Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection
Authors: Fabian Sanchis-Gomar, Carl J. Lavie, Abhishek Sharma, Brandon M. Henry, Giuseppe Lippi
Journal: Annals of Internal Medicine (2021)

LettersJune 2021Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 InfectionFREEFabian Sanchis-Gomar, MD, PhD, Carl J. Lavie, MD, Abhishek Sharma, MD, Brandon M. Henry, MD, Giuseppe Lippi, MDFabian Sanchis-Gomar, MD, PhDUniversity of Valencia and INCLIVA Biomedical Research Institute, Valencia, SpainSearch for more papers by this author, Carl J. Lavie, MDThe University of Queensland School of Medicine, Brisbane, Queensland, AustraliaSearch for more papers by this author, Abhishek Sharma, MDGundersen Health System, La Crosse, WisconsinSearch for more papers by this author, Brandon M. Henry, MDCincinnati Children's Hospital Medical Center, Cincinnati, OhioSearch for more papers by this author, Giuseppe Lippi, MDUniversity of Verona, Verona, ItalySearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0014 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We read with interest Anderson and colleagues' excellent study (1) of 2466 adults hospitalized with laboratory-confirmed COVID-19. They showed that obese patients had a higher risk for intubation and death, with a striking 60% increase in those with class 3, or severe, obesity. This risk was most notable in those younger than 65 years.A recent meta-analysis of 13 studies and 7196 hospitalized patients showed that those with obesity had a 39% higher risk for more severe illness—defined as a need for intensive care unit admission or invasive mechanical ventilation or death—than their nonobese counterparts (2). These results support Anderson and colleagues' findings.The potential mechanisms explaining the increased risk posed by COVID-19 in obese patients as reviewed by Anderson and colleagues (1) were similar overall to those explored in detail in a recent review on this topic (3). However, a point not emphasized by Anderson and colleagues that could be the most important factor is that SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptors in the lungs and other organs and that this receptor is even more abundant in adipocytes than in lung tissue. As such, adipose tissue acts as a potent viral reservoir (2, 3) and increases the overall viral load in those with higher adiposity.Prevention of obesity and its progression is clearly urgently needed throughout the world (4). Increasing physical activity and fitness, as well as encouraging appropriate lifestyle habits and diet, may reduce obesity and its progression and promote a healthier immune system (5). In the meantime, during the COVID-19 pandemic, clinicians should recognize the markedly increased risk associated with obesity and the need for more aggressive triage and treatment in obese patients.References1. Anderson MR, Geleris J, Anderson DR, et al. Body mass index and risk for intubation or death in SARS-CoV-2 infection. A retrospective cohort study. Ann Intern Med. 2020;173:782-90. [PMID: 32726151] doi:10.7326/M20-3214 LinkGoogle Scholar2. Sharma A, Garg A, Rout A, et al. Association of obesity with more critical illness in COVID-19 [Letter]. Mayo Clin Proc. 2020;95:2040-2. [PMID: 32861346] doi:10.1016/j.mayocp.2020.06.046 CrossrefMedlineGoogle Scholar3. Sanchis-Gomar F, Lavie CJ, Mehra MR, et al. Obesity and outcomes in COVID-19: when an epidemic and pandemic collide. Mayo Clin Proc. 2020;95:1445-53. [PMID: 32622449] doi:10.1016/j.mayocp.2020.05.006 CrossrefMedlineGoogle Scholar4. Lavie CJ, Laddu D, Arena R, et al. Healthy weight and obesity prevention: JACC health promotion series. J Am Coll Cardiol. 2018;72:1506-31. [PMID: 30236314] doi:10.1016/j.jacc.2018.08.1037 CrossrefMedlineGoogle Scholar5. Laddu DR, Lavie CJ, Phillips SA, et al. Physical activity for immunity protection: Inoculating populations with healthy living medicine in preparation for the next pandemic [Editorial]. Prog Cardiovasc Dis. 2021;64:102-4. [PMID: 32278694] doi:10.1016/j.pcad.2020.04.006 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Fabian Sanchis-Gomar, MD, PhD; Carl J. Lavie, MD; Abhishek Sharma, MD; Brandon M. Henry, MD; Giuseppe Lippi, MDAffiliations: University of Valencia and INCLIVA Biomedical Research Institute, Valencia, SpainThe University of Queensland School of Medicine, Brisbane, Queensland, AustraliaGundersen Health System, La Crosse, WisconsinCincinnati Children's Hospital Medical Center, Cincinnati, OhioUniversity of Verona, Verona, ItalyDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBody Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection Michaela R. Anderson , Joshua Geleris , David R. Anderson , Jason Zucker , Yael R. Nobel , Daniel Freedberg , Jennifer Small-Saunders , Kartik N. Rajagopalan , Richard Greendyk , Sae-Rom Chae , Karthik Natarajan , David Roh , Ethan Edwin , Dympna Gallagher , Anna Podolanczuk , R. Graham Barr , Anthony W. Ferrante , and Matthew R. Baldwin Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection Michaela R. Anderson , Anthony W. Ferrante , Matthew R. Baldwin Metrics Cited byEffect of Obesity on Clinical Outcomes in COVID-19 PatientsBody Composition and Pulmonary DiseasesReviving the mutual impact of SARS-COV-2 and obesity on patients: From morbidity to mortality June 2021Volume 174, Issue 6 Page: 885-886 ePublished: 15 June 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...