> top > projects > LitCovid-sentences > docs > PMC:7455781 > annotations
LitCovid-sentences  

PMC:7455781 JSONTXT 19 Projects

Annnotations TAB TSV DIC JSON TextAE-old TextAE

Id Subject Object Predicate Lexical cue
T1 0-116 Sentence denotes Controlled obesity status: a rarely used concept, but with particular importance in the COVID-19 pandemic and beyond
T2 118-126 Sentence denotes Abstract
T3 127-286 Sentence denotes Obesity is a chronic disease that causes and aggravates several other diseases, and early reports suggest it is an important risk factor for COVID-19 severity.
T4 287-469 Sentence denotes Although a deeper understanding of this relationship is vital, it is also important to inform the general public about the risks and, ideally, offer strategies to mitigate the risks.
T5 470-645 Sentence denotes As “resolution” of obesity in the short-term is not feasible, it is indeed possible that smaller weight losses and increase in physical activity can actually reduce the risks.
T6 646-869 Sentence denotes In this context, we propose that a term called “controlled obesity” be more often used and studied, in which those who have lost over 10% of their maximal weight and, ideally, are physically active are considered healthier.
T7 870-1055 Sentence denotes This context can have much broader usefulness, beyond the pandemics, as evidence points that weight loss over 10% can significant reduce overall health risks, irrespective of final BMI.
T8 1057-1069 Sentence denotes Introduction
T9 1070-1222 Sentence denotes Obesity is a chronic and recurrent disease associated with increased disability, comorbidities, and reduced quality of life, as well as life expectancy.
T10 1223-1400 Sentence denotes Several severe diseases are caused or aggravated by obesity and early reports on Covid-19 infection have included obesity as an important risk factor for disease severity [1–5].
T11 1401-1520 Sentence denotes Recently, the Centers for Disease Control and Prevention included body mass index (BMI) over 30 kg/m2 as a risk factor.
T12 1521-1653 Sentence denotes Reporting obesity as a disease associated with Covid-19 severity is utterly important for clinical care, research and public health.
T13 1654-1783 Sentence denotes However, there have been reports of increased stigma and personal responsibility, as obesity has been seen as a lifestyle choice.
T14 1784-1944 Sentence denotes It is clearly important to provide a right message in which there is no blame the individual, but, at the same time, emphasize strategies to mitigate the risks.
T15 1945-2145 Sentence denotes If obesity is a disease, achieving a “normal weight” would be the only way to mitigate the risks or is it possible to have a “controlled obesity state”, in which risks of several diseases are reduced?
T16 2146-2339 Sentence denotes For example, as a comparison, diabetes is also a risk factor for Covid-19 and several epidemiological studies have shown that good glycemic control is associated with reduced risk of infection.
T17 2340-2498 Sentence denotes So, a simple public message for diabetes is to maintain your blood sugar under control (generally an HbA1c < 7%), but not necessarily in a non-diabetic level.
T18 2499-2537 Sentence denotes Shouldn't we do the same with obesity?
T19 2539-2596 Sentence denotes Obesity as an important risk factor for COVID-19 severity
T20 2597-2847 Sentence denotes Obesity has consistently been associated with increased COVID-19 severity, hospitalization rates and mortality, although the magnitude of the relation is still unclear as data are heterogeneous, due to different study protocols and populations [1–6].
T21 2848-2994 Sentence denotes The very large database of OpenSAFELY study examined more than 10,000 deaths in the UK and compared to over 17 million people from the UK Biobank.
T22 2995-3047 Sentence denotes In this study, obesity was divided according to BMI:
T23 3048-3183 Sentence denotes 30–34.9, 35–39.9 and over 40 kg/m2 or more, and these ranges were associated with a 1.23, 1.81 and 2.66 increased in risk of death [3].
T24 3184-3411 Sentence denotes Other studies found higher rates of hospitalization and mechanical ventilation in individuals with obesity [2, 5], and one meta-analysis found a 2.31 increased risk of COVID-19 complications in those with obesity diagnosis [3].
T25 3412-3591 Sentence denotes Moreover, the impact of the disease seems to be even greater in younger populations, which led to some authors to propose that “obesity shift severe COVID-19 to younger ages” [6].
