Association of Obesity and Diabetes With SARS-CoV-2 Infection and Symptoms in the COVID-19 Community Research Partnership
Authors: Mongraw-Chaffin Morgana , Tjaden Ashley Hogan , Seals Austin Lyles , Miller Kristen , Ahmed Naheed , Espeland Mark A , Gibbs Michael , Thomas Dorey , Uschner Diane , Weintraub William S , Edelstein Sharon L ,   Covid-19 Community Research Partnership, Wierzba Thomas F , Sanders John Walton , Herrington David , Espeland Mark A , Williamson John , Mongraw-Chaffin Morgana , Bertoni Alain , Alexander-Miller Martha A , Castri Paola , Mathews Allison , Munawar Iqra , Seals Austin Lyles , Ostasiewski Brian , Ballard Christine Ann Pittman , Gurcan Metin , Ivanov Alexander , Zapata Giselle Melendez , Westcott Marlena , n Karen Blinso , Blinson Laura , Mistysyn Mark , Davis Donna , Doomy Lynda , Henderson Perrin , Jessup Alicia , Lane Kimberly , Levine Beverly , McCanless Jessica , McDaniel Sharon , Melius Kathryn , O’Neill Christine , Pack Angelina , Rathee Ritu , Rushing Scott , Sheets Jennifer , Soots Sandra , Wall Michele , Wheeler Samantha , White John , Wilkerson Lisa , Wilson Rebekah , Wilson Kenneth , Burcombe Deb , Saylor Georgia , Lunn Megan , Ordonez Karina , O’Steen Ashley , Wagner Leigh , Runyon Michael S , McCurdy Lewis H , Gibbs Michael A , Taylor Yhenneko J , Calamari Lydia , Tapp Hazel , Ahmed Amina , Brennan Michael , Munn Lindsay , RN PhD , Dantuluri Keerti L , Hetherington Timothy , Lu Lauren C , Dunn Connell , Hogg Melanie , Price Andrea , Leonidas Marina , Manning Melinda , Rossman Whitney , Gohs Frank X , Harris Anna , Priem Jennifer S , Tochiki Pilar , Wellinsky Nicole , Silva Crystal , PhD Tom Ludden , Hernandez Jackeline , Spencer Kennisha , McAlister Laura , William Weintraub , Miller Kristen , Washington Chris , Moses Allison , Dolman Sarahfaye , Zelaya-Portillo Julissa , Erkus John , Blumenthal Joseph , Barrientos Ronald E Romero , Bennett Sonita , Shah Shrenik , Mathur Shrey , Boxley Christian , Kolm Paul , Franklin Ella , Ahmed Naheed , Larsen Moira , Richard Oberhelman , Keating Joseph , Kissinger Patricia , Schieffelin John , Yukich Joshua , Beron Andrew , Teigen Johanna , Karen Kotloff , Chen Wilbur H , Friedman-Klabanoff DeAnna , Berry Andrea A , Powell Helen , Roane Lynnee , Datar Reva , Reilly Colleen , Adolfo Correa , Navalkele Bhagyashri , Castillo Alexandra , Ward Lori , Santos Robert P , Anugu Pramod , Gao Yan , Green Jason , Sandlin Ramona , Moore Donald , Drake Lemichal , Horton Dorothy , Johnson Kendra L , Stover Michael , Lagarde William H , Daniel LaMonica , Maguire Patrick D , Hanlon Charin L , McFayden Lynette , Rigo Isaura , Hines Kelli , Smith Lindsay , Harris Monique , Lissor Belinda , Cook Vivian , Eversole Maddy , Herrin Terry , Murphy Dennis , Kinney Lauren , Diehl Polly , Abromitis Nicholas , Pierre Tina St , Heckman Bill , Evans Denise , March Julian , Whitlock Ben , Moore Wendy , Arthur Sarah , Conway Joseph , Gallaher Thomas R , Johanson Mathew , Brown Sawyer , Dixon Tina , Reavis Martha , Henderson Shakira , Zimmer Michael , Oliver Danielle , Jackson Kasheta , Menon Monica , Bishop Brandon , Roeth Rachel , Robin King-Thiele , Hamrick Terri S , Ihmeidan Abdalla , Hinkelman Amy , Okafor Chika , Brown Regina B Bray , Brewster Amber , Bouyi Danius , Lamont Katrina , Yoshinaga Kazumi , Vinod Poornima , Denbel Giera , Lo Jason , Mayet-Khan Mariam , Mittal Akash , Motwani Reena , Raafat Mohamed , Schultz Evan , Joseph Aderson , Parkeh Aalok , Patel Dhara , Afridi Babar , Uschner Diane , Edelstein Sharon L , Santacatterina Michele , Strylewicz Greg , Burke Brian , Gunaratne Mihili , Turney Meghan , Zhou Shirley Qin , Tjaden Ashley H , Fette Lida , Buahin Asare , Bott Matthew , Graziani Sophia , Soni Ashvi , Diao Guoqing , Renteria Jone , Christopher Mores , Porzucek Abigail , Rebecca Laborde , Acharya Pranav , Lucy Guill , Lamphier Danielle , Schaefer Anna , Satterwhite William M , Anne McKeague , Ward Johnathan , Naranjo Diana P , Darko Nana , Castellon Kimberly , Brink Ryan , Shehzad Haris , Kuprianov Derek , McGlasson Douglas , Hayes Devin , Edwards Sierra , Daphnis Stephane , Todd Britnee , Goodwin Atira , Ruth Berkelman , Emory  , Hanson Kimberly , Zeger Scott , Hopkins Johns , Reilly Cavan , Edwards Kathy , Vanderbilt Helene Gayle , Trust Chicago Community , Redd Stephen 
Published: December 2022

Abstract

Context
Obesity and diabetes are established risk factors for severe SARS-CoV-2 outcomes, but less is known about their impact on susceptibility to COVID-19 infection and general symptom severity.

Objective
We hypothesized that those with obesity or diabetes would be more likely to self-report a positive SARS-CoV-2 test, and, among those with a positive test, have greater symptom severity and duration.

Methods
Among 44 430 COVID-19 Community Research Partnership participants, we evaluated the association of self-reported and electronic health record obesity and diabetes with a self-reported positive COVID-19 test at any time. Among the 2663 participants with a self-reported positive COVID-19 test during the study, we evaluated the association of obesity and diabetes with self-report of symptom severity, duration, and hospitalization. Logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, and health care worker status.

Results
We found a positive graded association between body mass index (BMI) category and positive COVID-19 test (overweight odds ratio [OR] 1.14 [1.05-1.25]; obesity I OR 1.29 [1.17-2.42]; obesity II OR 1.34 [1.19-1.50]; obesity III OR 1.53 [1.35-1.73]), and a similar but weaker association with COVID-19 symptoms and severity among those with a positive test. Diabetes was associated with COVID-19 infection but not symptoms after adjustment, with some evidence of an interaction between obesity and diabetes.

Conclusion
While the limitations of this health system convenience sample include generalizability and selection around test seeking, the strong graded association of BMI and diabetes with self-reported COVID-19 infection suggests that obesity and diabetes may play a role in risk for symptomatic SARS-CoV-2 beyond co-occurrence with socioeconomic factors.