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Obesity implies risk of COVID-19 regardless of age, sex, ethnicity and health condition

Obesity implies risk of COVID-19 regardless of age, sex, ethnicity and health condition

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Conclusion presented by Brazilian researchers in Obesity Research & Clinical Practice is based on analysis of nine clinical studies involving 6,577 patients infected by SARS-CoV-2 in five countries

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Credit: Francisco Juliherme Pires de Andrade

The probability that an obese person will develop severe COVID-19 is high regardless of age, sex, ethnicity, and the presence of co-morbidities such as diabetes, high blood pressure, and heart or lung disease, according to a study by Brazilian researchers published in Obesity Research & Clinical Practice.

The systematic review and meta-analysis of relevant data in the scientific literature focus on nine clinical studies, which in aggregate reported the evolution of 6,577 COVID-19 patients in five countries. The authors conclude that obesity is itself a factor that favors rapid progression to critical illness requiring intensive care and significantly increases the risk of death. The associated research project was supported by São Paulo Research Foundation – FAPESP .

“Several factors contribute to the progression to critical illness in the obese organism. One is the limited capacity to produce interferons [a class of proteins secreted by defense cells and essential to inhibit viral replication] and antibodies. In addition, adipose tissue functions as a reservoir for the virus, maintaining it in the organism for longer,” said Silvia Sales-Peres , a professor at the University of São Paulo (USP) in Bauru and principal investigator for the project.

This potentially higher viral load, she explained, is not the only problem faced by patients with a high body mass index (BMI). Recent research shows that the chronic low-grade inflammation typical of obesity – caused by excessive expansion of adipose cells – makes the inflammatory cytokine storm triggered by SARS-CoV-2 even more damaging to the lungs.

“Obese patients usually present with impaired respiratory function, as abdominal adipose tissue compresses the diaphragm and prevents it from moving normally,” Sales-Peres said. “In sum, various concurrent factors make these patients more predisposed to dependency on mechanical ventilation and other kinds of intensive care if they contract COVID-19. In the studies we analyzed, 9.4% of the obese patients treated in intensive care units died.”

Risk scale

BMI is a measure of body fat proportional to height and weight that applies to adult men and women and is considered the international standard for diagnosing malnutrition and obesity. It is calculated by dividing weight in kilograms by height in meters squared. Generally speaking, overweight corresponds to a BMI of 25 or more, while 30 or more indicates obesity. Almost 60% of Brazilians are overweight and some 20% are obese, according to the Health Ministry’s telephone surveillance survey on risk factors for chronic diseases (Vigitel).

“A higher degree of susceptibility to the novel coronavirus when a person reaches a certain number on the BMI scale is no accident. Impaired antibody production and chronic inflammation favor progression of COVID-19 in overweight subjects,” Sales-Peres said. “Our analysis also showed that the risk associated with obesity is even greater for smokers or subjects with co-morbidities such as diabetes, hypertension, and lung disease.”

She went on to argue that studies like this are important both to alert patients to the need to protect themselves against the virus and to help health services prepare for the potential demand for intensive care.

“We embarked on the study in April when it wasn’t so clear that obesity would be considered a major risk factor for COVID-19,” she said.

For the systematic review, the authors first searched Medline, Embase, Web of Science, BVS/Lilacs, SciELO, Scopus, and Google Scholar to select studies published on or before April 27 using key terms such as obesity and COVID-19. They identified 40 and ended up with eight that matched the inclusion criteria and were considered worthy of meta-analysis because they contained scientific evidence at the highest level to orient clinical practice.

“The 2018 Vigitel survey pointed to 30% growth in the overall prevalence of overweight in Brazil compared with 2006. Considering only the 18-24 group, the increase was 55.7%. This makes discussing the risk of severe COVID-19 associated with obesity extremely important,” Sales-Peres said.

