Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

Cathelijne M van Zelst*, Matthijs L Janssen, Nadine Pouw, Erwin Birnie, Manuel Castro Cabezas, Gert-Jan Braunstahl

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background Several characteristics of the metabolic syndrome, such as obesity and hypertension, have emerged as risk factors for a poor clinical outcome in COVID-19. However, most reports lack data on the metabolic syndrome itself. This study investigated prospectively the relationship between respiratory deterioration and the presence of metabolic syndrome or abdominal adiposity in patients with COVID-19.

Methods A prospective observational cohort study analysing patients with respiratory symptoms who presented at a local emergency department in the Netherlands. The influence of abdominal adiposity-assessed by an increased waist-hip ratio-and metabolic syndrome on respiratory deterioration and the length of hospital stay were analysed with multivariable logistic regressions and Kaplan-Meier analyses.

Results In total, 166 patients were analysed, of whom 86 (52%) tested positive for COVID-19. The prevalence of metabolic syndrome did not differ between patients with COVID-19 with and without the need for intubation or level of supportive care (37.5% vs 48.4%, p=0.338). In contrast, abdominal adiposity is an independent risk factor for respiratory distress in COVID-19, adjusted for metabolic syndrome, age, gender and BMI (OR 1.11, 95% CI 1.02 to 1.20, p=0.014).

Conclusion This study shows that abdominal adiposity, and not the presence of metabolic syndrome, is associated with clinical deterioration in COVID-19. This prospective study provides further insight into the risk stratification of patients with COVID-19 based on a simple measurement as the waist and hip circumference.

Original languageEnglish
Article numbere000792
Pages (from-to)1-10
Number of pages10
JournalBMJ open respiratory research
Issue number1
Publication statusPublished - Dec-2020


  • Adiposity
  • Adult
  • Aged
  • COVID-19/complications
  • Female
  • Humans
  • Hypertension/complications
  • Length of Stay/statistics & numerical data
  • Male
  • Metabolic Syndrome/complications
  • Middle Aged
  • Netherlands/epidemiology
  • Obesity/complications
  • Obesity, Abdominal/complications
  • Prevalence
  • Prospective Studies
  • Respiratory Distress Syndrome/epidemiology
  • Risk Factors
  • SARS-CoV-2/genetics
  • Waist-Hip Ratio/methods

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