CT-Measured Visceral and Pericardial Fat Predict Severe COVID-19 Outcomes: Study
USA: Researchers found that higher levels of pericardial and visceral adipose tissue measured on CT scans years before the COVID-19 pandemic independently predicted the risk of hospitalization and death from SARS-CoV-2 infection. The association remained significant even after adjusting for BMI, waist circumference, diabetes, hypertension, and cardiovascular disease, suggesting that fat distribution may be a stronger predictor of severe COVID-19 outcomes than traditional obesity measures alone.
The findings were published in BMC Pulmonary Medicine by Nadine Al-Naamani and colleagues. The researchers sought to determine whether specific fat depots identified on pre-pandemic computed tomography (CT) scans were associated with the risk of severe COVID-19 outcomes. While obesity has long been recognized as a risk factor for severe SARS-CoV-2 infection, body mass index (BMI) does not distinguish where fat is stored in the body, which may influence disease risk.
The researchers analyzed data from the C4R study, incorporating participants from the Jackson Heart, CARDIA, MESA, and Framingham Heart studies. CT scans performed between 2000 and 2011 were used to measure pericardial, visceral, subcutaneous, and hepatic fat, and these measurements were linked to COVID-19 outcomes after March 2020.
The analysis included 8,412 participants with available CT adiposity data. Over a median follow-up of 547 days, 184 individuals experienced severe COVID-19 outcomes, including hospitalization or death due to SARS-CoV-2 infection.
The study identified significant associations between certain fat depots and severe COVID-19 risk:
- Higher pericardial adipose tissue was associated with a substantially increased risk of COVID-19 hospitalization or death.
- Greater visceral adipose tissue was also linked to a higher likelihood of severe SARS-CoV-2 outcomes.
- These associations persisted even after accounting for BMI, waist circumference, diabetes, hypertension, cardiovascular disease, and other cardiometabolic risk factors.
- Subcutaneous adipose tissue initially showed an association with severe outcomes, but the relationship disappeared after adjustment for obesity-related factors.
- Hepatic fat deposition was not associated with the risk of hospitalization or death from COVID-19.
The findings suggest that fat distribution may be a more important predictor of severe COVID-19 outcomes than overall body weight. Excess visceral and pericardial fat, which are linked to inflammation and cardiometabolic dysfunction, may increase vulnerability to severe SARS-CoV-2 infection.
The authors noted that CT-based measures of adiposity could help improve risk assessment for severe infectious diseases. Notably, these associations were observed even though the CT scans had been performed years before the pandemic.
Overall, greater pericardial and visceral adipose tissue independently predicted COVID-19 hospitalization or death beyond traditional obesity measures. The researchers called for further studies to clarify the underlying mechanisms and assess the role of CT-derived fat measurements in future risk prediction models.
Reference:
Al-Naamani, N., Balte, P., Shashaty, M.G.S. et al. CT-adipose measures identify severe SARS-CoV-2 risk beyond traditional obesity metrics: a C4R cohort study. BMC Pulm Med (2026). https://doi.org/10.1186/s12890-026-04338-4
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