Public health policy should promote an integrated and intersectoral approach to obesity, she argued, and should have regulatory and enforcement authority. “There should be a transformational mobilization to encourage outdoor physical exercise and healthy dietary habits from early childhood,” she said. “This should be a coordinated initiative across all three tiers of government so as to enable integrated planning, funding, and strategy to promote wellness and prevent obesity.”

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About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at http://www.fapesp.br/en and visit FAPESP news agency at http://www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.

Media Contact
Heloisa Reinert
hreinert@fapesp.br

Original Source

https://agencia.fapesp.br/34343/

Related Journal Article

http://dx.doi.org/10.1016/j.orcp.2020.07.007

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Could investing in bonds yield better returns than equities in 2023?

It’s not news that 2022 has been a tough one for stock markets. There have been sectors, like energy and utilities, that…
The post Could investing…

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It’s not news that 2022 has been a tough one for stock markets. There have been sectors, like energy and utilities, that have bucked the negative trend but the big picture has been bleak. The UK’s large cap FTSE 100 index has faired better than most and is more or less flat for the year thanks to its heavy weighting towards energy, industrial commodities, and finance.

Source: CSIMarket

But it’s been a volatile ride and the end of the year could still drag London’s benchmark index into the red.

ftse100index

Over in the USA, the major indices have suffered significant losses. The growth companies, especially in the tech sector, that saw Wall Street enjoy over a decade of strong growth with only the occasional short-lived correction have been among those hit hardest by inflation hitting decades-long highs and interest rates rising.

That’s seen the tech-heavy Nasdaq Composite register an over 30% loss for the year-to-date and the broader based S&P 500 is down a little under 18% over 2022.

nasdaq composite

However, while the hangover from the Covid-19 pandemic and Russia’s invasion of Ukraine were unpredictable events that have undoubtedly deepened stock market losses, a turn of the market cycle is not a surprise. The bull market that preceded the 2022 bear market was the longest in history, supported by unprecedented levels of quantitative easing and record-low interest rates in major developed economies.

If anything, the surprise was that the bull market for equities persisted for as long as it did and pushed valuations so high. More bearish analysts had been warning of a reversal for years before it actually transpired.

What has been far more surprising, almost unprecedented, is that bond markets have failed to live up to their traditional portfolio role of providing insurance against an equities bear market. When equities, especially growth stocks, enter bear territory, bonds usually go in the opposite direction, rising with interest rates and an influx of capital seeking a safe haven.

Traditionally, a portfolio with a 60% allocation to equities and 40% allocation to bonds should come into its own during periods like this year. The bond allocation would be expected to cushion the blow of an equities bear market, paying its way for lower returns than equities during the good times.

But in the third quarter of this year, a traditionally conservative portfolio with a 40% allocation to equities would have actually underperformed one 100% allocated to equities. Inflation remaining stubbornly high this year despite the Fed and other central banks including the Bank of England has upended the conventional investing wisdom that equities and bonds do not both move in the same direction – the foundational principle of traditional diversification strategies.

But will that change in 2023? Could bonds outperform equities next year in a way that means investors should consider increasing their portfolio weighting towards fixed-income investments?

Why have bonds not lived up to their billing in 2022?

Nothing has worked well for diversified investors this year, not equities, not bonds and not the traditional 60/40 portfolio split between the two asset classes. But will this year prove a blip or has the relationship bet equities and bonds changed fundamentally?

Analysts including Morningstar’s Lauren Solberg believe the performance of the bond market next year will be most influenced by inflation. If inflation remains high, bonds could continue to struggle alongside equities. However, if major central banks including the Fed manage to wrestle inflation back down towards target levels, especially if that is accompanied by a recession, bonds would be expected to revert to their traditional anti-correlation with equities.

This year, one they would have been expected to benefit from a flight from equities and rising interest rates, has been the worst for bonds in modern history. It’s also been the only time in history that stocks and bonds have both recorded losses for three consecutive quarters.

chart2

Source: Morningstar

Sky-high inflation, which is bad for both equities and bonds, has negated the usually positive impact on bonds of a bear market for equities and rising interest rates.

Will bonds return to form in 2023?

