Abdominal obesity phenotype is associated with COVID-19 chest X-ray severity score better than BMI-based obesity

Abstract

Purpose Chest X-ray (CXR) severity score and BMI-based obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score has not yet been fully explored. Methods This retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19. Results Patients with abdominal obesity showed significantly higher CXR severity scores and had higher rates of CXR severity scores ≥ 8 compared to those without abdominal obesity ( P < 0.001; P = 0.001, respectively). By contrast, patients with normal weight, with overweight and those with BMI-based obesity showed no significant differences in either CXR severity scores or in the rates of CXR severity scores ≥ 8 ( P = 0.104; P = 0.271, respectively). Waist circumference and waist-to-height ratio (WHtR) correlated more closely with CXR severity scores than BMI ( r = 0.43, P < 0.001; r = 0.41, P < 0.001; r = 0.17, P = 0.012, respectively). The area under the curves (AUCs) for waist circumference and WHtR were significantly higher than that for BMI in identifying a high CXR severity score (≥ 8) (0.68 [0.60–0.75] and 0.67 [0.60–0.74] vs 0.58 [0.51–0.66], P = 0.001). A multivariate analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25–2.45, P < 0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07–2.81, P = 0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94–0.97, P < 0.001) as the only independent factors associated with high CXR severity scores. Conclusion Abdominal obesity phenotype is associated with a high CXR severity score better than BMI-based obesity in hospitalized patients with COVID-19. Therefore, when visiting the patient in a hospital setting, waist circumference should be measured, and patients with abdominal obesity should be monitored closely. Level of evidence Cross-sectional descriptive study, Level V.

The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia

“…In our study, WC showed a strong association with intensive ventilatory support. In line with our findings, Malavazos et al and Van Zelst and colleagues found that central obesity measured through WC was the best predictor for the radiological severity of disease and negative outcome, respectively [29,30]. Advocated as a vital sign in clinical practice, the measurement of WC is a simple, inexpensive, bedside and easily standardizable method that is considered important for risk stratification [28].…”

Non-Communicable Diseases Risk Factors and the Risk of COVID-19 Infection among University Employees in Indonesia

“…A study found that abdominal obesity was associated with a high chest x-ray severity score better than BMI. [24] UK study found that high WC was associated with positive COVID-19 test only in people > 65 years, independent of BMI. [25] Another study found a positive association between WC and COVID-19 susceptibility (OR = 1.38; 95% CI: 1.07-1.78; p=0.015).…”

Noncommunicable diseases risk factors and the risk of COVID-19 among university employees in Indonesia

“…Clinical studies on abdominal obesity and COVID-19 are still evolving. One study found that abdominal obesity was associated with a high chest x-ray severity score better than BMI [ 33 ]. A UK study found that high WC was associated with a positive test for the SARS-CoV-2 virus only in people ≥ 65 years, independent of BMI [ 34 ].…”