The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health

Bette Loef; Jolanda M.A. Boer; Marian Beekman; Floris Huider; Dorret I. Boomsma; Jenny van Dongen; Eco J.C. de Geus; Martijn Huisman; Karien Stronks; W. M.Monique Verschuren; Saskia W. van den Berg; Lifelines Corona Research initiative

doi:10.1038/s41366-024-01660-x

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health

Bette Loef^*, Jolanda M.A. Boer, Marian Beekman, Floris Huider, Dorret I. Boomsma, Jenny van Dongen, Eco J.C. de Geus, Martijn Huisman, Karien Stronks, W. M.Monique Verschuren, Saskia W. van den Berg, Lifelines Corona Research initiative

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Obesity may affect an individual’s immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection. Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements. Results: Individuals with overweight (25 ≤ BMI < 30 kg/m²) (odds ratio (OR) = 1.08, 95%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m²) (OR = 1.43, 95%-CI 1.18–1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95%-CI 1.04–1.14, I² = 0%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95%-CI 0.999–1.55, I² = 57%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk. Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.

Original language	English
Article number	e13128
Pages (from-to)	586-595
Number of pages	10
Journal	International Journal of Obesity
Volume	49
Issue number	4
Early online date	31 Oct 2024
DOIs	https://doi.org/10.1038/s41366-024-01660-x
Publication status	Published - Apr 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Funding

The current study was funded by the Dutch Ministry of Health, Welfare and Sports as part of the COVID-19 program, subtheme Health Impact. The Doetinchem Cohort Study is supported by the Dutch Ministry of Health, Welfare and Sport and the National Institute for Public Health and the Environment. The HELIUS study is also funded by the Dutch Heart Foundation (2010 T084), ZonMw (200500003), the European Union (FP-7) (278901), and the European Fund for the Integration of non-EU immigrants (EIF) (2013EIF013). The HELIUS COVID-19 substudy was also supported by ZonMw (10430022010002) and the Public Health Service of Amsterdam (Research and Development 2021 75722692, Public Health Laboratory grant 2022). The HELIUS study is conducted by Amsterdam UMC, location Academic Medical Center and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The Longitudinal Aging Study Amsterdam (LASA) is largely supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. The Leiden Longevity Study has received funding from the European Union\u2019s Seventh Framework Programme (FP7/2007-2011: grant agreementnr 259679). This study was further supported by BBMRI-NL, a Research Infrastructure financed by the Dutch government (NWO 184.021.007 and 184.033.111), and the VOILA consortium (ZonMw; 457001001). The Lifelines initiative has been made possible by subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University and the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen). NTR is supported by the Corona Fast track grant: Extended twin-family study of COVID-19 and its impact (NWO-440-20-022). The NEO study is supported by the participating Departments, Division, and Board of Directors of the Leiden University Medical Center, and by the Leiden University, Research Profile Area Vascular and Regenerative Medicine. The Maastricht Study is supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant 31\u2009O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), CAPHRI Care and Public Health Research Institute (Maastricht, the Netherlands), NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands), and by unrestricted grants from Janssen-Cilag BV (Tilburg, the Netherlands), Novo Nordisk Farma BV (Alphen aan den Rijn, the Netherlands), and Sanofi-Aventis Netherlands BV (Gouda, the Netherlands). The Rotterdam Study is funded by the Erasmus University Medical Centre and Erasmus University, Rotterdam; the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sport; the European Commission (DG XII); and the Municipality of Rotterdam. The current study was funded by the Dutch Ministry of Health, Welfare and Sports as part of the COVID-19 program, subtheme Health Impact. The Doetinchem Cohort Study is supported by the Dutch Ministry of Health, Welfare and Sport and the National Institute for Public Health and the Environment. The HELIUS study is also funded by the Dutch Heart Foundation (2010 T084), ZonMw (200500003), the European Union (FP-7) (278901), and the European Fund for the Integration of non-EU immigrants (EIF) (2013EIF013). The HELIUS COVID-19 substudy was also supported by ZonMw (10430022010002) and the Public Health Service of Amsterdam (Research and Development 2021 75722692, Public Health Laboratory grant 2022). The HELIUS study is conducted by Amsterdam UMC, location Academic Medical Center and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The Longitudinal Aging Study Amsterdam (LASA) is largely supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. The Leiden Longevity Study has received funding from the European Union\u2019s Seventh Framework Programme (FP7/2007-2011: grant agreementnr 259679). This study was further supported by BBMRI-NL, a Research Infrastructure financed by the Dutch government (NWO 184.021.007 and 184.033.111), and the VOILA consortium (ZonMw; 457001001). The Lifelines initiative has been made possible by subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University and the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen). NTR is supported by the Corona Fast track grant: Extended twin-family study of COVID-19 and its impact (NWO-440-20-022). The NEO study is supported by the participating Departments, Division, and Board of Directors of the Leiden University Medical Center, and by the Leiden University, Research Profile Area Vascular and Regenerative Medicine. The Maastricht Study is supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant 31 O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), CAPHRI Care and Public Health Research Institute (Maastricht, the Netherlands), NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands), and by unrestricted grants from Janssen-Cilag BV (Tilburg, the Netherlands), Novo Nordisk Farma BV (Alphen aan den Rijn, the Netherlands), and Sanofi-Aventis Netherlands BV (Gouda, the Netherlands). The Rotterdam Study is funded by the Erasmus University Medical Centre and Erasmus University, Rotterdam; the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sport; the European Commission (DG XII); and the Municipality of Rotterdam.

