Supplemental material - BMJ Nutrition, Prevention & Health

Overweight and Obesity as Risk Factors for COVID-19-Associated Hospitalizations and Death:

Systematic Review and Meta-Analysis.

SUPPLEMENTAL MATERIAL

Legends for Supplemental Tables and Figures

Supplemental Figure 1. Forest plots, studies from the general population

Supplemental Figure 1.1. Forest plot illustrating the association between BMI continuous (1 unit increase) and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental Figure 1.2. Forest plot illustrating the association between overweight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.3. Forest plot illustrating the association between obese vs normal weight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.4. Forest plot illustrating the association between obese vs non-obese and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.5. Forest plot illustrating the association between extreme obese vs normal weight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.6. Forest plot illustrating the association between extreme obese vs non-obese and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.7. Forest plot illustrating the association between non-BMI defined obesity and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental Figure 2. Funnel plots, studies from the general population

Supplemental 2.1. Funnel plots with pseudo 95% confidence limits for BMI continuous, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.2. Funnel plots with pseudo 95% confidence limits for overweight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.3. Funnel plots with pseudo 95% confidence limits for obese vs normal weight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.4. Funnel plots with pseudo 95% confidence limits for obese vs non-obese, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.5. Funnel plots with pseudo 95% confidence limits for extreme obese vs normal weight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.6. Funnel plots with pseudo 95% confidence limits for extreme obese vs non-obese, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental 2.7. Funnel plots with pseudo 95% confidence limits for non-BMI defined obesity, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

Supplemental Table 1. Characteristics and quality assessment of included studies

Supplemental Table 2. Pooled estimate of the association between obesity and COVID-19 outcomes, general

population and cohort studies.

Supplemental Table 3. Pooled estimate of the association between obesity and COVID-19 outcomes, general

population and prospective cohort studies.

References

BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) bmjnph

doi: 10.1136/bmjnph-2021-000375:e000375.0 2022;bmjnph, et al. Sawadogo W

Supplemental Figure 1. Forest plots, studies from the general population

Supplemental 1.1. Forest plot illustrating the association between BMI continuous (1 unit increase) and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.2. Forest plot illustrating the association between overweight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

(a)

(b)

(c)

(a)

(b)

(c)



Supplemental 1.3. Forest plot illustrating the association between obese vs normal weight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

(a)

(b)

(c)



Supplemental 1.4. Forest plot illustrating the association between obese vs non-obese and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

(a)

(b)

(c)



Supplemental 1.5. Forest plot illustrating the association between extreme obese vs normal weight and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of outcomes pertaining to a severe disease.

Supplemental 1.6. Forest plot illustrating the association between extreme obese vs non-obese and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations

of outcomes pertaining to a severe disease.

Supplemental 1.7. Forest plot illustrating the association between non-BMI defined obesity and (a) hospital admission, ICU and IMV; (b) death; (c) the combinations of

outcomes pertaining to a severe disease.

(a)

(b)

(c)

(a)

(b)

(c)

(a)

(c)

(b)



Supplemental Figure 2. Funnel plots, studies from the general population

(a) (b) (c)

Supplemental 2.1. Funnel plots with pseudo 95% confidence limits for BMI continuous, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

(a) (b) (c)

Supplemental 2.2. Funnel plots with pseudo 95% confidence limits for overweight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

(a) (b) (c)

Supplemental 2.3. Funnel plots with pseudo 95% confidence limits for obese vs normal weight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

(a) (b) (c)

Supplemental 2.4. Funnel plots with pseudo 95% confidence limits for obese vs non-obese, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease



(a) (b) (c)

Supplemental 2.5. Funnel plots with pseudo 95% confidence limits for extreme obese vs normal weight, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

(a) (b) (c)

Supplemental 2.6. Funnel plots with pseudo 95% confidence limits for extreme obese vs non-obese, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease

(a) (b) (c)

Supplemental 2.7. Funnel plots with pseudo 95% confidence limits for non-BMI defined obesity, (a) hospital admission, ICU and IMV, (b) death, (c) combinations of outcomes pertaining to a severe disease



