Visceral Adiposity Elevates the Risk of Critical Condition in COVID‐19: A Systematic Review and Meta‐Analysis

Földi, M.; Farkas, Nelli; Kiss, Szabolcs; Dembrovszky, Fanni; Szakács, Zsolt; Balaskó, Márta; Hegyi, Péter; Szentesi, Andrea

doi:10.1002/oby.23096

Cited by 70 publications

(59 citation statements)

References 35 publications

(50 reference statements)

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“…Table 1 depicts the list of main studies and meta-analyses associating obesity or BMI or visceral fat with COVID-19 risk and outcomes including the severity of infection, hospitalizations, hospitalizations in the ICU, administration of invasive mechanical ventilation (IMV), and mortality [19][20][21][22][23]24••, 25-30, 31••, [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”

Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

“…In a prospective observational cohort study analyzing 166 patients with respiratory symptoms who presented at an emergency department in the Netherlands, increased WHR was an independent risk factor for respiratory distress in COVID-19 (OR 1.11, 95% CI: 1.02-1.20), adjusting for age, gender, BMI, and metabolic syndrome. Based on recent meta-analyses of retrospective studies, an abnormal fat distribution, particularly visceral adipose tissue (VAT) expansion determined by computed tomography (CT)-based quantification, was found to be a significant independent factor of hospitalization, admission to the ICU, and worse clinical outcomes such as the need of intubation, adjusting for age, gender, and BMI [46,47]. Difficult airway management and prone positioning (critical in the [58][59][60].…”

Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

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Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

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Purpose of Review A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the “obesity paradox,” and presents implications in prevention and treatment as well as future perspectives. Recent Findings Data from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors: (i) impaired innate and adaptive immune responses; (ii) chronic inflammation and oxidative stress; (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement; (iv) overactivation of the renin–angiotensin–aldosterone system; (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue; (vi) associated cardiometabolic comorbidities; (vii) vitamin D deficiency; (viii) gut dysbiosis; and (ix) mechanical and psychological issues. Summary Mechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.

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Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

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“…Recent publications have reported that higher BMI, higher abdominal visceral adipose tissue, higher intermuscular adipose tissue, reduced liver density, reduced lumbar SMD, and reduced pectoral muscle area are associated with worse clinical outcomes in COVID-19 patients in terms of disease severity and death [ 5 , 19 – 25 ]. While CT scans of the abdomen are rarely available for unselected series of COVID-19 patients, chest CT has been widely used in some centers to rapidly assess the presence of pneumonia and stratify patients with different disease severity [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…The possible role of body composition parameters as prognostic factors for COVID-19 severity has been initially explored [ 5 , 19 , 20 , 22 – 25 ]. However, the underlying causal relationship remains to be determined and contextualized in the complex pathogenetic pathways involved in COVID-19 progression.…”

Section: Introductionmentioning

confidence: 99%

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

et al. 2021

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We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

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“…Those adipocytes may be directly infected by SARS-CoV-2, leading to aggravation of the inflammatory infiltrate and massive interstitial edema. A meta-analysis that pooled three studies with 208 patients showed that patients who needed invasive mechanical ventilation (IMV) had higher visceral fat area values than patients who did not need IMV (37), indicating the risk of respiratory dysfunction in patients with obesity and severe COVID-19.…”

Section: Obesity and Covid-19mentioning

confidence: 99%

The Centrality of Obesity in the Course of Severe COVID-19

et al. 2021

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The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global public health challenge. Most patients do not experience severe complications, but approximately 25% of patients progress to acute respiratory distress syndrome (ARDS), and the mortality rate is approximately 5–7%. Clinical findings have determined several risk factors for severe complications and mortality in COVID-19 patients, such as advanced age, smoking, obesity, and chronic diseases. Obesity is a common and serious health problem worldwide that initiates a cascade of disorders, including hypertension, cardiovascular disease (CVD), diabetes mellitus, and chronic kidney disease (CKD). The presence of these disorders is linked to a more severe course of COVID-19. Given the “epidemic” of obesity worldwide and the importance of obesity in the progression of COVID-19, we investigated the mechanisms through which obesity increases the susceptibility to and severity of COVID-19 to support the selection of more appropriate therapies for individuals with obesity.

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Visceral Adiposity Elevates the Risk of Critical Condition in COVID‐19: A Systematic Review and Meta‐Analysis

Cited by 70 publications

References 35 publications

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

The Centrality of Obesity in the Course of Severe COVID-19

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