The relationship between overweight and obesity
With infection by viruses and bacteria it is not an issue that can surprise us. As an example, in California when the appearance of the influenza A (H1N1) virus occurred, initially detected in the United States but which subsequently spread to other places on the planet, 61% of the patients who died were obese. Therefore, this concern from the beginning of knowing the existence of the disease about the importance of metabolic control of infected patients is easily understandable. Among other factors, which we will briefly analyze later, changes in cellular metabolism will significantly compromise the immune system.
Obviously, overweight, obesity and two of their main comorbidities, type 2 diabetes mellitus, and hypertension are situations in which metabolic alterations play a fundamental role and which, together with age, have been identified as risk factors. risk that are most likely influencing the evolution of the disease.
The mechanisms by which overweight and obesity favor the worse prognosis in COVID-19 positive patients have not really been specifically studied. However, it is not difficult to imagine that one of the causes is inflammation.
It has been determined that the worse evolution of infected patients seems to be related to a so-called "inflammatory storm" where the body itself, when trying to defend itself from the virus, probably causes a true "cytokine storm" that what it really does is self-damage organs such as the kidney, the heart and obviously the lungs. In this sense, it is well known that excess fat is associated with a pro-inflammatory state, which could easily increase due to virus infection.
Overweight/obesity has been linked to a higher incidence of lung diseases, such as asthma, chronic obstructive pulmonary disease or sleep apnea-hypopnea syndrome, which would mean in these cases that the virus will encounter patients who already have problems in their lungs. the functioning of the lung, which will increase their risk of a worse outcome if they are infected by COVID-19.
We have discussed the concern about metabolic capacity in relation to COVID-19 infection. If we talk about metabolic capacity we have to consider the mitochondria. The cell's ability to generate ATP resides in the mitochondria; we could say that they are the lungs of the cells to obtain the energy they need for their normal functioning.
To our knowledge, there are no data published in the scientific literature on whether COVID-19 also attacks the mitochondria. However, these data do exist for other viral infections. For example, a virulence factor from the severe acute respiratory syndrome coronavirus (SARS-CoV), called ORF-9b (Open Reading Frames), induces the degradation of the DRP1 protein, meaning that mitochondria They cannot complete their life cycle that helps them reproduce inside the cell and this also seems to be related to limiting the interferon response in the cell against the virus.
The COVID-19 genome initially appears to be similar to that of typical coronaviruses and contains at least ten open reading frames (ORFs) and although interferon alpha 2-B has been one of the drugs used in Wuhan against COVID-19, There are really no conclusive studies yet on the existence of specific antivirals effective against COVID-19. Whether the COVID-19 virus can directly affect the mitochondria has not yet been determined. Regardless of the fact that a priori it is very likely that this is the case, due to their characteristics, in addition, people who are overweight/obese have a lower number of mitochondria and a greater number of them are dysfunctional, that is, they are not capable of generating enough ATP, which makes them a perfect target for COVID-19 to further damage the cell, preventing its normal respiration.
Source: Magazine "with health"
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