LitCovid-sentences  

PMC:7455781 / 1057-11009 JSONTXT 12 Projects

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Id Subject Object Predicate Lexical cue
T8 0-12 Sentence denotes Introduction
T9 13-165 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 166-343 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 344-463 Sentence denotes Recently, the Centers for Disease Control and Prevention included body mass index (BMI) over 30 kg/m2 as a risk factor.
T12 464-596 Sentence denotes Reporting obesity as a disease associated with Covid-19 severity is utterly important for clinical care, research and public health.
T13 597-726 Sentence denotes However, there have been reports of increased stigma and personal responsibility, as obesity has been seen as a lifestyle choice.
T14 727-887 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 888-1088 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 1089-1282 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 1283-1441 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 1442-1480 Sentence denotes Shouldn't we do the same with obesity?
T19 1482-1539 Sentence denotes Obesity as an important risk factor for COVID-19 severity
T20 1540-1790 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 1791-1937 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 1938-1990 Sentence denotes In this study, obesity was divided according to BMI:
T23 1991-2126 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 2127-2354 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 2355-2534 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 2535-3187 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 3188-3351 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 3353-3422 Sentence denotes Obesity, weight loss and hard outcomes in observational data and RCTs
T29 3423-3596 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 3597-3726 Sentence denotes In the first place, clinical meaningful and sustained weight loss is very hard to be achieved, even in dedicated clinical trials.
T31 3727-3885 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 3886-4035 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 4036-4232 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 4233-4425 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 4426-4572 Sentence denotes So, only data from intervention studies that produces clinical meaningful mean weight losses can clearly demonstrates the benefits of weight loss.
T36 4573-4666 Sentence denotes The best evidence of reduced outcomes after weight loss comes from bariatric surgery cohorts.
T37 4667-4848 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 4849-4912 Sentence denotes Data about infection rate, however, are virtually non-existent.
T39 4913-5142 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 5143-5303 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 5304-5466 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 5467-5669 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 5670-5810 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 5811-5960 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 5961-6055 Sentence denotes In regard to infections, though, there are not any data from weight loss intervention studies.
T46 6056-6243 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 6245-6293 Sentence denotes Clinical achievable weight loss and risk factors
T48 6294-6486 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 6487-6680 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 6681-6814 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 6815-7061 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 7062-7119 Sentence denotes Low-grade inflammation reduces as well after weight loss.
T53 7120-7228 Sentence denotes Magkos et al. have shown that 11–16% weight loss can substantially reduce obesity-related inflammation [15].
T54 7229-7381 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 7382-7481 Sentence denotes An important concept here is that these risk reductions are observed irrespective of baseline BMIs.
T56 7482-7601 Sentence denotes In this regard, similar percentage weight losses in individuals with very similar basal BMIs can have similar benefits.
T57 7602-7839 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 7840-8020 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 8022-8091 Sentence denotes Controlled obesity status: would it be an important clinical message?
T60 8092-8265 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 8266-8502 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 8503-8742 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 8743-8940 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 8941-9128 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 9129-9218 Sentence denotes So, ideally, we should exclude data on those who unintentionally lost weight in the past.
T66 9219-9393 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 9394-9611 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 9612-9706 Sentence denotes Data of disease severity on patients who performed bariatric surgery could likewise be useful.
T69 9707-9952 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.