Younger US Group With Severe COVID-19 More Likely to be Obese   Mark Mascolini In a multicenter US study, younger people admitted to a hospital intensive care unit (ICU) with COVID-19 were more likely to be obese than older people [1]. In populations with high obesity rates, the researchers predict, “COVID-19 will affect younger populations more than previously reported.” When the COVID-19 epidemic reached Baltimore, David Kass and coauthors at Johns Hopkins Hospital noticed that many younger people admitted to the ICU with SARS-CoV-2 infection were obese. Curious, Kass started phoning colleagues at other ICUs around the United States and they confirmed seeing similar trends. One reason COVID-19 may pose a particular threat in the United States, Kass and coauthors suggest, is the 36% prevalence of obesity in this country, compared with 20% in Italy and 6% in China [2]. To address these issues, the Johns Hopkins team organized a study of body mass index (BMI) and COVID-19 in ICUs at their hospital and in New York, Ohio, Washington State, Florida, and Pennsylvania. The analysis included 265 people admitted to an ICU with COVID-19, 58% of them men. Median BMI stood at 29.3 kg/m2, in the overweight range just below the obesity threshold of 30 kg/m2. Only 25% of the group had a BMI below 26 kg/m2, while 25% had a BMI above 34.7 kg/m2. Least squares univariate and multivariate analysis found a significant inverse correlation between age and BMI—the younger the patient, the more likely they were obese (r2 = 0.051, P = 0.0002). Male or female sex did not affect chances of obesity. The authors note several problems obesity may cause or compound in people with COVID-19: restricted breathing, impaired immune response to viral infection, greater inflammation, greater diabetes risk, and oxidant stress adversely affecting cardiovascular function. They call for more targeting of younger adults with public messages about COVID-19, lowering the threshold for SARS-CoV-2 testing in obese people, and “maintaining greater vigilance” for COVID-19 in young obese people. References 1. Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020 May 4. pii: S0140-6736(20)31024-2. doi: 10.1016/S0140-6736(20)31024-2. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31024-2.pdf 2. WHO. Global Health Observatory (GHO) data: overweight and obesity. 2017. https://www.who.int/gho/ncd/risk_factors/overweight_obesity/obesity_adults/en