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Obesity is a risk factor for increased difficulty in most modalities of airway management. It decreases ease and effectiveness of face mask ventilation, supraglottic airway device use and front of neck airway techniques and probably makes laryngoscopy more difficult. When difficulty occurs, airway rescue techniques are more likely to fail in the obese patient. Obesity also increases the risk of aspiration and difficulty in lung ventilation, both of which may necessitate changes in anaesthetic technique. Most importantly, obesity reduces the time available for airway management before hypoxia supervenes. To worsen matters, obesity reduces the efficacy of pre-oxygenation and safe apnoea time is less prolonged with apnoeic oxygenation techniques than in the non-obese population. To compound these factors obesity is associated with obesity-specific (e.g. obstructive sleep apnoea, obesity hypoventilation syndrome) and non-specific co-morbidities (diabetes, asthma, hypertension). With increasing numbers of obese patients and increasing degrees of obesity in the surgical population it is essential that all anaesthetists are familiar with the potential complications of airway management in the obese and the techniques that may mitigate or manage risk.
Despite the training and skills of airway managers, airway management complications still occur and may cause patient harm or death. The causes are multifactorial and may include patient, environment and clinician factors. Airway complications likely contribute to a significant proportion of deaths due to anaesthesia and are certainly more common outside the operating theatre and especially in the critical care unit. Reported incidences of failure and harm during airway management vary depending on the population studied and definitions used. Numbers may be of less value than understanding themes that help us improve care and reduce harm. The chapter emphasises that conventional research (e.g. device evaluation studies and randomised controlled trials) may be of little use in identifying low frequency events and complications because of their restricted inclusion and exclusion criteria, the use of devices only by experts and in conventional settings and because of their focus on efficacy rather than safety. The chapter highlights the important and growing role of registries and databases. Several are described in detail including the 4th National Audit Project and the Dutch ‘mini-NAP’. The value and limitations of litigation databases are explored. Specific complications of note are described at the end of the chapter.
To describe prenatal and postpartum consumption of water, cows’ milk, 100 % juice and sugar-sweetened beverages (SSB) among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programme in New York City (NYC) and to identify correlates of SSB intake in this population.
Cross-sectional data were collected from structured questionnaires that included validated beverage frequency questionnaires with the assistance of container samples. The association of maternal and household factors and non-SSB consumption with habitual daily energetic (kJ (kcal)) intake from SSB was assessed by using multivariable median regression.
WIC programme in NYC, NY. Data were collected in 2017.
388 pregnant or postpartum women (infant aged <2 years) from the NYC First 1000 Days Study.
Median age was 28 years (interquartile range (IQR) 24–34); 94·1 % were Hispanic/Latina, and 31·4 % were pregnant. Overall, 87·7 % of pregnant and 89·1% of postpartum women consumed SSB ≥ once weekly, contributing to a median daily energetic intake of 410 kJ (98 kcal) (IQR (113–904 kJ) 27–216) and 464 kJ (111 kcal) (IQR (163–1013 kJ) 39–242), respectively. In adjusted analyses, only consumption of 100 % juice was associated with greater median energetic intake from SSB (adjusted β for each additional ounce = 13; 95% CI 8, 31 (3·2; 95 % CI 2·0, 7·3).
Among pregnant and postpartum women in WIC-enrolled families, interventions to reduce SSB consumption should include reduction of 100 % juice consumption as a co-target of the intervention.
Childhood obesity is of increasing concern in South Africa, and interventions to promote healthy behaviours related to obesity in children are needed. Young children in urban low-income settings are particularly at risk of excess adiposity. The current study aimed to describe how parents of preschool children in an urban South African township view children’s movement and dietary behaviours, and associated barriers and facilitators.
A contextualist qualitative design was utilised with in-depth interviews conducted in the home setting and analysed using reflexive thematic analysis. Field notes were used to contextualise findings.
Four neighbourhoods in a predominantly low-income urban township.
Sixteen parents (fourteen mothers, two fathers) of preschool-age children were recruited via preschools.
