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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity is a multifactorial&#44; complex&#44; chronic metabolic disease<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> associated with chronic inflammation that plays an essential role in the development of type 2 diabetes mellitus &#40;DM2&#41;&#44; dyslipidemia&#44; hypertension &#40;HT&#41;&#44; cardiovascular diseases &#40;CVD&#41;&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; the 2019-nCoV coronavirus is devastating the planet&#46; It has diverse clinical manifestations including&#44; most notably&#44; lung disease&#46; The risk factors for infectious diseases depend on the host&#44; the pathogen&#44; and the environment&#46; Various factors associated with the severity and a worse prognosis of 2019-nCoV infection have been described&#44; such as age&#44; presence of chronic diseases such as DM2 or HT&#44; and diseases that compromise the immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the few series that have been published&#44; obesity is also included among these factors&#44; especially for those younger than 65 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Obesity is associated with a worse immune response and a poor prognosis for respiratory infections&#44; as was observed during the influenza A &#40;H1N1&#41; epidemic in 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> At baseline&#44; people with obesity have an associated low grade of chronic inflammation&#59; they have decreased concentrations of anti-inflammatory adiponectin and elevated concentrations of proinflammatory cytokines such as interleukin 6&#44; tumor necrosis factor alpha&#44; and leptin&#44; which are produced in visceral and subcutaneous abdominal fatty tissue&#44; especially in males&#46; All are associated with greater severity of disease caused by 2019-nCoV&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This &#8220;inflamed&#8221; microenvironment predisposes people with obesity to an abnormal cellular and humoral immune response leading to&#44; on one hand&#44; greater susceptibility to and delay in resolution of the infection and&#44; on the other hand&#44; the onset of severe lung injury and lesser immunization coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Associated with inflammation&#44; obesity predisposes the body to a state of hypercoagulability&#44; in this case boosted by 2019-nCoV&#46; It is also important not to forget abnormalities in respiratory dynamics&#44; also especially of note in males&#44; as it confers greater predisposition to respiratory diseases such as asthma or hypoventilation syndromes&#44; aggravated by microaspirations secondary to gastroesophageal reflux disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Recent publications have described a relationship between people with obesity and greater contagiousness due to the fact that they may exhale the virus for a longer time or favor the appearance of more virulent strains&#44; both due to the particular proinflammatory microenvironment and lower interferon production&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this scenario of uncertainty&#44; with the worldwide dissemination of the infection and the obesity epidemic&#44; clinicians must pay close attention and must monitor and treat people with obesity early and aggressively&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nevertheless&#44; once the 2019-nCoV tsunami passes&#44; we must not forget the lessons learned&#46; The approach to epidemics transcends the healthcare field and requires the involvement of political authorities and civil society&#46; The beneficial effects of moderate physical exercise on the immune system are well-known&#59; it modulates inflammation and insulin resistance&#44; preventing cellular aging and the formation of free radicals&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Social policies must be aimed at promoting a healthy lifestyle&#44; regular physical exercise&#44; and achieving a healthy weight&#44; thus breaking the toxic relationship between obesity and infection&#46;</p></span>"
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Correspondence
Obesity and 2019-nCoV: A risky relationship
Obesidad y coronavirus 2019nCoV: una relación de riesgo
J. Carretero Gómeza,
Corresponding author
juanicarretero@gmail.com

Corresponding author.
, J.C. Arévalo Loridoa, F.J. Carrasco Sánchezb
a Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
b Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity is a multifactorial&#44; complex&#44; chronic metabolic disease<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> associated with chronic inflammation that plays an essential role in the development of type 2 diabetes mellitus &#40;DM2&#41;&#44; dyslipidemia&#44; hypertension &#40;HT&#41;&#44; cardiovascular diseases &#40;CVD&#41;&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; the 2019-nCoV coronavirus is devastating the planet&#46; It has diverse clinical manifestations including&#44; most notably&#44; lung disease&#46; The risk factors for infectious diseases depend on the host&#44; the pathogen&#44; and the environment&#46; Various factors associated with the severity and a worse prognosis of 2019-nCoV infection have been described&#44; such as age&#44; presence of chronic diseases such as DM2 or HT&#44; and diseases that compromise the immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the few series that have been published&#44; obesity is also included among these factors&#44; especially for those younger than 65 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Obesity is associated with a worse immune response and a poor prognosis for respiratory infections&#44; as was observed during the influenza A &#40;H1N1&#41; epidemic in 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> At baseline&#44; people with obesity have an associated low grade of chronic inflammation&#59; they have decreased concentrations of anti-inflammatory adiponectin and elevated concentrations of proinflammatory cytokines such as interleukin 6&#44; tumor necrosis factor alpha&#44; and leptin&#44; which are produced in visceral and subcutaneous abdominal fatty tissue&#44; especially in males&#46; All are associated with greater severity of disease caused by 2019-nCoV&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This &#8220;inflamed&#8221; microenvironment predisposes people with obesity to an abnormal cellular and humoral immune response leading to&#44; on one hand&#44; greater susceptibility to and delay in resolution of the infection and&#44; on the other hand&#44; the onset of severe lung injury and lesser immunization coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Associated with inflammation&#44; obesity predisposes the body to a state of hypercoagulability&#44; in this case boosted by 2019-nCoV&#46; It is also important not to forget abnormalities in respiratory dynamics&#44; also especially of note in males&#44; as it confers greater predisposition to respiratory diseases such as asthma or hypoventilation syndromes&#44; aggravated by microaspirations secondary to gastroesophageal reflux disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Recent publications have described a relationship between people with obesity and greater contagiousness due to the fact that they may exhale the virus for a longer time or favor the appearance of more virulent strains&#44; both due to the particular proinflammatory microenvironment and lower interferon production&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this scenario of uncertainty&#44; with the worldwide dissemination of the infection and the obesity epidemic&#44; clinicians must pay close attention and must monitor and treat people with obesity early and aggressively&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nevertheless&#44; once the 2019-nCoV tsunami passes&#44; we must not forget the lessons learned&#46; The approach to epidemics transcends the healthcare field and requires the involvement of political authorities and civil society&#46; The beneficial effects of moderate physical exercise on the immune system are well-known&#59; it modulates inflammation and insulin resistance&#44; preventing cellular aging and the formation of free radicals&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Social policies must be aimed at promoting a healthy lifestyle&#44; regular physical exercise&#44; and achieving a healthy weight&#44; thus breaking the toxic relationship between obesity and infection&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Carretero G&#243;mez J&#44; Ar&#233;valo Lorido JC&#44; Carrasco S&#225;nchez FJ&#46; Obesidad y coronavirus 2019nCoV&#58; una relaci&#243;n de riesgo&#46; Rev Clin Esp&#46; 2020&#59;220&#58;387&#8211;388&#46;</p>"
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