Obesity and Impaired Metabolic Health Increase Risk of COVID-19-Related Mortality in Young and Middle-Aged Adults to the Level Observed in Older People: The LEOSS Registry

Research output: Contribution to journalResearch articleContributedpeer-review


  • German Center for Diabetes Research (DZD e.V.)
  • University of Cologne
  • German Center for Infection Research, Partner Site Bonn-Cologne
  • Technical University of Munich
  • University Hospital Frankfurt
  • Ingolstadt Hospital
  • Friedrich Schiller University Jena
  • University of Regensburg
  • Hospital Passau
  • Klinikum Bremen-Mitte
  • Infectiology
  • Maria Hilf Hospital Moenchengladbach
  • Ruhr University Bochum
  • University Hospital Augsburg
  • Heinrich Heine University Düsseldorf
  • German Institute of Human Nutrition Potsdam-Rehbruecke
  • Harvard University


Advanced age, followed by male sex, by far poses the greatest risk for severe COVID-19. An unresolved question is the extent to which modifiable comorbidities increase the risk of COVID-19-related mortality among younger patients, in whom COVID-19-related hospitalization strongly increased in 2021. A total of 3,163 patients with SARS-COV-2 diagnosis in the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort were studied. LEOSS is a European non-interventional multi-center cohort study established in March 2020 to investigate the epidemiology and clinical course of SARS-CoV-2 infection. Data from hospitalized patients and those who received ambulatory care, with a positive SARS-CoV-2 test, were included in the study. An additive effect of obesity, diabetes and hypertension on the risk of mortality was observed, which was particularly strong in young and middle-aged patients. Compared to young and middle-aged (18–55 years) patients without obesity, diabetes and hypertension (non-obese and metabolically healthy; n = 593), young and middle-aged adult patients with all three risk parameters (obese and metabolically unhealthy; n = 31) had a similar adjusted increased risk of mortality [OR 7.42 (95% CI 1.55–27.3)] as older (56–75 years) non-obese and metabolically healthy patients [n = 339; OR 8.21 (95% CI 4.10–18.3)]. Furthermore, increased CRP levels explained part of the elevated risk of COVID-19-related mortality with age, specifically in the absence of obesity and impaired metabolic health. In conclusion, the modifiable risk factors obesity, diabetes and hypertension increase the risk of COVID-19-related mortality in young and middle-aged patients to the level of risk observed in advanced age.


Original languageEnglish
Article number875430
Pages (from-to)1-12
Number of pages12
JournalFrontiers in medicine
Issue number2022
Publication statusPublished - 11 May 2022


Sustainable Development Goals

ASJC Scopus subject areas


  • COVID-19, diabetes, hypertension, impaired metabolic health, mortality, obesity

Library keywords