key: cord-0734560-ltt81x29
authors: Iacobellis, Gianluca; Malavazos, Alexis Elias; Ferreira, Tanira
title: COVID‐19 rise in Younger adults with Obesity: Visceral Adiposity can predict the Risk
date: 2020-07-03
journal: Obesity (Silver Spring)
DOI: 10.1002/oby.22951
sha: 10e6fd8620e8a18a114ca7aeb96bf80bfe99ba8a
doc_id: 734560
cord_uid: ltt81x29

A concerning rise in coronavirus disease 2019 (COVID‐19) cases has been recently reported, particularly in the USA. The causes of this increase are likely multifactorial and the object of an ongoing health and socio‐economic debate. However, preliminary data indicate that the new COVID‐19 cases are increasing among younger and obese adults. Considering this recent spike, the timing of the paper by Deng et al is of particular importance (1). Deng et al not only confirmed that obesity is a major and independent risk factor for COVID‐19 complications in young adults (2), they pointed out ectopic and visceral fat depots as new markers of that risk. The authors found that computed tomography (CT) imaging of fatty liver and epicardial adipose tissue (EAT) were significantly higher in severely and critically ill COVID‐19 patients under 40 years old as compared to those with milder disease.

Miami, FL, 33136, USA. confirmed that obesity is a major and independent risk factor for COVID-19 complications in young adults (2), they pointed out ectopic and visceral fat depots as new markers of that risk.

The authors found that computed tomography (CT) imaging of fatty liver and epicardial adipose tissue (EAT) were significantly higher in severely and critically ill COVID-19 patients under 40 years old as compared to those with milder disease.

In the past few months we learned that obesity is undoubtedly a risk factor for COVID-19 complications and mortality (2) . This is particularly important in the USA where the prevalence of obesity currently exceeds 40%. The higher risk of people with obesity to develop severe COVID-19 cardiac and pulmonary injuries can be attributed to multiple factors such as the chronic inflammatory status, the delayed immune response and possibly fat tissue serving as reservoir for the virus (3). However, there is an additional mechanism that may not be immediately identified, the ectopic and visceral fat accumulation. We now face a different phenotype of the high risk patient, much younger, certainly obese, but with prominent visceral obesity.

Deng's findings may provide new insights to untangle the intricate, and still unclear, physiopathologic pathways leading to COVID-19 organ damage. The role of EAT in causing and This article is protected by copyright. All rights reserved.

worsening the COVID-19 cardiac complications recently emerged (4) . EAT is an inflammatory depot with dense macrophage infiltrates, highly enriched in pro-inflammatory cytokines, such as interleukin (IL6), a cytokine which is overexpressed in COVID-19 patients. EAT and the myocardium share the same microcirculation. EAT inflammatory cytokines can reach out to the myocardium via vasa vasorum or paracrine pathways (4) . Hence, EAT is likely implicated in COVID-19 myocardial inflammation and cardio-respiratory failure.

Intrahepatic and peri-renal fat infiltration can also play a causative and predictive role of severe COVID-19. Deng et al found that severely and critically ill young individuals with obesity presented with imaging signs of liver fat deposition (1) . Fatty liver and peri-renal fat accumulation can contribute to insulin resistance, hyperglycemia and hypoalbuminemia, all measurable predictors of COVID-19 complications, as recently highlighted (5) .

Remarkably, Deng's paper reminds us that EAT and intra-hepatic fat can be clinically measured with CT or standard ultrasound. CT-measured EAT and liver density could serve as a reliable indicator of inflammation in COVID-19 patients (4).

We could therefore use clinical and imaging tools to better phenotype and stratify younger individuals with visceral obesity, probably asymptomatic or paucisymptomatic, but at higher risk of COVID-19 morbidity and mortality. Promisingly, visceral and ectopic fat can be targeted and reduced with lifestyle and pharmacological interventions.

Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study

Obesity could shift severe COVID-19 disease to younger ages

Targeting the Adipose Tissue in COVID-19

Does epicardial fat contribute to COVID-19 myocardial inflammation?

Admission hyperglycemia and radiological findings of SARS-CoV2 in patients with and without diabetes