Summary of your 'study carrel' ============================== This is a summary of your Distant Reader 'study carrel'. The Distant Reader harvested & cached your content into a collection/corpus. It then applied sets of natural language processing and text mining against the collection. The results of this process was reduced to a database file -- a 'study carrel'. The study carrel can then be queried, thus bringing light specific characteristics for your collection. These characteristics can help you summarize the collection as well as enumerate things you might want to investigate more closely. This report is a terse narrative report, and when processing is complete you will be linked to a more complete narrative report. Eric Lease Morgan Number of items in the collection; 'How big is my corpus?' ---------------------------------------------------------- 29 Average length of all items measured in words; "More or less, how big is each item?" ------------------------------------------------------------------------------------ 4166 Average readability score of all items (0 = difficult; 100 = easy) ------------------------------------------------------------------ 47 Top 50 statistically significant keywords; "What is my collection about?" ------------------------------------------------------------------------- 29 obesity 11 SARS 10 COVID-19 5 covid-19 5 BMI 4 patient 3 child 2 weight 2 intervention 2 ACE2 1 woman 1 variable 1 surgery 1 study 1 snap 1 set 1 olfactory 1 obese 1 minimal 1 metabolic 1 insulin 1 increase 1 health 1 food 1 circular 1 circrna 1 bariatric 1 angiotensin 1 adolescent 1 activity 1 TNF 1 RNA 1 OBEDIS 1 NAFLD 1 Food 1 EASO 1 China Top 50 lemmatized nouns; "What is discussed?" --------------------------------------------- 1773 obesity 868 patient 549 disease 529 risk 517 study 379 child 350 infection 347 cell 329 factor 314 weight 278 health 275 % 262 mortality 248 tissue 222 food 217 response 215 outcome 205 inflammation 205 diabetes 203 group 198 pandemic 195 surgery 190 type 180 analysis 178 activity 177 datum 173 role 172 treatment 171 intervention 164 individual 164 effect 159 syndrome 159 age 155 coronavirus 148 review 146 system 146 body 146 adolescent 141 year 141 level 140 time 138 function 137 loss 137 cytokine 135 care 128 people 126 insulin 126 evidence 125 severity 123 prevalence Top 50 proper nouns; "What are the names of persons or places?" -------------------------------------------------------------- 584 COVID-19 321 SARS 244 CoV-2 239 BMI 101 ACE2 89 Obesity 80 al 79 Health 75 China 66 RNA 64 et 61 • 59 States 58 United 51 IL-6 51 Association 48 ICU 47 OBEDIS 46 H1N1 43 Coronavirus 42 Wuhan 41 TNF 41 Study 41 CVD 39 Disease 38 meta 34 New 34 EASO 33 T 33 . 32 RAAS 32 PA 32 Food 31 Risk 31 II 30 α 30 York 30 US 30 NAFLD 26 World 25 sha 25 Covid-19 24 circRNAs 24 Organization 23 kg 23 Program 23 OB 23 City 22 Nutrition 22 DOI Top 50 personal pronouns nouns; "To whom are things referred?" ------------------------------------------------------------- 262 it 160 we 85 they 31 them 22 i 7 itself 7 's 6 she 6 one 4 you 4 us 3 he 2 themselves 2 hsa_circh19 1 mrnas 1 him 1 her 1 covid-10 1 30-days Top 50 lemmatized verbs; "What do things do?" --------------------------------------------- 3075 be 830 have 445 increase 358 associate 257 include 204 use 162 show 161 relate 151 reduce 129 lead 121 require 119 base 117 do 115 induce 112 report 109 compare 104 provide 98 contribute 95 suggest 92 consider 91 find 86 recommend 80 identify 78 affect 76 protect 75 promote 70 cause 70 assess 69 demonstrate 66 need 65 improve 65 control 62 decrease 61 make 61 develop 59 hospitalize 56 infect 56 impair 55 predict 55 involve 55 follow 54 know 52 reserve 52 express 51 result 49 play 48 remain 47 observe 47 confirm 46 emerge Top 50 lemmatized adjectives and adverbs; "How are things described?" --------------------------------------------------------------------- 338 high 337 severe 320 obese 291 also 276 clinical 268 not 261 metabolic 243 more 243 - 211 covid-19 205 immune 191 inflammatory 188 such 185 respiratory 180 adipose 161 other 151 well 143 low 140 viral 137 physical 136 however 133 acute 121 cardiovascular 114 bariatric 107 most 107 important 103 chronic 102 several 95 only 95 non 95 human 95 as 92 systematic 92 further 89 great 89 fatty 88 many 88 healthy 85 overweight 78 potential 77 specific 77 pulmonary 77 long 75 medical 75 even 73 significant 72 large 70 dietary 68 olfactory 68 likely Top 50 lemmatized superlative adjectives; "How are things described to the extreme?" ------------------------------------------------------------------------- 32 most 21 least 9 high 9 good 9 Most 8 great 6 strong 5 large 3 bad 2 poor 2 near 2 mild 2 late 1 tough 1 simple 1 short 1 low 1 healthy 1 early 1 common 1 close 1 big Top 50 lemmatized superlative adverbs; "How do things do to the extreme?" ------------------------------------------------------------------------ 75 most 8 least 5 well Top 50 Internet domains; "What Webbed places are alluded to in this corpus?" ---------------------------------------------------------------------------- 