Four themes were developed: children’s autonomy and the limits of parental control; balancing trust and fears; the appeal of screens; and aspirations and pressures of parenthood. Barriers to healthy behaviours included children’s food preferences, aspirations and pressures to consume unhealthy foods, other adults giving children snacks, lack of safe places to play, unhealthy food environments and underlying structural factors. Facilitators included set routines, the preschool environment, safe places to play and availability of healthy foods.
Low-income families in Soweto face many structural challenges that cannot easily be addressed through public health interventions, but there may be opportunities for behavioural interventions targeting interpersonal and organisational aspects, such as bedtime routines and preschool snacks, to achieve positive changes. More research on preschoolers’ movement and dietary behaviours, and related interventions, is needed in South Africa.
Suicide and cardiovascular disease rank among the leading causes of disability and premature mortality worldwide. Young adult suicide attempters are at increased risk of mortality from cardiovascular disease even compared to those with major depressive disorder suggesting an increased burden of cardiovascular risk factors. We compared the cardiovascular risk burden between youth attempters and other high-risk individuals.
Participants were from the Collaborative Psychiatric Epidemiology Surveys (CPES), a U.S. population-based study, aged 18–30 years [suicide attempt (SA): n = 303; suicidal ideation (SI): n = 451; controls: n = 3671]; and psychiatric inpatients admitted for a SA (n = 38) or SI (n = 40) and healthy controls (n = 37) aged 15–30 years. We computed a cardiovascular risk score and high- and low-risk latent classes based on risk factors of high blood pressure, obesity, and smoking.
Suicide attempters showed an increased cardiovascular risk score (CPES: B = 0.43, 95% confidence interval (CI) 0.31–0.54, p < 0.001; inpatient sample: B = 1.61, 95% CI 0.53–2.68, p = 0.004) compared to controls. They were also more likely to be classified in the high cardiovascular risk group (CPES: odds ratio (OR) 3.36, 95% CI 1.67–6.78, p = 0.001; inpatient sample: OR 9.89, 95% CI 1.38–85.39, p = 0.03) compared to those with SI (CPES: OR 1.15, 95% CI 0.55–2.39, p = 0.71; inpatient sample: OR 1.91, 95% CI 0.25–15.00, p = 0.53).
Youth attempters show an increased burden for cardiovascular risk compared to other high-risk individuals in inpatient and population-based samples. Clinicians should pay particular attention to cardiovascular risk factors among suicide attempters in order to reduce their risk for cardiovascular events.
Intermittent food restriction (IFR) is used mainly for weight loss, however, its effects on adipose tissue are not known when alternating with obesogenic diet. To demonstrate its effects on morphological dynamics of fat deposits, female Wistar were distributed into the groups: standard control (ST-C), with commercial diet; DIO control (DIO-C), with a diet that induces obesity (DIO) during the first and last 15 days, replaced by a standard diet for 30 intermediate days; standard restricted (ST-R), with standard diet during the first and last 15 days, with six cycles of IFR at 50% of ST-C; and DIO restricted (DIO-R), in DIO during the first and last 15 days, with six cycles of IFR at 50% of DIO-C. At 105 days of life, white adipose tissue (WAT) and brown adipose tissue (BAT) deposits were collected, weighed and histology performed. IFR groups showed higher food intake (DIO-R: 670.8±31.86kcal/g vs DIO-C: 606.5±26.23kcal/g, p<0.0001), energy efficiency (DIO-R: 3.80±0.15 g/kcal vs DIO-C: 3.26±0.17 g/kcal, p<0.0001), WAT (DIO-R: 5.65±0.30g/100g, ST-R: 3.64±0.23g/100g vs. DIO-C: 4.56±0.30g/100g, ST-C: 2.87±0.31g/100g, p<0.0001) and BAT (DIO-R: 0.13±0.004g/100g vs DIO-C: 0.13±0.005g/100g, p<0.0001) than its respective controls. Furthermore, IFR groups presented hypertrophy of WAT and BAT, as well as fibrosis in BAT. Thus, IFR can establish prospective resistance to weight loss by favoring changes in adipose tissue morphology, increased energy intake, and efficiency. Finally, the DIO diet before and after IFR aggravates the damages caused by the restriction.
