The Role of Bioelectrical Impedance Analysis in Predicting COVID-19 Outcome

Djordje Stevanovic; Vladimir Zdravkovic; Mina Poskurica; Marina Petrovic; Ivan Cekerevac; Nemanja Zdravkovic; Sara Mijailovic; Dusan Todorovic; Ana Divjak; Dunja Bozic; Milos Marinkovic; Aleksandra Jestrovic; Anja Azanjac; Vladimir Miloradovic

doi:10.3389/fnut.2022.906659

The Role of Bioelectrical Impedance Analysis in Predicting COVID-19 Outcome

Front Nutr. 2022 Jul 11:9:906659. doi: 10.3389/fnut.2022.906659. eCollection 2022.

Authors

Djordje Stevanovic^{1

2}, Vladimir Zdravkovic^{1

2}, Mina Poskurica², Marina Petrovic^{1

3}, Ivan Cekerevac^{1

3}, Nemanja Zdravkovic⁴, Sara Mijailovic⁵, Dusan Todorovic^{6

7}, Ana Divjak^{8

9}, Dunja Bozic³, Milos Marinkovic¹⁰, Aleksandra Jestrovic¹⁰, Anja Azanjac^{1

11}, Vladimir Miloradovic^{1

2}

Affiliations

¹ Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
² Cardiology Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia.
³ Pulmonology Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia.
⁴ Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
⁵ Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
⁶ Ophthalmology Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia.
⁷ Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
⁸ Department of Physical Medicine and Rehabilitation, University Clinical Center Kragujevac, Kragujevac, Serbia.
⁹ Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
¹⁰ Clinic of Endocrinology, Diabetes Mellitus and Metabolic Diseases, University Clinical Center Kragujevac, Kragujevac, Serbia.
¹¹ Clinic of Rheumatology and Allergology, University Clinical Center Kragujevac, Kragujevac, Serbia.

Abstract

Background: Published data regarding the impact of obesity on COVID-19 outcomes are inconsistent. However, in most studies, body composition was assessed using body mass index (BMI) alone, thus neglecting the presence and distribution of adipose tissue. Therefore, we aimed to investigate the impact of body and visceral fat on COVID-19 outcomes.

Methods: Observational, prospective cohort study included 216 consecutive COVID-19 patients hospitalized at University Clinical Center Kragujevac (Serbia) from October to December 2021. Body composition was assessed using the BMI, body fat percentage (%BF), and visceral fat (VF) via bioelectrical impedance analysis (BIA). In addition to anthropometric measurements, variables in the research were socio-demographic and medical history data, as well as admission inflammatory biomarkers. Primary end-points were fatal outcomes and intensive care unit (ICU) admission.

Results: The overall prevalence of obesity was 39.3% according to BMI and 50.9% according to % BF, while 38.4% of patients had very high VF levels. After adjusting odds ratio values for cofounding variables and obesity-related conditions, all three anthropometric parameters were significant predictors of primary end-points. However, we note that % BF and VF, compared to BMI, were stronger predictors of both mortality (aOR 3.353, aOR 3.05, and aOR 2.387, respectively) and ICU admission [adjusted odds ratio (aOR) 7.141, aOR 3.424, and aOR 3.133, respectively].

Conclusion: Obesity is linked with COVID-19 mortality and ICU admission, with BIA measurements being stronger predictors of outcome compared to BMI use alone.

Keywords: COVID-19; body fat percentage; body mass index; obesity; visceral fat.