Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection
Authors: Michaela R. Anderson, Anthony W. Ferrante, Matthew R. Baldwin
Journal: Annals of Internal Medicine (2021)

LettersJune 2021Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 InfectionFREEMichaela R. Anderson, MD, MS, Anthony W. Ferrante, MD, PhD, Matthew R. Baldwin, MD, MSMichaela R. Anderson, MD, MSColumbia University Irving Medical Center, New York, New YorkSearch for more papers by this author, Anthony W. Ferrante, MD, PhDColumbia University Irving Medical Center, New York, New YorkSearch for more papers by this author, Matthew R. Baldwin, MD, MSColumbia University Irving Medical Center, New York, New YorkSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0015 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: As noted by Dr. Sanchis-Gomar and colleagues, evidence that obesity is associated with an increased risk for critical illness, intubation, and death in patients with SARS-CoV-2 infection continues to accumulate. The hypothesis that adipocyte expression of ACE2 contributes to worse clinical outcomes is attractive. However, in both murine models and humans, respiratory viral infections that do not use ACE2 receptors are associated with an increased risk for respiratory failure in obese persons. This suggests that non–ACE2-dependent mechanisms link obesity and respiratory failure (1–3).Data show that ACE2 mRNA expression is greater in abdominal visceral adipose tissue than in the lungs. However, no evidence thus far indicates that this leads to a substantial accumulation of SARS-CoV-2 in adipose tissue. A recent case series of 4 patients with SARS-CoV-2 infection undergoing emergent surgery failed to detect SARS-CoV-2 RNA in abdominal visceral or subcutaneous adipose tissue (4). Further work is needed in this area, and we hope that our article, along with others published recently in Annals, continues to promote such enthusiastic and thoughtful discussions.References1. Milner JJ, Rebeles J, Dhungana S, et al. Obesity increases mortality and modulates the lung metabolome during pandemic H1N1 influenza virus infection in mice. J Immunol. 2015;194:4846-59. [PMID: 25862817] doi:10.4049/jimmunol.1402295 CrossrefMedlineGoogle Scholar2. Morgan OW, Bramley A, Fowlkes A, et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010;5:e9694. [PMID: 20300571] doi:10.1371/journal.pone.0009694 CrossrefMedlineGoogle Scholar3. Karki S, Muscatello DJ, Banks E, et al. Association between body mass index and laboratory-confirmed influenza in middle aged and older adults: a prospective cohort study. Int J Obes (Lond). 2018;42:1480-8. [PMID: 29515210] doi:10.1038/s41366-018-0029-x CrossrefMedlineGoogle Scholar4. Safari S, Keyvani H, Malekpour Alamdari, et al. Abdominal surgery in patients with COVID-19: detection of SARS-CoV-2 in abdominal and adipose tissues. Ann Surg. 2020;272:e253-6. [PMID: 32568751] doi:10.1097/SLA.0000000000004165 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Michaela R. Anderson, MD, MS; Anthony W. Ferrante, MD, PhD; Matthew R. Baldwin, MD, MSAffiliations: Columbia University Irving Medical Center, New York, New YorkDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-3214. 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 Fabian Sanchis-Gomar , Carl J. Lavie , Abhishek Sharma , Brandon M. Henry , Giuseppe Lippi Metrics Cited byThe Role of Nutrition in Mitigating the Effects of COVID-19 from Infection through PASC June 2021Volume 174, Issue 6 Page: 886 ePublished: 15 June 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...