Supplemental Table 1. Characteristics and quality assessment of included studies (n=208)

First Author Country Design Participants N Obesity classification COVID severity NOS

Abdel-Gelil G.1 Egypt prospective general population 114 BMI continuous severe pneumonia,

AKI, ICU

8

Abumayyaleh M.2 Multicounty retrospective general population 3635 BMI < 25, 25-30, >30 death 7

Agca M.3 Turkey retrospective general population 284 normal weight, overweight, obese ICU, IMV 7

Alguwaihes A. 4 Saudi Arabia retrospective adult 439 obese, non-obese death, ICU, IMV 7

Alkhatib A. 5 USA cross

sectional

African Americans 158 BMI continuous ICU 7

Almazeedi S. 6 Kuwait retrospective general population 1096 BMI<30, ≥30 death, ICU 8

Al-Sabah S. 7 Kuwait retrospective general population 1158 BMI:18.5–24.9, 25.0–29.9, 30–34.9, 35–39.9, ≥40

ICU 7

Al-Salameh A. 8 France retrospective general population 329 normal weight, overweight, obese ICU, death 8

Anderson M. 9 USA retrospective adult 2466 BMI <18.5, 18.5 to 24.9, 25 to

29.9, 30 to 34.9, 35 to 39.9, ≥40 death or intubation 8

Antwi-Amoabeng D. 10

USA retrospective general population 172 BMI> 30, <30 death 7

Apea V. 11 England prospective age > 16 years 1737 obese, non-obese death 7

Arshada S. 12 USA retrospective general population 2541 BMI<30, ≥30 death 7

Badedi M. 13 Saudi Arabia case-control general population 323 Obese, non-obese death 6

Bahl A. 14 USA prospective age ≥ 18 years 1461 BMI continuous death 8

Balfanz P. 15 Germany retrospective general population 125 obese, non-obese ARDS or death 7

Bellini B. 16 Italy retrospective general population 7540 BMI ≥30, <30 hospitalization 6

Bennett K. 17 Ireland retrospective general population 19789 BMI > 40, < 40 hospitalization,

ICU, death

7

Bhatt A. 18 USA retrospective patients with heart

failure

8383 Non-obese, obese, morbid obese death 6

Breland J. 19 USA retrospective U.S. army veterans 9347 BMI continuous hospitalization,

ICU, death

6

Brouqui P. 20 France retrospective age ≥ 18 years 1107 obese, non-obese death or ICU 7

Bunne K. 21 USA retrospective general population 124 visceral adipose tissue ICU or death 7

Cai H. 22 China retrospective general population 455 BMI continuous severe/critical 7

Cai Q. 1 23 China prospective adult 383 BMI <18.5, 18.5–23.9, 24.0–27.9,

≥28 severe COVID-19 8

Cai Q. 2 24 China retrospective general population 298 BMI continuous progression to

severity

7

Cai Shao-H. 25 China retrospective general population 96 BMI < 24, ≥24 ICU 7

Cao P. 26 China retrospective age ≥ 18 years 1637 underweight, normal, overweight,

obese

severe pneumonia,

oxygen therapy

7

Cariou B. 27 France retrospective patients with

diabetes

1020 BMI continuous IMV or death 6

Carillo-Vega M. 28 Mexico retrospective general population 9946 obese, non-obese hospitalization 7

Caussy C. 29 France retrospective general population 340 BMI≥ 30, <30 ICU 6

Cavallaro M. 30 England retrospective general population 13954 obesity (clinical) ICU, death 7



Cedano J. 31 USA retrospective adult 448 BMI>30, <30 death 7

Chand S. 32 USA retrospective adult 300 BMI continuous death 6

Conway B. 33 USA retrospective general population 8810 obese, non-obese death 6

Coss-Rovirosa M. 34 Mexico retrospective age ≥ 18 years 355 normal weight, overweight, obese IMV 6

Cottini M. 35 Italy prospective age ≥ 18 years 338 obese, non-obese hospitalization 7

Cummins L. 36 England retrospective age ≥ 16 years 1781 obese, non-obese hospitalization,

