Obesity and COVID-19: The role of visceral adipose tissue

Abstract

INTRODUCTION: During the unprecedented health crisis of the COVID-19 pandemic it was suggested that obesity might aggravate severe acute respiratory syndrome coronavirus-2 (SARS CoV-2). Therefore, this study aims to investigate the association between Compute Tomography (CT)-based measurements of visceral and subcutaneous fat as measures of obesity and COVID-19 severity. METHODS: 30 patients with laboratory-confirmed COVID-19 and a mean age of 65.59 plus/minus 13.06 years from a level one medical center in Berlin, Germany, were retrospectively analyzed and included in the present analysis. SARS-CoV-2 was confirmed by polymerase chain reaction from throat swaps or deep nasal swabs on the day of admission. Severe clinical courses of COVID-19 were defined by hospitalization in intensive care unit (ICU) and invasive mechanical ventilation. All patients received low-dose chest CT-based fat measurements at the level of the first lumbar vertebra. RESULTS: An increase in visceral fat area (VFA) by one square decimeter was associated with a 22.53-fold increased risk for ICU treatment and a 16.11-fold increased risk for mechanical ventilation (adjusted for age and sex). For upper abdominal circumference, each additional centimeter of circumference showed a 1.13-fold increased risk for ICU treatment and a 1.25-fold increased risk for mechanical ventilation. There was no significant correlation of subcutaneous fat area (SFA) or body mass index (BMI) with severe clinical courses of COVID-19. CONCLUSIONS: Our results suggest that visceral adipose tissue and upper abdominal circumference specifically increasing the risk of COVID-19 severity. CT-based quantification of visceral adipose tissue and upper abdominal circumference in routinely acquired chest CTs may therefore be a simple tool for risk assessment in SARS-CoV-2-patients.

Association of bioelectric impedance analysis body composition and disease severity in COVID-19 hospital ward and ICU patients: The BIAC-19 study

“…Lastly, the cross-sectional nature of the BIA measurements complicates inter-individual comparability. As both disease and treatment influence body composition, mainly through loss of LBM and increase of fluid overload, differences in time-to-measurement are an important consideration [ 45 , 46 ]. In particular, for ICU patients, in whom fluid overload is common and has prevented BIA measurements from becoming a standard of practice.…”

Factors Associated with Increased Morbidity and Mortality of Obese and Overweight COVID-19 Patients

“…Simonnet et al [ 46 ] identified a risk factor for severity in COVID-19 patients that was solely dependent on the BMI value. Nevertheless, Petersen et al [ 52 ] indicated that visceral adipose tissue and upper abdominal circumference directly raise the risk of COVID-19 incidence and proposed the use of CT-based visceral adipose tissue quantification as a specific risk assessment tool for SARS-CoV-2 patients on regularly obtained chest CTs. Certain factors that exacerbate the clinical evolution of COVID-19 infection in obese patients are the difficulty of pulmonary ventilation in these subjects, with reduced diaphragmatic excursions and a remarkable increase in anatomical death space [ 12 ].…”

Immunoglobulin G and immunoglobulin M positivity in relation to coronavirus disease 2019 severity

“…During the health crisis due to the COVID-19 pandemic, multiple studies suggested that obesity could exacerbate the acute respiratory syndrome. In a study by Petersen et al [20] that included 30 patients confirmed for COVID-19 by qPCR from a medical center in Berlin, Germany, retrospectively analyzed, hospitalized in an ICU, and under mechanical ventilation, an increase in visceral fat per square decimeter, as well as each additional centimeter of abdominal circumference, was associated with an increased risk of requiring mechanical ventilation in a hospitalized patient. This is in line with the results of this survey as demonstrated with the Pearson test.…”