Body mass index, diabetes, inflammation and survival in COVID-19: a retrospective study evaluating the obesity paradox in an urban hospital center
- 1Department of Endocrinology & Metabolism, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA, United States
- 2Department of Endocrinology, West Virginia University, Morgantown, WV, United States
- 3Department of Biomedical Education and Data Science, Temple University, Philadelphia, PA, United States
Abstract
Background: Severe coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality, particularly among patients with comorbidities such as diabetes and obesity. The combined influence of glycemic control, hyperglycemia, and body mass index (BMI) on disease severity remains incompletely understood, particularly in underserved urban populations.
Methods: This retrospective study evaluated 478 adults hospitalized with confirmed COVID-19 between March and May 2020 at an urban academic medical center to examine the impact of diabetes, glycemic control, and body mass index (BMI) on clinical outcomes. Data collected included demographics, comorbidities, BMI, diabetes type, baseline hemoglobin A1c (HbA1c), inflammatory markers, intensive care unit (ICU) admission, mechanical ventilation, hyperglycemia, and glucocorticoid use.
Results: Among patients with available HbA1c measurements, those with diabetes who developed cytokine storm had significantly higher mean HbA1c than those without cytokine storm. Obesity and overweight were highly prevalent, with 45% of patients classified as obese (BMI ≥30 kg/m²) and 29% classified as overweight (BMI 25–29 kg/m²). Diabetes was associated with increased ICU admission, mechanical ventilation, and steroid-induced hyperglycemia. Mortality was higher among older patients, Black patients, and those with diabetes, hypertension, hyperglycemia, greater glucocorticoid use, or ICU admission. Notably, patients with overweight or obesity demonstrated improved survival compared with those of normal weight, consistent with an obesity paradox in this urban cohort. Multivariable analysis identified steroid-induced hyperglycemia, obstructive sleep apnea, and higher methylprednisolone use as independent predictors of ICU admission, whereas higher BMI was associated with a lower risk of adverse outcomes.
Conclusions: Diabetes and hyperglycemia were associated with greater COVID-19 severity, increased ICU utilization, and higher mortality, while higher BMI offered potential survival benefits. These findings highlight the complex interplay between metabolic dysfunction, obesity, and COVID-19 outcomes, suggesting the presence of an obesity paradox in hospitalized patients, and emphasize the importance of early recognition and management of diabetes and hyperglycemia to improve clinical outcomes.
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BibTeX
@article{sadiq2026body,
title = {{Body mass index, diabetes, inflammation and survival in COVID-19: a retrospective study evaluating the obesity paradox in an urban hospital center}},
author = {Sanah Sadiq and Rashelle Ripa and Huaqing Zhao and Kristin Criner},
journal = {Frontiers in Clinical Diabetes and Healthcare},
year = {2026},
month = oct,
doi = {10.3389/fcdhc.2026.1946918},
url = {https://doi.org/10.3389/fcdhc.2026.1946918},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Body mass index, diabetes, inflammation and survival in COVID-19: a retrospective study evaluating the obesity paradox in an urban hospital center
AU - Sanah Sadiq
AU - Rashelle Ripa
AU - Huaqing Zhao
AU - Kristin Criner
PY - 2026
DA - 2026/10/13
JO - Frontiers in Clinical Diabetes and Healthcare
DO - 10.3389/fcdhc.2026.1946918
UR - https://doi.org/10.3389/fcdhc.2026.1946918
AB - Background: Severe coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality, particularly among patients with comorbidities such as diabetes and obesity. The combined influence of glycemic control, hyperglycemia, and body mass index (BMI) on disease severity remains incompletely understood, particularly in underserved urban populations. Methods: This retrospective study evaluated 478 adults hospitalized with confirmed COVID-19 between March and May 2020 at an urban academic medical center to examine the impact of diabetes, glycemic control, and body mass index (BMI) on clinical outcomes. Data collected included demographics, comorbidities, BMI, diabetes type, baseline hemoglobin A1c (HbA1c), inflammatory markers, intensive care unit (ICU) admission, mechanical ventilation, hyperglycemia, and glucocorticoid use. Results: Among patients with available HbA1c measurements, those with diabetes who developed cytokine storm had significantly higher mean HbA1c than those without cytokine storm. Obesity and overweight were highly prevalent, with 45% of patients classified as obese (BMI ≥30 kg/m²) and 29% classified as overweight (BMI 25–29 kg/m²). Diabetes was associated with increased ICU admission, mechanical ventilation, and steroid-induced hyperglycemia. Mortality was higher among older patients, Black patients, and those with diabetes, hypertension, hyperglycemia, greater glucocorticoid use, or ICU admission. Notably, patients with overweight or obesity demonstrated improved survival compared with those of normal weight, consistent with an obesity paradox in this urban cohort. Multivariable analysis identified steroid-induced hyperglycemia, obstructive sleep apnea, and higher methylprednisolone use as independent predictors of ICU admission, whereas higher BMI was associated with a lower risk of adverse outcomes. Conclusions: Diabetes and hyperglycemia were associated with greater COVID-19 severity, increased ICU utilization, and higher mortality, while higher BMI offered potential survival benefits. These findings highlight the complex interplay between metabolic dysfunction, obesity, and COVID-19 outcomes, suggesting the presence of an obesity paradox in hospitalized patients, and emphasize the importance of early recognition and management of diabetes and hyperglycemia to improve clinical outcomes.
SN - 2673-6616
ER -