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Overgewicht geeft virussen meer kans

Van de patiënten die met COVID-19 op een Nederlandse IC terechtkomen (1) lijden velen aan het ‘metaboolsyndroom’: een combinatie van overgewicht, hoge bloeddruk en een verstoorde glucose- en vethuishouding. Het is een bekende voorloper van diabetes mellitus type 2, hart- en vaatziekten en kanker (2-5). Maar waarom verhoogt het metabool syndroom bij een (virus)infectie de kans op een ernstig verloop (6,7)?

Frits Muskiet – 16 april 2021
Overgewicht geeft virussen meer kans 3

Wat het metaboolsyndroom en de risicofactoren voor ernstige COVID-19 (8-10) gemeen hebben is een toestand van chronische ‘metaflammatie’. Dit is een samenvoeging van metabolisme (stofwisseling) en inflammatie (ontsteking) (11-14). Het is een vorm van laaggradige ontsteking in het gehele lichaam met continu licht verhoogde hoeveelheden ontstekingsstoffen (cytokinen). Zo’n systemische ontstekingsreactie kost weinig energie. Dat is anders dan bij een acute infectie. Afhankelijk van de ernst, kost die zo’n 25 tot 60 procent extra energie (15-17). Chronische ‘metaflammatie’ wordt veroorzaakt door een slechte leefstijl, waaronder onvolwaardige voeding, onvoldoende beweging en slaap, ongunstige darmbacteriën en chronische stress (13,14,18). Hoe meer vetmassa, des te erger de metaflammatie(19-24).

Dat ons immuunsysteem onder deze omstandigheden hapert(19-22), wordt zichtbaar als een ziekteverwekker binnendringt (25). Bij ernstige infecties, zoals met SARS-Cov-2 (26-28), SARS-CoV (29) en influenza A (22), reageert het immuunsysteem dan zwak en/of traag. Obese COVID-19 patiënten dragen veel grotere hoeveelheden virus bij zich en raken het minder snel kwijt (26). Bij de uitbraak van de Mexicaanse griep in 2009 tekende de relatie tussen overgewicht en ernstig ziekteverloop zich ook al af (22). Het virus krijgt simpelweg meer kans. De immuunreactie is ‘gedempt’ en er is grotere kans op bijkomende infecties. Vaccinatie en antimicrobiële middelen zijn minder effectief. Ook kan het virus sneller muteren (19,20,22). Obesitas en diabetes vormden ook een risico voor ernstige infecties met SARS-CoV (30,31) en MERS-CoV (10,32,33); de voorgangers van SARS-Cov-2.

Hoe meer vetmassa, des te erger de metaflammatie

Het mechanisme is te verklaren vanuit een disbalans tussen onderdelen van de immuunreactie. Bij gezonde mensen zijn deze perfect op elkaar afgestemd. Metaflammatie zorgt ervoor dat bij ernstige virusinfecties de verschillende soorten (immuun)cellen niet goed met elkaar communiceren (10,22,25). Het gaat mis in de eerste verdedigingslijn die de vermenigvuldiging en verspreiding van het virus moet tegengegaan (10,34-40c). Het virus frustreert dit proces en grijpt zijn kans. In plaats van eerst te verdedigen stuurt het immuunsysteem steeds meer ontstekingscellen naar de longen: de plek waar het virus binnenkwam. Deze aanval veroorzaakt een lokaal slagveld met veel schade. De ontstekingsreactie versterkt zichzelf door de roep van de signaalstoffen om nog meer hulp. Er ontstaat een ‘cytokinenstorm’ en stolling. Met vaak fatale gevolgen (8,10,41,42). Lees ook: Coronapatiënten overlijden niet aan het virus per se, maar aan een overactief immuunsysteem.

Waarom vertoont een chronisch licht ontstoken lichaam geen goede immuunrespons? Dat heeft te maken met de ontregeling van de stofwisseling. De hormoonhuishouding en energiestofwisseling liggen overhoop. Door de metaflammatie ontstaat ongevoeligheid voor de hormonen insuline (6,19,21,43-45) en leptine (6,10,19,21,29,46-49). De daarbij verstoorde glucosehuishouding staat centraal in de overreactie van het immuunsysteem (50-60). Behalve van energie is het geactiveerde immuunsysteem ook sterk afhankelijk van vitamines en mineralen (61-65). Tekorten daarvan worden gezien bij ernstige COVID-19 (67-69), ouderen (68-72) en bij obesitas en diabetes (73). Uit het onderzoek is niet het detail, maar wel de conclusie allang duidelijk: het lichaam in conditie houden of brengen, is het beste advies. Het is niet te laat om gisteren te beginnen!

Prof. dr. Frits Muskiet is emeritus hoogleraar Pathofysiologie en Klinisch Chemische Analyse. Eerdere columns van Muskiet vindt u hier. De columns verschenen eerder in ons ledenmagazine Uitzicht.

                Percentage Nederlandse COVID-19 patiënten in de IC

MMV maakt wekelijks een selectie uit het nieuws over voeding en leefstijl in relatie tot kanker en andere medische condities.

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                    Geactiveerd immuunsysteem, insuline en glucose

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                    Immuunsysteem en vitaminen/mineralen

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                    COVID-19 en vitaminen/mineralen

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                    Ouderen en vitaminen/mineralen

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