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COVID-19 and Metabolic Syndrome: The

Pathophysiology

Hendra Susanto, S.Pd., M.Kes., Ph.D.

Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang,
Malang, Indonesia
Department of Biotechnology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang,
Malang, Indonesia
Molecular Physiology Laboratory, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

June 27, 2021

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https://www.miskawaanhealth.com/understanding-metabolic-syndrome/
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 Metabolic Syndrome
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❑ Metabolic syndrome is metabolic abnormalities resulting from

an insulin resistance state associated with abdominal/central
obesity ( > 20-25 % of the world population).

❑ Metabolic syndrome is confirmed with the presence of the

following criteria:
- Excess body weight - High blood pressure
- High plasma glucose - Low HDL
- High triglycerides
(Grundy et al. Circulation, 2004; Kahn et al. Diabetes Care, 2005; IDF, 2006; Despres, J.P. and Lemieux, I. Nature, 2006)

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 Excellence in Learning Innovation Obesity
❑ Obesity is abnormal or excessive fat accumulation (an increase adipose
tissue mass). (Tchernof, A. & Despress, J.P. Physiol Rev, 2013)

❑The fundamental cause of obesity is an energy imbalance. Importantly, obesity

has become a new trend in Asian populations. (Rosen D.E. and Spiegelman, B.M. Nature,
2006; Misra, A., and Khurana, L. International Journal of Obesity, 2011; WHO, 2011; Tchernof, A. & Despress, J.P.
Physiol Rev, 2013)

❑The progression of obesity associated with insulin resistance, chronic

inflammation, T2DM, and hepatocellular carcinoma. Excess body weight is
also associated with increased cancer mortality. (Deng, T. et al. Annu. Rev. Pathol. Mech. Dis.
2016)

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Obesity, Insulin Resistance, and T2DM Development
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Obesity

↑ inflammation ↑ liver Triglyceride

↑ Plasma Glucose
(ROS, IL-6, TNF-α, JNK-1) (SREBP1c, ACC, FAS)

↑ Risk of Insulin Resistance, Chronic Hyperglycemia,

↑ Risk of NAFLD (fatty liver)

↑ Compensatory β cell hyperplasia

↑ β cell failure (late stage)

T2DM/NIDDM
(Chiang, D.J. et al. Am J Physiol Gastrointest Liver Physiol, 2011; Prentki, M. and Nolan, C.J. J.Clin. Invest, 2006)
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Diabetes Mellitus
▪ The global prevalence of diabetes
1.5-3.7
diabetes has risen from 108 million Million
(4.7%) in 1980 ➔ 422 million death
caused by
(8.5%) in 2014. high blood
glucose &
diabetes

▪ Diabetes prevalence has been Stroke

Stroke and
and
Retinopathy
Blindness
rising more rapidly in middle- and CVD
CVD
low-income countries. Nephropathy
Nephropathy

▪ WHO projects that diabetes will be DFU

DFU

the 7th leading cause of death in

2030 (World Health Organization, 2016)
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COVID-19
The Future Global Challenge…..

https://www.docwirenews.com/docwire-pick/covid-19-update-india-breaks-new-virus-records-over-weekend-more-global-cases-in-last-two-weeks-than-first-six-months-of-pandemic-and-more/
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 The Current Trend of COVID-19 Incidence Worldwide
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(WHO, 2021) 8
Renin-Angiotensin Aldosterone System (RAAS) and COVID-19
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COVID-19

(Bourgonje et al, 2020, J Pathol 251:228-248)

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Excellence in Learning Innovation Hypothesis
?
Metabolic
SARS-CoV-2 ? Perturbancies, ? Metabolic
(+) Inflammation Syndrome

Accelerate
Mortality Rate
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Changes in the prevalence of metabolic syndrome, dyslipidemia, impaired fasting glucose/diabetes mellitus, arterial
hypertension and obesity after COVID-19 outbreak

(Auriemma, et al. 2021, Journal of Endocrinological Investigation) 12

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METABOLIC DISTURBANCIES
AND COVID-19
Metabolic syndrome ~ the highest fatality rate
COVID-19 patients (Stefan et al., 2020, Nature Review
Endocrinology 16:341-342)

Metabolic syndrome ~ ACE2 ~ COVID-19 ➔ ↑

mortality rate in patients with COVID-19
(Bourgonje et al, 2020, J Pathol 251:228-248)

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Inflammatory
mechanisms
underlying the
aggravation of
COVID-19
patients with
pre-existing
metabolic
disorders.