ICU, death

8

Czernichow S. 37 France prospective age 18-79 years 5795 BMI <18.5, 18.5-24.9, 25-29.9, 30-

34.9, ≥ 40

death 8

Dana R. 38 France retrospective general population 222 BMI <30, 30-39, ≥ 40 Death 7

De Andrade C. 39 Brazil cross-

sectional

general population 89405 obese, non-obese death 7

Denova-Gutiérrez E. 40

Mexico cross-

sectional

general population 3844 obese, non-obese ICU 8

Di Bella S. 41 Italy prospective adult 132 neck circumference IMV 8

Docherty A. 42 UK prospective general population 20133 obese, non-obese death 8

Dres M. 43 Multicounty prospective age > 70 years 1199 BMI <25, 25-29.9, 30-34.9, 35-

39.9, ≥ 40

death 7

Eastment M. 44 Columbia retrospective U.S. army veterans 25925 BMI <18.5, 18.5-24.9, 25-29.9, 30-

34.9, 35-39.9, ≥40

hospitalization,

ICU, IMV, death

6

Ebinge J. 45 USA retrospective general population 442 BMI<30, ≥30 ICU or intubation 7

Elhadi M. 46 Libya prospective general population 465 BMI continuous death 8

Farrell R. 47 Ireland retrospective general population 257 overweight/obese, normal weight death, ICU 6

Favre G. 48 France retrospective general population 165 visceral fat IMV or death 6

Fernandes D. 49 USA retrospective,

prospective

children and youth

≤22 years

315 BMI ≥95th percentile for age and sex

ICU 7

Ferrando-Vivas P. 50 UK retrospective general population 9990 BMI continuous death 7

Filardo T. 51 USA retrospective general population 270 BMI ≥30, <30 death 7

Florence A. 52 France retrospective patients with

rheumatic and

inflammatory

diseases

694 BMI <30, 30–39.9, ≥40 ICU or death 6

Fox T. 53 USA retrospective age ≥18 years 355 BMI continuous death 7

Frank R. 54 USA retrospective general population 305 BMI <25, 25-30, 30-35, ≥35 intubation or death 7

Fresán U. 55 Spain prospective general population 1105 BMI ≥ 40, <40 hospitalization,

ICU or death

9

Fried M. 56 USA retrospective general population 11721 obese, non-obese IMV, death 7

Fu C. 57 USA case control general population 4184 underweight, overweight, normal

weight, obese, morbidly obese

death 7

Gao F. 58 China case control adult 150 BMI ≥25, <25 severe COVID-19 7

Gao M. 59 UK prospective general population 13503 BMI continuous hospitalization,

ICU, death

9

Garcıa-Alvarado F. 60 Mexico prospective general population 105 obese, non-obese death 8

Garibaldi B. 61 USA retrospective general population 832 BMI continuous severe disease

including death

8



Gayam V. 62 USA retrospective African Americans 408 BMI continuous death 6

Giacomelli A. 1 63 Italy prospective general population 233 BMI ≥ 30, <30 death 8

Giacomelli A. 2 64 Italy prospective general population 520 obese, non-obese death 7

Goehler A. 65 USA retrospective general population 378 VAT, normal weight, overweight,

obese

death 6

Gonçalves D. 66 Brazil retrospective general population 182700 obese, non-obese IMV, ICU, death 6

Goodman K. 67 USA retrospective general population 42102 obese, non-obese death 7

Goyal P. 68 USA retrospective general population 1687 obese, normal weight death 8

Grosgurin O. 69 Switzerland retrospective general population 2607 BMI continuous ICU 6

Gu T. 70 USA retrospective general population 5698 BMI<18.5, 18.5 -24.9, 25-29.9, ≥30 hospitalization,

ICU

8

Gude-Sampedro F. 71 Spain retrospective general population 10454 obese, non-obese hospitalization,

ICU, death

7

Guerson-Gil A. 72 USA retrospective age ≥18 years 3530 BMI 18.5–24.9, <18.5, 25-29.9, 30-