1 www.frontiersin.org 1 www.crd.york Top 50 URLs; "What is hyperlinked from this corpus?" ---------------------------------------------------- 1 http://www.frontiersin.org/articles/10.3389/fendo 1 http://www.crd.york Top 50 email addresses; "Who are you gonna call?" ------------------------------------------------- Top 50 positive assertions; "What sentences are in the shape of noun-verb-noun?" ------------------------------------------------------------------------------- 10 obesity is also 4 obesity are also 4 patients were more 3 obesity be more 3 patients were overweight 2 analyses were also 2 covid-19 were more 2 diseases including metabolic 2 group recommends subjective 2 mortality was significantly 2 obesity had higher 2 obesity has also 2 obesity have more 2 obesity increases mortality 2 obesity induced inflammation 2 obesity is highly 2 obesity is not 2 obesity is strongly 2 obesity was not 2 obesity was significantly 2 obesity were also 2 obesity were more 2 obesity were risk 2 patients considering bariatric 2 patients required invasive 1 % are obese 1 % do not 1 % had bmi 1 % had obesity 1 % increased odds 1 % require admission 1 % required mechanical 1 activities is often 1 activity are more 1 activity is also 1 activity is important 1 activity is lower 1 activity were not 1 analyses comparing obesity 1 analysis including patients 1 analysis using propensity 1 analysis was not 1 bmi does not 1 bmi has not 1 bmi was disproportionately 1 bmi was more 1 bmi was not 1 bmi were more 1 bmi were relevant 1 cells are cytotoxic Top 50 negative assertions; "What sentences are in the shape of noun-verb-no|not-noun?" --------------------------------------------------------------------------------------- 1 activity were not statistically 1 analysis was not possible 1 covid-19 is not currently 1 data are not adequate 1 data is not currently 1 food is not only 1 infection are not fully 1 inflammation is not only 1 obesity are not yet 1 obesity does not directly 1 obesity is not uncommon A rudimentary bibliography -------------------------- id = cord-318391-2s0rjfn8 author = Akirov, Amit title = Tackling Obesity During the COVID‐19 Pandemic date = 2020-08-14 keywords = BMI; COVID-19; obesity summary = A study to assess the effects of lockdown during COVID-19 epidemic on lifestyle in patients with type 2 diabetes in north India reported carbohydrate consumption and frequency of snacking increased in 21% and 23% of study participants, respectively, while exercise duration decreased in 42% and weight gain was documented in 23% of patients [14] . Furthermore, obesity class I (BMI>30 kg/m2) and obesity class II (BMI>35 kg/m2) have been associated with an increased risk for need of invasive mechanical ventilation in patients hospitalized for COVID-19, independent of age, sex, diabetes mellitus and hypertension [9, 13] . A study from China reported similar findings, noting the association of obesity with high mortality risk in young patients with COVID-19 [3] . Data from England reported that patients with type 1 or type 2 diabetes were at increased risk for COVID-19 associated mortality, and there was a U-shaped relationship with BMI. Obesity is clearly a pivotal risk factor associated with severe disease -including greater rate of hospital admission, ICU admission, need for ventilation and excess mortality. doi = 10.1002/dmrr.3393 id = cord-266380-lu6hj3a2 author = Alfaris, Nasreen title = Management of obesity in Saudi Arabia during the era of COVID‐19: A clash of two pandemics date = 2020-10-01 keywords = obesity summary = In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, 2 but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection. In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, 2 but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection. Key challenges that were specific for obesity care, included reduced access to healthcare resources, isolating patients, limiting their physical activity, and causing disruptions in eating habits with irregular mealtimes, frequent snacking, more processed meals, and increased anxiety and depression. 5 At a time when the focus is only the immediate COVID-19 pandemic, our patients with obesity should not be lost, nor forgotten. doi = 10.1002/oby.23055 id = cord-012493-pwbzffo9 author = Alligier, Maud title = OBEDIS Core Variables Project: European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions date = 2020-01-16 keywords = OBEDIS; intervention; minimal; obesity; set; variable; weight summary = • It provided information that made it likely to impact treatment response, according to the relevant literature (especially studies that aimed to stratify patients) • It was feasible: Given that each clinical trial has limits on budget and time as well as research team expertise, the OBEDIS group aimed to minimize the burden of including each variable in future trials. Data for the minimal core set should include: the number of attempts, whether the patient has undertaken individual/group behavioral interventions (pertaining to nutrition/PA/psychology), whether treatment included