(Hua, et al. 2021, Biomedicine & Pharmacotherapy 140 : 111685 ) 14

 Metabolic Syndrome and COVID-19
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(Sharma, et al. 2021, Obesity Research & Clinical Practice 15: 163–171 15
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Alterations in immunity
that amplify responses to
SARS-CoV-2 in MAFLD,
obese and DM2 patients

(Lamadrid et al. 2021, Frontiers in Immunology) 16

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Metabolic
Syndrome
and
COVID-19

(Hua, et al. 2021, Biomedicine & Pharmacotherapy 140 : 111685 ) 17

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Metabolic
Syndrome and
COVID-19

(Lamadrid et al. 2021, Frontiers in Immunology) 18

 Metabolic Syndrome and COVID-19
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(Vasques-Monteiro IML et al. , 2021, World J Gastroenterol 27(16): 1738-1750 ) 19

 Metabolic Syndrome and COVID-19
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(Vasques-Monteiro IML et al. , 2021, World J Gastroenterol 27(16): 1738-1750 ) 20

 Metabolic Syndrome and COVID-19
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(Silva et al. 2021, Frontiers in Physiology 21

 Metabolic
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Syndrome and COVID-19 Mortality
Obesity and Diabetes Mellitus

↑ inflammation ↑ Insulin Resistance ↑ MAFLD

↑ Cytokine Storm

↑ Patient Succeptibility ~ SARS-CoV-2

↑ Mortality Prevalence

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 METABOLIC DISTURBANCIES AND
COVID-19
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Metabolic Imbalance
& Nutritional
Intervention?

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“Makanlah untuk kebutuhan BUKAN untuk
keinginan”
Excellence in Learning Innovation Keseimbangan Asupan Nutrisi dan COVID-19

?
Sedentary lifestyle selama pandemik covid 19

Kualitas daily intake ?

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 POTENSI KELOR DAN PANDEMI COVID-19
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M. oleifera leaf → green material anti M. oleifera → antioxidants properties ~ its

malnutrisi (Barichella et al. International Journal of Food phytochemicals, e.g. flavonoids,
Sciences and Nutrition 2019, 70 (1):107-115) isothiocyanates (Kou et al. Nutrients 2018, 10:343)

M. oleifera leaf → sangat berpotensi sbg M. oleifera Seed extract → anti

anti hypertension, anti diabetes, dan inflammatory agent [Jaja-Chimedza et al. Plos ONE
autism (Fahey et al. Nutrients 2019, 11:1547) 2017, 12 (8):e0182658]

M. oleifera leaf dan Kandungan Nutrisinya: 7x vitamin C pd jeruk; 4x Calcium pada susu;
4x vitamin A pd wortel; 2x protein pd susu; 3x Potassium pd pisang ?
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The Potential Target for

Drugs Development
against SARS-CoV-2

(Ho et al. , 2021, Drug Discovery Today 26

The Potential Role of Metabolic Syndrome in Patients with SARS-CoV-2
Infection
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↑ SARS-CoV-2 exposure ↑ BMI, BP, FBG,

Lipid, IR

↑ Pro-inflammatory cytokine
? (cytokine storm)

↑ Organs Failure

↓ Patients Survival Rate

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Conclusion
❖Metabolic Syndrome merupakan faktor komorbiditas potensial
peningkatan kerentanan pasien dan derajat keparahan akibat severe
COVID-19 infection.

❖Penatalaksanaan klinik yang optimal terhadap metabolic homeostasis

dari tekanan darah, kadar glukosa, and lipid menjadi penting untuk
pencegahan keparahan pada pasien COVID-19.

❖Target treatment infeksi COVID-19/SARSCoV-2 perlu difokuskan pada

ACE/ACE2 imbalance, cytokine storm, inflamasi, dan parameter
metabolik penting lain yang terlibat dalam siklus circadian untuk
meningkatkan survival rate pasien.
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Xie Xie

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