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

Graziano, Elena; Peghin, Maddalena; Martino, Maria De; Carlo, Chiara De; Porto, Andrea Da; Bulfone, Luca; Casarsa, Viviana; Sozio, Emanuela; Fabris, Martina; Cifù, Adriana; Grassi, Bruno; Curcio, Francesco; Isola, Miriam; Sechi, Leonardo A.; Tascini, Carlo; Croatto, Lucia; Ditaranto, Pierpaolo; Ditaranto, Leonardo Maria

doi:10.1016/j.clnesp.2022.07.003

Cited by 11 publications

(5 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, our study showed a significant increase in mortality for patients with BMI ≥ 40, both compared to other BMI categories and specifically compared to normal BMI of 20–29.9, likely owing to the increased power of our investigation. Our results were similar to a study conducted in Italy by Graziano et al [ 14 ], who found that an increased waist circumference and abdominal adiposity were associated with an increased need for IMV. We also observed an increase of 37% for odds of requiring IMV, 36% for odds of mortality associated with IMV, and 38% for odds of developing septic shock among obese patients.…”

Section: Discussionsupporting

confidence: 92%

Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study

Khokher

Iftikhar

Abrahamian

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Coronavirus disease 2019 (COVID-19) caused significant morbidity and mortality worldwide. There is limited information describing the hospital outcomes of COVID-19 patients in regard to specific body mass index (BMI) categories. Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult patients (≥18 years of age) with a primary hospitalization for COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization, and compare the outcomes among patients categorized according to BMI. Results: A total of 305,284 patients were included in this study. Of them, 248,490 had underlying obesity, defined as BMI ≥ 30. The oldest patients were observed to have BMI < 19, while youngest patients were in the BMI > 50 category. BMI < 19 category had the highest crude in-hospital mortality rate. However, after adjusted regression, patients with BMI > 50 (adjusted odds ratio (aOR) 1.63, 95% CI 1.48–1.79, p-value < 0.001) had the highest increased odds, at 63%, of in-hospital mortality compared to all other patients in the study. Patients with BMI > 50 also had the highest increased odds of needing invasive mechanical ventilation (IMV) and mortality associated with IMV compared to all other patient, by 37% and 61%, respectively. Obese patients were noted to have shorter average hospital length of stay (LOS), by 1.07 days, compared to non-obese patients, but there was no significant difference in average hospitalization charges. Conclusion: Among obese patients primarily hospitalized with COVID-19, those with BMI ≥ 40 had significantly increased rates of all-cause in-hospital mortality, need for IMV, mortality associated with IMV, and septic shock. Overall, obese patients had shorter average hospital LOS, however, did not have significantly higher hospitalization charges.

show abstract

Section: Discussionsupporting

confidence: 92%

Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study

Khokher

Iftikhar

Abrahamian

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…The regions with the highest share of body fat were the abdominal region and the suprailiac region. In this sense, the study by Graziano et al [22] indicates that although obesity and metabolic syndrome (MS) are not associated with greater intensive oxygen support, this association is significant in patients with excessive abdominal adiposity [22]. According to recent evidence, adequate control of metabolic disorders is important to reduce the risk of severe COVID-19 [23].…”

Section: Discussionmentioning

confidence: 99%

“…However, in a prospective study on the impact of obesity, metabolic syndrome and body composition on clinical outcomes and mortality of patients with COVID-19, an abdominal adipose tissue paradox was found, since waist circumference and visceral tissue metabolically active (VTM) were risk factors for more intensive oxygen support, but not for mortality [22]. Compared to the non-severe COVID-19 group, VTM accumulation levels were significantly higher in COVID-19 patients with a severe condition.…”