obesity drugs or bariatric surgery, and the maximal weight loss and weight regain as a result of these attempts. A measure of muscle strength, as an important component of muscular fitness, is therefore also recommended for the minimal core set, since the evidence in aggregate shows that muscle strength is associated with reduced mortality in all BMI categories and that resistance training (designed to increase muscle strength), even without weight loss, improves health risk [53] . doi = 10.1159/000505342 id = cord-354805-5wnp02wd author = Concepción‐Zavaleta, Marcio José title = COVID‐19 and obesity: The intersection between a pandemic and an epidemic in a developing country date = 2020-09-21 keywords = obesity summary = We have read with great interest the prospective cohort study published by Czernichow et al (1), wherein they found that obesity doubles mortality in patients hospitalized with coronavirus disease (COVID‐19), using as an indicator anthropometric, the body mass index (BMI). We have read with great interest the prospective cohort study published by Czernichow et al 1 , wherein they found that obesity doubles mortality in patients hospitalized with coronavirus disease (COVID-19), using as an indicator anthropometric, the body mass index (BMI). Excess mortality and severity of the COVID-19 disease in people with obesity is also prevalent in developing countries with constrained resources such as Peru, in which preliminary findings reported by the Ministry of Health show that among people with obesity died from COVID-19, 85.5% had obesity as assessed by BMI. 6 As studies have highlighted the association between this disease and its mortality and severity of SARS-CoV-2 infection, Peru and other countries are recognizing the importance of considering obesity as a disease and developing effective health system strategies and public health approaches. doi = 10.1002/oby.23027 id = cord-261891-yiiz9s53 author = Czernichow, Sébastien title = Obesity doubles mortality in patients hospitalized for SARS‐CoV‐2 in Paris hospitals, France: a cohort study on 5795 patients date = 2020-08-20 keywords = BMI; covid-19; obesity summary = 8 Preliminary data from different cohorts of patients infected by COVID-19 of small sample size (lower than 400 patients), with short follow-up or with poorly described BMI indicate poorer prognosis in people with obesity compared to other patients. However, it is not possible to conclude from these results that obesity is an independent factor of mortality for patients infected with COVID-19 due to the small sample sizes of these studies, neither to have a precise estimate of obesity size effect due to the absence of BMI categories and incomplete follow-up. We imputed missing BMI category using predictive mean matching considering as the following as explaining variables: comorbidities (hypertension, diabetes, sleep apnea, dyslipidemia, chronic kidney disease, heart failure, cancer), smoking status, sex, age and indirect information regarding BMI value (obesity from free-text reports, variables extracted from 4-digits E66 ICD-10 codes and malnutrition ICD-10 codes). doi = 10.1002/oby.23014 id = cord-034066-fsp7e5x5 author = Di Figlia-Peck, Stephanie title = Treatment of children and adolescents who are overweight or obese date = 2020-10-21 keywords = BMI; activity; adolescent; child; intervention; obesity; weight summary = 2 And in 2008, the Agency for Healthcare Research and Quality of the HHS came out with an Evidence-Based/Technology Assessment entitled "The Effectiveness of Weight Management Programs in Children and Adolescents." 3 In addition to these government-sponsored guidelines, recommendations for management of overweight and obesity in this population have been issued by multiple other organizations. One 12month technology-based program for adolescents with Type 2 diabetes "was not sufficient to produce weight loss with the combination of web intervention and group sessions and telephone follow up, but improvements in sedentary behavior and use of behavior change strategies expected to lead to behavior change was evidenced." 32 Telemedicine, in theory, should be able to compensate for some of the barriers that prevent access to and utilization of family based comprehensive behavioral interventions for child and adolescent obesity. doi = 10.1016/j.cppeds.2020.100871 id = cord-277074-1emlkii0 author = Ekiz, Timur title = Relationship between COVID-19 and obesity date = 2020-06-02 keywords = obesity summary = From this point of view, we determined the obesity prevalence of the top 20 ranked countries by total deaths due to COVID-19. The data regarding the obesity prevalence of countries were obtained from global health services data of the World Health Organization [1, 2] . Herein, we believe that cardiovascular and metabolic effects, sleep apnea, vitamin D deficiency, dysregulation of the renin-angiotensin-aldosterone system (RAAS) as well as sarcopenia should be taken into account as obesity-related confounders to COVID-19. The adipose tissue can manifest as a reservoir for a wider viral spread with