Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

Abstract

BackgroundSeveral characteristics of the metabolic syndrome, such as obesity and hypertension, have emerged as risk factors for a poor clinical outcome in COVID-19. However, most reports lack data on the metabolic syndrome itself. This study investigated prospectively the relationship between respiratory deterioration and the presence of metabolic syndrome or abdominal adiposity in patients with COVID-19.MethodsA prospective observational cohort study analysing patients with respiratory symptoms who presented at a local emergency department in the Netherlands. The influence of abdominal adiposity—assessed by an increased waist–hip ratio—and metabolic syndrome on respiratory deterioration and the length of hospital stay were analysed with multivariable logistic regressions and Kaplan-Meier analyses.ResultsIn total, 166 patients were analysed, of whom 86 (52%) tested positive for COVID-19. The prevalence of metabolic syndrome did not differ between patients with COVID-19 with and without the need for intubation or level of supportive care (37.5% vs 48.4%, p=0.338). In contrast, abdominal adiposity is an independent risk factor for respiratory distress in COVID-19, adjusted for metabolic syndrome, age, gender and BMI (OR 1.11, 95% CI 1.02 to 1.20, p=0.014).ConclusionThis study shows that abdominal adiposity, and not the presence of metabolic syndrome, is associated with clinical deterioration in COVID-19. This prospective study provides further insight into the risk stratification of patients with COVID-19 based on a simple measurement as the waist and hip circumference.Trial registration numberNL8580.

Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review

“…Our search was limited by published full-text article in English language. Most studies investigating this association used BMI categories as the predictor variable [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Four cross-sectional studies did not specify the used classification of obesity [38][39][40][41] presumably using the WHO guidelines defining obesity as BMI of 30 or higher.…”

“…Four cross-sectional studies did not specify the used classification of obesity [38][39][40][41] presumably using the WHO guidelines defining obesity as BMI of 30 or higher. Outcome variables included: hospitalization [36,38,42], ICU admission [31,35,37,38,[43][44][45], intubation [24,25,29,37,38], invasive mechanical ventilation [26,31,34], disease severity [27,28,30,33] and death [24][25][26][27][28][29]32,[38][39][40][41]. Of the eleven studies investigating the association between BMI and mortality in hospitalized COVID-19 patients, ten studies observed an increased mortality rate in patients that were overweight (BMI ≥ 25 to <30) [24,32], or suffering from obesity (BMI ≥ 30) [25,29,[38][39][40][41], or severe obesity (BMI ≥ 35) [26,…”

Does abdominal obesity influence immunological response to SARS-CoV-2 infection?

“…Obesity-induced adipose tissue inflammation and its effects on the immune system play a crucial role in the pathogenesis of SARS-CoV-2 infection [ 11 ]. Not only general obesity but also specifically abdominal obesity, more so than metabolic syndrome, seem to be associated with clinical deterioration, especially respiratory distress, in COVID-19 [ 13 ]. Increased abdominal visceral adiposity compromises pulmonary function in supine patients by decreased diaphragmatic excursion, while the base of the lung ventilation is also impaired, resulting in reduced oxygen saturated blood levels [ 14 ].…”

“…A dysfunctional adipose tissue with a low adiponectin/leptin ratio may cause increased oxidative stress and inflammation [ 15 ]. Thus, it has been reported that abdominal visceral adiposity predicts respiratory distress in COVID-19 patients [ 13 ]. Likewise, obesity impairs immune function and provokes chronic inflammation by increasing the number of B cells in visceral adipose tissue and producing autoreactive immunoglobulins [ 16 ].…”

Association of central obesity and high body mass index with function and cognition in older adults

“…CO, through its "inflammaging" effect, is associated with disability and mortality. It is associated with lower lung function and in a most recent study, abdominal obesity measured by increased waist-hip ratio and not metabolic syndrome was associated with increased respiratory deterioration in COVID-19 (28,29). WC and abdominal obesity are also associated with vertebral fracture risk (30).…”