Higher intakes of sodium may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary sodium intake and measures of adiposity in children and adults. Given the previous link between sodium intake and the consumption of sugar-sweetened beverages (SSBs), which are a known risk factor for obesity, a secondary aim examining the relationship between sodium intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCTs) which reduced dietary sodium (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher sodium intakes were associated with overweight/obesity in adults (5 studies; n=11,067; (OR) 1.74, 95%CI 1.43,2.13) and in children (3 studies; n=3625, OR=3.29,2.25, 4.80); and abdominal obesity (5 studies; n=19,744; OR=2.04, 1.72, 2.42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCTs in adults indicated a trend for lower body weight on reduced sodium compared to control diets (15 studies; n=5274; -0.29 kg, -0.59,0.01; P=0.06), however it is unclear if energy intakes were also altered on reduced sodium diets. Among children higher sodium intakes were associated with higher intake of SSBs (4 studies, n=10,329, b=22, 16,26 g/d), no studies were retrieved for adults. Overall there was a lack of high quality studies retrieved. Whilst cross-sectional evidence indicates sodium intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or randomised controlled trials.
We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above.
We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined.
Households from all the administrative regions of Ghana.
Included 3350 adults aged 50 years and older.
The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants.
Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative.
Although developing countries are experiencing some of the fastest rises in the prevalence of adult overweight and obesity, little is known about the pace of the problem among young people in transition from adolescence to adulthood. This study examined the trend and associated socio-demographic predictors of overweight/obesity (BMI ≥25kg/m2) from 1993 to 2014 among women aged 15–24 years in Ghana and projected the future prevalence from 2019 to 2040. Descriptive statistics, the arithmetic linear change model, and binary logistic regression were applied to data on women aged 15–24 years from five nationally representative Ghana Demographic and Health Surveys conducted in 1993 (N=488), 1998 (N=517), 2003 (N=1832), 2008 (N=1693) and 2014 (N=1491). Overall, overweight/obesity among women aged 15–24 years almost tripled between the 1993 (6.8%; 95% CI=4.9–9.3) and 2014 (19.5%; 95% CI=17.3–21.2) surveys. Based on the arithmetic linear change model, overweight/obesity is projected to increase linearly to over 35% among the 15–24 year cohort of women by 2040. Age, educational level, wealth status, occupation, type of locality, ethnicity, frequency of viewing TV per week, parity and contraceptive use were found to be significant predictors of overweight/obesity among this sub-group of women. The trend of overweight/obesity demonstrated in this group of women could potentially provide momentum for further increases in the prevalence of overweight/obesity and associated health outcomes in the coming years in Ghana. This underscores the need for urgent national-level public health intervention efforts to curtail the problem.
Singapore, an urbanised, developed nation, with a high reliance on food importation and a high prevalence of eating out is facing rising rates of obesity and diabetes. The objective of the current study was to characterise and evaluate the Singapore government’s policies to improve the food environment and to identify and prioritise concrete actions.
The Healthy Food Environment Policy Index tool and process were used. An expert panel rated the Singapore government’s implementation of forty-seven indicators compared with international best practice in 2018. Indicators were prioritised, and specific recommendations were proposed by panel.
Twenty experts primarily from academia.
As compared with international benchmarks, the level of implementation of most indicators (thirty-three indicators, 70 %) by the Singapore government was evaluated as being at least moderate. Highly rated indicators included those related to provision of healthier meals at school, supporting the use of healthier ingredients by food vendors and governmental leadership. More policy indicators (6, 26 %) as compared with infrastructure support indicators (2, 8 %) received a ‘very little or no implementation’ rating. After rating, the experts prioritised eleven indicators and proposed thirty-one actions informed by several considerations including those of effectiveness, political acceptability, feasibility and unique characteristics of food retail in Singapore.