T26 3592-4244 Sentence denotes The mechanisms by which obesity is associated with severe COVID-19 are still unknown, but several have been proposed [1, 2, 5]: increased inflammation, with enhanced production of cytokines; increased risk of microthrombosis; respiratory dysfunction (as decreased pulmonary expandability and cardiorespiratory fitness); technical difficulties in intensive care units (challenging orotracheal intubation and eight limits in imaging exams, less benefits of prone position); more prolonged viral shedding; and increased risk of other comorbidities associated with worse prognosis (as type 2 diabetes, hypertension, sleep apnea and cardiovascular disease).
T27 4245-4408 Sentence denotes Likely, many of those factors are closely linked to insulin resistance and visceral fat and improving insulin sensitivity could hypothetically reduce risks [1, 7].
T28 4410-4479 Sentence denotes Obesity, weight loss and hard outcomes in observational data and RCTs
T29 4480-4653 Sentence denotes Unfortunately, we have very little evidence that voluntary clinical weight loss is associated with reduced hard outcomes, even on observational data, due to several reasons.
T30 4654-4783 Sentence denotes In the first place, clinical meaningful and sustained weight loss is very hard to be achieved, even in dedicated clinical trials.
T31 4784-4942 Sentence denotes Even studies in which intensive behavior treatment was offered have shown no more than 10% of individuals achieving 10% weight loss after 1 or 2 years [8, 9].
T32 4943-5092 Sentence denotes Schwartz and colleagues brilliantly reviewed the biological, and not psychological reasons why weight loss and maintenance is so hard to achieve [9].
T33 5093-5289 Sentence denotes Briefly, probably a hypothalamic set-point exists in which every effort for losing weight is counterbalanced by increased hunger and drive to eat, reduced satiety and decreased energy expenditure.
T34 5290-5482 Sentence denotes In this context, in epidemiological data, probably the vast majority of patients with clinical meaningful weight loss represent a group of involuntary weight loss, due to a underlying disease.
T35 5483-5629 Sentence denotes So, only data from intervention studies that produces clinical meaningful mean weight losses can clearly demonstrates the benefits of weight loss.
T36 5630-5723 Sentence denotes The best evidence of reduced outcomes after weight loss comes from bariatric surgery cohorts.
T37 5724-5905 Sentence denotes The SOS Study, for example, has shown reduced risk of mortality, cardiovascular events, cancer (mostly in women) and several other diseases, as type 2 diabetes and sleep apnea [10].
T38 5906-5969 Sentence denotes Data about infection rate, however, are virtually non-existent.
T39 5970-6199 Sentence denotes Surely, we cannot exclude that the benefits come from the surgical procedure itself, but as the majority of patients in SOS performed restrictive procedures, it is very unlikely that the benefits are weight loss independent [11].
T40 6200-6360 Sentence denotes Several other surgical cohorts have shown similar results and bariatric surgery is the most effective and evidence-based long-term treatment for severe obesity.
T41 6361-6523 Sentence denotes In contrast, however, the evidence regarding non-surgical weight loss on reduced hard outcomes, including cardiovascular events and mortality are less compelling.
T42 6524-6726 Sentence denotes An example of failure is the LOOK AHEAD Study in which intensive behavior treatment was not superior to a control group regarding cardiovascular events after 9 years in a type 2 diabetes population [8].
T43 6727-6867 Sentence denotes However, a sub-analysis focusing in those who attained at least 10% weight loss, indeed evidenced a reduction of cardiovascular events [12].
T44 6868-7017 Sentence denotes A meta-analysis of RCTs with more than 17,000 confirmed that intentional weight loss was associated with a 15% reduction in all-cause mortality [13].
T45 7018-7112 Sentence denotes In regard to infections, though, there are not any data from weight loss intervention studies.
T46 7113-7300 Sentence denotes Nevertheless, the same is true for diabetes: there is no direct evidence from intervention trials that glycemic control reduces infections, although there is high biological plausibility.
T47 7302-7350 Sentence denotes Clinical achievable weight loss and risk factors
T48 7351-7543 Sentence denotes Since weight loss to “normalize” BMI is rarely achieved, there is good evidence that clinical achievable weight loss improves cardiovascular risk factors and several substitutive markers [14].
T49 7544-7737 Sentence denotes For example, 5–7% weight loss leads to a reduction in in insulin resistance and consequently, reduction in glycemia, triglycerides, blood pressure and ectopic fat deposition, as liver fat [14].
T50 7738-7871 Sentence denotes 10% weight loss has a dramatic effect on liver fibrosis in patients with non-alcoholic liver disease, and several other risk markers.