Funders	Funder number
Pearl String Initiative Diabetes
Stichting De Weijerhorst
Stichting Sint Annadal
NUTRIM School of Nutrition and Translational Research in Metabolism
Leids Universitair Medisch Centrum
Erasmus Universiteit Rotterdam
Novo Nordisk Farma BV
Erasmus Medisch Centrum
Rijksuniversiteit Groningen
Dutch Ministry of Economic Affairs
Janssen Nederland
Ministerie van Volksgezondheid, Welzijn en Sport
Dutch Government
BBMRI-NL
National Institute for Public Health and the Environment
Care and Public Health Research Institute, Universiteit Maastricht
Cardiovascular Center, Medical College of Wisconsin
Universiteit Leiden
Sanofi-Aventis Netherlands BV
CARIM School for Cardiovascular Diseases
Health Foundation Limburg
Ministerie van Onderwijs, Cultuur en Wetenschap
Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care
European Commission	278901, FP-7
European Fund	2013EIF013, 10430022010002
European Regional Development Fund	31 O.041
Hartstichting	2010 T084
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	184.033.111, 457001001, NWO-440-20-022, 184.021.007
Public Health Service of Amsterdam	2021 75722692
European Union’s Seventh Framework Programme	259679
Public Health Laboratory	2022
ZonMw	200500003

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Loef, B., Boer, J. M. A., Beekman, M., Huider, F., Boomsma, D. I., van Dongen, J., de Geus, E. J. C., Huisman, M., Stronks, K., Verschuren, W. M. M., van den Berg, S. W., & Lifelines Corona Research initiative (2025). The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health. International Journal of Obesity, 49(4), 586-595. Article e13128. https://doi.org/10.1038/s41366-024-01660-x

@article{83e84186373645f7b70e1b1a492795bd,

title = "The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health",

abstract = "Background: Obesity may affect an individual{\textquoteright}s immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection. Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements. Results: Individuals with overweight (25 ≤ BMI < 30 kg/m2) (odds ratio (OR) = 1.08, 95\%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m2) (OR = 1.43, 95\%-CI 1.18–1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95\%-CI 1.04–1.14, I2 = 0\%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95\%-CI 0.999–1.55, I2 = 57\%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk. Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.",

author = "Bette Loef and Boer, \{Jolanda M.A.\} and Marian Beekman and Campman, \{Sophie L.\} and Hoogendijk, \{Emiel O.\} and Floris Huider and Pagen, \{Demi M.E.\} and Splinter, \{Marije J.\} and \{van der Velde\}, \{Jeroen H.P.M.\} and Boomsma, \{Dorret I.\} and Dagnelie, \{Pieter C.\} and \{van Dongen\}, Jenny and \{de Geus\}, \{Eco J.C.\} and Martijn Huisman and Ikram, \{M. Arfan\} and Annemarie Koster and Silvan Licher and Mierau, \{Jochen O.\} and \{de Mutsert\}, Ren{\'e}e and Picavet, \{H. Susan J.\} and Rosendaal, \{Frits R.\} and Schram, \{Miranda T.\} and Slagboom, \{P. Eline\} and \{van der Spoel\}, Evie and Karien Stronks and Verschuren, \{W. M.Monique\} and \{van den Berg\}, \{Saskia W.\} and \{Lifelines Corona Research initiative\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2025",

month = apr,

doi = "10.1038/s41366-024-01660-x",

language = "English",

volume = "49",

pages = "586--595",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Springer Nature",

number = "4",

}

Loef, B, Boer, JMA, Beekman, M, Huider, F , Boomsma, DI , van Dongen, J , de Geus, EJC , Huisman, M, Stronks, K, Verschuren, WMM, van den Berg, SW & Lifelines Corona Research initiative 2025, 'The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health', International Journal of Obesity, vol. 49, no. 4, e13128, pp. 586-595. https://doi.org/10.1038/s41366-024-01660-x

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health. / Loef, Bette; Boer, Jolanda M.A.; Beekman, Marian et al.
In: International Journal of Obesity, Vol. 49, No. 4, e13128, 04.2025, p. 586-595.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection

T2 - a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health

AU - Loef, Bette

AU - Boer, Jolanda M.A.

