Association between underweight and excess body weight before sars-cov-2 infection and clinical outcomes of covid-19: multicenter study

• This is a cohort of 1308 individuals from northeastern Brazil; • Individuals with underweight and overweight were more hospitalized due to COVID-19; • BMI categories were not independently associated with hospitalization, mechanical ventilation or death; • Age and NCDs cofounding the association between body weight status and outcomes of COVID-19. The present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before COVID-19 diagnosis and clinical outcomes in patients infected with SARS-COV-2. A multicenter cohort study was carried out in 8 different states in Northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation and death. Multivariable logistic regression models - adjusted based on age, sex and previous comorbidities – were used to assess the effects of extremes in body weight status on clinical outcomes. 1308 individuals were assessed (33.6% of them were elderly individuals). Univariable analyses showed that only hospitalization was more often observed among underweight (3.2 vs. 1.2%) and overweight (68.1 vs. 63.3%) individuals. Cardiovascular diseases, in turn, were more often observed in all clinical outcomes (hospitalization [19.7% vs. 4.8%]; mechanical ventilation [19.9% vs. 13.5%] and death [21.8% vs. 14.1%]). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (Underweight: OR: 1.10 [CI95%: 0.50; 2.41]; Excess body weight: 0.81 [0.57; 1.14]), mechanical ventilation (Underweight: 0.92 [0.52; 1.62]; Excess weight: 0.90 [0.67; 1.19]) and death (Underweight: 0.61 [0.31; 1.20]; Excess body weight: 0.88 [0.63; 1.23]). Underweight and excess body weight were not independently associated with clinical outcomes in COVID-19 patients in the herein analyzed cohort; this finding indicates that the association between these variables may be confounded by both age and comorbidities.