T51 7872-8118 Sentence denotes If visceral fat and insulin resistance are important players in the relationship of body fat and COVID-19 severity [1, 7], modest weight losses could have impact on reduction of risks, as already suggested [1], although no direct evidence exists.
T52 8119-8176 Sentence denotes Low-grade inflammation reduces as well after weight loss.
T53 8177-8285 Sentence denotes Magkos et al. have shown that 11–16% weight loss can substantially reduce obesity-related inflammation [15].
T54 8286-8438 Sentence denotes The same is true about pulmonary function and sleep apnea severity, other possible mediators of the relationship of obesity with COVID-19 severity [14].
T55 8439-8538 Sentence denotes An important concept here is that these risk reductions are observed irrespective of baseline BMIs.
T56 8539-8658 Sentence denotes In this regard, similar percentage weight losses in individuals with very similar basal BMIs can have similar benefits.
T57 8659-8896 Sentence denotes Why this happens is not exactly known, but is probably related to ectopic lipid deposition and personal fat thresholds, in which insulin resistance and metabolic disturbances appears when the subcutaneous expansion limit is achieved [1].
T58 8897-9077 Sentence denotes Continuous weight gain will lead to ectopic fat deposition in organs like liver, muscle and pancreas and increased insulin resistance can also act as a curb to further weight gain.
T59 9079-9148 Sentence denotes Controlled obesity status: would it be an important clinical message?
T60 9149-9322 Sentence denotes Shouldn´t we use more often the term “controlled obesity” for those individuals, not only for Covid-19, but generally speaking, to nearly all diseases associated to obesity?
T61 9323-9559 Sentence denotes Surely, direct evidence is still scarce, as we pointed out, but this can be a simple message, especially in situations as Covid-19 pandemics, in which is virtually impossible to lose a massive amount of weight in a short period of time.
T62 9560-9799 Sentence denotes The concept of a metabolically healthy obesity, achieved through moderate weight reductions not enough to reach the BMI of 25 kg/m2 target, is not novel and has been previously proposed as the “low hanging fruit” in obesity treatment [16].
T63 9800-9997 Sentence denotes The main problem in using this concept is that there is no universal number below which the risk is reduced, since it depends on the individual weight history, which is also subject to recall bias.
T64 9998-10185 Sentence denotes Other factor that could bias this analysis is the already discussed reverse causation: weight loss could be a proxy of a subclinical disease, in which the overall prognosis would be poor.
T65 10186-10275 Sentence denotes So, ideally, we should exclude data on those who unintentionally lost weight in the past.
T66 10276-10450 Sentence denotes Nonetheless, we believe that attaining self-reported maximal weight would be a relevant clinical information to be considered in future studies with Covid-19 and beyond [17].
T67 10451-10668 Sentence denotes If we demonstrate, even with case–control studies, that those who voluntarily lost weight in the past have a better prognosis in Covid-19, we can start providing a simple and achievable message for those with obesity.
T68 10669-10763 Sentence denotes Data of disease severity on patients who performed bariatric surgery could likewise be useful.
T69 10764-11009 Sentence denotes If, hopefully, the pandemic vanishes in the future as a vaccine is delivered, we could still use this concept to improve metabolic health and reduce the stigma of individuals with obesity, in which bariatric surgery is not indicated or feasible.
T70 11011-11027 Sentence denotes Publisher's Note
T71 11028-11146 Sentence denotes Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T72 11148-11164 Sentence denotes Acknowledgements
T73 11165-11212 Sentence denotes Both authors exchanged ideas about the article.
T74 11213-11257 Sentence denotes BH wrote the first draft and MCM revised it.
T75 11259-11292 Sentence denotes Compliance with ethical standards
T76 11294-11315 Sentence denotes Conflict of interests
T77 11316-11534 Sentence denotes BH received travel grants from Novo Nordisk and Aché Pharmaceuticals; received honoraria for lectures from Novo Nordisk, Eli Lilly, and Boehringer-Ingelheim; and is on the Advisory Board for Novo Nordisk and Eli Lilly.
T78 11535-11729 Sentence denotes MCM received travel grants from Novo Nordisk; received honoraria for lectures from Novo Nordisk, EMS Pharmaceutical, and Eurofarma Pharmaceuticals; and is on the Advisory Board for Novo Nordisk.
T79 11731-11747 Sentence denotes Ethical approval
T80 11748-11857 Sentence denotes This article does not contain any studies with human participants or animals performed by any of the authors.
T81 11859-11875 Sentence denotes Informed consent
T82 11876-11896 Sentence denotes No Informed Consent.