Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity

Paola Gualtieri, Carmela Falcone, Lorenzo Romano, Sebastiano Macheda, Pierpaolo Correale, Pietro Arciello, Nicola Polimeni, Antonino De Lorenzo, Paola Gualtieri, Carmela Falcone, Lorenzo Romano, Sebastiano Macheda, Pierpaolo Correale, Pietro Arciello, Nicola Polimeni, Antonino De Lorenzo

Abstract

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 hours and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

Keywords: CT scan; body composition; diagnostic imaging; fat; inflammation; lean; liver attenuation; muscle wasting; obesity.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Liver attenuation between lean and obese groups at baseline; between baseline and follow up, comparisons for (b) suprailiac thickness, (c) liver attenuation, (d) liver/spleen attenuation ratio, and (e) spinae erector muscle cross sectional area are shown. Values are presented as mean ± standard deviation. The statistical significance attributed to results with * p < 0.05, ** p < 0.005, and *** p < 0.001.
Figure 2
Figure 2
(Right) representation of metabolic pathways in response to critical condition. (Left) difference to CT images of liver attenuation between baseline and follow-up. FFA: Free Fatty Acids; GLUT: Glucose Transporter; IL: Interleukin; NK: Natural Killer; ROS: Reactive Oxygen Species; TGF: Transforming Growth Factor; TNF: Tumor necrosis factor.

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