Association Between Obesity and COVID-19 Disease Severity in Saudi Population

Figures & data

Table 1 Distribution of Patients with COVID-19 According to Demographic Characteristics, N = 951, Saudi Arabia

		Class of Obesity						Total	P-value
		Underweight (≤18.5 kg/m^2)	Normal (18.5–24.9 kg/m^2)	Overweight (25.0–29.9 kg/m^2)	Class 1 Obesity (30–34.9 kg/m^2)	Class 2 Obesity (35–39.9 kg/m^2)	Class 3 Obesity (≥40 kg/m^2)
Sex	Male	37 (5.6%)	195 (29.4%)	253 (38.1%)	117 (17.6%)	39 (5.9%)	23 (3.5%)	664 (70%)	<0.05
	Female	18 (6.3%)	68 (23.8%)	98 (34.3%)	44 (15.4%)	37 (12.9%)	21 (7.3%)	286 (30%)
Nationality	Saudi	52 (10.4%)	122 (24.5%)	159 (31.9%)	78 (15.7%)	55 (11%)	32 (6.4%)	498 (52.9%)	<0.05
	Non-Saudi	4 (0.9%)	141 (31.1%)	192 (42.4%)	83 (18.3%)	21 (4.6%)	12 (2.6%)	453 (47.6%)
Age	0–2.5 years	9 (69.2%)	4 (30.8%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	13 (1.4%)	<0.05
	2.6–5 years	9 (81.8%)	1 (9.1%)	0 (0%)	0 (0%)	0 (0%)	1 (9.1%)	11 (1.16%)
	6–20 years	25 (30.1%)	29 (34.9%)	13 (15.7%)	8 (9.6%)	4 (4.8%)	4 (4.8%)	83 (10%)
	21–40 years	10 (2.6%)	126 (32.9%)	148 (38.6%)	64 (16.7%)	21 (5.5%)	14 (3.7%)	383 (40%)
	41–60 years	1 (0.3%)	76 (22.9%)	141 (42.5%)	62 (18.7%)	33 (9.9%)	19 (5.7%)	332 (30%)
	>61 years	2 (1.6%)	27 (21.1%)	48 (37.5%)	27 (21.1%)	18 (14.1%)	6 (4.7%)	128 (10%)
Severity of illness	Mild	51 (8.5%)	170 (28.2%)	208 (34.6%)	97 (16.1%)	48 (8%)	28 (4.7%)	602 (63%)	<0.05
	Moderate	3 (1.8%)	49 (29.3%)	78 (46.7%)	25 (15%)	9 (5.4%)	3 (1.8%)	167 (17.6%)
	Severe	0 (0%)	26 (25.5%)	35 (34.3%)	22 (21.6%)	11 (10.8%)	8 (7.8%)	102 (10.7%)
	Critical	2 (3.2%)	15 (23.8%)	24 (38.1%)	12 (19%)	5 (7.9%)	5 (7.9%)	63 (6.6%)
Site of admission	ICU	0 (0%)	14 (23.3%)	30 (50%)	13 (21.7%)	2 (3.3%)	1 (1.7%)	60 (10%)	<0.05
	General ward	20 (4%)	158 (31.7%)	194 (39%)	82 (16.5%)	29 (5.8%)	15 (3%)	498 (50%)
	Unknown	26 (10.8%)	51 (21.2%)	71 (29.5%)	44 (18.3%)	31 (12.9%)	18 (7.5%)	241 (30%)

Table 2 Distribution of Confirmed Cases of COVID-19 According to Symptoms, N=951

Symptoms	Class of Obesity						Total	P-value
	Underweight (≤18.5 kg/m^2)	Normal (18.5–24.9 kg/m^2)	Overweight (25.0–29.9 kg/m^2)	Class I Obesity (30–34.9 kg/m^2)	Class II Obesity (35–39.9 kg/m^2)	Class III Obesity (≥40 kg/m^2)
Cough	2 (0.7%)	85 (29.1%)	126 (43.2%)	59 (20.2%)	12 (4.1%)	8 (2.7%)	292 (30%)	<0.05
Fever	4 (1.4%)	81 (27.7%)	131 (44.9%)	58 (19.9%)	12 (4.1%)	6 (2.1%)	292 (30%)	<0.05
Sore throat	0 (0%)	10 (32.3%)	11 (35.5%)	5 (16.1%)	4 (12.9%)	1 (3.2%)	31 (3.30%)	0.65
Shortness of breath	1 (0.5%)	59 (30.6%)	75 (38.9%)	42 (21.8%)	8 (4.1%)	8 (4.1%)	193 (20%)	<0.05
Diarrhoea	0 (0%)	19 (40.4%)	16 (34%)	9 (19.1%)	1 (2.1%)	2 (4.3%)	47 (5%)	0.14
Vomiting	0 (0%)	4 (40%)	3 (30%)	1 (10%)	1 (10%)	1 (10%)	10 (1%)	0.81
Nausea	0 (0%)	6 (50%)	3 (25%)	2 (16.7%)	0 (0%)	1 (8.3%)	12 (13%)	0.45
Asymptomatic	2 (6.3%)	14 (43.8%)	9 (28.1%)	5 (15.6%)	2 (6.3%)	0 (0%)	32 (3.4%)	0.35