34.9, ≥40

death, intubation 8

Gupta S. 73 USA retrospective age ≥18 years 2215 BMI <25, 25-29.9, 30-34.9, 35-

39.9, ≥40

death 7

Hajifathalian K. 74 USA retrospective age ≥18 years 770 BMI <18.5, 18.5-30, ≥30 ICU, IMV, death 7

Halasz G. 75 Italy retrospective general population 242 BMI 18.5-24.9, 25-29.9, 30-34.9,

35-39.9, ≥40

death 7

Hamer M. 76 UK prospective age 40 to 69 years 760 BMI<25, 25-30, ≥30 hospitalization 8

Hashemi N. 77 USA retrospective general population 363 obese, non-obese IMV, ICU, death 7

Hendren N. 78 USA Retrospective general population 7606 BMI <18.5, 18.5-24.9, 25.0-29.9,

30-34.9, 35.0–39.9, ≥40

death or

mechanical

ventilation

7

Huet T. 79 France prospective general population 96 BMI continuous IMV or death 8

Iaccarino G. 80 Italy cross-

sectional

general population 2378 obese, non-obese ICU 7

Ioannou G. 81 USA retrospective U.S. army veterans 10131 BMI < 18.5, 18.5-24.9, 25.0-29.9,

30-34.9, ≥35

hospitalization,

IMV, death

7

Jayanama K. 82 Thailand retrospective age ≥15 years 147 <18.5, 18.5-22.9; 23-24.9; ≥25 severe pneumonia 7

Kaeuffer C. 83 France prospective adult 1045 BMI <25, 25-29.9, ≥30 death 8

Kalligeros M. 84 USA retrospective adult 103 BMI <25, 25-29.9, 30-34.9, ≥35 ICU, IMV 7

Kang I. 85 Korea retrospective general population 3827 <18.5, 18.5-22.9, 23-24.9, 25.0-

29.9, ≥30

death 7

Karras A. 86 France retrospective general population 169 BMI continuous ICU, death 6

Kayem G. 87 France retrospective pregnant women 617 BMI>30, <30 oxygen requiring +

critical disease

7

Killerby M. 88 USA case control age ≥18 years 531 BMI<30, ≥30 hospitalization 8

Kim L. 89 USA retrospective general population 2491 BMI<30, ≥30 ICU, death 7

Kim Shin-W. 90 Korea retrospective general population 2254 BMI >25, <25 death 7

Kim So Y. 91 Korea retrospective general population 4057 BMI ≥25, <25 death 6

Kim T. 92 USA retrospective adult 10861 BMI<18.5, 18.5-24.9, 25-29.9, 30-

34.9, 35-39.9, ≥40

IMV, death. 8

Klang E. 93 USA retrospective general population 3406 BMI< 30, 30–40, ≥ 40 death 8



Kompaniyets L. 1 94 USA retrospective age ≥18 years 148494 BMI <18.5, 18.5-24.9, 25-29.9, 30-

34.9, 35–39.9, 40–44.9, >45

hospitalization,

ICU, IMV, death

7

Kompaniyets L. 2 95 USA cross-

sectional

children age ≤ 18 43465 obese, non-obese hospitalization,

severe disease

(ICU, IMV, death)

7

Krause M. 96 USA retrospective general population 85 obese, non-obese death 7

Krishnamoorthy G. 97 USA retrospective age >15 years 744 BMI continuous death 7

Kristan M. 98 USA retrospective patient with

diabetes

569 BMI continuous hospitalization,

death

6

Kuderer N. 99 Multicounty retrospective patients with

cancer

928 obese, non-obese death 6

Lassale C. 100 UK retrospective middle-aged adults 640 BMI continuous hospitalization 8

Leoni M. 101 Italy retrospective general population 242 obese, non-obese death 6

Liu B. 102 Australia retrospective general population 4055 obese, non-obese ICU or death 7

Lohia P. 103 USA retrospective age ≥18 years 1871 obese, non-obese ICU, IMV, death 8

