Bioelectric Impedance Analysis in COVID-19 positive patients. A prospective prevalence study

Rationale:
A new coronavirus (SARS-CoV-2 positive patients) has emerged, causing a pandemic of severe respiratory distress syndrome. Retrospective case series show critically ill patients are likely to be older men with pre-existing comorbidities.1 In hospitalized COVID-19 patients multiple obesity-related comorbidities were found to be independent risk factors for severity of disease, including hypertension, hyperlipidaemia, diabetes and cardiovascular disease.2 A possible explanation for this observation is that adipose tissue serves as a reservoir for the SARS-CoV-2 virus, predispositioning obese individuals to a higher or more persistent viral load.3 However, it stands to reason that if the quantity of fat tissue alone is related to severity of disease, females would be at higher risk, due to their innate higher fat percentage. A possible explanation is that not merely the quantity but the location of fat tissue is of importance. Although females have a higher absolute fat percentage, males tend to have more visceral as opposed to subcutaneous fat. In addition, in the East-Asian population – were the virus originated – there is a relatively low prevalence of obesity as defined by BMI, as individuals of Asian descent have a propensity for ectopic and visceral fat storage, while those of European descent are storing more of the excess fat in subcutaneous depots.4 This could explain the current lack of evidence showing a direct relation between obesity as defined by BMI and severity of disease in SARS-CoV-2 patients.
Hypothesis: Severity of disease and mortality in SARS-CoV-2 patients is related to a high quantity of visceral fat.
Aim: to measure the quantity and localisation of adipose tissue in hospitalised and severely ill SARS-CoV-2 patients.
Inclusion criteria: All patients ≥ 18 years old, admitted to the ICU or the COVID-ward, who have tested positive for SARS-CoV-2 and for whom informed consent was given by patient/legal representative.
Exclusion criteria: patients <18 years of age. Pregnant patients. Patients with electrical implants such as a pacemaker or ICD. Patients who cannot maintain posture for the (10-15 min) duration of the measurement.
Methods: The Inbody S10 Body Composition Analyser will be used for bioelectric impedance analysis will be used once during ICU or COVID-ward stay for every SARS-CoV-2 positive patient admitted during the study period.
Primary objective: to measure body composition and specifically fat percentage and localisation in SARS-CoV-2 positive patients.
Secondary objective: to compare body composition and fat percentage and localisation between SARS-CoV-2 positive patients with severe course of disease (i.e. leading to ICU admission or in-ward mortality) and those with milder course of disease (i.e. ward-to-home discharge).

Severity of disease and mortality in SARS-CoV-2 patients is related to a high quantity of visceral fat

?