Table 3 Distribution of Confirmed Cases of COVID-19 According to Comorbidities, N=951

Comorbidities	Class of Obesity						Total	P-value
	Underweight (≤18.5 kg/m^2)	Normal (18.5–24.9 kg/m^2)	Overweight (25.0–29.9 kg/m^2)	Class I Obesity (30–34.9 kg/m^2)	Class II Obesity (35–39.9 kg/m^2)	Class III Obesity (≥40 kg/m^2)
Hypertension	0 (0%)	25 (26.6%)	37 (39.4%)	21 (22.3%)	7 (7.4%)	4 (4.3%)	94 (10%)	0.14
Diabetes mellitus	1 (0.7%)	46 (31.1%)	56 (37.8%)	30 (20.3%)	11 (7.4%)	4 (2.7%)	148 (20%)	<0.05
Asthma	0 (0%)	10 (25%)	15 (37.5%)	11 (27.5%)	4 (10%)	0 (0%)	40 (4.23%)	0.18
COPD	0 (0%)	1 (7.1%)	7 (50%)	3 (21.4%)	3 (21.4%)	0 (0%)	14 (1.5%)	0.17
Coronary heart disease	0 (0%)	8 (28.6%)	12 (42.9%)	3 (10.7%)	3 (10.7%)	2 (7.1%)	28 (3%)	0.66
Heart failure	0 (0%)	6 (27.3%)	9 (40.9%)	4 (18.2%)	2 (9.1%)	1 (4.5%)	22 (2.33%)	0.91
Stroke	1 (8.3%)	3 (25%)	5 (41.7%)	0 (0%)	3 (25%)	0 (0%)	12 (1.3%)	0.21
Malignancy	0 (0%)	4 (26.7%)	8 (53.3%)	0 (0%)	2 (13.3%)	1 (6.7%)	15 (1.6%)	0.39
Chronic kidney disease	0 (0%)	12 (35.3%)	16 (47.1%)	4 (11.8%)	2 (5.9%)	0 (0%)	34 (4.3%)	0.44
Chronic liver disease	0 (0%)	2 (16.7%)	3 (25%)	3 (25%)	4 (33.3%)	0 (0%)	12 (1.8%)	<0.05
Immunocompromised disease	3 (8.8%)	10 (29.4%)	15 (44.1%)	3 (8.8%)	2 (5.9%)	1 (2.9%)	34 (5.4%)	0.45
Organ transplant	0 (0%)	0 (0%)	1 (100%)	0 (0%)	0 (0%)	0 (0%)	1 (0.1%)	0.88

Table 4 Outcome of Clinical Management in Patients with COVID-19

Category	Class of Obesity							P-value
	Underweight (≤18.5 kg/m^2)	Normal (18.5–24.9 kg/m^2)	Overweight (25.0–29.9 kg/m^2)	Class I Obesity (30–34.9 kg/m^2)	Class II Obesity (35–39.9 kg/m^2)	Class III Obesity (≥40 kg/m^2)	N (%)
Medications
Antibiotics	4 (1.3%)	94 (30.1%)	132 (42.3%)	58 (18.6%)	16 (5.1%)	8 (2.6%)	312 (30%)	<0.05
Antimalaria	0 (0%)	19 (30.2%)	27 (42.9%)	13 (20.6%)	4 (6.3%)	0 (0%)	63 (6.6%)	<0.05
Bronchodilator	3 (2.9%)	28 (27.2%)	50 (48.5%)	17 (16.5%)	3 (2.9%)	2 (1.9%)	103 (10%)	<0.05
Corticosteroid	-	8 (33.3%)	10 (41.7%)	5 (20.8%)	1 (4.2%)	-	24 (2.5%)	<0.05
Response to medications
Symptoms improving	7 (1.6%)	141 (32.6%)	179 (41.4%)	77 (17.8%)	18 (4.2%)	10 (2.3%)	432 (50%)	0.87
Clinical outcome
Death	0 (0%)	2 (15.4%)	5 (38.5%)	1 (7.7%)	2 (15.4%)	3 (23.1%)	13 (2%)	<0.05
Hospital admission period in days (Mean ± SD)	10.14 ± 4.74	9.62 ± 5.86	10.37 ± 6.37	10.16 ± 5.61	9.57 ± 4.01	9.5 ± 4.37	10.02 ± 5.91	0.94

Table 5 Association of BMI and Diabetes Mellitus with Severe/Critical COVID-19

Risk Factor	B	S.E.	Wald	df	P value	Exp (B)	95% CI for EXP (B)
							Lower	Upper
Underweight (≤18.5 kg/m^2)	−1.258	0.747	2.840	1	0.09	0.284	0.066	1.228
Overweight (25.0–29.9 kg/m^2)	0.142	0.233	0.369	1	0.54	1.152	0.730	1.820
Class I obesity (30–34.9 kg/m^2)	0.410	0.272	2.278	1	0.13	1.507	0.885	2.569
Class II obesity (35–39.9 kg/m^2)	0.491	0.347	2.002	1	0.15	1.634	0.828	3.226
Class III obesity (≥40 kg/m^2)	1.056	0.388	7.408	1	<0.05	2.874	1.344	6.149
History of diabetes mellitus	1.684	0.202	69.270	1	<0.05	5.385	3.622	8.005