Section: Discussionmentioning

confidence: 99%

Body Composition and Level of Physical Activity in Post-COVID-19 Patients

Bila,

Silva,

Bicalho

et al. 2023

ACRI

View full text Add to dashboard Cite

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created a public health crisis. Body composition is an important nutritional indicator, knowledge of which allows the subdivision of body weight into some components, mainly lean mass or fat-free mass and body fat mass of individuals. Aim: To evaluate lean mass and body fat in post-COVID-19 patients, correlating them with length of stay, pre-hospitalization and post-hospitalization and patients' level of physical activity, specifying relative segmental fat. Methodology: Observational, cross-sectional study, with quantitative analysis, with a convenience sample, approved by the Research Ethics Committee of the State University of Minas Gerais. Patients undergoing care/rehabilitation in the physiotherapy/outpatient sector at a Regional Rehabilitation Center, with a history of diagnosis of COVID-19, aged 20 years or over, of both sexes, were invited to participate in the research. Lean body mass (LBM) and body fat (BF) were obtained by evaluating horizontal tetrapolar electrical bioimpedance (BIA). Body fat segmentation was collected by measuring skinfold thickness. Physical activity level (PAL) was obtained using the International Physical Activity Questionnaire (IPAQ). The hospitalization history was obtained by filling out the registration form. Results: Data from 20 patients were analyzed. The average LBM found was 69.7% and 30.3% of BF. There was no correlation between sedentary lifestyle and LBM. 50% of patients had previous comorbidities and 50% had a mild form of COVID-19 infection. 10% required hospitalization and ventilator support. 85% were physically active or very active. There was a greater presence of body fat in the abdominal and suprailiac region. Conclusion: LBM proved to be superior to other studies carried out and no statistically significant correlation was found between LBM and history of hospitalization, time elapsed since illness and PAL. The regions with the greatest share of body fat were abdominal and suprailiac, important for inflammatory reasons and risk factors for various diseases, especially cardiovascular diseases.

show abstract

“…In the last year, little evidence of an obesity paradox has been emerging in COVID-19 patients' outcomes. Graziano et al (47) demonstrated that both an increased waist circumference (WC) and bioimpedance analysis were significantly associated with the need for increased ventilator support, but not with ICU admission andabove all-not with mortality rate. In a large multicenter study, only very high BMI (> 40 kg/m 2 ) was associated with higher mortality in COVID-19 cases (48).…”

Section: Discussionmentioning

confidence: 99%

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Janes,

Sozio,

Gigli

et al. 2023

Front. Neurol.

Self Cite

View full text Add to dashboard Cite

Background and purposeStroke has been described as a COVID-19 complication. However, its occurrence rate, risk factors, and causal relationships are still not well established.MethodsWe describe the characteristics of confirmed COVID-19-related strokes among all cases of COVID-19 hospitalized in our health network, from November 1, 2020 to April 30, 2021. Risk factor analysis has been conducted for ischemic stroke (IS), which represents 92% of all confirmed cases of Covid-19-related strokes, and a “causal attribution to infection” classification is provided.ResultsIn all, 62/4105 hospitalized COVID-19 patients had an acute stroke (1.51%). Severe COVID-19 (OR 2.27—CI 1.06–4.77; p = 0.032), atrial fibrillation (OR 3.65—CI 1.63–7.98; p = 0.001), and ischemic heart disease (OR 4.590—CI 1.714–12.137; p = 0.002) proved to be independent risk factors for IS, while obesity was a protective factor (OR 0.90—CI 0.82–0.97; p = 0.012). COVID-19 had a causal role in 32.1% of IS cases, was a relevant cofactor in 28.6% of cases of IS, and was a possible trigger in 39.3% of events.ConclusionOur stroke occurrence rate is consistent with other population-based reports (range 0.34–2.7%). Prespecified peculiar clinical and radiological features allow the distinction between “IS caused by COVID-19” and “IS triggered by COVID-19.” Clinical history of vascular diseases and risk factors is crucial in determining the risk of IS in patients with COVID-19. However, the protective effect of a BMI > 30 kg/m2 seems to suggest an obesity paradox.

show abstract

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

Cited by 11 publications

References 49 publications

Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study

Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study

Body Composition and Level of Physical Activity in Post-COVID-19 Patients

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Contact Info

Product

Resources

About