Supported by documented evidence, an independent expert panel identified areas of strengths and provided specific recommendations to meaningfully improve the Singapore food environment to facilitate healthier eating. Fundamental recommendations including improving nutrition profiling and strengthening monitoring systems have the potential to positively influence environments across policy domains.
The face and construct validity of the Iranian version of the Yale Food Addiction Scale (YFAS) was evaluated, and the convergent validity and test–retest reliability of both Iranian and original versions of YFAS for obese women were assessed.
The internal consistency of the YFAS was analysed. Exploratory factor analysis for dichotomous data was performed by varimax rotation, polychoric correlation coefficients and confirmatory factor analysis (CFA). Convergent validity was established by evaluating the correlation between the original and the Iranian versions of YFAS and the Binge Eating Scale (BES). The intraclass correlation coefficient (ICC) was measured between test–retest results.
A weight management clinic in Tehran.
450 obese women.
The single-factor structure indicated that the factor loadings for all the items were > 0·5, except for three items (explained proportion variance = 51 %). Based on CFA, the single factor had a better fit to the data after excluding three items. The Kuder–Richardson-20 coefficient was 0·86 for the total twenty-two items. The symptom count and diagnostic version of both the Iranian (ICC = 0·92 and 0·87, respectively) and original YFAS (ICC = 0·92 and 0·86, respectively) were stable over 2 weeks. Both the symptom count and the diagnostic version of these two scales had significant correlations with the measures of BES (P < 0·001).
The initial reliability and validity of the Iranian version of the YFAS among obese women are supported. Further studies should be conducted on men and normal/overweight samples.
Breakfast is considered as the most important meal of the day. The habit of skipping this meal in adolescence tends to remain until adulthood and has been associated with cardiometabolic risk factors. This study estimated the prevalence of skipping breakfast and its association with cardiometabolic risk factors. This is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), with a nationally representative sample of 36,956 Brazilian adolescents, aged 10 to 17 years, enrolled in public and private schools. The outcomes were: excess body weight (body mass index), central obesity (waist circumference and waist/height ratio), lipid profile (total cholesterol, LDLc, HDLc, and triglycerides) and glycidic profile (fasting glycemia, fasting insulin, and glycated hemoglobin). The association between skipping breakfast and each outcome was estimated using multiple logistic regression models (Odds Ratio [OR] and 95% Confidence Interval). Prevalence of skipping breakfast was 68.7% and, after adjustments, it was associated with excess body weight (OR = 1.51), central obesity both by waist circumference (OR = 1.36) and by waist/height ratio (OR = 1.44) and high fasting glucose levels (OR = 1.54), fasting insulin (OR = 1.45), and glycated hemoglobin (OR = 1.23). Thus, skipping breakfast was high among adolescents and those who skip this meal are more likely to have total and central obesity, as well as high levels of total cholesterol, fasting insulin, fasting glycemia and glycated hemoglobin, regardless of factors relative to lifestyle and demographic and socioeconomic characteristics.
The rising rate of childhood overweight follows the increase in maternal obesity, since perinatal events impact offspring in a diversity of metabolic disorders. Despite many studies that have linked dietary consumption, overnutrition, or maternal obesity as the mediators of fetal metabolic programming, there are gaps regarding the knowledge about the contribution of different maternal phenotypes to the development of metabolic disturbances in offspring. This study aimed to investigate whether maternal high-fat diet (HFD) consumption without the development of the obese phenotype would protect offspring from metabolic disturbances. Female mice were fed standard chow diet or a HFD for 4 weeks before mating. HFD females were classified into obesity-resistant (OR) or obesity-prone (OP), according to weight gain. OP females presented with higher adiposity, fasting serum glucose and insulin, cholesterol and non-esterified fatty acid (NEFA). Newborn offspring from OP dams showed higher serum glucose and insulin and alteration in hepatic gene expression that may have contributed to the rise in hepatic fat content and decline of glycogen levels in the liver. Despite offspring from OR and OP females having showed similar growth after the day of delivery, offspring from OP females had higher caloric intake, fasting glucose, serum triglycerides and altered hepatic gene expression, as well as glucose and pyruvate intolerance and lower insulin sensitivity at d28 compared with offspring from OR females. Maternal pre-pregnancy serum glucose, insulin, and NEFA positively correlated with serum glucose and fat liver content and negatively correlated with hepatic glycogen in offspring. In conclusion, our results show that maternal resistance to diet-induced obesity partially protects offspring from early metabolic disturbances.
