key: cord-0691678-nffepexe
authors: Landecho, MF Manuel Fortún; Frühbeck, Gena
title: Benefits of bariatric surgery prior to SARS CoV 2 infection in modulating the response to COVID‐19
date: 2020-10-06
journal: Obesity (Silver Spring)
DOI: 10.1002/oby.23059
sha: 2822b50bcec35039a3e29602c57cf46658b97728
doc_id: 691678
cord_uid: nffepexe

As of October 2020, the Severe Acute Respiratory Syndrome coronavirus 2 (SARS‐CoV‐2), responsible for Coronavirus Disease 2019 (COVID‐19), has infected over 33million individuals and killed over one million people worldwide. (https://coronavirus.jhu.edu/map.html accessed October 1 2020) Obesity and its complications are linked to severe forms of COVID‐19, favouring an increased hospitalization and mortality rate. Despite being the gold‐standard for the treatment of selected individuals with severe obesity, there is scarce information on whether or not bariatric surgery modifies the prognosis of people living with obesity in the current COVID‐19 pandemic. Bel Lassen and colleagues have carried out the first study with a high number of patients in their sample, bringing light into this area of uncertainty. The authors provide evidence of the importance of diabetes itself as a risk factor for severe COVID‐19.

This article is protected by copyright. All rights reserved treatment of selected individuals with severe obesity, there is scarce information on whether or not bariatric surgery modifies the prognosis of people living with obesity in the current COVID-19 pandemic. Bel Lassen and colleagues (2) have carried out the first study with a high number of patients in their sample, bringing light into this area of uncertainty. The authors provide evidence of the importance of diabetes itself as a risk factor for severe COVID-19.

The study describes the prevalence of symptom-based likelihood of COVID-19 (CL group), with a retrospective comparison of the characteristics at baseline, and one-year post-procedure, in a survey-based analysis of 738 patients who had bariatric surgery prior to the pandemic.

Symptoms suggesting COVID-19 occurred in 62 (8.4%) patients while, at the time of the survey, a global estimation reported an estimated prevalence of COVID-19 cases of 9.9% (3). Four among the 62 patients (6.4%) had severe COVID-19 requiring hospitalization and one of them (1.6%) died, which means that even with a similar symptomatic infection rate, mortality was significantly below the one observed in patients with obesity not treated with surgery (4). The mechanisms potentially underlying this effect are unknown but may be multifactorial.

Interestingly, the COVID-19-likely (CL) group exhibited two major differences with the group of patients who experienced no symptoms suggesting SARS-CoV-2 infection. On one hand, the CL group had a higher proportion of persistent type 2 diabetes at the last follow-up. On the other, the CL group presented a lower body mass index (BMI) at the time of lockdown, with higher percent weight loss since surgery. Severe forms of COVID-19 requiring hospitalization were associated with persistent type 2 diabetes at the last follow-up visit. This fact may add argument to the independent risk factor relevance of diabetes itself in association with COVID-19 severity. A second factor was the lower BMI observed in the CL group, which seems counterintuitive. Although no experimental evidence has been gathered in this line, patients with functional malnutrition post surgery may be at higher risk for severe COVID-19. Functional malnutrition is most frequently observed in patients who are lost to follow-up, thereby stressing the importance of a long-term care following bariatric surgery.

This article is protected by copyright. All rights reserved Prospective studies are difficult to design and perform; thus in the absence of class 1Aevidence, this retrospective study supports that having undergone bariatric surgery prior to COVID-19 and the subsequent improved glycemic control seems to protect people living with obesity from more severe COVID 19. In this context, additional factors will need to be investigated as plausible beneficial effects of bariatric surgery, including direct or indirect postoperative immunomodulatory actions that might counteract the immunological derangements observed in severe obesity (5) and, as well, the crucial role of nutritional follow up after surgery.

European Association for the Study of Obesity Position Statement on the Global COVID-19 Pandemic

COVID-19 and its severity in bariatric surgery operated patients. Obesity (Silver Spring) Online ahead of print

Estimating the burden of SARS-CoV-2 in France

Obesity and mortality of COVID-19. Meta-analysis

Obesity and COVID-19: a perspective from the European Association for the Study of Obesity on immunological perturbations, therapeutic challenges, and opportunities in obesity