Background Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. Methods We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. Results EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01–1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67–28.0%) and 5.1% (95% CI 0.19–14.0%) of the effect of age and 19.4% (95% CI 4.67–63.0%) and 12.8% (95% CI 0.03–46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. Conclusion EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.

The human body is a complex system maintained in homeostasis thanks to the interactions between multiple physiological regulation systems. When faced with physical or biological perturbations, this system must react by keeping a balance between adaptability and robustness. The SARS-COV-2 virus infection poses an immune system challenge that tests the organism’s homeostatic response. Notably, the elderly and men are particularly vulnerable to severe disease, poor outcomes, and death. Mexico seems to have more infected young men than anywhere else. The goal of this study is to determine the differences in the relationships that link physiological variables that characterize the elderly and men, and those that characterize fatal outcomes in young men. To accomplish this, we examined a database of patients with moderate to severe COVID-19 (471 men and 277 women) registered at the “Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán” in March 2020. The sample was stratified by outcome, age, and sex. Physiological networks were built using 67 physiological variables (vital signs, anthropometric, hematic, biochemical, and tomographic variables) recorded upon hospital admission. Individual variables and system behavior were examined by descriptive statistics, differences between groups, principal component analysis, and network analysis. We show how topological network properties, particularly clustering coefficient, become disrupted in disease. Finally, anthropometric, metabolic, inflammatory, and pulmonary cluster interaction characterize the deceased young male group.

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Individuals with type 1 diabetes have increased morbidity and mortality due to cardiovascular disease (CVD), being the cause of death in 40% of these patients. A high proportion develop CVD before 50 years. Objective of this study was to explore factors associated with subclinical cardiovascular disease using aortic stiffness markers including pulse wave velocity (APWv), aortic augmentation index (AIx) and carotid intima-media thickness (cIMT). Material and Methods: Cross-sectional study carried out in the Type 1 Diabetes Clinic of a tertiary center in Mexico City. Demographic and biochemical variables were evaluated. Anthropometric and body composition analysis was performed using bioelectrical impedance. Assessment of the APWv and cIMT was carried out using ultrasound and AIx with aortic tonometry. Statistical analyses were performed using SPPS version 21, a P value < 0.05 was considered significant. Results: 49 patients have been included, 25(51%)women. Mean age of the participants was 38.1±11.9 years. Mean age at diagnosis was 17± 8.8 years and time median time since diagnosis 20(range 6 to 43) 17± 8.8 years. A positive correlation was found between APWv and time since diagnosis, total cholesterol and visceral adipose tissue and a negative association with eGFR. The AIx showed positive correlation with time since diagnosis, age, body mass index (BMI) and systolic blood pressure. The cIMT showed a positive correlation with time since diagnosis, BMI and a negative association with eGFR. We did not find associations between the stiffness markers and A1c or albuminuria. In the linear regression analysis only time since diagnosis remained significantly and independently associated with the AIx after adjusting for age, BMI and systolic blood pressure. Conclusions: This preliminary report shows that time since type 1 diabetes diagnosis is positively and independently associated with markers of aortic rigidity (AIx) in this population of young adults with type 1 diabetes. Disclosure F.M. Rodriguez: None. B. Rivas: None. C. Lara: None. D. Uribe: None. A.J. Martagon: None. P. Almeda-Valdes: None. J.A. Garay Mora: None. N. Ramirez Pedraza: None.

Objective: Osteoporosis is typically identified as a disease of postmenopausal women, however; it has been observed that in patients with type 1 diabetes (T1D) fractures associated with osteoporosis four to six times more common, in both sexes and at an early age (≈ 50 years). The objective of this study was to find associations between the bone mineral density (BMD), T-score and Z-score at the femoral neck, hip and spine and selected characteristics of patients with T1D. Methods: BMD of patients with T1D was evaluated with DXA (GE Healthcare Lunar). A correlation analysis was performed to identify associations between glycated hemoglobin, 25-hydroxyvitamin D concentration, years since diagnosis and diabetic, estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Results: We included 43 patients, with a mean age of 38.1 years, the mean BMD in the femoral neck was 0.94±0.13, in the hip 0.93±0.14 and the spine 1.11±0.13. We observed a negative correlation between the years since diagnosis of T1D and the BMD and T-score in the femoral neck and hip. There was a negative correlation between the ACR and the BMD, T-score and Z-score in the femoral neck and total hip and a positive correlation between the eGFR and the BMD and T-score in the femoral neck and hip. Conclusions: In this study we identify some factors that might impact and decrease the BMD in patients with T1D including long time since diagnosis, older age of patients and presence of diabetic nephropathy. The ACR could be an indicator of early bone metabolic changes in patients with T1D. Further studies are required to confirm this association and to define the optimal age for BMD evaluation in patients with T1D. Disclosure C. Lara: None. F. Rodriguez: None. T. Viveros-Ruiz: None. P. Almeda-Valdes: None. D. Uribe: None. B. Rivas: None. N. Ramirez Pedraza: None. J.A. Garay Mora: None.