Impact of visceral fat on the prognosis of coronavirus disease 2019: an observational cohort study

Abstract

Background Clarification of the risk factors for coronavirus disease 2019 (COVID-19) severity is strongly warranted for global health. Recent studies have indicated that elevated body mass index (BMI) is associated with unfavorable progression of COVID-19. This is assumed to be due to excessive deposition of visceral adipose tissue (VAT); however, the evidence investigating the association between intra-abdominal fat and COVID-19 prognosis is sparse. We therefore investigated whether measuring the amount of intra-abdominal fat is useful to predict the prognosis of COVID-19. Methods The present study enrolled 53 consecutive cases of COVID-19 patients aged ≥ 20 years with chest computed tomography (CT) scans. The VAT area, total adipose tissue (TAT) area, and VAT/TAT ratio were estimated using axial CT images at the level of the upper pole of the right kidney. Severe COVID-19 was defined as death or acute respiratory failure demanding oxygen at ≥ 6 L per minute, a high-flow nasal cannula, or mechanical ventilation. The association of VAT/TAT with the incidence of progression to a severe state was estimated as a hazard ratio (HR) using Cox regression analysis. To compare the prediction ability for COVID-19 disease progression between BMI and VAT/TAT, the area under the receiver operating characteristic curve (AUC) of each was assessed. Results A total of 15 cases (28.3% of the whole study subjects) progressed to severe stages. The incidence of developing severe COVID-19 increased significantly with VAT/TAT (HR per 1% increase = 1.040 (95% CI 1.008–1.074), P = 0.01). After adjustment for potential confounders, the positive association of VAT/TAT with COVID-19 aggravation remained significant (multivariable-adjusted HR = 1.055 (95% CI 1.000–1.112) per 1% increase, P = 0.049). The predictive ability of VAT/TAT for COVID-19 becoming severe was significantly better than that of BMI (AUC of 0.73 for VAT/TAT and 0.50 for BMI; P = 0.0495 for the difference). Conclusions A higher ratio of VAT/TAT was an independent risk factor for disease progression among COVID-19 patients. VAT/TAT was superior to BMI in predicting COVID-19 morbidity. COVID-19 patients with high VAT/TAT levels should be carefully observed as high-risk individuals for morbidity and mortality.

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“…[ 20 ] underline that BMI poorly reflects actual body fat excess, whereas waist circumference better describes obesity. This issue should be more appropriately investigated as it has already been reported that a higher ratio of visceral fat in relation to total adipose tissue was superior to BMI also in predicting COVID-19 morbidity and mortality [ 24 ].…”

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“…Therefore, in a population with a high obesity prevalence, young individuals are more severely affected than is generally thought [ 69 ]. And there are now several systematic reviews and meta-analysis concluding that overweight and obesity is an important risk factor for COVID-19 severity [ 21 , 70 , 71 , 72 , 73 ], especially when it is characterized by excessive visceral adipose tissue [ 73 , 74 , 75 , 76 ].…”

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“…Recent literature data suggest that in addition to the well-established association between BMI-based obesity and severe COVID-19 outcome, the body fat distribution is also important; in particular, visceral adipose tissue and upper abdominal circumference have been proposed as simple tools for risk assessment in COVID-19 patients [ 122 , 123 , 124 , 125 ]. More recently, an interesting prospective multicenter study on hospitalized COVID-19 patients with respiratory failure showed that a larger neck circumference phenotype patient is more prone to have a negative outcome, a large neck being associated with an increased proinflammatory and prothrombotic status.…”