Abstract
Obesity has been recognized as an independent risk factor for critical illness and major severity in subjects with coronavirus disease 2019 (COVID-19). The role of fat distribution, particularly visceral fat (often linked to metabolic abnormalities), is still unclear. The adipose tissue represents a direct source of cytokines responsible for the pathological modifications occurring within adipose tissue in obese subjects. Adipokines are a crucial connection between metabolism and immune system: their dysregulation in obesity contributes to chronic low-grade systemic inflammation and metabolic comorbidities. Therefore the increased amount of visceral fat can lead to a proinflammatory phenotypic shift. This review analyzes the interrelation between obesity and COVID-19 severity, as well as the cellular key players and molecular mechanisms implicated in adipose inflammation, investigating if adipose tissue can constitute a reservoir for viral spread, and contribute to immune activation and cytokines storm. Targeting the underlying molecular mechanisms might have therapeutic potential in the management of obesity-related complications in COVID-19 patients.
Highlights
Obesity is more prevalent in developed countries, because of increased consumption of sugars, and saturated fats with low levels of fibers and antioxidant molecules
Our perspective about COVID-19 is changing from a viral agent responsible for a respiratory disease toward a facilitator of complication and increased mortality in obese patients, with a dose-response curve, where higher body mass index result to be at most risk
This finding suggests a bidirectional relationship between COVID-19 and metabolic diseases: on the one hand, pre-existing metabolic diseases potentiate the severity of COVID-19, on the other hand, this viral infection exacerbate precedent metabolic frailty [3]
Summary
Obesity is more prevalent in developed countries, because of increased consumption of sugars, and saturated fats with low levels of fibers and antioxidant molecules. The amplified risk of obese patients to develop severe COVID-19 manifestations can depend on numerous factors, such as the chronic systemic phlogistic state, the decreased immune response, and even the adipose tissue itself, which represents a reservoir for the virus [4].
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