{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:19:59Z","timestamp":1760231999288,"version":"build-2065373602"},"reference-count":78,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T00:00:00Z","timestamp":1665619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"School of Oncology of the German Cancer Consortium","award":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"],"award-info":[{"award-number":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"]}]},{"name":"Medical Faculty of Ludwig-Maximilians-University","award":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"],"award-info":[{"award-number":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"]}]},{"name":"Deutsche Forschungsgemeinschaft","award":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"],"award-info":[{"award-number":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"]}]},{"name":"China Scholarship Council","award":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"],"award-info":[{"award-number":["1089","SFB-TRR 388\/1 2021\u2014452,881,907 TP C05","201908080031"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Overweight and obesity are associated with chronic low-grade inflammation and represent risk factors for various diseases, including COVID-19. However, most published studies on COVID-19 defined obesity by the body mass index (BMI), which does not encounter adipose tissue distribution, thus neglecting immunometabolic high-risk patterns. Therefore, we comprehensively analyzed baseline anthropometry (BMI, waist-to-height-ratio (WtHR), visceral (VAT), epicardial (EAT), subcutaneous (SAT) adipose tissue masses and liver fat, inflammation markers (CRP, ferritin, interleukin-6), and immunonutritional scores (CRP-to-albumin ratio (CAR), modified Glasgow prognostic score, neutrophile-to-lymphocyte ratio, prognostic nutritional index)) in 58 consecutive COVID-19 patients of the early pandemic phase with regard to the necessity of invasive mechanical ventilation (IMV). Here, metabolically high-risk adipose tissues represented by increased VAT, liver fat, and WtHR strongly correlated with higher levels of inflammation, pathologic immunonutritional scores, and the need for IMV. In contrast, the prognostic value of BMI was inferior and absent with regard to SAT. Multivariable logistic regression analysis identified an optimized IMV risk prediction model employing liver fat, WtHR, and CAR. In summary, we suggest an immunometabolically risk-adjusted model to predict COVID-19-induced respiratory failure better than BMI-based stratification, which warrants prospective validation.<\/jats:p>","DOI":"10.3390\/nu14204280","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T22:21:11Z","timestamp":1665699671000},"page":"4280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk Stratification Based on a Pattern of Immunometabolic Host Factors Is Superior to Body Mass Index\u2014Based Prediction of COVID-19-Associated Respiratory Failure"],"prefix":"10.3390","volume":"14","author":[{"given":"David M.","family":"Cordas dos Santos","sequence":"first","affiliation":[{"name":"Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"Cancer and Immunometabolism Research Group, Gene Center LMU Munich, 81377 Munich, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lian","family":"Liu","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Munich (CCCM), LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melvin","family":"Gerisch","sequence":"additional","affiliation":[{"name":"Cancer and Immunometabolism Research Group, Gene Center LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-3037","authenticated-orcid":false,"given":"Johannes C.","family":"Hellmuth","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"von Bergwelt-Baildon","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"},{"name":"Comprehensive Cancer Center Munich (CCCM), LMU Munich, 81377 Munich, Germany"},{"name":"COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-1952","authenticated-orcid":false,"given":"Wolfgang G.","family":"Kunz","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-8258","authenticated-orcid":false,"given":"Sebastian","family":"Theurich","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"Cancer and Immunometabolism Research Group, Gene Center LMU Munich, 81377 Munich, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,13]]},"reference":[{"key":"ref_1","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":"ref_2","doi-asserted-by":"crossref","first-page":"e067516","DOI":"10.1136\/bmj-2021-067516","article-title":"Anthropometric and adiposity indicators and risk of type 2 diabetes: Systematic review and dose-response meta-analysis of cohort studies","volume":"376","author":"Jayedi","year":"2022","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1098-3597(99)90002-9","article-title":"Obesity and its comorbid conditions","volume":"2","author":"Khaodhiar","year":"1999","journal-title":"Clin. Cornerstone"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"Obesity Phenotypes, Diabetes, and Cardiovascular Diseases","volume":"126","author":"Tchernof","year":"2020","journal-title":"Circ. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S1473-3099(06)70523-0","article-title":"Obesity and infection","volume":"6","author":"Falagas","year":"2006","journal-title":"Lancet Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1007\/s13679-021-00448-8","article-title":"Obesity as a risk factor for severe COVID-19: Summary of the best evidence and implications for health care","volume":"10","author":"Sattar","year":"2021","journal-title":"Curr. Obes. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"155121","DOI":"10.1016\/j.metabol.2021.155121","article-title":"Obesity, metabolic phenotypes and COVID-19","volume":"128","author":"Sanoudou","year":"2022","journal-title":"Metab. Clin. Exp."