COVID-19 Induces Body Composition and Metabolic Alterations

Abstract

BackgroundIndividuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are highly susceptible to disease-related metabolic dysregulation given the hyperinflammatory immune response of coronavirus disease 2019 . These changes are remarkably involved in multiple steps in adipogenesis and lipolysis. This study aimed to elaborate on the significant relations of COVID-19 infection with body fat distribution, changes in serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before and after the infection. MethodsIn this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Validated food frequency (FFQ) and physical activity questionnaires were completed. Body composition was assessed in this investigation. On the second visit, those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. All measurements were re-measured in the second visit. ResultsIn a total of 441 patients, the mean age was 38.82±4.63 years. There were 224 (50.79%) male subjects, and 217 (49.20%) were females. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups. When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were. Serum insulin and HOMA-IR levels increased significantly after infection compared to the primary measurements. ConclusionIndividuals with COVID-19 infection may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes such as muscle loss and fat accommodation.

Diabetes Mellitus, Energy Metabolism, and COVID-19

“…Clinically relevant weight loss during COVID-19 is common even in mild forms ( 202 ) and is followed by weight regain with increased abdominal adiposity ( 203 ). In a study that compared changes in body composition and insulin resistance (as assessed by homeostasis model assessment of insulin resistance [HOMA-IR]) in people with or without COVID-19, the former showed an increase in percentage fat mass despite a reduction in BMI, and significant increases in fasting plasma glucose, insulin, and HOMA-IR compared to pre-COVID-19 ( 204 ). These data suggest an association of COVID-19 and possibly other factors, such as inactivity, reduced food intake during illness, and increased food intake during recovery, with worsening body composition and glucose metabolism.…”

“…Importantly, studies that estimated insulin sensitivity/resistance and/or β-cell function ( Table 3 ) have several limitations. Most included a relatively low number of participants, time of blood sampling since hospital admission and definition of hyperglycemia were not standardized, some did not adjust for between-group differences in age, BMI, preexisting diabetes, or other important baseline characteristics ( 107 , 191 , 278 ) did not provide a description of the non-COVID-19 control group ( 280 ), did not specify the time of follow-up ( 191 , 275 ), did not make a statistical comparison of longitudinal differences in insulin resistance between people with and without COVID-19 ( 204 ), did not take the effects of steroid and/or insulin therapy during hospital stay into account ( 191 , 276 , 278 ), did not assess/adjust for longitudinal changes in BMI and/or body composition, performed pre-post comparisons using data from different individuals ( 279 ), had highly variable follow-up since SARS-CoV-2 infection/COVID-19 ( 204 , 277 ), or used nonstandardized definitions to classify participants as insulin resistant ( 107 ).…”