{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T16:07:58Z","timestamp":1776960478435,"version":"3.51.4"},"reference-count":45,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell'Istruzione dell'Universita e della Ricerca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","clinicalnutritionespen.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical Nutrition ESPEN"],"published-print":{"date-parts":[[2022,10]]},"DOI":"10.1016\/j.clnesp.2022.07.003","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T18:47:50Z","timestamp":1658256470000},"page":"437-444","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":21,"special_numbering":"C","title":["The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia"],"prefix":"10.1016","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-9359","authenticated-orcid":false,"given":"Elena","family":"Graziano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddalena","family":"Peghin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-9578","authenticated-orcid":false,"given":"Maria","family":"De Martino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"De Carlo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Da Porto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1657-4888","authenticated-orcid":false,"given":"Luca","family":"Bulfone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viviana","family":"Casarsa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6247-5958","authenticated-orcid":false,"given":"Emanuela","family":"Sozio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9745-2841","authenticated-orcid":false,"given":"Martina","family":"Fabris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Cif\u00f9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Grassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9070-4807","authenticated-orcid":false,"given":"Francesco","family":"Curcio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-1720","authenticated-orcid":false,"given":"Miriam","family":"Isola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6242-0209","authenticated-orcid":false,"given":"Leonardo Alberto","family":"Sechi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Tascini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Croatto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierpaolo","family":"Ditaranto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo Maria","family":"Ditaranto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"3","key":"10.1016\/j.clnesp.2022.07.003_bib1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1093\/cid\/ciq152","article-title":"A\u00a0novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1)","volume":"52","author":"Louie","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"8","key":"10.1016\/j.clnesp.2022.07.003_bib2","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.1016\/S1473-3099(18)30127-0","article-title":"Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission","volume":"18","author":"Hui","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"21","key":"10.1016\/j.clnesp.2022.07.003_bib3","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.1001\/jama.289.21.JOC30885","article-title":"Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area","volume":"289","author":"Booth","year":"2003","journal-title":"JAMA"},{"key":"10.1016\/j.clnesp.2022.07.003_bib4","doi-asserted-by":"crossref","first-page":"e4113","DOI":"10.1093\/cid\/ciaa1787","article-title":"Impact of sex and metabolic comorbidities on COVID-19 mortality risk across age groups: 66,646 inpatients across 613 U.S. Hospitals","volume":"73","author":"Goodman","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"12","key":"10.1016\/j.clnesp.2022.07.003_bib5","doi-asserted-by":"crossref","first-page":"2282","DOI":"10.1002\/oby.23014","article-title":"Obesity doubles mortality in patients hospitalized for severe acute respiratory syndrome coronavirus 2 in paris hospitals, France: a cohort study on 5,795 patients","volume":"28","author":"Czernichow","year":"2020","journal-title":"Obesity"},{"issue":"3","key":"10.1016\/j.clnesp.2022.07.003_bib6","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.orcp.2021.02.008","article-title":"Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry","volume":"15","author":"Abumayyaleh","year":"2021","journal-title":"Obes Res Clin Pract"},{"issue":"11","key":"10.1016\/j.clnesp.2022.07.003_bib7","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1016\/j.numecd.2020.07.047","article-title":"The obesity paradox: analysis from the SMAtteo COvid-19 REgistry (SMACORE) cohort","volume":"30","author":"Biscarini","year":"2020","journal-title":"Nutr Metabol Cardiovasc Dis"},{"key":"10.1016\/j.clnesp.2022.07.003_bib8","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.nut.2016.07.016","article-title":"Obesity paradox in patients with community-acquired pneumonia: is inflammation the missing link?","volume":"33","author":"Braun","year":"2017","journal-title":"Nutrition"},{"issue":"6","key":"10.1016\/j.clnesp.2022.07.003_bib9","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1016\/j.chest.2021.01.081","article-title":"Relationship between obesity and ventilator-associated pneumonia: a post hoc analysis of the NUTRIREA2 trial","volume":"159","author":"Nseir","year":"2021","journal-title":"Chest"},{"issue":"2","key":"10.1016\/j.clnesp.2022.07.003_bib10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.pcad.2018.05.005","article-title":"Obesity and the obesity paradox in heart failure","volume":"61","author":"Horwich","year":"2018","journal-title":"Prog