There is differing opinion among analysts and market observers about what 2023 might hold in store for bond markets. The more common expectation is that bonds will do a much better job at insulating portfolios than this year with yields now much higher than they were in late 2021.

However, others believe that a secular change in the correlation relationship between equities and bonds is now underway. That is based on the expectation that inflation, even if it falls meaningfully in 2023, could remain at higher levels and be more prone to volatility than it has been over the past couple of decades.

Recent research published by Truist Wealth shows that U.S. government-backed debt has delivered average annual returns of 6.6% over the past four recessions, beating both high-yield ‘junk’ and investment-grade corporate bonds. That would indicate 2023 could be a very good year for bond investors with the right exposure – a focus on government rather than private sector debt. However, we’ve already seen a significant divergence from historical patterns this year.

Marta Norton, chief investment officer for the Americas at Morningstar Investment Management, believes 2023 could be hold opportunities for fixed income, across government-backed and corporate bonds:

“When you look over the past 10 years, it’s really only been an equity story: It’s been such a good market to take on equity risk, a tremendously good time to be an equity investor. But today, it’s harder to know where to invest the marginal dollar. Fixed income is looking more appealing than it has in some time. You don’t have to take enormous risk to earn some return, and that’s a mindset shift to the environment we had before.”

While she acknowledges that U.S. equities now look a lot more attractively priced than they did a year ago, she cautions against investors rushing back to the market and thinks the bear cycle could last longer than many expect. She says the “buy the dip”mentality that has worked so well over the past decade could mean investors risk suffering meaningful losses by moving into a losing market.

She doesn’t advise not investing in equities but that investors should instead drip feed any investment instead of trying to time a bottom.

She is more confident in the opportunities around fixed income investments, especially higher-quality, shorter-dated fixed income, which she says comes with the added benefit of lower risk, especially if a deeper recession materialises.

Christian Mueller-Glissmann, head of asset allocation research within portfolio strategy at Goldman Sachs agrees. He notes the gap in yields between stock and bonds has narrowed substantially since the COVID-19 crisis and is now relatively low. The same is true for riskier credit, which yields relatively little compared with practically risk-free Treasuries and means investors are getting little premium for the risk of owning equities or high-yield credit in comparison to lower-risk bonds. As a result, equities and high-yield debt are particularly exposed to an economic slowdown or recession:

“That just makes equities and riskier debt very vulnerable for disappointments on growth next year”.

Lisa Shalett, chief investment officer of Wealth Management at Morgan Stanley is also championing bonds for 2023. She concludes:

“We continue to believe it is premature to call an end to the bear market for U.S. stocks. Investors may have moved on from inflation concerns, but they cannot ignore the economic picture. For now, investors should consider reducing U.S. large-cap index exposure. Instead, look to Treasuries, munis and investment-grade corporate credit. Stay patient and collect coupon income.”

What about UK Gilts vs London-listed equities?

Should investors mainly exposed to London-listed rather than Wall Street-based equities be thinking along similar lines? The FTSE 100 has remained largely flat in 2022, finally benefitting from its lack of growth stocks and heavy weighting to more traditional sectors like energy, commodities and finance.

London-listed equities were considered cheap before 2022, which is another reason valuations have not fallen in the same way as they have in the USA. On the other hand, they are also less likely to see as much upside if a recession is avoided next year and economic sentiment improves.

The FTSE 100 has also been boosted considerably by the soaring valuation of big energy companies like BP and Shell and utilities such as Centrica, which has compensated for companies in other sectors, such as consumer cyclicles, losing value. Energy prices easing off next year, which is by no means guaranteed depending on how geopolitical factors play out, would be negative for the benchmark index.

The UK’s outlook for both equities and government debt is not particularly positive. RBC Wealth Management summarises:

“A crippling cost of living, austerity measures, and the Bank of England tightening monetary policy will all conspire to create a prolonged recession in the UK, in our view. We advocate an underweight position in UK equities, although we are mindful that depressed valuations may produce interesting dividend income opportunities. We have a negative outlook on UK sovereign debt, as increased government debt issuance and the Bank of England proceeding to sell its Gilts portfolio will likely create a Gilt supply glut.”

