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Obesity is one of the main severe COVID-19 risk factors. SARS-CoV-2 causes endothelitis that lead to inflammation and prothrombotic state. Also visceral adipose tissue is a source of different prothrombogenic and proinflammatory cytokines that make prognosis and survival of patients with COVID-19 worse. The synergy of the COVID-19 and obesity pandemics is a double blow to health, especially in young patients. Weight loss due to lifestyle modifications and vaccination are effective methods of the severe COVID-19 prevention in obese patients. This review presents the main pathogenetic aspects of cardiovascular disease development and progression in obese patients with COVID-19 and possible methods of adverse outcomes prevention in this group of patients.Copyright © 2022 Authors. All rights reserved.
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Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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Obesity is associated with several diseases, including mental health. Adipose tissue is distributed around the internal organs, acting in the regulation of metabolism by storing and releasing fatty acids and adipokine in the tissues. Excessive nutritional intake results in hypertrophy and proliferation of adipocytes, leading to local hypoxia in adipose tissue and changes in these adipokine releases. This leads to the recruitment of immune cells to adipose tissue and the release of pro-inflammatory cytokines. The presence of high levels of free fatty acids and inflammatory molecules interfere with intracellular insulin signaling, which can generate a neuroinflammatory process. In this review, we provide an up-to-date discussion of how excessive obesity can lead to possible cognitive dysfunction. We also address the idea that obesity-associated systemic inflammation leads to neuroinflammation in the brain, particularly the hypothalamus and hippocampus, and that this is partially responsible for these negative cognitive outcomes. In addition, we discuss some clinical models and animal studies for obesity and clarify the mechanism of action of anti-obesity drugs in the central nervous system.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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The proceedings contain 67 papers. The topics discussed include: cardiovascular system and COVID-19;long term sequale on COVID-19;fighting vascular disease: thoughts about 2022 Taiwan hypertension guidelines;quantification of hemodynamic parameters using 4D flow MRI;nanomedicine for the treatment of atherosclerosis;direct thrombus imaging;clinical outcome in patients with deep vein thrombosis;cardiovascular benefits of SGLT-2 inhibitor;central blood pressure and pressure wave reflection in cardiovascular abnormalities: do not put them in shade;association between excess pressure and cognitive function among elderly population;visceral adipose tissue, coronary artery calcification and heart failure: a moderated mediation analysis;and the cardio-ankle vascular index was associated with CHADS2 score in patients with atrial fibrillation: a coupling registry study.
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Background and Aims: In patients with COVID-19, obesity may increase risk of hospitalisation, use of mechanical ventilation and patient mortality. High liver fat, body mass index (BMI) and male sex are significant predictors of hospitalisation risk following COVID-19. However, BMI is a poor indicator of body fat distribution. Here, we studied ectopic fat accumulation within the liver and pancreas and body composition through multiparametric magnetic resonance (mpMR) and compared participants with and without hospitalisation for COVID-19. Method: Participants with laboratory-confirmed or clinically suspected SARSCoV- 2 infection were recruited to the COVERSCAN study (NCT04369807;median time from initial symptoms = 177 days) and underwent a multi-organ mpMR scan (CoverScan®, Perspectum Ltd). Measures of liver and pancreatic fat (PDFF), liver fibroinflammation (cT1) and body composition [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle index (SMI)] were analysed. Differences between participants hospitalised (n = 59) and not hospitalised (n = 348) for COVID-19 were assessed using Wilcoxon signedrank tests. Univariate and multivariate analyses were performed on all biomarkers to assess the hospitalisation risk. Data presented are median values. Results: Approximately 6-months after initial symptoms, participants hospitalised following COVID-19 had significantly elevated pancreatic fat (3.8 % vs 2.8 %, p < 0.01), liver fat (3.8 % vs 2.4 %, p < 0.01) and liver cT1 (735ms vs 706ms, p < 0.01) compared to those who convalesced at home. Though hospitalised participants had a significantly elevated BMI (27 kg/m2 vs 25 kg/m2, p = 0.014), it was VAT, but not SAT, that was significantly elevated (132 cm2 vs 86 cm2, p < 0.01). Univariate analysis revealed that male sex, advanced age and elevated BMI, VAT, pancreatic fat, liver fat, and liver cT1 were all significantly predictive of hospitalisation following COVID- 19. In multivariate analysis, only age remained significantly predictive of hospitalisation. In hospitalised people with obesity (³ 30 kg/m2), VAT, liver cT1 and liver fat, but not BMI nor pancreatic fat, remained significantly elevated [VAT: 220 cm2 vs 152cm2, p = 0.01 (Figure 1);liver fat: 9.9 % vs 4.2 %, p = 0.003;liver cT1: 782ms vs 742ms, p = 0.012]. Conclusion: mpMR revealed significantly elevated visceral and ectopic fat deposition within the liver and pancreas in hospitalised participants following COVID-19. In obese participants, BMI was not significantly different in hospitalised, and non-hospitalised patients, whereas visceral fat, liver fibroinflammation and liver fat were significantly elevated. Our work highlights body fat distribution an important consideration for COVID-19 risk profiling, which cannot be sufficiently evaluated based on BMI alone. (Figure Presented) Figure 1. Comparison of liver fat (left), pancreatic fat (middle) and visceral adipose tissue (right) between participants hospitalised and not hospitalised following COVID-19.