Louapre C. 104 France retrospective patients with

multiple sclerosis

347 BMI <30, ≥30 severe disease

including death

6

Lunski M. 105 USA retrospective patients with

cancer


Malavazos A. 106 Italy retrospective general population 215 waist circumference, obese, non-

obese

chest X ray

severity score

7

Marmarchi F. 107 USA retrospective age ≥18 years 288 BMI continuous death 6

Martinez-Portilla R. 108

Mexico retrospective women 181088 obese, non-obese ICU, IMV, death 7

McGurnaghan S. 109 Scotland retrospective general population 2724 BMI continuous death or ICU 6

Mejı´a F. 110 Peru retrospective adult 369 obese, non-obese death 7

Mejia-Vilet J. 111 Mexico prospective age >18 years 705 BMI > 30, <30 ICU 8

Menezes M. 112 Brazil retrospective pregnant women 2475 obese, non-obese ICU 6

Menezes S. 113 Brazil retrospective general population 10713 obese, non-obese hospitalization 7

Merzon E. 114 Israel retrospective 5 to 60-year-old 1870 obese, non-obese hospitalization 6

Monteiro A. 115 USA retrospective age >18 years 112 obese, non-obese death, ICU, IMV 6

Moon A. 116 Multicounty retrospective patients with

chronic liver

disease

152 BMI<30, ≥30 death 7

Mostaghim A. 117 USA retrospective age >18 years 789 BMI<30, 30-34.9 and >35 ICU 7

Motaib I. 118 Morocco retrospective adult 107 BMI<25, 25-29.9, ≥30 ICU 7

Muñoz-Price L. 119 USA cross-

sectional

general population 2595 BMI continuous hospitalization,

ICU, IMV, death

7

Munoz-Rodríguez J. 120

Spain prospective general population 12126 obese, non-obese death 8

Murillo-Zamora E. 121 Mexico retrospective age >18 years 66123 BMI<30, ≥30 death 7

Naaraayan A. 122 USA retrospective general population 348 normal weight, overweight, obese

1, obese 2, obese 3

death 7

Nachega J. 123 DRC retrospective general population 766 obese, non-obese death 7



Nakeshbandi M. 124 USA retrospective general population 684 BMI 18.50-24.99, 25.00-29.99, ≥ 30

death, intubation 7

Nanda S. 125 USA retrospective age >18 years 1169 BMI continuous death or ICU 6

Neira D. 126 USA retrospective general population 10216 obese, non-obese hospitalization 7

Nijman G. 127 Netherlands prospective general population 1006 BMI continuous death 8

O’Horo J. 128 USA retrospective general population 7217 BMI <18.5, 18.5-24.9, 25-29.9, 30-

39.9, >=40

hospitalization 7

Okauchi Y. 129 Japan retrospective general population 133 BMI ≥25, <25 oxygen

requirement

6

Olivas-Martinez A. 130 Mexico prospective adult 800 normal, overweight, obese 1, 2, 3 death 7

Omrani A. 131 Qatar retrospective general population 5000 BMI continuous death, ICU 7

Ong S. 132 Singapore retrospective general population 182 BMI <25, ≥25 ICU, IMV, death 7

Pablos J. 133 Spain retrospective general population 456 obese, non-obese ICU or IMV or

death

7

Palaiodimos L. 134 USA retrospective general population 200 BMI <25, 25–34, ≥ 35 death, intubation 8

Parikh R. 135 USA retrospective general population 160 BMI>30, <30 death, IMV 6

Patel K. 136 UK retrospective middle-aged adults 13502 waist to hip ratio death 6

Pediconi F. 137 Italy retrospective general population 62 visceral adipose tissue ICU 6

Peña J. 138 Mexico retrospective general population 323671 obese, non-obese death 7

Peng Y. 139 China prospective cardiovascular

patients

244 BMI <24, ≥24 death 7

Petersen A. 140 Germany retrospective general population 30 visceral adipose tissue ICU, intubation 6

Peters S. 141 UK retrospective middle-aged adults 502493 BMI continuous death 6

Petrilli C. 142 USA prospective general population 2725 BMI <25, <25-29.9, 30-39.9, ≥ 40 hospitalization,

death

8

Pettit N. 143 USA retrospective general population 238 BMI <30, ≥30 death, admission

hypoxemia

7

Phipps M. 144 USA retrospective patients with liver

injury

2273 BMI > 35 death or discharge

to hospice

6

Pietri L. 145 France retrospective general population 113 BMI <25, <25-29.9, ≥ 30 ICU or death 7

