Visceral fat is associated to the severity of COVID-19

• Published in: Metabolism, clinical and experimental Vol. 115; p. 154440
• Main Authors: Favre, Guillaume, Legueult, Kevin, Pradier, Christian, Raffaelli, Charles, Ichai, Carole, Iannelli, Antonio, Redheuil, Alban, Lucidarme, Olivier, Esnault, Vincent
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Angiotensin-converting enzyme; Angiotensin-Converting Enzyme 2 - immunology; Body Mass Index; Coronavirus disease 19; COVID-19 - complications; COVID-19 - diagnostic imaging; COVID-19 - epidemiology; COVID-19 in Metabolism; Female; France; Humans; Intra-Abdominal Fat - diagnostic imaging; Life Sciences; Male; Middle Aged; Obesity; Obesity, Abdominal - complications; Obesity, Abdominal - diagnostic imaging; Obesity, Abdominal - epidemiology; Predictive Value of Tests; Prognosis; Respiration, Artificial; Risk Factors; Severe acute respiratory syndrome coronavirus 2; Subcutaneous fat; Subcutaneous Fat - diagnostic imaging; Tomography, X-Ray Computed; Visceral fat; France; Visceral fat; Obesity; ACE; RTq-PCR; RAAS; WAT; COVID-19; VF; Coronavirus disease 19; Severe acute respiratory syndrome coronavirus 2; CT; SARS-CoV-2; SCF; Subcutaneous fat; Angiotensin-converting enzyme; BMI
• ISSN: 0026-0495; 1532-8600; 1532-8600
• DOI: 10.1016/j.metabol.2020.154440

Excess visceral fat (VF) or high body mass index (BMI) is 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. To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI. 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. 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). 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. •Visceral fat is associated with COVID-19 severity in Caucasian adults.•The expression of angiotensin converting enzyme type 2, the receptor of SARS-Cov2, in visceral fat may contribute to the cytokine storm.•Metabolic health of patients with COVID-19 should be carefully evaluated.