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Metabolism . Visceral fat is associated to the severity of COVID-19

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  • Metabolism . Visceral fat is associated to the severity of COVID-19


    Metabolism


    . 2020 Nov 24;115:154440.
    doi: 10.1016/j.metabol.2020.154440. Online ahead of print.
    visceral fat is associated to the severity of COVID-19


    Guillaume Favre 1 , Kevin Legueult 2 , Christian Pradier 2 , Charles Raffaelli 3 , Carole Ichai 4 , Antonio Iannelli 5 , Alban Redheuil 6 , Olivier Lucidarme 7 , Vincent Esnault 8



    Affiliations

    Abstract

    Background: Excess visceral fat (VF) or high body mass index (BMI) are risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients.
    Aim: To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI.
    Methods: We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR.
    Results: Among 165 patients with a mean BMI of 26.1 ? 5.4 kg/m2, VF was associated with severe COVID-19 (p = 0.022) and SCF was not (p = 0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p = 0.010). The best predictive value for severe COVID-19 was found for a VF area ≥ 128.5 cm2 (ROC curve), which was independently associated with COVID-19 severity (p < 0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r2 = 0.27 vs 0.0008).
    Conclusion: Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.

    Keywords: Angiotensin-converting enzyme; Coronavirus disease 19; Obesity; Severe acute respiratory syndrome coronavirus 2; Subcutaneous fat; Visceral fat.

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