Pouwels S. 146 Netherlands retrospective general population 143 BMI ≥30, <30 death 7

Prasannan L. 147 USA cross

sectional

pregnant patients 4873 BMI continuous severe COVID-19 6

Price-Haywood E. 148 USA retrospective general population 3481 BMI ≥30, <30 hospitalization,

death

7

Rapp J. 149 USA retrospective general population 4062 BMI >35, <35 death 6

Richardson S. 150 USA retrospective adults aged 18–39 1013 BMI>30, <30 death 7

Robles-Pérez E. 151 Mexico prospective social security

workers


Rodriguez-Gonzalez

C. 152

Spain retrospective general population 1255 BMI <30, ≥30 death 7

Rojas-Marte G. 153 USA retrospective age ≥18 years 238 obese, non-obese intubation 6

Rossi A. 154 Italy prospective general population 95 normal weight, overweight, obese death 9

Rossi P. 155 Italy prospective general population 2143 obese, non-obese hospitalization,

death

7



Rottoli M. 156 Italy retrospective general population 482 BMI ≥30, <30 ICU, death 7

Rubio-Rivas M. 157 Spain retrospective general population. 12066 BMI continuous death 7

Salacup G. 158 USA retrospective general population 242 BMI continuous death 7

Sallis R. 159 USA retrospective age ≥18 years 48440 BMI <25, 25-29, 30-39, ≥40 hospitalization,

ICU, death

8

Sauver J. 160 USA retrospective general population 9928 under/normal weight, overweight,

obese

hospitalization or

death

7

Schavemaker R. 161 Netherlands prospective age ≥18 years 1122 BMI <25, 25-29, ≥30 death 8

Schmidt M. 162 Multicounty prospective age >16 years 4244 BMI <25, 25-29, ≥30 death 8

Schonfeld D. 163 Argentina retrospective general population 207079 obese, non-obese ICU or death 7

Schuelter-Trevisol F. 164

Brazil prospective general population 211 obese, non-obese ICU 8

Schwerzmann M. 165 Multicounty prospective patient with

congenital heart

disease

105 BMI >25, <25 hospitalization or

IMV or death

7

Seiglie J. 166 USA retrospective general population 450 BMI 18.5, 18.5–24.9, 25.0–29.9, ≥ 30

ICU, IMV, death 7

Serván-Mori E. 167 Mexico cross

sectional

adult 795878 obese, non-obese hospitalization,

death

7

Shah P. 168 USA retrospective general population 522 BMI <30, 30-40, ≥ 40 death 7

Silva I. 169 Brazil retrospective age 20–59 159704 obese, non-obese death, ICU 6

Simonnet A. 170 France retrospective general population 124 BMI <25, 25-30, 30-35, >35 IMV 7

Singh S. 171 USA retrospective general population 41513 BMI ≥ 30, <30 death, IMV,

hospitalization

7

Smati H. 172 USA retrospective age ≥18 years 460 BMI <25, 25-29.9, ≥ 30 hospitalization 6

Smati S. 173 France retrospective patients with

diabetes

1965 BMI 18.5-24.9, 25-29.9, 30-34.9,

≥35

IMV, death 7

Sonmez A. 174 Turkey retrospective adult 18 426 obese, non-obese death 7

Suleyman G. 175 USA retrospective general population 463 BMI ≥40 ICU, IMV 7

Suresh S. 176 USA retrospective general population 1983 obese, non-obese ICU, IMV, death 7

Takemoto M. 177 Brazil cross-

sectional

obstetric patients 978 obese, non-obese death 6

Targhera G. 178 China retrospective general population 339 BMI ≥25, <25 severe COVID-19 7

Tartof S. 179 USA retrospective general population 6916 BMI <18.5, 18.5-24, 25-29, 30-34,

35-39, 40-44, ≥45

death 8

Tchang B. 180 USA retrospective age ≥18 years 3533 underweight, normal weight,

overweight, obese

IMV or ICU or

death

8

Thomson R. 181 UK prospective general population 156 obese, normal weight death 7

