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.

全球范围内已有接种疫苗个体发生突破性新型冠状病毒（SARS-CoV-2）感染的报道，此类患者的住院与死亡风险均有所升高。因此，明确可干预的风险因素——这些因素可能影响疫苗针对重型COVID-19的保护效力——并据此启动早期医学干预，具有重要意义。本研究依托英国生物样本库（UK Biobank）与2021年全国健康访谈调查（National Health Interview Survey, NHIS）开展基于人群的研究，共纳入两个数据库中年龄≥50岁的20362名参与者，以及两个数据库中年龄≥18岁的2588名新型冠状病毒检测阳性者，其中分别有33.1%与67.7%的受试者接种了1剂及以上疫苗。在英国生物样本库队列中，随访起始时间为疫苗接种日期，截止至2021年10月18日。分析结果显示，肥胖与代谢异常（即高血糖、高脂血症及高血压）是接种疫苗人群发生重型COVID-19的可干预风险因素（所有P值均<0.05）。当存在代谢异常时，无论是否合并肥胖，受试者发生重型COVID-19的风险均高于代谢健康个体（所有P值均<0.05）。此外，针对此类代谢异常的药物干预措施——包括降压治疗（调整后风险比（adjusted hazard ratio, aHR）=0.64，95%置信区间（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）——均与该结局的风险显著降低相关。本研究结果表明，加强对肥胖及代谢异常患者的主动健康管理，对于降低疫苗接种后重型COVID-19的发生率至关重要。