Recent models of obesity and eating behaviour have implicated both automatic responding to food-related cues and executive functioning in driving dietary choice. This study aimed to relate grazing severity to high weight with and without significant eating disorder features via the effects of inhibition and degree of goal-directed behaviour, in persons with obesity with and without significant eating disorder features compared to healthy controls. Forty-four participants with obesity (43.1% endorsing marked eating disorder features), and 43 healthy-weight age- and sex-matched participants (N = 87; 67.8% female, age = 28.57 (8.70; 18.18–58.34) years, BMI = 29.18 (7.80; 18.65–51.95) kg/m2) completed demographic and eating disorder-related questionnaires, a neuropsychological task of inhibition and an instrumental decision-making task. Bootstrapped serial mediation analyses were performed to examine the effect of group on grazing via goal-directed behaviour and inhibition. While significant differences existed between the groups in terms of inhibition, goal-directed behaviour and grazing severity, the effect of group on grazing severity was not found to be mediated by the degree of behavioural goal-directedness and inhibition. Therefore, :in persons with obesity with or without eating disorder symptoms, putative relationships between a reduced inhibitory profile and/or behaviour that is less flexible and goal-directed and eating behaviours such as grazing, remain unclear.
Parental practices can affect children’s weight and body mass index and may even be related to a high prevalence of obesity. Therefore, the aim of this study was to evaluate the relationship between parents’ practices related to feeding their children and excess weight in preschoolers in Bucaramanga, Colombia, using artificial intelligence as an analytical and novel approximation. A Cross-sectional study was carried out between September and December 2017. Sample included preschoolers who attended child development institutions belonging to the Colombian Institute for Family Wellbeing (Instituto Colombiano de Bienestar Familiar (ICBF, Spanish acronym)) in Bucaramanga and the metropolitan area (sample size n=384). Outcome variable was excess weight, defined as body mass index for age. Main independent variable was parental feeding practices. Confounding variables that were analyzed included sociodemographic characteristics, food consumption, and the physical activity of the children. All equipment used for the anthropometric measurements was calibrated. Logistic regression was used to predict the effect of parental practices on the excess weight of the children, and the area under the curve (AUC) was used to measure performance. The parental practices with the greatest association with excess weight in the children involved using food to control their behavior and restricting the amount of food they offered (use of food to control emotions (OR: 1.77; CI 95%: 1.45- 1.83, p=0.034) and encouraging children to eat less (OR: 1.22; CI 95%: 1.14 - 1.89; p= 0.045)). There were no significant differences between fathers and mothers in terms of the use of food to control the behavior of their children or restricting their children’s food consumption. Childrearing practices related to feeding were found to be an important predictor of excess weight in children. The results of this study represent implications for the public health considering this as a baseline for the design of nutrition education interventions focused on parents of preschooler vulnerable children.
With simultaneous efforts to address a huge burden of malnutrition, especially among children and younger women, India also encounters a mushrooming prevalence of overweight and obesity among the adult population. This study analysed data from two consecutive rounds of the National Family Health Survey (NFHS) conducted in 2005–06 and 2015–16, to present the burden of overweight and obesity among adult men and women in India. The findings highlight a rising burden of overweight and obesity, although the level and the extent of change over the study period varied across states. The district-wise analysis revealed geographical clusters of overweight and obesity. Further investigation suggests that overweight or obesity are not exclusive to urban areas, and economically well-off populations are more inclined to be overweight or obese. The trends and patterns of overweight and obesity in India argue for timely public health preparedness and interventions to avoid the rising incidence of non-communicable diseases in India.