Timberlake D. 182 USA retrospective general population 295 obese ICU, IMV, death 7

Toussie D. 183 USA retrospective age 21 to 50 years 145 BMI <25, 26-30, 31-40, >40 hospitalization,

IMV

6

Tripathi S. 184 Multicounty retrospective age <18 years 795 BMI <5, 5-85, 85-95, ≥ 95 percentiles

critical illness

including death

7

Van Gerwen M. 185 USA retrospective general population 3703 BMI <25, 25-30, >30 hospitalization,

IMV, death

8



Van Zelst C. 186 Netherland prospective age ≥18 years 166 hip to waist ratio intubation or ICU

Vial M. 187 Chile retrospective general population 381 BMI continuous ICU or death 7

Vouga M. 188 Multicounty case control pregnant women 926 BMI>30, <30 severe adverse

maternal outcomes

6

Wang J. 189 China retrospective general population 297 BMI < 24, 24-28, > 28 severe COVID-19 7

Wang JJ. 190 China retrospective general population 185 BMI continuous severe COVID-19 7

Wang Y. 191 China retrospective general population 97 BMI continuous death 7

Wang Z. 192 USA retrospective general population 6158 BMI continuous death 7

Wargny M. 193 France retrospective patients with

diabetes

2951 BMI continuous death 7

Watanabe M. 194 Italy retrospective general population 150 visceral adipose tissue ICU 7

Wei W. 195 USA retrospective general population 206741 BMI <18.5, 18.5-25, 25-30, 30-35,

35-40, ≥40

hospitalization 8

Weizman O. 196 France retrospective general population 2878 BMI continuous ICU or death 7

Williamson E. 197 UK retrospective general population 10926 obese, non-obese death 8

Wu X. 198 China retrospective general population 1091 underweight, normal weight,

overweight, obese

IMV, ICU, death 6

Yang Y. 199 China retrospective general population 143 visceral adiposity severe COVID-19 7

Yates T. 200 UK retrospective middle-aged adults 1001 BMI<18.5, 18.5-24.9, 25-29.9, ≥30 severe COVID-19,

death

7

Yi P. 201 China retrospective general population 100 BMI continuous disease severity 6

Yordanov Y. 202 France prospective general population 7320 BMI ≤25, 25-30, >30 hospitalization or

death

7

Yoshida Y. 203 USA retrospective general population 776 BMI <25, 25-29.9, 30-34.9, 35-

39.9, ≥40

ICU, IMV, death 7

Yu T. 204 China cross-

sectional

general population 95 BMI continuous pneumonia

exacerbation

7

Zaferani A. 205 Iran retrospective general population 192 BMI continuous severe disease 6

Zhang J. 206 China retrospective general population 463 BMI: 18.5–23.9, 24.0–27.9, > 28.0 ICU or IMV 7

Zheng K. 207 China retrospective patients with fatty

liver disease

66 BMI >25, <25 severe COVID-19 6

Zhu Z. 208 UK retrospective middle-aged adults 489769 BMI <18.5, 18.5-25, 25-30, 30-35,

35-40, ≥40

severe COVID-19 7



https://pubmed-ncbi-nlm-nih-gov.proxy.library.vcu.edu/?term=Vial+MR&cauthor_id=33317458

Supplemental Table 2. Pooled estimate of the association between obesity and COVID-19 outcomes, general population and cohort studies (n=158)

Exposure Studies with single outcomes Studies with combinations of outcomes c

Hospital admission + ICU +IMV d Hospital admission ICU a IMV b Death

BMI continuous (5 units) Number of studies Pooled OR, 95% CI

1 1.22 (1.16 to 1.28)

4 1.28 (1.00 to 1.69)

0

14 1.10 (1.00 to 1.16)

12 1.34 (1.16 to 1.54)

4 1.28 (1.10 to 1.54)

Overweight vs normal weight Number of studies Pooled OR, 95% CI

7 1.22 (1.07 to 1.39)

10 1.20 (1.01 to 1.43)

12 1.22 (1.09 to 1.37)

20 1.00 (0.90 to 1.10)