increased shedding, immune activation, and cytokine amplification in relevant patients as well [4, 5] . First of all, obesity is a predominant risk factor for OSA (obesity hypoventilation syndrome), and OSA patients may be vulnerable to COVID-19. The dysregulation/increase of the RAAS has been shown in OSA patients, likewise in obesity [6] . Is Adipose Tissue a Reservoir for Viral Spread, Immune Activation and Cytokine Amplification in COVID-19. doi = 10.1016/j.dsx.2020.05.047 id = cord-011333-yyhwtnza author = Faienza, Maria Felicia title = Childhood obesity, cardiovascular and liver health: a growing epidemic with age date = 2020-02-04 keywords = BMI; NAFLD; child; obesity summary = Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, cardiovascular diseases, and diabetes risk during adulthood. The raising prevalence of obesity, metabolic syndrome together with insulin resistance [43] , worldwide is associated with liver abnormalities encompassing the clinical spectrum of nonalcoholic fatty liver disease (NAFLD). Physical inactivity affects a vast majority of children and adolescents who become prone to high obesity rates and related diseases, including CVD and NAFLD. Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, CVD, and diabetes risk during adulthood. The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis doi = 10.1007/s12519-020-00341-9 id = cord-267505-4tw7kfek author = Frühbeck, Gema title = European Association for the Study of Obesity Position Statement on the Global COVID-19 Pandemic date = 2020-04-27 keywords = EASO; obesity summary = However, people with obesity have an elevated risk of hospitalization, serious illness, and mortality, likely due to chronic lowgrade inflammation [1] , an altered immune response to infection, as well as related cardiometabolic comorbidities [2] , and the COVID-19 pandemic is likely to have a significant impact on people with obesity. Given that obesity is a prevalent, persistent, serious, complex, chronic, and relapsing disease among the general population [3] , it is important that we pay special attention to these challenges especially during the COVID-19 pandemic and when planning management of the aftermath to avoid placing an even greater burden on individuals, health systems, and society over the short, medium, and long term. The role of EASO is crucial in (1) identifying the particular needs of healthcare providers and persons living with obesity during the COVID-19 pandemic, (2) disseminating sciencebased information, and (3) sharing knowledge, evidence-based recommendations, and guidance toward the clinical, patient, and policy communities using social and other media, which allow us to reach millions of people across Europe. doi = 10.1159/000508082 id = cord-288255-p8uzrsbd author = Goossens, Gijs H. title = Obesity and COVID-19: A Perspective from the European Association for the Study of Obesity on Immunological Perturbations, Therapeutic Challenges, and Opportunities in Obesity date = 2020-08-13 keywords = ACE2; COVID-19; SARS; obesity; patient summary = authors: Goossens, Gijs H.; Dicker, Dror; Farpour-Lambert, Nathalie J.; Frühbeck, Gema; Mullerova, Dana; Woodward, Euan; Holm, Jens-Christian Evidence from studies in humans indicates that people with obesity are characterized by systemic low-grade inflammation, higher susceptibility to infections, dampened immune response to infectious agents, as well as higher morbidity and mortality associated with infections, and demonstrate an impaired immune response to vaccinations and antimicrobial treatment [25] [26] [27] [28] . Together, these findings imply that evaluation of cytokine profiles and immune cell subsets in patients with SARS-CoV-2 infection, and a deeper understanding of the underlying processes, will significantly contribute to better treatment strategies and clinical management of COVID-19 [37] . At the same time, the rapidly emerging clinical data require ongoing scrutiny to understand not only the risks and benefits of single drugs to tackle COVID-19, but also the interaction with pharmacological agents commonly used in people with obesity and related NCDs, including type 2 diabetes and cardiovascular diseases, who are especially at risk of or hospitalized with SARS-CoV-2 infection. doi = 10.1159/000510719 id = cord-325138-riu4jdc2 author = Hassink, Sandra G. title = Obesity and Hunger Threaten the Foundations of Child Health date = 2020-08-13 keywords = Food; obesity; snap summary = 29 Specific federal programs which "serve as critical supports for the physical and mental health and academic competence of children " are SNAP, WIC, Child and Adult Care Food Program, School breakfast and lunch program, and the Summer Food Service Program 26 Food programs like these are opportunities to provide healthy food for children most at risk for food insecurity and obesity. WIC provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and nonbreastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. Making WIC widely accessible to families hit hard by COVID-19 is crucial because WIC has been shown to both reduce the prevalence