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

Abstract

Objective: A higher BMI has become acknowledged as one of the important risk factors for developing critical condition in coronavirus disease 2019 (COVID-19). In addition to BMI, body composition, and particularly visceral adiposity, might be an even more accurate measure to stratify patients. Therefore, the aim of this study was to evaluate the association between the distributions of computed-tomography-quantified fat mass and critical condition of patients with COVID-19.

Methods: A systematic search was conducted in five databases for studies published until November 17, 2020. In the meta-analysis, pooled mean difference (standardized mean difference [SMD]) of visceral fat area (VFA; in square centimeters) was calculated between patients in the intensive care unit and those in general ward and between patients with the requirement for invasive mechanical ventilation (IMV) and those without the IMV requirement.

Results: The quantitative synthesis revealed that patients requiring intensive care had higher VFA values (SMD = 0.46, 95% CI: 0.20-0.71, P < 0.001) compared with patients on the general ward. Similarly, patients requiring IMV had higher VFA values (SMD = 0.38, 95% CI: 0.05-0.71, P = 0.026) compared with patients without the IMV requirement.

Conclusions: VFA values were found to be significantly higher in patients with critical condition. Therefore, abdominal adiposity seems to be a risk factor in COVID-19, and patients with central obesity might need special attention.

Figure 1

PRISMA flowchart for the study selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

SMD of visceral adipose tissue in patients needing ICU or IMV compared with visceral adipose tissue in patients not needing these. (A) Non‐ICU versus ICU. (B) Non‐IMV versus IMV. ICU, intensive care unit; IMV, invasive mechanical ventilation; SMD, standardized mean difference. [Color figure can be viewed at wileyonlinelibrary.com]