While it may not appeal to patriotic sentiment, investors looking for the best risk-to-reward ratio in 2023 might be better served to invest in U.S. Treasuries than UK Gilts if a fixed income approach is favoured.

The post Could investing in bonds yield better returns than equities in 2023? first appeared on Trading and Investment News.

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Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Authored by Victoria Kelly-Clark via The Epoch Times,

Australia has…

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Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Authored by Victoria Kelly-Clark via The Epoch Times,

Australia has seen a spike in its mortality rates in 2022, with the Australian Bureau of Statistics (ABS) stating that by the end of August 2022, 128,797 deaths had been registered, which is 18,671 deaths, or 17 percent, more than the historical average.

In the data release on Nov. 25, the ABS noted that of registered deaths; there had been a rise in the number of Australians dying from dementia (18.9 percent above the baseline average), diabetes (20.8 percent higher than the baseline average), cancer, and COVID-19.

Karen Cutter, a spokesperson for the Actuaries Institute of Australia (AIA) said in a media release (pdf) that even after the Institute’s COVID-19 Mortality Working Group removed all “from” and “with” COVID-19 deaths, it was not clear why Australians were dying in larger numbers from other diseases such as ischaemic heart disease, cancer, and cerebrovascular disease in 2021 and 2022.

In an analysis (pdf) from Nov. 3, the AIA noted that 1,200 more Australians had died from ischaemic heart disease than expected, while cerebrovascular disease had 450 more deaths than normal. Meanwhile, mortality rates from diabetes increased by 400 deaths, and dementia saw an extra 800 deaths.

According to the ABS, between January and August this year, 7,727 Australians died from COVID-19.

“It is not clear what might be driving this, although we expect that at least part of the excess will be in respect of people who otherwise may have succumbed to respiratory disease in 2020 and 2021,” said Cutter.

They also said that diabetes deaths have generally been higher than expected throughout the pandemic.

Cutter noted that the AIA had also noticed that of the excess deaths in the 0-44 and 45-64 age bands were small, and the number of women dying was higher than expected.

She has called on the federal government to launch an inquiry into the cause of the spike.

“The differences are worth investigation, although the small numbers mean that there is considerable natural variation,” she said.

Spiking Mortality Rates a Global Phenomenon

The spike in mortality rates is being experienced globally, with the UK’s Chief Medical Officer, Sir Chris Whitty, as well as Sir Patrick Vallance, the country’s Chief Scientific Adviser, declaring the country is facing a “prolonged period” of excess deaths after people differed treatment during the initial stages of the pandemic.

Meanwhile, the UK’s health secretary Steve Barclay said that the government needed to come clean about the excess deaths.

In a speech to the Spectator Health Summit in London on Nov. 28, Barclay said that the government must share the scale of the COVID backlog, which he estimated was now “around now 7.1 million patients.”

We know from the data that there are more 50-to 64-year olds with cardiovascular issues. It’s the result of delays in that age group seeing a GP because of the pandemic and, in some cases, not getting statins for hypertension in time,” he said.

“When coupled with delays in ambulance times, we see this reflected in the excess death numbers. In time, we may well see a similar challenge in cancer data,” Barclay said.

COVID-19 Lingering Effects

The AIA agrees that delayed medical treatment may be a cause behind Australia’s rising death rate.

In an analysis of the pandemic in 2022, they said that it was highly likely that delays in medical care was a contributing factor to the excess death rates from other diseases.

“Pressure on the health, hospital and aged care systems, including ambulance ramping and bed block, could lead to people not getting the care they require, either as they avoid seeking help, or their care is not as timely as it might have been in pre-pandemic times,” they said.

“There is some evidence that this may be affecting cancer deaths. It may also be a factor in higher deaths from other causes, such as ischaemic heart disease, diabetes, and the large ‘other’ category.”