Due to the higher costs and selection bias of directly measuring weight, the majority of body weight data are based on survey responses. However, these statements are subject to systematic biases of social desirability; therefore, it is important to evaluate the magnitude of bias through indirect indicators such as rounding of weights. Data from seven rounds of the Spanish National Health Survey from 1995 to 2017 were included in the study, with 113,284 subjects. A general rounding index of weights terminating in 0 and 5, and a partial rounding index that estimated the bias direction, were used to estimate the bias distribution in the self-reporting of body weight. All body weights were systematically rounded, although more strongly in the lower weights and even more so in the higher weights. Lower weights were rounded up, and the higher weights rounded down. Regarding gender, men had higher rounding indices than women. The subjects generally reported a weight closer to the socially desirable weight. Rounding allows estimating the historical evolution of this bias in health and nutrition surveys, having more accurate information by population segments and designing public policies against obesity aimed at the more affected social segments.
Osteoarthritis (OA) is associated with functional limitations that can impair mobility and reduce quality of life in affected individuals. Excess body weight in OA can exacerbate impaired physical function, highlighting the importance of weight management in this population. The aim of this systematic review was to compare the effects of different dietary interventions for weight loss on physical function in overweight and obese individuals with OA.
A comprehensive search of five databases was conducted to identify relevant articles for inclusion. Studies were included that examined the effect of dietary weight loss interventions, with or without exercise, on physical function in adults with OA who were overweight or obese. Quality and risk of bias were assessed using the Quality Criteria Checklist for primary research. Primary and secondary outcomes were extracted, including change in weight and physical function which included performance-based and self-report measures.
Nineteen relevant studies were included, which incorporated lifestyle interventions (n 8), diet in combination with meal replacements (DMR; n 5) and very low-energy diets (VLED; n 6) using meal replacements only. Pooled data for eight RCT indicated a mean difference in Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function of 12·4 and 12·5 % following DMR or VLED interventions, respectively; however, no statistically significant change was detected for lifestyle interventions.
Our findings suggest that partial use of meal replacements is as effective as their sole use in the more restrictive VLED. Both dietary interventions are more effective than lifestyle programmes to induce significant weight loss and improvements in physical function.
Consumption of sugar-sweetened beverages (SSBs) during pregnancy has been associated with childhood obesity. Research in which rodent dams have been given high-fat/high-sugar diets has consistently found metabolic alterations in their offspring. However, what remains unclear is the potential impact on the developing fetus of giving sugar in isolation at concentrations similar to SSBs to the mothers. Therefore, we conducted a systematic review and meta-analysis (Protocol No: 127115 on Prospero) to identify potential relationships between maternal sucrose consumption and metabolic outcomes in offspring of rodent (rat or mouse) models. We analysed studies that provided rodent mothers dams with access to sucrose solutions (8–20% w/v) prior to conception, during pregnancy and/or lactation and that reported offspring outcomes of body weight (BW), body composition and glycaemic control. Following a systematic search of four databases (PubMed, EMBASE, Web of Science and Scopus) performed on 15 January 2019, maternal and offspring data from 15 papers were identified for inclusion. Only rat studies were identified. Meta-analyses were performed on standardised mean differences for maternal and offspring BW and fasting glucose levels, with subgroup analyses of strain, sucrose concentration, exposure period and sex of offspring. A bias towards the inclusion of only data from male offspring was identified and this limited interpretation of potential sexually dimorphic outcomes. Maternal sucrose exposure was associated with an increased risk of obesity and poor glucose disposal in adult and aged offspring.
As COVID-19 continues to spread worldwide, severe disease and mortality have been observed in obese patients. We discuss how obesity and obesity-associated factors such as ‘meta-flammation’, dietary fat intake and paradoxical suppression of the innate immune response within the pulmonary compartment may be crucial determinants in the host response to a novel viral pathogen. Modulation of immune cell bioenergetics and metabolic potential plays a central role in the innate immune response to infection, and as we strive to combat this new global health threat, immunometabolism of the innate immune system warrants attention.