Cardiovasc Dis"},{"key":"10.1016\/j.clnesp.2022.07.003_bib11","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.metabol.2018.11.001","article-title":"Obesity and cancer risk: emerging biological mechanisms and perspectives","volume":"92","author":"Avgerinos","year":"2019","journal-title":"Metabolism"},{"key":"10.1016\/j.clnesp.2022.07.003_bib12","article-title":"The impact of obesity on severe disease and mortality in people with SARS-CoV-2: a systematic review and meta-analysis","author":"Seidu","year":"2020","journal-title":"Endocrinol Diabetes Metab"},{"key":"10.1016\/j.clnesp.2022.07.003_bib13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ejim.2021.06.028","article-title":"The link between nutritional status and outcomes in COVID-19 patients in ICU: is obesity or sarcopenia the real problem?","volume":"91","author":"Molfino","year":"2021","journal-title":"Eur J Intern Med"},{"issue":"12","key":"10.1016\/j.clnesp.2022.07.003_bib14","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"3","key":"10.1016\/j.clnesp.2022.07.003_bib15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/156482650402500310","article-title":"WHO global strategy on diet, physical activity and health","volume":"25","author":"Waxman","year":"2004","journal-title":"Food Nutr Bull"},{"issue":"5","key":"10.1016\/j.clnesp.2022.07.003_bib16","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.2337\/diabetes.52.5.1210","article-title":"NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older","volume":"52","author":"Alexander","year":"2003","journal-title":"Diabetes"},{"issue":"4","key":"10.1016\/j.clnesp.2022.07.003_bib17","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1016\/j.clnu.2020.10.021","article-title":"Estimation of skeletal muscle mass by bioimpedance and differences among skeletal muscle mass indices for assessing sarcopenia","volume":"40","author":"Xu","year":"2021","journal-title":"Clin Nutr"},{"issue":"23","key":"10.1016\/j.clnesp.2022.07.003_bib19","first-page":"2526","article-title":"Acute respiratory distress syndrome: the Berlin Definition","volume":"307","author":"Force","year":"2012","journal-title":"JAMA"},{"key":"10.1016\/j.clnesp.2022.07.003_bib20","unstructured":"WHO. Novel coronavirus COVID-19 therapeutic trial synopsis 2020 [Available from: https:\/\/www. who.int\/blueprint\/priority-diseases\/key-action\/COVID-19_Treatment_ Trial_Design_Master_Protocol_synopsis_Final_18022020.pd."},{"issue":"4","key":"10.1016\/j.clnesp.2022.07.003_bib21","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1530\/EJE-20-0541","article-title":"How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalised COVID-19 patients? Results from a single Italian centre","volume":"183","author":"Rottoli","year":"2020","journal-title":"Eur J Endocrinol"},{"issue":"20","key":"10.1016\/j.clnesp.2022.07.003_bib22","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"issue":"6","key":"10.1016\/j.clnesp.2022.07.003_bib23","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1016\/j.dsx.2020.10.012","article-title":"The impact of metabolic syndrome on morbidity and mortality among intensive care unit admitted COVID-19 patients","volume":"14","author":"Alamdari","year":"2020","journal-title":"Diabetes Metabol Syndr"},{"key":"10.1016\/j.clnesp.2022.07.003_bib24","doi-asserted-by":"crossref","first-page":"188","DOI":"10.2337\/dc20-1714","article-title":"Metabolic syndrome and COVID-19 mortality among adult black patients in new orleans","volume":"44","author":"Xie","year":"2020","journal-title":"Diabetes Care"},{"issue":"7","key":"10.1016\/j.clnesp.2022.07.003_bib25","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1002\/oby.22831","article-title":"High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation","volume":"28","author":"Simonnet","year":"2020","journal-title":"Obesity"},{"key":"10.1016\/j.clnesp.2022.07.003_bib26","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/CCM.0000000000005216","article-title":"Body mass index and mortality in coronavirus disease 2019 and other diseases: a cohort study in 35,506 ICU patients","volume":"50","author":"Kooistra","year":"2021","journal-title":"Crit Care Med"},{"issue":"11","key":"10.1016\/j.clnesp.2022.07.003_bib27","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S2213-8587(21)00244-8","article-title":"COVID-19 and metabolic disease: mechanisms and clinical management","volume":"9","author":"Steenblock","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"10.1016\/j.clnesp.2022.07.003_bib28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/s41574-019-0310-7","article-title":"Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity","volume":"16","author":"Ross","year":"2020","journal-title":"Nat Rev Endocrinol"},{"key":"10.1016\/j.clnesp.2022.07.003_bib29","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s40519-021-01173-w","article-title":"Abdominal obesity phenotype is associated with COVID-19 chest X-ray severity score better than BMI-based obesity","volume":"27","author":"Malavazos","year":"2021","journal-title":"Eat Weight Disord"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib30","article-title":"Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19","volume":"7","author":"van Zelst","year":"2020","journal-title":"BMJ Open Respir Res"},{"issue":"2","key":"10.1016\/j.clnesp.2022.07.003_bib31","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1007\/s00261-020-02693-2","article-title":"Visceral adipose tissue in patients with COVID-19: risk stratification for