Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives
Curr Obes Rep. 2021 Apr 28. doi: 10.1007/s13679-021-00436-y
Maria Dalamaga 1, Gerasimos Socrates Christodoulatos 2, Irene Karampela 2 3, Natalia Vallianou 4, Caroline M Apovian 5
- 26 health factors increase the risk of COVID-19 – all are associated with low vitamin D
- Obesity is just one of the 26
- Vitamin D levels have been crashing since 1995 (Polish Children, Elite Military, etc)
Items in both categories Virus and Obesity are listed here:
- Co-Epidemic of Obesity and COVID-19 (a co-epidemic of Vitamin D not mentioned) – April 2021
- COVID-19 hospitalizations: 63% associated with diabetes, obesity, hypertension or heart failure – Feb 2021
- Light case of COVID-19 in immunocompromised obese man with many comordities but good level of vitamin D – March 2021
- Obese get less benefit from vaccines: influenza, hepatitis B, rabies and now COVID-19 - March 2021
- 26 health factors increase the risk of COVID-19 – all are associated with low vitamin D
- Virus (adeno-36) increases Obesity which then increases risk of another virus (Influenza) - Oct 2013
- Increased weight in children 8X more likely for each unit increase in adenovirus (if ignore Vitamin D) – Nov 2019
- 25 year review of Adenovirsus and obesity – 2018
- Adenovirus-36 is strongly associated with Obesity (possibly prevented and treated by Vitamin D)
- Adenovirus-36 association with obesity letter to editor – 2011
- Obesity pandemic since 1975 - is it due to Vitamin D, Magnesium, Iodine, adenovirus, or what
- Low vitamin D then Obesity then adenovirus-36
Overview Obesity and Vitamin D contains the following summary
- FACT: People who are obese have less vitamin D in their blood
- FACT: Obese need a higher dose of vitamin D to get to the same level of vit D
- FACT: When obese people lose weight the vitamin D level in their blood increases
- FACT: Adding Calcium, perhaps in the form of fortified milk, often reduces weight
- FACT: 153 trials for vitamin D intervention of obesity as of Sept 2020
- FACT: Less weight gain by senior women with > 30 ng of vitamin D
- FACT: Dieters lost additional 5 lbs if vitamin D supplementation got them above 32 ng - RCT
- FACT: Obese lost 3X more weight by adding $10 of Vitamin D
- FACT: Those with darker skins were more likely to be obese Sept 2014
- OBSERVATION: Many mammals had evolved to add fat and vitamin D in the autumn
- and lose both in the Spring - unfortunately humans have forgotten to lose the fat in the Spring
- SUGGESTION: Probably need more than 4,000 IU to lose weight if very low on vitamin D due to
risk factors such as overweight, age, dark skin, live far from equator,shut-in, etc.
- Obesity category has
Fast weight loss by Obese: Summary of the data as of Sept 2019
1) 50,000 IU Vitamin D weekly for at least 6 months
If gut problems, should use a gut-friendly form of vitamin D
2) Add calorie restriction diet and light exercise after ~2 months*
* Vitamin D levels must be above 30ng/ml to help with weight loss
* Start losing weight 2 months sooner if take a 50,000 IU daily for a week
3) More weight loss if also add Magnesium or cofactors
30% Improved Vitamin D response with Magnesium - a Vitamin D Cofactor
Note: Magnesium reduces weight loss by itself as well
20% improved vitamin D response if also add Omega-3 a Vitamin D Cofactor
Note: Omega-3 reduces weight loss by itself as well
4) More weight loss if also improve activation of Vitamin D Receptor
Vitamin D Receptor activator: 0-30% improved Vitamin D response
Obesity 1.5 X more likely if poor Vitamin D Receptor – meta-analysis Nov 2019
Update Dec 2019 - Dr. Greger plant-based eating (not diet) for both weight loss and health.
