Al-Naamani, Nadine; Balte, Pallavi; Shashaty, Michael G. S.; Sharaf, Asma; Terry, James G.; Carr, John Jeffrey; Allison, Matthew; Anderson, Cheryl A. M.; Bhatt, Surya P.; Long, Michelle T.; Christie, Jason D.; Oelsner, Elizabeth C.; Anderson, Michaela R. (2026). . BMC Pulmonary Medicine, 26(1), 326.
Higher body mass index (BMI), a measure of body weight relative to height, has been linked to a greater likelihood of severe illness and death from SARS-CoV-2, the virus that causes COVID-19. However, BMI does not show where fat is stored in the body, and fat location may provide additional information about health risks. This study examined whether fat stored around the heart (pericardial adipose tissue, or PAT), around the organs in the abdomen (visceral adipose tissue, or VAT), beneath the skin (subcutaneous adipose tissue, or SAT), or in the liver was associated with hospitalization or death from SARS-CoV-2 infection. Researchers used data from 8,412 participants in four large U.S. cohort studies. Body fat was measured using computed tomography (CT) scans performed between 2000 and 2011, several years before the COVID-19 pandemic, and SARS-CoV-2 outcomes were tracked beginning March 1, 2020. During a median follow-up of 547 days, 184 participants were hospitalized or died from SARS-CoV-2 infection. Greater amounts of fat around the heart and abdominal organs were associated with higher hazards of hospitalization or death. Specifically, a doubling of fat around the heart was associated with a 62% higher hazard, while a one-standard-deviation increase in visceral abdominal fat was associated with a 41% higher hazard. These associations remained after accounting for BMI, waist circumference, diabetes, cardiovascular disease, and high blood pressure. Fat beneath the skin was also associated with hospitalization or death initially, but this association was no longer present after accounting for BMI and health conditions related to obesity. Fat accumulation in the liver was not associated with these outcomes. Overall, the findings suggest that fat stored around the heart and internal abdominal organs may be associated with severe outcomes from SARS-CoV-2 infection independently of BMI and several related health conditions. Further research is needed to determine whether CT-based measurements of fat distribution could help assess the risk of severe illness from viral infections and to better understand how body fat may be linked to lung injury.