of food insecurity 42, 43 and obesity 44 and is an important contributor to early childhood health. doi = 10.1016/j.acap.2020.08.010 id = cord-333368-kjrk8nn9 author = Huizinga, Gabrielle P title = The Collision of Meta-Inflammation and SARS-CoV-2 Pandemic Infection date = 2020-09-03 keywords = COVID-19; SARS; obesity summary = While obesity and diabetes may complicate the delivery of supportive care in critical illness regardless of the underlying disease, lessons learned from the interaction of obesity with other systemic inflammatory syndromes suggest that obesity modifies biologic factors related to SARS-CoV-2 infection and the COVID-19 syndrome. In seasonal and pandemic influenza, however, obese individuals may be more susceptible to severe viral respiratory disease even if they mount a serologic response to vaccination 25 A c c e p t e d M a n u s c r i p t 11 Along with possible impairments in pathogen clearance, obese hosts are more likely to experience the breakdown of respiratory epithelium during a pulmonary infection, which leads to increased fluid in the airway space. doi = 10.1210/endocr/bqaa154 id = cord-321997-3dkl6iha author = Hussain, Abdulzahra title = Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease date = 2020-04-29 keywords = obesity summary = title: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Not only, NASH and NAFLD are important predictive factors for the outcomes in acute and chronic disease processes but also the obesity surgery and its complications [7] . We believe more powerful studies are needed to confirm why obesity is a risk factor for critical illness and or mortality in Covid-19. Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Effect of Body Mass Index, Metabolic Health and Adipose Tissue Inflammation on the Severity of Non-alcoholic Fatty Liver Disease in Bariatric Surgical Patients: a Prospective Study Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity Anand U 3 .Non-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations Nonalcoholic Steatohepatitis Is Associated With Increased Mortality in Obese Patients Undergoing Bariatric Surgery Risk of COVID-19 for patients with obesity doi = 10.1016/j.metabol.2020.154256 id = cord-300991-ipy24zxp author = Khan, Amira Sayed title = Obesity and COVID-19: Oro-Naso-Sensory Perception date = 2020-07-08 keywords = SARS; TNF; covid-19; obesity; olfactory summary = Through a recent upsurge of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, the clinical assessment of most of the coronavirus disease 19 (COVID-19) patients clearly presents a health condition with the loss of oro-naso-sensory (ONS) perception, responsible for the detection of flavor and savor. Hence, obesity represents a great risk factor for SARS-CoV-2 infection, as it may hide the viral-associated altered ONS symptoms, thus leading to a high mortality rate in these subjects. Moreover, the number of immunosuppressive T-regulatory, Treg (CD4 + CD25 + Foxp3 + ) cells and concentrations of IL-6, IL-10, and C-reactive protein (CRP) were upregulated in patients with severe COVID-19 [18] , suggesting that SARS-CoV-2 infection may lead to "over-immunosuppression" in the case of obesity ( Figure 1 ). SARS-CoV-2 infection may further aggravate the ONS functions; mask the obesity-induced inflammation, including loss of taste and smell; and render the obese subjects more vulnerable and prone to severe pathophysiological consequences such as RTI, leading to death. doi = 10.3390/jcm9072158 id = cord-311535-ppkwd1kp author = Korakas, Emmanouil title = Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes date = 2020-07-01 keywords = SARS; covid-19; obesity summary = The production of increased amounts of cytokines such as TNFα, IL-1, IL-6, and monocyte chemoattractant protein (MCP-1) lead to oxidative stress and defective function of innate and adaptive immunity, whereas the activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome seems to play a crucial role in the pathogenesis of the infection. Endothelial dysfunction and arterial stiffness could favor the recently discovered infection of the endothelium by SARS-CoV-2, whereas alterations in cardiac structure and function and the prothrombotic microenvironment in obesity could provide a link for the increased cardiovascular events in these patients. Chronic inflammation and oxidative stress, hypercytokinemia, immune dysregulation, endothelial dysfunction, and cardiovascular abnormalities are all possible mechanisms through which the excess in adipose tissue could lead to the acute hyperinflammatory state that characterizes severe SARS-CoV-2 infections and is responsible for its complications. doi = 10.1152/ajpendo.00198.2020 id = cord-329308-ipui7lo6 author = Lim, Soo title = Proper Management of People with Obesity during the COVID-19 Pandemic date = 2020-06-30 keywords = ACE2; COVID-19; SARS; angiotensin; obesity summary = During the COVID-19 pandemic, people have tended to gain weight because of environmental factors imposed by quarantine policies, such as decreased physical activity and increased consumption of unhealthy food. The common medications used to treat people with obesity, such as glucagon-like peptide-1 analogues, statins, and antiplatelets agents, should be continued because these agents have anti-inflammatory properties and play protective roles against cardiovascular and all-cause mortality. 