合并肥胖与代谢异常的个体实施更为积极的健康管理，对于降低接种疫苗后重症COVID-19的发病风险具有重要意义。