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1046\/j.1467-789x.2001.00025.x","article-title":"Obesity and immune function relationships","volume":"2","author":"Marcos","year":"2001","journal-title":"Obes. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1038\/ni.2343","article-title":"Immunological complications of obesity","volume":"13","author":"Kanneganti","year":"2012","journal-title":"Nat. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1038\/sj.ijo.0801792","article-title":"The relation of body fat mass and distribution to markers of chronic inflammation","volume":"25","author":"Festa","year":"2001","journal-title":"Int. J. Obes. Relat. Metab. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.diabres.2004.11.007","article-title":"Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-alpha and IL-6","volume":"69","author":"Park","year":"2005","journal-title":"Diabetes. Res. Clin. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/oby.2003.74","article-title":"Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression","volume":"11","author":"Megias","year":"2003","journal-title":"Obes. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Radigan, K.A., Morales-Nebreda, L., Soberanes, S., Nicholson, T., Nigdelioglu, R., Cho, T., Chi, M., Hamanaka, R.B., Misharin, A.V., and Perlman, H. (2014). Impaired clearance of influenza A virus in obese, leptin receptor deficient mice is independent of leptin signaling in the lung epithelium and macrophages. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0108138"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.2147\/IDR.S319029","article-title":"Delayed SARS-CoV-2 Clearance in Patients with Obesity","volume":"14","author":"Zhang","year":"2021","journal-title":"Infect. Drug. Resist."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1467-789X.2011.00952.x","article-title":"Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis","volume":"13","author":"Ashwell","year":"2012","journal-title":"Obes. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1467-789X.2009.00623.x","article-title":"Subcutaneous and visceral adipose tissue: Structural and functional differences","volume":"11","author":"Ibrahim","year":"2010","journal-title":"Obes. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1053\/meta.2001.21693","article-title":"Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity","volume":"50","author":"Smith","year":"2001","journal-title":"Metabolism"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S0899-9007(02)01003-1","article-title":"Clinical and pathophysiological consequences of abdominal adiposity and abdominal adipose tissue depots","volume":"19","author":"Misra","year":"2003","journal-title":"Nutrition"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1038\/ijo.2012.72","article-title":"Deep subcutaneous adipose tissue is more saturated than superficial subcutaneous adipose tissue","volume":"37","author":"Lundbom","year":"2013","journal-title":"Int. J. Obes."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s12020-013-0099-4","article-title":"Epicardial adipose tissue in endocrine and metabolic diseases","volume":"46","author":"Iacobellis","year":"2014","journal-title":"Endocrine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ijcard.2018.09.089","article-title":"Epicardial adipose tissue and cardiovascular diseases","volume":"278","author":"Ansaldo","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1065","DOI":"10.1152\/ajpendo.00442.2002","article-title":"Visceral fat and liver fat are independent predictors of metabolic risk factors in men","volume":"284","author":"Nichaman","year":"2003","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1038\/sj.bjc.6606087","article-title":"An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: A Glasgow Inflammation Outcome Study","volume":"104","author":"Proctor","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_24","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"Onodera","year":"1984","journal-title":"Nihon Geka Gakkai Zasshi"},{"key":"ref_25","first-page":"5","article-title":"Ratio of neutrophil to lymphocyte counts\u2014Rapid and simple parameter of systemic inflammation and stress in critically ill","volume":"102","author":"Zahorec","year":"2001","journal-title":"Bratisl. Lek Listy"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Almasaudi, A.S., Dolan, R.D., Edwards, C.A., and McMillan, D.C. (2020). Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer. Cancers, 12.","DOI":"10.3390\/cancers12071986"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"741061","DOI":"10.3389\/fimmu.2021.741061","article-title":"Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis","volume":"12","author":"Karimi","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_28","first-page":"52","article-title":"The predictive value of pre-treatment inflammatory markers in advanced non-small-cell lung cancer","volume":"17","author":"Kasymjanova","year":"2010","journal-title":"Curr. Oncol."},{"key":"ref_29","first-page":"11386","article-title":"Expressions of SAA, CRP, and FERR in different severities of COVID-19","volume":"24","author":"Liu","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1093\/ije\/dyab012","article-title":"The role of C-reactive protein as a prognostic marker in COVID-19","volume":"50","author":"Stringer","year":"2021","journal-title":"Int. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Elshazli, R.M., Toraih, E.A., Elgaml, A., El-Mowafy, M., El-Mesery, M., Amin, M.N., Hussein, M.H., Killackey, M.T., Fawzy, M.S., and Kandil, E. (2020). Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS ONE, 15.","DOI":"10.1101\/2020.07.08.20141218"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12941-020-00362-2","article-title":"Plasma CRP level is positively associated with the severity of COVID-19","volume":"19","author":"Chen","year":"2020","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e2221","DOI":"10.1002\/rmv.2221","article-title":"C-reactive protein as an effector molecule in Covid-19 pathogenesis","volume":"31","author":"Carrero","year":"2021","journal-title":"Rev. Med. Virol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1056\/NEJMoa1305584","article-title":"Clinical findings in 111 cases of influenza A (H7N9) virus infection","volume":"368","author":"Gao","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3264","DOI":"10.1158\/1078-0432.CCR-06-3067","article-title":"Body composition as an independent determinant of 5-fluorouracil\u2013based chemotherapy toxicity","volume":"13","author":"Prado","year":"2007","journal-title":"Clin. Cancer Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jcct.2019.05.004","article-title":"Non-contrast cardiac CT-based quantitative evaluation of epicardial and intra-thoracic fat in healthy, recently menopausal women: Reproducibility data from the Kronos Early Estrogen Prevention Study","volume":"14","author":"Jayawardena","year":"2020","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1750-2659.2011.00318.x","article-title":"Is abdominal obesity associated with the 2009 influenza A (H1N1) pandemic in Korean school-aged children?","volume":"6","author":"Kim","year":"2012","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/dom.14199","article-title":"Obesity as a risk factor for COVID-19 mortality in women and men in the UK Biobank: Comparisons with influenza\/pneumonia and coronary heart disease","volume":"23","author":"Peters","year":"2021","journal-title":"Diabetes Obes. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"726967","DOI":"10.3389\/fendo.2021.726967","article-title":"COVID-19 and obesity: Role of ectopic visceral and Epicardial adipose tissues in myocardial injury","volume":"12","author":"Lasbleiz","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"154319","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":"ref_41","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1093\/eurheartj\/ehaa471","article-title":"Does epicardial fat contribute to COVID-19 myocardial inflammation?","volume":"41","author":"Malavazos","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"154317","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"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"154440","DOI":"10.1016\/j.metabol.2020.154440","article-title":"Visceral fat is associated to the severity of COVID-19","volume":"115","author":"Favre","year":"2021","journal-title":"Metabolism"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"154893","DOI":"10.1016\/j.metabol.2021.154893","article-title":"The presence of NAFLD influences the transition of metabolically healthy to metabolically unhealthy obesity and the ten-year cardiovascular disease risk: A population-based cohort study","volume":"128","author":"Kouvari","year":"2022","journal-title":"Metab. Clin. Exp."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"626425","DOI":"10.3389\/fmed.2021.626425","article-title":"Metabolic associated fatty liver disease is associated with an increased risk of severe COVID-19: A systematic review with meta-analysis","volume":"8","author":"Hegyi","year":"2021","journal-title":"Front. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1007\/s00262-020-02680-y","article-title":"Pretreatment body mass index and clinical outcomes in cancer patients following immune checkpoint inhibitors: A systematic review and meta-analysis","volume":"69","author":"Chen","year":"2020","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/j.cgh.2022.01.045","article-title":"Mendelian Randomization Analysis Reveals No Causal Relationship Between Nonalcoholic Fatty Liver Disease and Severe COVID-19","volume":"20","author":"Li","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.jhep.2020.09.006","article-title":"NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression\u2014The debate continues","volume":"74","author":"Mushtaq","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Hu, Q., Wang, G., Ren, J., Ren, H., Li, G., Wu, X., Gu, G., Li, R., Guo, K., and Deng, Y. (2021). Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08424-0"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1038\/s41430-022-01120-7","article-title":"Association among prognostic nutritional index, post-operative infection and prognosis of stage II\/III gastric cancer patients following radical gastrectomy","volume":"76","author":"Xiao","year":"2022","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1007\/s00586-020-06622-1","article-title":"Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?","volume":"30","author":"Ushirozako","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"E148","DOI":"10.1097\/BRS.0000000000003226","article-title":"Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery: A Consecutive Series","volume":"45","author":"Kobayashi","year":"2020","journal-title":"Spine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1080\/14017431.2019.1709656","article-title":"Modified Glasgow Prognostic Score is a novel predictor of clinical outcome in heart failure with preserved ejection fraction","volume":"54","author":"Bolat","year":"2020","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Correa-Rodr\u00edguez, M., Pocovi-Gerardino, G., Callejas-Rubio, J.L., Fern\u00e1ndez, R.R., Mart\u00edn-Amada, M., Cruz-Caparros, M.G., Ortego-Centeno, N., and Rueda-Medina, B. (2019). The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus. Nutrients, 11.","DOI":"10.3390\/nu11030638"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1177\/0961203318787058","article-title":"Prognostic nutritional index is correlated with disease activity in patients with systemic lupus erythematosus","volume":"27","author":"Ahn","year":"2018","journal-title":"Lupus"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Isoda, K., Tsuji, S., Harada, Y., Yoshimura, M., Nakabayashi, A., Sato, M., Nagano, H., Kim, D., Hashimoto, J., and Ohshima, S. (2022). Potential of