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Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until October 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia, and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (all p < 0.05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (all p < 0.05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive [adjusted hazard ratio (aHR) 0.64, 95% CI 0.48–0.86; p = 0.003], glucose-lowering [aHR 0.55, 95% CI 0.36–0.83; p = 0.004], and lipid-lowering treatments [aHR 0.50, 95% CI 0.37–0.68; p < 0.001]) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination. [Display omitted] • Obesity and metabolic abnormalities are highly prevalent in patients with severe COVID-19 • Obesity and metabolic abnormalities are associated with an increased risk of severe COVID-19 • In vaccinated patients, metabolic abnormalities are risk factors for severe COVID-19 • Interventions targeting metabolic abnormalities may reduce the risk of severe COVID-19 Fan et al. show that obesity and metabolic abnormalities were modifiable risk factors for severe COVID-19 events in vaccinated patients. When metabolic abnormalities (namely, hyperglycemia, hyperlipidemia, or hypertension) were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal people. Moreover, pharmacological interventions targeting such abnormalities were significantly associated with a reduced risk for this outcome. [ABSTRACT FROM AUTHOR]

Obesity is associated with an increased risk of digestive polyps, whereas all obesity are not created equally. The role of metabolic states in occurrence risks of polyps among individuals with varying degrees of obesity remains unknown. Our study aimed to evaluate the association between metabolic obesity phenotypes and the occurrence of digestive polyps. Data from 9,278,949 patients between 2016 and 2018 from the National Inpatient Sample (NIS) database, a nationally representative database of all discharges from US health-care hospitals, were analyzed. According to obesity phenotype, the study population was classified into four groups: metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). We calculated the incidence rates of various digestive polyps (stomach/duodenum, colon and rectum polyps) among these participants by searching the hospital records for ICD-10 diagnosis codes indicating each gastric, duodenum, colon or rectal polyps. The multiple stepwise regression analysis and further in-depth subgroup analysis were used to determine the associations between metabolic obesity phenotypes and the occurrence of digestive polyps. In the total or female population, those with the MUNO and MUO phenotypes had significantly higher prevalence of digestive polyps compared with individuals with the MHNO or MHO phenotypes (all p < 0.05) and a significant difference was not found between MUNO and MUO phenotypes (p > 0.05). Obese subjects seem to be more likely to develop stomach and duodenum polyps or colon polyps than non-obese subjects in metabolically healthy people of males (MHO vs. MHNO, p < 0.05), whereas obesity status seems to have little effect on the occurrence of digestive polyps in metabolically healthy people of females (MHO vs. MHNO, p >0.05). After adjusting for the potential confounders, the MHO, MUNO and MUO phenotypes were all risk factors for stomach and duodenum polyps (OR = 1.46, 95% CI: 1.36–1.58, p < 0.01; OR = 1.19, 95% CI: 1.14–1.25, p < 0.01; OR = 1.44, 95% CI: 1.35–1.55, p < 0.01, respectively) or colon polyps (OR = 1.28, 95% CI: 1.21–1.35, p < 0.01; OR = 1.18, 95% CI: 1.14–1.22, p < 0.01; OR = 1.46, 95% CI: 1.38–1.54, p < 0.01, respectively) compared with the MHNO phenotype，especially in menopausal female. Interestingly, we also observed in further in-depth subgroup analysis that metabolic abnormalities may have a greater impact on the occurrence of digestive polyps than obesity (all p < 0.05). Both metabolic abnormities and obesity were associated with a higher risk of digestive polyps. The effect of metabolism on digestive polyp occurrence may be stronger than that of obesity, highlighting the importance of abnormal metabolic status modification regardless of obesity status. Clinical intervention should not only focus on obesity, but also on metabolic abnormalities to decrease digestive polyp risk. [Display omitted] • Both metabolic abnormities and obesity were associated with a higher risk of digestive polyps. • The effect of metabolism on the occurrence of digestive polyps may be stronger than that of obesity. • Clinical intervention should not only focus on obesity but also on metabolic abnormalities. • Sex differences in the occurrence of digestive polyps were highlighted. [ABSTRACT FROM AUTHOR]