8 1.18 (1.00 to 1.39)

21 1.19 (1.12 to 1.28)

Obese vs normal weight Number of studies Pooled OR, 95% CI

8 1.40 (1.20 to 1.62)

11 2.08 (1.51 to 2.87)

11 2.15 (1.68 to 2.76)

26 1.24 (1.11 to 1.38)

9 1.44 (1.26 to 1.64)

22 1.73 (1.53 to 1.97)

Obese vs non-obese Number of studies Pooled OR, 95% CI

10 1.76 (1.50 to 2.07)

20 1.81 (1.53 to 2.14)

13 1.65 (1.39 to 1.97)

48 1.25 (1.17 to 1.32)

11 1.88 (1.44 to 2.45)

32 1.74 (1.59 to 1.92)

Extreme obese vs normal weight Number of studies Pooled OR, 95% CI

4 1.98 (1.76 to 2.23)

4 1.81 (1.08 to 3.05)

2 3.03 (1.92 to 4.77)

11 1.96 (1.61 to 2.38)

2 1.69 (1.42 to 2.01)

8 2.08 (1.53 to 2.81)

Extreme obese vs non-obese Number of studies Pooled OR, 95% CI

2 3.08 (1.60 to 5.92)

2 3.95 (1.08 to 14.46)

2 2.39 (1.96 to 2.91)

7 2.37 (1.75 to 3.21)

2 1.69 (1.31 to 2.19)

4 3.19 (2.17 to 4.70)

Non-BMI define obesity e Number of studies Pooled OR, 95% CI

0

3 1.79 (1.00 to 3.21)

2 1.27 (1.13 to 1.42)

1 2.00 (1.32 to 3.02)

5 1.58 (1.14 to 2.20)

4 1.32 (1.16 to 1.49)

a ICU, intensive care unit b IMV, invasive mechanical ventilation, or intubation. c Studies whose endpoint was the combination of two or more of the following: hospital admission, ICU, IMV, death or other conditions pertaining to a severe disease. d Pooled of studies included in hospital admission, ICU and IMV. e non-BMI defined obesity include neck circumference, waist circumference, waist to hip ratio, visceral adipose tissue.



Supplemental Table 3. Pooled estimate of the association between obesity and COVID-19 outcomes, general population and prospective cohort studies (n=29)

Exposure Hospital admission + ICU +IMV a

Death Studies with combinations of outcomes b

BMI continuous (5 units) Number of studies Pooled OR, 95% CI

1 1.34 (1.15 to 1.69)

4 1.10 (0.95 to 1.22)

2 0.95 (0.73 to 1.28)

Overweight vs normal weight Number of studies Pooled OR, 95% CI

1 1.30 (1.08 to 1.57)

6 1.09 (0.94 to 1.26)

1 1.39 (1.13 to 1.71)

Obese vs normal weight Number of studies Pooled OR, 95% CI

1 1.80 (1.47 to 2.20)

8 1.43 (1.10 to 1.85)

1 1.57 (1.25 to 1.97)

Obese vs non-obese Number of studies Pooled OR, 95% CI

4 3.24 (1.39 to 7.56)

7 1.36 (1.23 to 1.51)

1 2.30 (1.29 to 4.10)

Extreme obese vs normal weight Number of studies Pooled OR, 95% CI

1 2.45 (1.79 to 3.36)

3 1.99 (1.29 to 3.05)

0 -

Extreme obese vs non-obese Number of studies Pooled OR, 95% CI

1 2.20 (1.65 to 2.93)

0 -

1 2.30 (1.20 to 4.40)

Non-BMI define obesity c Number of studies Pooled OR, 95% CI

1 1.26 (1.12 to 1.42)

0 -

1 1.11 (1.03 to 1.20

a Pooled of studies included in hospital admission, ICU and IMV. The estimates for hospital admission, ICU and IMV were not showed separately because of low number of studies. b Studies whose endpoint was the combination of two or more of the following: hospital admission, ICU, IMV, death or other conditions pertaining to a severe disease. c Non-BMI defined obesity include neck circumference, waist circumference, waist to hip ratio, visceral adipose tissue.



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