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BACKGROUND: 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. 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⯱â¯5.4â¯kg/m2, VF was associated with severe COVID-19 (pâ¯=â¯0.022) and SCF was not (pâ¯=â¯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 (pâ¯=â¯0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5â¯cm2 (ROC curve), which was independently associated with COVID-19 severity (pâ¯<â¯0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r2â¯=â¯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.
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Visceral fat is associated to the severity of COVID-19
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