His book does not mention Vitamin D nor Adenovirus
- As of June 21, the page had: 34 trials, 5 trial results, 17 meta-analyses and reviews, 59 observations, 34 recommendations, 53 associations, 88 speculations, 45 videos see related: Governments, HealthProblems, Hospitals, Dark Skins, 26 risk factors are ALL associated with low Vit D, Recent Virus pages Fight COVID-19 with 50K Vit D weekly Vaccine problems
Purpose of review: A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the "obesity paradox," and presents implications in prevention and treatment as well as future perspectives.
Recent findings: Data from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors:
- (i) impaired innate and adaptive immune responses;
- (ii) chronic inflammation and oxidative stress;
- (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement;
- (iv) overactivation of the renin-angiotensin-aldosterone system;
- (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue;
- (vi) associated cardiometabolic comorbidities;
- (vii) vitamin D deficiency;
- (viii) gut dysbiosis; and
- (ix) mechanical and psychological issues.
Mechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.
Based on a recent meta-analysis of 8176 COVID-19 patients participating in 26 studies, individuals with severe COVID-19 presented 65% (OR: 1.65, 95% CI: 1.30-2.09) more vitamin D deficiency (<50 nmol/L) compared with mild caseso f the infection. Interestingly, a serum vitamin D concentration of less than 75 nmol/L increased hospitalization by 81% (OR: 1.81, 95% CI: 1.41-2.21) and mortality by 82% (OR: 1.82,95%CI: 1.06-2.58) from COVID-19 . However, vitamin D deficiency (OR: 1.35, 95% CI: 0.80-1.88) was not associated with an increased likelihood of COVID-19 infection [156, 157].
At the molecular level, vitamin D and its receptor (VDR), which is expressed on immune (B cells, T cells, and antigen- presenting cells) and pulmonary epithelial cells, plays an important role in both the innate and adaptive immune responses . Vitamin D induces the transcriptional expression of antimicrobial peptides such as cathelicidins and defensins. Cathelicidins act by destructing the bacterial cell membranes and the enveloped viruses such as SARS-CoV-2, while defensins enhance chemotaxis of inflammatory cells through increased capillary permeability . At the same time, vitamin D decreases pro-inflammatory cytokines, such as IL-6 and TNF-a, which are involved in the development of the cytokine storm in COVID-19 that precedes ARDS .
Remarkably, obesity is associated with vitamin D deficiency due to the lipophilic nature ofthe adipose tissue which acts as an isolator of vitamin D rather than a depot . Other mechanisms linking higher BMI to lower vitamin D include the lesser skin exposure to sunlight, the diminished outdoor physical activity, the lower vitamin D intake, and the reduced intestinal absorption of vitamin D [161, 162].
Interestingly, vitamin D deficiency has been found to be an independent risk factor for the development of ARDS, its severity, and mortality. Notably, a bulk of recent studies have reported that vitamin D deficiency is associated with severe COVID-19 and a higher risk for progression to ARDS . Interestingly, the biologic pathways involved in the pleiotropic actions of vitamin D intersect with the dysregulated mechanisms during COVID-19-related ARDS, providing some possible explanations behind this association. Vitamin D and its metabolites are implicated in the ACE2 expression, modulate genes associated with thrombotic pathways, particularly those related to angiogenesis, activate the lung-protective cathelicidin, and downregulate pro-inflammatory cytokines blocking the cytokine storm, such as TNF-a, IL-6, IL-8, IL- 12, and IFN-y . Collectively, vitamin D deficiency may be a potential link between obesity and COVID-19-associated ARDS . However, the exact efficacy ofvitamin D supplementation for the prevention of or as a potential adjunct therapeutic option for COVID-19 remains to be determined. Currently, a number of RCTs are actively investigating the potential benefits of vitamin D supplementation.
Shorturl = is.gd/3pandemicCo-Epidemic of Obesity and COVID-19 (a co-epidemic of Vitamin D not mentioned) – April 2021
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