severity","volume":"46","author":"Chandarana","year":"2021","journal-title":"Abdom Radiol (NY)"},{"key":"10.1016\/j.clnesp.2022.07.003_bib32","doi-asserted-by":"crossref","DOI":"10.1016\/j.metabol.2020.154319","article-title":"Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19","volume":"111","author":"Watanabe","year":"2020","journal-title":"Metabolism"},{"key":"10.1016\/j.clnesp.2022.07.003_bib33","doi-asserted-by":"crossref","DOI":"10.1016\/j.metabol.2020.154317","article-title":"The role of visceral adiposity in the severity of COVID-19: highlights from a unicenter cross-sectional pilot study in Germany","volume":"110","author":"Petersen","year":"2020","journal-title":"Metabolism"},{"issue":"4","key":"10.1016\/j.clnesp.2022.07.003_bib34","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1016\/j.clnu.2020.10.023","article-title":"Association of bioelectric impedance analysis body composition and disease severity in COVID-19 hospital ward and ICU patients: the BIAC-19 study","volume":"40","author":"Moonen","year":"2021","journal-title":"Clin Nutr"},{"key":"10.1016\/j.clnesp.2022.07.003_bib35","article-title":"Phase angle and standardized phase angle from bioelectrical impedance measurements as a prognostic factor for mortality at 90 days in patients with COVID-19: a longitudinal cohort study","author":"Cornejo-Pareja","year":"2021","journal-title":"Clin Nutr"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib36","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1161\/CIRCULATIONAHA.106.675355","article-title":"Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study","volume":"116","author":"Fox","year":"2007","journal-title":"Circulation"},{"issue":"6","key":"10.1016\/j.clnesp.2022.07.003_bib37","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/S1473-3099(21)00019-0","article-title":"Identification and validation of clinical phenotypes with prognostic implications in patients admitted to hospital with COVID-19: a multicentre cohort study","volume":"21","author":"Gutierrez-Gutierrez","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13054-017-1615-3","article-title":"Can body mass index predict clinical outcomes for patients with acute lung injury\/acute respiratory distress syndrome? A meta-analysis","volume":"21","author":"Ni","year":"2017","journal-title":"Crit Care"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib39","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13054-017-1682-5","article-title":"Obesity and survival in critically ill patients with acute respiratory distress syndrome: a paradox within the paradox","volume":"21","author":"Ball","year":"2017","journal-title":"Crit Care"},{"issue":"15","key":"10.1016\/j.clnesp.2022.07.003_bib40","first-page":"2346","article-title":"Obesity and cancer: the role of adipose tissue and adipo-cytokines-induced chronic inflammation","volume":"7","author":"Divella","year":"2016","journal-title":"J\u00a0Cancer"},{"key":"10.1016\/j.clnesp.2022.07.003_bib41","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.clnesp.2021.12.001","article-title":"Impact of sarcopenia in SARS-CoV-2 patients during two different epidemic waves","volume":"47","author":"Menozzi","year":"2022","journal-title":"Clin Nutr ESPEN"},{"key":"10.1016\/j.clnesp.2022.07.003_bib42","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ebiom.2019.10.034","article-title":"Skeletal muscle as potential central link between sarcopenia and immune senescence","volume":"49","author":"Nelke","year":"2019","journal-title":"EBioMedicine"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib43","doi-asserted-by":"crossref","first-page":"5121","DOI":"10.1038\/s41598-021-84478-1","article-title":"MR-proADM as prognostic factor of outcome in COVID-19 patients","volume":"11","author":"Sozio","year":"2021","journal-title":"Sci Rep"},{"issue":"1","key":"10.1016\/j.clnesp.2022.07.003_bib44","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1186\/s13054-020-03328-0","article-title":"CXCL10 could drive longer duration of mechanical ventilation during COVID-19 ARDS","volume":"24","author":"Blot","year":"2020","journal-title":"Crit Care"},{"issue":"5","key":"10.1016\/j.clnesp.2022.07.003_bib45","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.2337\/diabetes.53.5.1285","article-title":"From blood monocytes to adipose tissue-resident macrophages: induction of diapedesis by human mature adipocytes","volume":"53","author":"Curat","year":"2004","journal-title":"Diabetes"},{"issue":"3","key":"10.1016\/j.clnesp.2022.07.003_bib46","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1056\/NEJMp2012910","article-title":"Racial health disparities and covid-19 - caution and context","volume":"383","author":"Chowkwanyun","year":"2020","journal-title":"N\u00a0Engl J Med"}],"container-title":["Clinical Nutrition ESPEN"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405457722004132?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405457722004132?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T07:11:03Z","timestamp":1762499463000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2405457722004132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":45,"alternative-id":["S2405457722004132"],"URL":"https:\/\/doi.org\/10.1016\/j.clnesp.2022.07.003","relation":{},"ISSN":["2405-4577"],"issn-type":[{"value":"2405-4577","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia","name":"articletitle","label":"Article Title"},{"value":"Clinical Nutrition ESPEN","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.clnesp.2022.07.003","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}