Abstract
BackgroundObesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU).MethodsProspective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day.ResultsObese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients.ConclusionThis is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.
Highlights
Obesity and steatosis are associated with COVID-19 severe pneumonia
According to the body mass index (BMI), 36% of the patients were categorized differently, in detail, 9% of the patients that presented a BMI within normal values were detected to have a fat mass (FM)% criteria for being considered “obese” according to FM% and age based on criteria presented by De Lorenzo [15] and 27% of the patients classified pre obese (PO) were “obese”. (Table 2) (Fig. 2)
Our data originally demonstrate that FM% and BMI correlates with the course of COVID-19 patients admitted to Intensive Care Unit (ICU)
Summary
Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. Adipose tissue releases high levels of leptin, which creates an unfavorable inflammatory milieu that leads to dysregulation of the immune response [6]. In 2009, during H1N1 pandemia, in obese patients it was characterized changing of differentiation of B cells [7, 8], predisposing to a greater risk of contracting influence, and of being more contagious towards other people [9]. Reduced response of virus-specific CD8 + lymphocytes and suboptimal macrophage functionality have been demonstrated, which could explain the low response to the vaccine stimulus [11]
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