Visceral Adiposity, Subcutaneous Adiposity, and Severe Coronavirus Disease-2019 (COVID-19): Systematic Review and Meta-Analysis

Pranata, Raymond; Lim, Michael Anthonius; Huang, Ian; Yonas, Emir; Henrina, Joshua; Vania, Rachel; Lukito, Antonia Anna; Nasution, Sally Aman; Alwi, Idrus; Siswanto, Bambang Budi

Background and Aims Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. Methods We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). Results There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p<0.001; I2: 0%) and TFA (mean difference 64.6 cm2 [26.2, 103.1], p=0.001; I2: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm2 [-4.9, 23.4], p=0.199; I2: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p=0.002; I2: 49.3%). Conclusion Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not. PROSPERO ID CRD42020215876.