The role of visceral adiposity in the severity of COVID-19: Highlights from a unicenter cross-sectional pilot study in Germany

Abstract

Background and aims Overall obesity has recently been established as an independent risk factor for critical illness in patients with coronavirus disease 2019 (COVID-19). The role of fat distribution and especially that of visceral fat, which is often associated with metabolic syndrome, remains unclear. Therefore, this study aims at investigating the association between fat distribution and COVID-19 severity. Methods Thirty patients with COVID-19 and a mean age of 65.6 ± 13.1 years from a level-one medical center in Berlin, Germany, were included in the present cross-sectional analysis. COVID-19 was confirmed by polymerase chain reaction (PCR) from nasal and throat swabs. A severe clinical course of COVID-19 was defined by hospitalization in the intensive care unit (ICU) and/or invasive mechanical ventilation. Fat was measured at the level of the first lumbar vertebra on routinely acquired low-dose chest computed tomography (CT). Results An increase in visceral fat area (VFA) by ten square centimeters was associated with a 1.37-fold higher likelihood of ICU treatment and a 1.32-fold higher likelihood of mechanical ventilation (adjusted for age and sex). For upper abdominal circumference, each additional centimeter of circumference was associated with a 1.13-fold higher likelihood of ICU treatment and a 1.25-fold higher likelihood of mechanical ventilation. Conclusions Our proof-of-concept study suggests that visceral adipose tissue and upper abdominal circumference specifically increase the likelihood of COVID-19 severity. CT-based quantification of visceral adipose tissue and upper abdominal circumference in routine chest CTs may therefore be a simple tool for risk assessment in COVID-19 patients.

Obesity in patients with COVID-19: a systematic review and meta-analysis

“…Excessive visceral adiposity may provide additional important information about COVID-19 risk, which is not captured in BMI. Evidence of value from two recent studies, which were not included in our analysis due to our study design and eligibility criteria, suggests that visceral adiposity increases the likelihood of severe COVID-19 [15,65]. Central obesity is defined as a state of excessive VAT accumulation [66].…”

Obesity and COVID-19

“…Similarly, Battisti et al (9) report that COVID-19 severity is associated with abdominal adipose tissue distribution. In another recent study (10), the authors find a positive association between visceral adipose tissue and upper abdominal circumference with COVID-19 severity. What is more, Yang et al (11) document that, in COVID-19 patients, visceral adiposity or high intramuscular fat deposition increases the risk for critical illness.…”

Reply to a Letter to the Editor “Is there an exposure–effect relationship between body mass index and invasive mechanical ventilation, severity, and death in patients with COVID‐19? Evidence from an updated meta‐analysis”

“…[7][8][9] Although BMI is widely used to diagnose obesity, 10 further phenotyping of patients with high BMI might improve risk stratification and help to reveal the underlying pathophysiology. [11][12][13][14][15][16] In summary, we are grateful to Liu et al…”