ArticlePloS one2020
Overweight/obesity as the potentially most important lifestyle factor associated with signs of pneumonia in COVID-19.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Obesity as an independent risk factor for COVID-19 severity and mortality.The Cochrane database of systematic reviews · 2023Pooled it
- Obesity and respiratory diseases: mechanisms, phenotypes, and clinical implications.Diabetology & metabolic syndrome · 2026Review
- Assessing risk of bias of cohort studies with large language models.Research synthesis methods · 2025Article
- Examining the risk of delirium in patients hospitalized with COVID-19: Insights from the homeless population.PloS one · 2025Article
- Respiratory complications of obesity: from early changes to respiratory failure.Breathe (Sheffield, England) · 2023Review
- Body Mass Index and Clinical Outcomes in Adult COVID-19 Patients of Diverse Ethnicities.Healthcare (Basel, Switzerland) · 2022Article
- Morbid obesity is associated with mortality and acute kidney injury in hospitalized patients with COVID-19.Clinical nutrition ESPEN · 2021Article
- Initial presenting symptoms, comorbidities and severity of COVID-19 patients during the second wave of epidemic in Myanmar.Tropical medicine and health · 2021Article
- Immunofibrotic drivers of impaired lung function in postacute sequelae of SARS-CoV-2 infection.JCI insight · 2021Article
- Role for Leptin and Leptin Receptors in Stem Cells During Health and Diseases.Stem cell reviews and reports · 2021Review
Corrections and comments
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe occurrence of pneumonia separates severe cases of COVID-19 from the majority of cases with mild disease. However, the factors determining whether or not pneumonia develops remain to be fully uncovered. We therefore explored the associations of several lifestyle factors with signs of pneumonia in COVID-19.
methodsBetween May and July 2020, we conducted an online survey of 201 adults in Germany who had recently gone through COVID-19, predominantly as outpatients. Of these, 165 had a PCR-based diagnosis and 36 had a retrospective diagnosis by antibody testing. The survey covered demographic information, eight lifestyle factors, comorbidities and medication use. We defined the main outcome as the presence vs. the absence of signs of pneumonia, represented by dyspnea, the requirement for oxygen therapy or intubation.
resultsSigns of pneumonia occurred in 39 of the 165 individuals with a PCR-based diagnosis of COVID-19 (23.6%). Among the lifestyle factors examined, only overweight/obesity was associated with signs of pneumonia (odds ratio 2.68 (1.29-5.59) p = 0.008). The observed association remained significant after multivariate adjustment, with BMI as a metric variable, and also after including the antibody-positive individuals into the analysis.
conclusionsThis exploratory study finds an association of overweight/obesity with signs of pneumonia in COVID-19. This finding suggests that a signal proportional to body fat mass, such as the hormone leptin, impairs the body's ability to clear SARS-CoV-2 before pneumonia develops. This hypothesis concurs with previous work and should be investigated further to possibly reduce the proportion of severe cases of COVID-19.
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