key: cord-0976974-2ku2360v
authors: Zabuliene, Lina; Ilias, Ioannis
title: Obesity, abdominal organ size and COVID-19 severity
date: 2020-09-17
journal: Med Hypotheses
DOI: 10.1016/j.mehy.2020.110279
sha: d04ef7e7cae52aa4a788733cdb538efb3cfe0a48
doc_id: 976974
cord_uid: 2ku2360v

nan

2 COVID-19 disease is usually more severe in patients with obesity (1); these patients need more often than normal-weight patients to be mechanically ventilated (2) . The abundant adipose tissue in subjects with obesity overexpresses the receptors and proteases that permit cellular entry of SARS-CoV-2; a role for adipose tissue acting as a virus reservoir and as an accelerator that reinforces violent systemic inflammatory and immune responses has been suggested (3). In a recent (albeit not yet peer-reviewed) study (n=750), larger-size abdominal organs (kidneys, pancreas, and liver; assessed with computed tomography) were consistently noted in subjects with obesity versus lean subjects (4). Abdominal and extrabdominal multiorgan localization of SARS-CoV-2 has been reported (5) . An abdominal-lung connection for SARS-CoV-2 pathogenesis has been proposed in this journal (6) .

Based on the above it could be hypothesized that the pathogenesis of the pervasive SARS-CoV-2 infection in patients with obesity may also be a function of the tissue mass -not only of adipose tissue but also of abdominal organs -which is "offered" for infection (we have to note that the assessed viral load has recently been linked with disease mortality (7)). Thus, patients with obesity may carry a relatively larger viral reservoir compared to lean patients, may

show overall more extensive infiltration/damage, have a more severe course of COVID-19 infection, and usually take longer to recover. The extent of tissue and organ COVID-19 involvement could be evaluated with biopsy/autopsy/tissue analyses. 3 

The authors declare no conflict of interest

Impact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review

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