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Aim. To evaluate epicardial adiposity (EA), verified on the basis of epicardial adipose tissue (EAT) thickness according to echocardiography, as a possible predictor of the severity of coronavirus disease 2019 (COVID-19) course in overweight and obese patients in a retrospective analysis of data. Material and methods. We analyzed data on 165 patients (age, 45,2±4,7 years;men, 67,9%;body mass index, 31,4±3,5 kg/m2) who received outpatient or inpatient treatment for symptomatic COVID-19 in period from March 2020 to November 2021. Patients with diabetes, stage III-V chronic kidney disease and/or cardiovascular disease were excluded from the analysis, with the exception of hypertension. EA was verified in the case of EAT thickness ≥4,8 mm for persons aged 35-45 years and ≥5,8 mm for persons 46-55 years old. Results. Patients with EA were characterized by higher hospitalization rates (52,2% vs 9,0%, p<0,01), moderate (56,5% vs 19,7%, p<0,01), high and very high severity (17,4% vs 3,3%, p<0,01) of disease course, lung injury of CT-1, CT-2 and CT-3 (32,6% vs 9,8% (p<0,01), 21,7% vs 7,4% (p<0,05), and 15,2% vs 2,5% (p<0,01), respectively), invasive ventilation (8,7% vs 0,8%, p<0,05) and C-reactive protein >10 mg/l (69,6% vs 21,3%, p<0,01). Predictors of hospitalization for symptomatic COVID-19 according to multivariate logistic regression analysis were age, fasting glycemia, systolic blood pressure, EAT thickness, which was characterized by the highest standardized regression coefficient among other predictors (0,384, p<0,001). Conclusion. EAT thickness may be one of the predictors of COVID-19 severity in overweight and obese patients. Persons with EA in the case of COVID-19 need more careful monitoring and measures to prevent severe course and complications.
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Background: Patients with SARS-CoV-2 who initially present with gastrointestinal (GI) symp-toms, with or without respiratory symptoms, have a milder clinical course than those who do not have GI complaints. Risk factors for severe COVID-19 disease include increased adiposity and sarcopenia, but whether these risk factors are similarly associated with worse outcomes among patients with GI symptoms has not been established. Methods: This was a retrospective study of hospitalized patients with COVID-19 who underwent abdominal CT scan for clinical indications within 30 days of positive SARS-COV-2 test. Abdominal body composition measures including skeletal muscle index (SMI), intramuscular adipose tissue index (IMATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral-to-subcutaneous adipose tissue ratio (VAT/SAT Ratio) were measured on a single axial CT slice at the L3 vertebral level. Hepatic steatosis was measured by absolute liver attenuation and by liver/spleen attenuation ratio. Clinical characteristics and outcomes were collected from the electronic medical record. GI symptoms were classified at time of first positive SARS-CoV-2 test. The association between body composition measurements and the primary outcome of death or discharge to hospice within 30 days after positive SARS-CoV-2 test was tested. Results: Of 190 patients with COVID-19 who had abdominal CT scans, 117 (62%) had GI symptoms including nausea, vomiting, diarrhea, or abdominal pain. Among those without GI symptoms at presentation, the most common reasons for abdominal CT scan were as part of a multi-organ evaluation of fever/sepsis, evaluation of GI symptoms that developed later during the hospital course, and evaluation for retroperitoneal hemorrhage. There were no differences in baseline patient characteristics comparing those with or without GI symptoms (Table 1). Patients with GI symptoms were less likely to be admitted to the ICU than patients without GI symptoms (16% versus 37% respectively;p <0.01) but had similar 30-day mortality (15% versus 18% respectively;p=0.66). Among patients with GI symptoms, those who died or were discharged to hospice had significantly increased IMATI (unadjusted p=0.025) and no differences in other measures (Table 2). On the other hand, among patients without GI symptoms, those who died or were discharged to hospice within 30 days had increased IMATI (p=0.049), reduced SMI (p=0.010), and increased VAT/SAT Ratio that was not statistically significant (p=0.419). Conclusions: Among patients with COVID-19, the relationship between measures of adiposity/sarcopenia and death differs in patients with and without GI symptoms.(Table Presented)Table 1. Clinical Characteristics among 190 patients hospitalized for COVID-19 based on presence of GI symptoms.(Table Presented)Table 2. Body composition measurements among 117 patients with GI symptoms and 73 patients with no GI symptoms based on death/hospice at 30 days.
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We retrospectively investigated, in 62 consecutive hospitalised COVID-19 patients (aged 70 ± 14 years, 40 males), the prognostic value of CT-derived subcutaneous adipose tissue and visceral adipose tissue (VAT) metrics, testing them in four predictive models for admission to intensive care unit (ICU), with and without pre-existing comorbidities. Multivariate logistic regression identified VAT score as the best ICU admission predictor (odds ratios 4.307-12.842). A non-relevant contribution of comorbidities at receiver operating characteristic analysis (area under the curve 0.821 for the CT-based model, 0.834 for the one including comorbidities) highlights the potential one-stop-shop prognostic role of CT-derived lung and adipose tissue metrics.