Obesity and Mortality Among Patients Diagnosed With COVID-19
Authors: Johannes Burtscher, Grégoire P. Millet, Martin Burtscher
Journal: Annals of Internal Medicine (2021)

LettersJune 2021Obesity and Mortality Among Patients Diagnosed With COVID-19FREEJohannes Burtscher, PhD, Grégoire P. Millet, PhD, Martin Burtscher, PhD, MDJohannes Burtscher, PhDUniversity of Lausanne, Lausanne, SwitzerlandSearch for more papers by this author, Grégoire P. Millet, PhDUniversity of Lausanne, Lausanne, SwitzerlandSearch for more papers by this author, Martin Burtscher, PhD, MDUniversity of Innsbruck, Innsbruck, AustriaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0065 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Tartof and colleagues' study (1) corroborates the scientific evidence showing that severe obesity plays a key role in the risk for death from COVID-19. In adjusted analyses of 6916 patients in Southern California, having a BMI between 40 and 44.9 kg/m2 and 45 kg/m2 or greater corresponding to class III obesity was associated with a risk for death that was, respectively, 2.7 and 4.2 higher than being of normal weight (that is, having a BMI between 18.5 and 24 kg/m2). Adjustment for various obesity-related comorbidities and confounders represents a noteworthy strength of this study (1). However, we believe that one potentially modulating factor has not been considered in this and nearly all other COVID-19 studies: individual cardiorespiratory fitness (CRF).Large-scale studies indicate a close association between increasing CRF due to regular physical activity and mortality reduction from all causes (2). Inclusion of CRF has also been shown to improve the identification of the mortality risk in men in most BMI and waist circumference categories (3). Tartof and colleagues suggest a common link between fat mass and COVID-19: elevated levels of angiotensin II, a proinflammatory and prothrombotic peptide hormone (1).Elevated angiotensin II levels in patients with COVID-19 may be related to the downregulation of angiotensin-converting enzyme 2, an endogenous inhibitor of angiotensin II (4). Some preliminary evidence suggests that the detrimental effects of binding of SARS-CoV-2 to angiotensin-converting enzyme 2 receptors may be modulated by the individual CRF level (5). Thus, regular physical activity (and improved CRF) might attenuate the “cytokine storm” often experienced in severely ill patients with COVID-19 and improve survival. If true, the initiation of physical activity and the improvement of CRF in obese persons could represent an attractive and probably more effective strategy than a policy focusing exclusively on weight reduction.References1. Tartof SY, Qian L, Hong V, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med. 2020;173:773-81. [PMID: 32783686] doi:10.7326/M20-3742 LinkGoogle Scholar2. Burtscher J, Burtscher M. Run for your life: tweaking the weekly physical activity volume for longevity [Editorial]. Br J Sports Med. 2020;54:759-60. [PMID: 31630092] doi:10.1136/bjsports-2019-101350 CrossrefMedlineGoogle Scholar3. Ricketts TA, Sui X, Lavie CJ, et al. Addition of cardiorespiratory fitness within an obesity risk classification model identifies men at increased risk of all-cause mortality. Am J Med. 2016;129:536.e13-20. [PMID: 26642906] doi:10.1016/j.amjmed.2015.11.015 CrossrefGoogle Scholar4. Vaduganathan M, Vardeny O, Michel T, et al. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N Engl J Med. 2020;382:1653-9. [PMID: 32227760] doi:10.1056/NEJMsr2005760 CrossrefMedlineGoogle Scholar5. Zbinden-Foncea H, Francaux M, Deldicque L, et al. Does high cardiorespiratory fitness confer some protection against proinflammatory responses after infection by SARS-CoV-2. Obesity (Silver Spring). 2020;28:1378-81. [PMID: 32324968] doi:10.1002/oby.22849 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Johannes Burtscher, PhD; Grégoire P. Millet, PhD; Martin Burtscher, PhD, MDAffiliations: University of Lausanne, Lausanne, SwitzerlandUniversity of Innsbruck, Innsbruck, AustriaDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0065. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoObesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization Sara Y. Tartof , Lei Qian , Vennis Hong , Rong Wei , Ron F. Nadjafi , Heidi Fischer , Zhuoxin Li , Sally F. Shaw , Susan L. Caparosa , Claudia L. Nau , Tanmai Saxena , Gunter K. Rieg , Bradley K. Ackerson , Adam L. Sharp , Jacek Skarbinski , Tej K. Naik , and Sameer B. Murali Obesity and Mortality Among Patients Diagnosed With COVID-19 Anastasios Kollias , Konstantinos G. Kyriakoulis , Konstantinos Syrigos Obesity and Mortality Among Patients Diagnosed With COVID-19 Andrew N. Bamji Obesity and Mortality Among Patients Diagnosed With COVID-19 Sara Y. Tartof , Sameer B. Murali , Debbie E. Malden Metrics Cited byHigh-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU June 2021Volume 174, Issue 6 Page: 887 ePublished: 15 June 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...