The Effects of Obesity and Metabolic Abnormalities on Severe COVID-19-related Outcomes after Vaccination: A Population-Based Study. Fan et al.

Published: 17 February 2023| Version 1 | DOI: 10.17632/ht6w2ndk46.1
Xiude Fan


Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until Oct. 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (All P < .05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (All P < .05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive (adjusted hazard ratio (aHR) .64, 95% CI .48-.86; P = .003), glucose-lowering (aHR .55, 95% CI .36-.83; P = .004) and lipid-lowering treatments (aHR .50, 95% CI .37-.68; P < .001)) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination.


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We conducted a prospective cohort study using data from the UK Biobank between Dec. 8, 2020 and Oct. 18, 2021, and a cross-sectional study based on data from the 2021 National Health Interview Survey to assess the association between risk factors, particularly obesity and metabolic abnormalities, and the risk of severe COVID-19 in vaccinated patients, as well as the role of pharmacological interventions targeting metabolic abnormalities in the risk of severe COVID-19. Data S1, unprocessed data underlying the display items in the manuscript, related to Figures 1A, 3A, 4B, 4C, 5D, 5E, S2, S3A, S4D, S4E, S5, and S6. This study used data from the UK Biobank (application number 89483). For details please contact All other data are contained in the article and its supplementary information or available upon reasonable request.


Shandong Provincial Hospital


Metabolic Disorder, Obesity, Health Care Management, COVID-19