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Epidemiology and Population Health

Association of excess visceral fat and severe illness in hospitalized COVID-19 patients in Japan: a retrospective cohort study

International Journal of Obesity volume 48, pages 674–682 (2024)Cite this article

Subjects

Abstracts

Background/objectives

Obesity, defined by body mass index (BMI), is a well-known risk factor for the severity of coronavirus disease 2019 (COVID-19). Adipose tissue distribution has also been implicated as an important factor in the body’s response to infection, and excess visceral fat (VF), which is prevalent in Japanese, may contribute significantly to the severity. Therefore, this study aimed to evaluate the association of obesity and VF with COVID-19 severe illness in Japan.

Subjects/methods

This retrospective cohort study involved 550 COVID-19 patients admitted to a tertiary care hospital with BMI and body composition data, including VF. The primary endpoint was severe illness, including death, due to COVID-19 during hospitalization. Logistic regression analysis was applied to examine the quartiles of BMI and VF on severe illness after adjusting for covariates such as age, sex, subcutaneous fat, paraspinal muscle radiodensity, and comorbidities affecting VF (COPD, cancer within 5 years, immunosuppressive agent use).

Results

The median age was 56.0 years; 71.8% were males. During hospitalization, 82 (14.9%) experienced COVID-19 severe illness. In the multivariate logistic regression analysis, Q4 of BMI was not significantly associated with severe illness compared to Q1 of BMI (OR 1.03; 95% CI 0.37–2.86; p = 0.95). Conversely, Q3 and Q4 of VF showed a higher risk for severe illness compared to Q1 of VF (OR 2.68; 95% CI 1.01–7.11; p = 0.04, OR 3.66; 95% CI 1.30–10.26; p = 0.01, respectively). Stratified analysis by BMI and adjusted for covariates showed the positive association of VF with severe illness only in the BMI < 25 kg/m2 group.

Conclusions

High BMI was not an independent risk factor for COVID-19 severe illness in hospitalized patients in Japan, whereas excess VF significantly influenced severe illness, especially in patients with a BMI < 25 kg/m2.

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Fig. 1: Flowchart describing patient selection.

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Data availability

The datasets generated and analyzed in this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank everyone who provides medical care to our COVID-19 patients. We especially acknowledge the following radiological technologists at the Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University: Hiroto Hada, Ryosuke Kaho, Kohei Maehara, Takuya Watanabe, Takumi Hiraishi, and Kosuke Inoue, for contributing to the collection and analysis of CT images.

Author information

Authors and Affiliations

  1. Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan

    Yuki Goto, Yuiko Nagamine, Tomoki Kawahara, Nobutoshi Nawa & Takeo Fujiwara

  2. Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Yuki Goto

  3. Center for Preventive Medical Sciences, Chiba University, Chiba, Japan

    Yuiko Nagamine

  4. Department of Tokyo Metropolitan Health Policy Advisement, Tokyo Medical and Dental University, Tokyo, Japan

    Mariko Hanafusa

  5. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Ukihide Tateishi

  6. Department of Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University, Tokyo, Japan

    Yutaka Ueki

  7. Disaster Medical Care Office, Tokyo Medical and Dental University, Tokyo, Japan

    Shigeru Miyamae

  8. Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Kenji Wakabayashi & Nobuyuki Nosaka

  9. Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Yasunari Miyazaki

  10. Department of Clinical Laboratory, Tokyo Medical and Dental University, Tokyo, Japan

    Shuji Tohda

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Contributions

YG and TF conceived and designed this study. All authors collected the data, and YG, YN, and TF analyzed the data statistically. YG wrote the first draft of the manuscript. All authors interpreted the results and revised the content critically. They all approved the final version for submission. TF supervised the entire work and is the guarantor.

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Correspondence to Takeo Fujiwara.

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Goto, Y., Nagamine, Y., Hanafusa, M. et al. Association of excess visceral fat and severe illness in hospitalized COVID-19 patients in Japan: a retrospective cohort study. Int J Obes 48, 674–682 (2024). https://doi.org/10.1038/s41366-024-01464-z

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