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Disclosures: The authors report no relevant financial disclosures.
January 13, 2021
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More visceral fat increases risk for COVID-19 ICU admission, mechanical ventilation

Disclosures: The authors report no relevant financial disclosures.
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Individuals with COVID-19 who are admitted to the ICU or treated with invasive mechanical ventilation have more visceral fat than those who are admitted to the hospital, but are not in critical condition, according to study data.

“Our most important finding is that visceral fat area was higher in patients admitted to the ICU and requiring invasive mechanical ventilation, which draws attention to the importance of abdominal adiposity in COVID-19,” Andrea Szentesi, PhD, operative director of the interdisciplinary research support group at the Institute for Translational Medicine at University of Pécs Medical School in Hungary, and colleagues wrote in a study published in Obesity. “A recent meta-analysis by Huang et al has come to the same conclusion; they have found higher visceral adipose tissue values in patients with critical condition, as well. However, their search interval was shorter, and we included two additional studies in the meta-analyses.”

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Researchers conducted a meta-analysis and systemic review of six studies involving 560 individuals with COVID-19 who were admitted to the ICU or treated with invasive mechanical ventilation. All the studies included data on the distribution of body fat mass. Researchers evaluated the association between COVID-19 ICU admission or mechanical ventilation and quantified fat mass.

In quantitative analysis, individuals with COVID-19 admitted to the ICU had a higher visceral fat area value than those who were hospitalized but not admitted to the ICU (standardized mean difference, 0.46; 95% CI, 0.2-0.71; P < .001). Individuals treated with mechanical ventilation also had more visceral fat than patients not treated with ventilation (standardized mean difference, 0.38; 95% CI, 0.05-0.71; P = .022).

In analyses adjusted for age and sex, two studies found increased visceral fat was associated with a higher risk for ICU admission. According to one study, visceral fat of more than 100 mm2 was not a significant risk factor for ICU admission, and a fourth study found that individuals admitted to the ICU had a higher visceral fat thickness compared with those in the general ward.

Two studies examined subcutaneous adipose tissue mass and its association with COVID-19 severity. Both studies did not find an association between subcutaneous fat mass and a higher risk for ICU admission, but one of the studies found an association between a high visceral fat to subcutaneous fat ratio and an increased risk for ICU admission.

In one study evaluating total fat area in COVID-19 patients, every 10 cm2 of total fat area increased the odds for ICU admission and invasive mechanical ventilation. Another study stated total fat area was a risk factor for ICU admission.

“In summary, we found that visceral fat area values were significantly higher in patients with critical condition,” the researchers wrote. “In light of the high prevalence of obesity, this area of research should be further investigated. Besides the distribution of body fat, adipose tissue-related substances as potential pharmacological targets might be worth studying as well.”