Abstract
While COVID-19 infection and mortality rates are soaring in Western countries, Southeast Asian countries have successfully avoided the second wave of the SARS-CoV-2 pandemic despite high population density. We provide a biochemical hypothesis for the connection between low COVID-19 incidence, mortality rates, and high visceral adiposity in Southeast Asian populations. The SARS-CoV-2 virus uses angiotensin-converting enzyme 2 (ACE2) as a gateway into the human body. Although the highest expression levels of ACE2 are found in people’s visceral adipose tissue in Southeast Asia, this does not necessarily make them vulnerable to COVID-19. Hypothetically, high levels of visceral adiposity cause systemic inflammation, thus decreasing the ACE2 amount on the surface of both visceral adipocytes and alveolar epithelial type 2 cells in the lungs. Extra weight gained during the pandemic is expected to increase visceral adipose tissue in Southeast Asians, further decreasing the ACE2 pool. In contrast, weight gain can increase local inflammation in fat depots in Western people, leading to worse COVID-related outcomes. Because of the biological mechanisms associated with fat accumulation, inflammation, and their differential expression in Southeast Asian and Western populations, the second wave of the pandemic may be more severe in Western countries, while Southeast Asians may benefit from their higher visceral fat depots.
Highlights
A second wave of the COVID-19 disease has rapidly been gaining momentum since early fall 2020
Data on population density (2018) were collected from World Bank statistics. In this Perspective article, we argue why human populations differ in SARS-CoV-2 infection prevalence and severity based on their differential build-up of energy reserves into subcutaneous and visceral fat depots, and why the second wave of COVID-19 may be more severe in Western countries
We hope that conclusions drawn from the obesity paradox in the COVID-19 context may help governments and individuals properly prepare for 2021 until vaccines against
Summary
A second wave of the COVID-19 disease has rapidly been gaining momentum since early fall 2020. Res. Public Health 2021, 18, 1029 as Taiwan and Vietnam have successfully avoided the second wave of the SARS-CoV-2 infection in spite of their high population density. Population density was negatively associated with COVID-19 cases (per 1 million inhabitants) in North America (τ = −0.48, p = 0.009, n = 16), but positively in East Eurasia (τ = 0.13, p = 0.40, n = 21). Data on population density (2018) were collected from World Bank statistics In this Perspective article, we argue why human populations differ in SARS-CoV-2 infection prevalence and severity based on their differential build-up of energy reserves into subcutaneous and visceral fat depots, and why the second wave of COVID-19 may be more severe in Western countries.
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