54 A cumulative effect of chronic inflammation and hypercytokinemia seems to bring about a hyperinflammatory response through macrophage active syndrome, especially in patients with severe COVID-19 (Fig. 2) . Letter to the Editor: obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Letter to the Editor: obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease doi = 10.7570/jomes20056 id = cord-338317-ro041w5l author = Lockhart, Sam M. title = When two pandemics meet: Why is obesity associated with increased COVID-19 mortality? date = 2020-06-29 keywords = SARS; covid-19; insulin; obesity summary = Thus, the association of obesity with worse 105 outcomes in acute lung infection or widespread alveolar damage of other types, appears to be 106 strongest and most consistent with COVID-19 and pandemic H1N1 influenza. In addition to being lower in obesity and most insulin 168 resistant states it is worth noting that adiponectin levels have been reported to be significantly 169 lower in many of the COVID-19 "at risk" groups e.g. Male < Females 20 and South Asians < White 170 is secreted from adipose tissue, associated with insulin resistance and likely contributes to 197 thrombotic risk in obesity by impairing fibrinolysis 23 . In summary, we have applied insights into the pathophysiology of the adverse consequences of 279 obesity and emerging evidence regarding the pathological mechanisms in COVID-19 to suggest 280 possible routes whereby obesity can exacerbate the tissue damage associated with infection by the 281 SARS-CoV-2 virus. doi = 10.1016/j.medj.2020.06.005 id = cord-319580-awtp0mpg author = McCartney, Stephen A. title = Obesity as a contributor to immunopathology in pregnant and non‐pregnant adults with COVID‐19 date = 2020-08-11 keywords = COVID-19; SARS; obesity; woman summary = The synergistic effects of obesity‐associated delays in immune control of COVID‐19 with mechanical stress of increased adipose tissue may contribute to a greater risk of pulmonary compromise in obese pregnant women. The expression of ACE2 by adipocytes and immune cells also suggests the possibility that adipose tissue may represent a potential reservoir for viral infection and may lead to increased viral burden or persistence; however, no studies to date have demonstrated that adipocytes can be directly infected with SARS-CoV-2. Maternal obesity has emerged as a key risk factor increasing susceptibility of pregnant women to severe COVID-19 disease. There is also an urgent need to focus research on how risk factors, like obesity, alter the immune response to SARS-CoV-2 and influence disease pathogenesis of COVID-19 (Box 1). What is the mechanism of increased risk for severe COVID-19 disease in obese nonpregnant and pregnant women? doi = 10.1111/aji.13320 id = cord-344614-5zcylf6k author = Moriconi, Diego title = Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding date = 2020-06-04 keywords = SARS; obesity summary = Partial least square regression analysis showed that BMI, age and CRP at admission were related to longer length of hospital stay, and time for negative swab. Our study shows that obesity is associated with a severer respiratory presentation of COVID-19 and severer elevation of inflammatory markers, likely leading to higher oxygen demands at admission, prolonged oxygen requirement during hospitalization, delayed viral clearance and extended hospital stay. For this reason, beyond the potential impact on the lung mechanics, obesity might influence the clinical presentation and evolution of SARS-COV-2 infection through J o u r n a l P r e -p r o o f exacerbation of the immune-inflammatory response related to the disease, as confirmed by the increased levels of several inflammatory markers detected in the peripheral blood of patients with obesity in our population. doi = 10.1016/j.orcp.2020.05.009 id = cord-316260-1t3ifsfi author = Nogueira-de-Almeida, Carlos Alberto title = COVID-19 and obesity in childhood and adolescence: A clinical review()() date = 2020-08-04 keywords = COVID-19; SARS; child; increase; obese; obesity summary = In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. 