the prognostic nutritional index to determine the risk factor for severe infection in elderly patients with rheumatoid arthritis. Mod. Rheumatol., ahead of print.","DOI":"10.1093\/mr\/roac001"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"107065","DOI":"10.1016\/j.intimp.2020.107065","article-title":"Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19","volume":"89","author":"Xue","year":"2020","journal-title":"Int. Immunopharmacol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e23566","DOI":"10.1002\/jcla.23566","article-title":"The Prognostic Nutritional Index is associated with mortality of COVID-19 patients in Wuhan, China","volume":"34","author":"Wang","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.medj.2020.06.005","article-title":"When two pandemics meet: Why is obesity associated with increased COVID-19 mortality?","volume":"18","author":"Lockhart","year":"2020","journal-title":"Medicine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1042\/CS20200492","article-title":"Covid-19: The renin\u2013angiotensin system imbalance hypothesis","volume":"134","author":"Lanza","year":"2020","journal-title":"Clin. Sci."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Xiao, L., Sakagami, H., and Miwa, N. (2020). ACE2: The key Molecule for Understanding the Pathophysiology of Severe and Critical Conditions of COVID-19: Demon or Angel?. Viruses, 12.","DOI":"10.3390\/v12050491"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"100283","DOI":"10.1016\/j.obmed.2020.100283","article-title":"Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients","volume":"19","year":"2020","journal-title":"Obes. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.bbrc.2020.10.066","article-title":"Obesity alters Ace2 and Tmprss2 expression in lung, trachea, and esophagus in a sex-dependent manner: Implications for COVID-19","volume":"538","author":"Sarver","year":"2021","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"G\u00f3mez-Zorita, S., Milton-Laskibar, I., Garc\u00eda-Arellano, L., Gonz\u00e1lez, M., and Portillo, M.P. (2021). An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22157975"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1016\/j.cmet.2021.09.009","article-title":"Hyperglycemia in acute COVID-19 is characterized by insulin resistance and adipose tissue infectivity by SARS-CoV-2","volume":"33","author":"Reiterer","year":"2021","journal-title":"Cell Metab."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e04696","DOI":"10.1016\/j.heliyon.2020.e04696","article-title":"Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional study and a pathophysiological framework on the role of fat tissue","volume":"6","author":"Moser","year":"2020","journal-title":"Heliyon"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1038\/s41366-021-00868-5","article-title":"Are adipokines the missing link between obesity, immune response, and outcomes in severe COVID-19?","volume":"45","author":"Blot","year":"2021","journal-title":"Int. J. Obes."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/nature21363","article-title":"Inflammation, metaflammation and immunometabolic disorders","volume":"542","author":"Hotamisligil","year":"2017","journal-title":"Nature"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1365-2265.2012.04384.x","article-title":"Association between circulating cytokine levels, diabetes and insulin resistance in a population-based sample (CoLaus study)","volume":"78","author":"Bastardot","year":"2013","journal-title":"Clin. Endocrinol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1373\/clinchem.2003.025858","article-title":"Association of interleukin-1\u03b2 gene polymorphism with body mass index in women","volume":"50","author":"Um","year":"2004","journal-title":"Clin. Chem."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1194\/jlr.M500294-JLR200","article-title":"Adipocyte death defines macrophage localization and function in adipose tissue of obese mice and humans","volume":"46","author":"Cinti","year":"2005","journal-title":"J. Lipid Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ccell.2022.06.005","article-title":"Sex and cancer immunotherapy: Current understanding and challenges","volume":"40","author":"Pala","year":"2022","journal-title":"Cancer Cell"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1038\/s41579-021-00573-0","article-title":"SARS-CoV-2 variants, spike mutations and immune escape","volume":"19","author":"Harvey","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e69091","DOI":"10.7554\/eLife.69091","article-title":"N501Y mutation of spike protein in SARS-CoV-2 strengthens its binding to receptor ACE2","volume":"10","author":"Tian","year":"2021","journal-title":"eLife"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.metabol.2018.09.005","article-title":"The epidemiology of obesity","volume":"92","author":"Chooi","year":"2019","journal-title":"Metabolism"},{"key":"ref_76","unstructured":"O\u2019Neill, J. (2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1097\/MCO.0000000000000485","article-title":"How to best assess abdominal obesity","volume":"21","author":"Fang","year":"2018","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.healun.2019.08.013","article-title":"Adipose tissue quantification and primary graft dysfunction after lung transplantation: The Lung Transplant Body Composition study","volume":"38","author":"Anderson","year":"2019","journal-title":"J. Heart Lung Transplant."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/20\/4280\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:53:34Z","timestamp":1760144014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/20\/4280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,13]]},"references-count":78,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["nu14204280"],"URL":"https:\/\/doi.org\/10.3390\/nu14204280","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2022,10,13]]}}}