They also noted that COVID-19 lingering health effects could also be contributing to the increased rates.

Studies show that coronavirus is associated with increased mortality risks from heart disease and other causes. However, because doctors certifying the death would not necessarily know of the infection if it had occurred months prior, this could demonstrate a causative link several months after recovery from COVID-19.

Tyler Durden Thu, 12/08/2022 - 21:00

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Chinese Health Official Admits 80-90% Of Population May End Up With COVID

Chinese Health Official Admits 80-90% Of Population May End Up With COVID

After just within the past week China’s government dramatically…

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Chinese Health Official Admits 80-90% Of Population May End Up With COVID

After just within the past week China's government dramatically pivoted from its ultra-harsh 'zero Covid' policy - a policy which had triggered unprecedented widespread protests against communist authorities and health officials as in some instances they barricaded whole neighborhoods into strictly controlled quarantine zones - toward what appears a full embrace of a more lax 'Swedish model' type approach, national health authorities are prepping the population for the coming Covid wave, which could impact an estimated 80 to 90% of the Chinese population, according to a fresh projection by Feng Zijian, a former deputy chief at China’s Centers for Disease Control and Prevention. 

"It’s going to be inevitable for most of us to get infected once, regardless of how the Covid-fighting measures are adjusted," Feng said Tuesday during a virtual conference discussing the zero Covid offramp at Tsinghua University in Beijing. As a senior health official, Feng is part of the central government's task force in implementing new policies which has moved away from the 'one size fits all' mentality that guided Beijing's health response since the pandemic began.

"Some 60% of Chinese people may be infected in the first wave, before the curve flattens, Feng predicted," as cited in Bloomberg. "By comparison, about 58% of the US population had been infected by February this year, according to a US Centers for Disease Control and Prevention analysis released in April. That was up from 33.5% in December."

Via Associated Press

So it seems two years too late, China is learning the lessons of a number of countries that embraced a more flexible stance based on understanding herd immunity early, also centered on protecting the most vulnerable demographic, the elderly and the infirm, while not shuttering the economy wholesale.

Further, as of Thursday morning in China (local time), health authorities are reporting "more than 20,000 new cases a day at the moment, as outbreaks flare from Beijing to the southern manufacturing hub of Guangzhou. That’s up from less than 100 a day in June, and zero for long periods of 2020."

But China says it's ready amid its more localized approach which will seek to prep hospitals, civic authorities, and the citizenry on "proper protective measures" - such as greater deployment of at home rapid antigen test kits. "It is better to direct the flood than block it," Lu Jiahai, a senior expert at the state drug regulator National Medical Products Administration (NMPA), said.

As for this approach looking more like a Swedish model policy (though don't expect anyone in Beijing to call it that), Caixin Global recently captured the following quotes which illustrate an astounding about-face in thinking on the pandemic among Chinese officials

Although there are challenges in the implementation of home quarantine, the infection risks should not be exaggerated, said University of Hong Kong’s Jin.

"Scientific guidelines should be provided for everyone to follow with a clear accountability mechanism, as there have been many examples that even couples in the same room didn’t infect each other," said Jin, citing the experience in Hong Kong, where home isolation has been widely adopted after the worst outbreaks hit in the spring.

One resident in Beijing agreed. "I think it is more important to eliminate the irrational fear of being infected, and at the same time learn how to reduce the risk of cross-infection," Ma Qiao, who has studied preventative medicine, told Caixin.

Some of the new measures from the communist government call for isolating asymptomatic or mild Covid cases at home rather than in quarantine camps or hospitals for seven days. Anyone in contact with the infected would have to quarantine at home for five days instead of eight days at a camp and then at home.

The State Council further disbanded the rule for people to show negative Covid tests before entering public places. As the SCMP summarized of the new approach this week: "The new policy stressed that basic social and medical services need to be provided. People's movements, work and production should not be restricted in low-risk areas." 

Tyler Durden Thu, 12/08/2022 - 20:40

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