The main findings of the present study were that metabolic indicators, including TC, TG, UA, and HbA1c, were significantly increased during the outbreak of COVID-19. Nevertheless, no statistical difference was observed in LDL, BMI, and BP.
Our results provided evidence that metabolic indicators associated with NCDs deteriorated during the COVID-19 outbreak in China. With the initiation of the first-level response to prevent the spread of COVID-19 during January 2020 and April 2020 in China5, 7, the impacts of social distancing and community containment on lifestyles may be among the most critical factors in the increase of TC, TG, UA, and HbA1c. People tend to eat and snack more during home quarantine conditions19. As lockdown caused problems in the food supply chain and economic recession, the consumption of processed foods characterized by high fat, high sugar, and high salt increased due to easy availability, storage, and use8, 20, 22. These dietary changes will lead to metabolic disorders related to NCDs in the COVID-19 outbreak and the subsequent period. Meanwhile, the closure of gyms, swimming pools, and exercise clubs, in addition to home quarantine, will inevitably reduce opportunities to exercise27. A longitudinal study demonstrated that time spent in sports activities decreased and the screen time increased in the COVID-19 storm21. This phenomenon is detrimental to health because physical activity is critical to control the symptoms and risk factors of NCDs28. Furthermore, fear of catching the virus, worrying about family, social isolation, financial pressure, rumors everywhere, and information overload lead to increased stress and anxiety levels, which will result in behaviour changes and physical health issues associated with NCDs23. Finally, as precious healthcare resources were diverted towards the prevention and control of COVID-19 epidemics, and to avoid cross-contamination in hospitals, routine management of NCDs has been scaled down during the peak period of the COVID-19 epidemic. Patients with NCDs who take angiotensin receptor blockers or angiotensin-converting enzyme Inhibitors regularly may stop their treatment without their doctor’s guidance for fear that these medications will increase the risk of COVID-19 infection through upregulation ACE2, which could lead to uncontrolled illness.
This is, as far as we know, the first study to explore blood lipid and uric acid levels among the general population during the outbreak of a public health emergency of international concern declared by the World Health Organization and proved that blood lipid and uric acid levels were increased. Though there is a lack of clinical evidence about the association between hyperlipidaemia/hyperuricaemia and COVID-19, it seems that metabolic disorders may indirectly affect the progression of COVID-19 through increasing the risk of NCDs. Moreover, lipids and cholesterol-rich membrane microdomains are essential for coronavirus entry into human cells29. High amounts of intracellular cholesterol and fatty acids are essential for the formation of the replication complex of COVID-1929. In this context, strengthening the screening and control of hyperlipidemia may have a double beneficial effect by reducing the NCD risk and interfering with COVID-19.
Our result that HbA1c was elevated in the COVID-19 storm provided further evidence for the prediction of previous arithmetic models22. However, previous studies focused on the glycaemic control in diabetes during the restrictions due to COVID-19 pandemics found no deteriorated results4, 24-26. These different results may be explained as follows. First, the sample size of previous studies is small (n=13, 33, 55, and 147), and patients with type 1 diabetes accounts for more than 90 percent of the studied population4, 24-26. Those representing patients with non-autoimmune forms of diabetes who were underrepresented in the previous study. Second, the patients in previous studies used both continuous glucose monitoring and platforms for remote data sharing and were younger (median/average age <45 years old) than those in our study (median age 64 years old) 4, 24-26. We speculate that the patients in previous studies may have better health literacy and compliance to avoid metabolic deteriorattion in the COVID-19 outbreak. Our study enrolled the general population, including healthy people and patients with NCDs, with a larger sample size, and thus the conclusion may be more general. Moreover, our research time is longer than that of previous studies. The present study compared metabolic changes during the peak period of the COVID-19 epidemic and the same period of last year, not the short period of lockdown and pre-lockdown. The impact of the COVID-19 epidemic on NCDs and its risks is existed not only during the strict lockdown period but also early on in the outbreak when fear was the prevailing emotion and the extended period of subsequent economic downturn and social distancing after lockdown. It will probably take time to fully evaluate the impact of the COVID-19 outbreak on the NCDs risks and control.
It is worth noting that we did not find significant differences in BMI and BP between the time of the COVID-19 outbreak and the same period last year. These results may be due to the small sample of BMI and BP of the participants in our study; additionally, most of them are young people who may have better health literacy and compliance to prevent metabolic deterioration in the COVID-19 storm.
The COVID-19 pandemic is expected to be long drawn. To meet the challenge that metabolic indicators associated with NCDs deteriorated during the COVID-19 outbreak, we should take action to prevent and control NCDs without delay. We can focus on the following aspects to avoid the adverse effects of the outbreak on the general population. First of all, as the primary care system plays a vital role in the prevention and control of NCDs, a hierarchical medical system should be further implemented, and medical education for general practitioners should be enhanced. General practitioners should not only focus on the prevention and control of infectious disease but also on NCDs within the context of their community. Metabolic indicators associated with NCDs should be further monitored by general practitioners during the outbreak to return them to normal as soon as possible, thus reducing the morbidity and mortality rates of NCDs. Telemedicine consults should be implemented where possible, and home delivery services should be arranged for essential medications. Second, with the development of 5th generation wireless systems, high-quality massive open online courses on health education should be developed by health workers to promote healthy behaviours at home. Health education and health-promoting behaviours have proven beneficial for metabolic management30. In addition, the government should take measures to ensure easy access to healthy foods for the population and should discourage the use or consumption of unhealthy products. Finally, to alleviate the psychological impact of the pandemic, information sharing should be enhanced, and proper psychological guidance should be implemented.
The main limitation of our study is that this study only reflected changes in metabolic indicators associated with NCDs during the COVID-19 outbreak. With no detailed information relating to particular changes in eating habits, physical activity, and psychological situation among the participants, we could not confirm which factor contributed the most to the deterioration of the metabolic indicators. In addition, these data referred to an adult cohort, including healthy people and patients with NCDs. Information on medical history that may affect the results was not recorded. More studies are necessary to fully evaluate the impact that COVID-19 has had on the health status at the population level, and going forward, it is of vital importance to collect information to better prevent and control NCDs.
In conclusion, metabolic indicators associated with NCDs deteriorated in the COVID-19 outbreak. It is a crucial time to strengthen action on prevention and control of NCDs to minimize the morbidity and mortality rates of COVID-19 in the short-term and reduce total morbidity and mortality rates of NCDs in the long-term, avoiding adding on to the burden of countries' healthcare systems.