3--6 The present review aims to identify the factors that contribute to the increase in the susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences, to collaborate for better clinical care of these patients. The three main risk factors that link obesity to COVID-19 demonstrated for adults 52 are also present among children and adolescents: chronic subclinical inflammation, impaired immune response, and underlying cardiorespiratory diseases. In conclusion, obesity in childhood and adolescence can be considered a risk factor for greater susceptibility and severity of COVID-19 and is associated with nutritional, cardiac, respiratory, renal, and immunological alterations, which may potentiate the complications of SARS-CoV-2 infection. doi = 10.1016/j.jped.2020.07.001 id = cord-301423-stod75j2 author = Parekh, Niyati title = Health behaviours during the coronavirus disease 2019 pandemic: implications for obesity date = 2020-08-04 keywords = food; health; obesity summary = DESIGN: We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. Sheltering-in-place has significantly altered health behaviours and the food environment by limiting opportunities for daily physical activities, encouraging screen time and sedentary behaviours, disturbing sleep and promoting consumption of ultraprocessed foods and alcohol. The average American adult spends 7·2-9·5 h/d engaged in sedentary behaviours, such as sitting while working, Higher alcohol intake Fig. 1 (colour online) Interrelationships of behavioural risk factors for weight gain that have been affected by the COVID pandemic; the confluence of these behavioural changes is hypothesised to exacerbate the national prevalence of obesity that is a threat for disease severity and mortality reading, watching television and using computers, smartphones or other devices (9) . doi = 10.1017/s1368980020003031 id = cord-301833-q8jiep32 author = Peres, Karina Colombera title = Body Mass Index and Prognosis of COVID-19 Infection. A Systematic Review date = 2020-08-14 keywords = BMI; COVID-19; obesity summary = Nine studies (two prospective cohorts, four retrospective cohorts and three cross-sectional) were included and assessed the relationship between obesity and COVID-19 prognosis. Most of the included studies showed some degree of association to: (a) higher BMI and worse clinical presentation and (b) obesity and need of hospitalization. Based on limited methodological quality studies, obesity seems to predict poor clinical evolution in patients with COVID-19. Herein, we perform a systematic review in order to evaluate if overweight and obesity may predict poor outcome in patients with COVID-19. We reviewed data from 17,568 patients with SARS-CoV-2 infection, included in nine studies. Most of these studies highlighted some level of association between obesity and disease severity, encompassing hospitalization rate, admission to ICU, invasive ventilation need and mortality. Once younger patients generally do not represent higher risk for a severe presentation of COVID-19, authors suggest that obesity may be an unrecognized risk factor for hospital care. doi = 10.3389/fendo.2020.00562 id = cord-351223-nnuoadh6 author = Pettit, Natasha N. title = Obesity is Associated with Increased Risk for Mortality Among Hospitalized Patients with COVID‐19 date = 2020-06-26 keywords = obesity; patient summary = [1] [2] [3] [4] [5] [6] [7] Early reports from Chinese series identified hypertension, diabetes, chronic pulmonary disease, and cardiovascular disease as the comorbidities most consistently associated with hospitalization, respiratory support, intensive care unit (ICU) admission, and death in COVID-19 patients. Subsequent reports from the United States and Europe suggested that patients with a higher body mass index (BMI) are at greater risk for hospital admission and severe disease requiring respiratory support. Secondary analyses included assessing the association of BMI group with oxygen requirement upon hospital admission, length of stay, ICU admission at any point, and mechanical ventilation at any point. Our study shows that amongst hospitalized patients with COVID-19 infection, obesity was significantly associated with mortality after adjusting for age, gender, and other comorbidities. This finding provides further evidence that obesity is a key comorbidity in COVID-19 that may not only predict severe disease requiring hospital admission, oxygen supplementation, or mechanical ventilation, but may also predict increased mortality. doi = 10.1002/oby.22941 id = cord-277803-7p1qu2rf author = Rubino, Francesco title = Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery date = 2020-05-07 keywords = bariatric; metabolic; obesity; patient; surgery summary = Given the uncertainty regarding the effects and duration of the COVID-19 outbreak, combined with the progressive nature of obesity, diabetes, and related conditions, delaying bariatric and metabolic surgery could increase the risks for morbidity and mortality in surgical candidates. doi = 10.1016/s2213-8587(20)30157-1 id = cord-325055-todb1d4x author = Rychter, Anna Maria title = Should patients with obesity be more afraid of COVID‐19? date = 2020-06-24 keywords = SARS; covid-19; obesity summary = Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID‐19 infection. Although the data regarding the impact of SARS-CoV-2 in individuals with obesity are limited and their association has not been fully defined yet, it has been observed that people suffering from excessive body weight may experience a more serious COVID-19 infection. 68 Whether the obesity paradox will be present among COVID-19 patients remains to be seen, nevertheless, the phenomenon was reported among other respiratory diseases, such as COPD or ARDS. 53, 69 Its pathophysiological basis remains unknown; however, an increased BMI seems to be associated with a better survival and a slower decline in the lung function in patients with a mild course of chronic obstructive pulmonary disease. Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Association of obesity with disease severity among patients with COVID-19. doi = 10.1111/obr.13083 id = cord-290551-a02tueuu author = Singh, Shailendra title = Impact of Obesity on Outcomes of Patients with COVID-19 in United States: A Multicenter Electronic Health Records Network Study. date = 2020-08-21 keywords = COVID-19; obesity; patient summary = title: Impact of Obesity on Outcomes of Patients with COVID-19 in United States: A Multicenter Electronic Health Records Network Study. We performed a retrospective cohort study using TriNetX (Cambridge, MA, USA), a global federated health research network that provided access to electronic medical records of patients from multiple large member healthcare organizations (HCOs) in United States. Our study using a large nationally representative database showed that COVID-19 patients with any degree of obesity had a significantly higher risk of hospitalization and intubation or death compared to patients without obesity. An analysis of a larger group of selected patients using diagnostic criteria of obesity as any time before the index event (after PSM n=9769) showed a higher risk for composite outcomes in the obesity group ( J o u r n a l P r e -p r o o f doi = 10.1053/j.gastro.2020.08.028 id = cord-354928-brliql4d author = Wang, Jian title = Overweight and obesity are risks factors of severe illness in patients with COVID‐19 date = 2020-07-31 keywords = COVID-19; obesity summary = CONCLUSION: Overweight and obesity were independent risk factors of severe illness in COVID‐19 patients. Old age and comorbidities, such as hypertension, diabetes, and chronic respiratory disease, were identified as risk factors of poor outcomes for COVID-19 patients according previous studies (3, 4) . Obesity was regarded as a common risk factor to aggravate the severity of respiratory diseases, which was associated with poor prognosis in influenza A (H1N1) pulmonary infection (5, 6) . A retrospective study enrolled 124 COVID-19 patients who were admitted to intensive care unit (ICU) showed more patients required invasive mechanical ventilation (IMV) therapy with increased body mass index (BMI) (12) . Several studies have demonstrated that the presence of type 2 diabetes was a significant risk factor of severe illness and fatal outcome of COVID-19 (24) (25) (26) . doi = 10.1002/oby.22979 id = cord-291627-5dqwyd9r author = Yadav, Rakhee title = SARS-CoV-2-host dynamics: Increased risk of adverse outcomes of COVID-19 in obesity date = 2020-07-21 keywords = COVID-19; China; SARS; obesity summary = 11 Many recent studies are now reporting obesity as one of the risk factors for severity of COVID-19 in USA, Brazil, UK, Italy, Spain and France [12] [13] [14] [15] [16] [17] [18] 67 (summarised in the In the current scenario, since USA has become the epi-centre of the COVID-19 pandemic; the dynamics of patient characteristics in terms of associated complications is showing a difference from the initial data put out by China. During the present pandemic, till now, it has been well established that cardiovascular diseases and diabetes are the major risk factors for poor outcomes but considering a higher BMI to be a forerunner for both these co-morbidities, the inclusion of obesity and overweight individuals as candidates for poor COVID-19 outcomes becomes very important. 58 Thus, the interaction between ACE2-RAS system, adipose tissue and the SARS-CoV-2 could, at least partially, explain the higher morbidity and mortality risk of COVID-19 in obese patients. doi = 10.1016/j.dsx.2020.07.030 id = cord-265139-x7g3jcjm author = Zaiou, Mohamed title = The Emerging Role and Promise of Circular RNAs in Obesity and Related Metabolic Disorders date = 2020-06-16 keywords = RNA; circrna; circular; obesity; study summary = There is also growing evidence that circRNAs are closely linked to non-alcoholic fatty liver disease (NAFLD), a disorder that is caused by a plethora of factors including hepatic lipid accumulation, adipose tissue and mitochondrial dysfunction, a high-fat diet, obesity, a chronic inflammatory state, insulin resistance (IR), and genetic and epigenetic factors [48, 55] . In addition to classical epigenetic modifications, a variety of ncRNAs have been uncovered in different cells and organs including adipose tissues, many of which are involved in the regulation of adipogenesis and other metabolic processes implying their role in the etiology of obesity [69] . Emerging evidence from in vitro and in vivo animal studies suggest that circRNAs are expressed in adipose tissues and may modulate adipogenesis and lipid metabolism. Collectively, the results from the above studies demonstrate that several circRNAs are differentially expressed in adipose tissue and support a significant role of these RNA species in the regulatory networks of adipogenesis. doi = 10.3390/cells9061473