AU - Beekman, Marian

AU - Campman, Sophie L.

AU - Hoogendijk, Emiel O.

AU - Huider, Floris

AU - Pagen, Demi M.E.

AU - Splinter, Marije J.

AU - van der Velde, Jeroen H.P.M.

AU - Boomsma, Dorret I.

AU - Dagnelie, Pieter C.

AU - van Dongen, Jenny

AU - de Geus, Eco J.C.

AU - Huisman, Martijn

AU - Ikram, M. Arfan

AU - Koster, Annemarie

AU - Licher, Silvan

AU - Mierau, Jochen O.

AU - de Mutsert, Renée

AU - Picavet, H. Susan J.

AU - Rosendaal, Frits R.

AU - Schram, Miranda T.

AU - Slagboom, P. Eline

AU - van der Spoel, Evie

AU - Stronks, Karien

AU - Verschuren, W. M.Monique

AU - van den Berg, Saskia W.

AU - Lifelines Corona Research initiative

PY - 2025/4

Y1 - 2025/4

N2 - Background: Obesity may affect an individual’s immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection. Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements. Results: Individuals with overweight (25 ≤ BMI < 30 kg/m2) (odds ratio (OR) = 1.08, 95%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m2) (OR = 1.43, 95%-CI 1.18–1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95%-CI 1.04–1.14, I2 = 0%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95%-CI 0.999–1.55, I2 = 57%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk. Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.

AB - Background: Obesity may affect an individual’s immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection. Methods: We analyzed data from nine prospective population-based cohorts of the Netherlands Cohorts Consortium, with a total of 99,570 participants, following a standardized procedure. Body mass index (BMI) and waist circumference (WC) were assessed two times before the pandemic, with approximately 5 years between measurements. SARS-CoV-2 infection was defined by self-report as a positive PCR or rapid-antigen test or as COVID-19 ascertained by a physician between March 2020 and January 2023. For three cohorts, information on SARS-CoV-2 infection by serology was available. Results were pooled using random-effects meta-analyses and adjusted for age, sex, educational level, and number of SARS-CoV-2 infection measurements. Results: Individuals with overweight (25 ≤ BMI < 30 kg/m2) (odds ratio (OR) = 1.08, 95%-confidence interval (CI) 1.04-1.13) or obesity (BMI ≥ 30 kg/m2) (OR = 1.43, 95%-CI 1.18–1.75) were more likely to report SARS-CoV-2 infection than individuals with a healthy body weight. We observed comparable ORs for abdominal overweight (men: 94 cm≤WC < 102 cm, women: 80 cm≤WC < 88 cm) (OR = 1.09, 95%-CI 1.04–1.14, I2 = 0%) and abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) (OR = 1.24, 95%-CI 0.999–1.55, I2 = 57%). Individuals with obesity long before the pandemic, but with a healthy body weight or overweight just before the pandemic, were not at increased risk. Conclusion: Overweight and obesity were associated with increased risk of SARS-CoV-2 infection with stronger associations for obesity. Individuals with a healthier weight prior to the pandemic but previous obesity did not have an increased risk of SARS-CoV-2, suggesting that weight loss in those with obesity reduces infection risk. These results underline the importance of obesity prevention and weight management for public health.

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U2 - 10.1038/s41366-024-01660-x

DO - 10.1038/s41366-024-01660-x

M3 - Article

AN - SCOPUS:85208052034

SN - 0307-0565

VL - 49

SP - 586

EP - 595

JO - International Journal of Obesity

JF - International Journal of Obesity

IS - 4

M1 - e13128

ER -

Loef B, Boer JMA, Beekman M, Huider F , Boomsma DI , van Dongen J et al. The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health. International Journal of Obesity. 2025 Apr;49(4):586-595. e13128. Epub 2024 Oct 31. doi: 10.1038/s41366-024-01660-x

The association of overweight, obesity, and long-term obesity with SARS-CoV-2 infection: a meta-analysis of 9 population-based cohorts from the Netherlands Cohorts Consortium: Epidemiology and Population Health

Abstract

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