Obesity and Mortality Among Patients Diagnosed With COVID-19
Authors: Sara Y. Tartof, Sameer B. Murali, Debbie E. Malden
Journal: Annals of Internal Medicine (2021)

LettersJune 2021Obesity and Mortality Among Patients Diagnosed With COVID-19FREESara Y. Tartof, PhD, MPH, Sameer B. Murali, MD, Debbie E. Malden, DPhil, MScSara Y. Tartof, PhD, MPHKaiser Permanente Southern California, Pasadena, CaliforniaSearch for more papers by this author, Sameer B. Murali, MDSouthern California Permanente Medical Group, Fontana, CaliforniaSearch for more papers by this author, Debbie E. Malden, DPhil, MScCenters for Disease Control and Prevention, Atlanta, GeorgiaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0064 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We thank all respondents for their expertise in identifying potential mediating factors underlying the observed association between BMI and COVID-19 severity described in our study.Dr. Kollias and colleagues describe how COVID-19 may exacerbate the known association between BMI and VTE. We did not directly examine the association between VTE and COVID-19 mortality. However, we clinically observed a slight (although nonsignificant) increased risk for death among patients with underlying peripheral vascular disease, a condition that likely shares similar pathophysiologic mechanisms with VTE (1). Because of the association between a high BMI and risk for VTE, as well as the biological plausibility for COVID-19 to potentiate VTE risk, physicians should consider the possibility of enhanced VTE risk among obese patients with COVID-19.Dr. Bamji highlights leptin as another potential mediator in the observed association between BMI and COVID-19 severity. In 2 recent studies, Wang and associates (2) and van der Voort and coworkers (3) showed a correlation among leptin levels, BMI, immunologic dysregulation, and COVID-19 disease severity. Because leptin levels are directly proportional to adiposity, this finding underscores the complex intersection between pathophysiologic mechanisms driving COVID-19–related critical illness and social determinants of health and lifestyle behaviors (4). Future prospective studies would help further clarify these observations.Dr. Burtscher and colleagues raise the important issue of the potential protective role of CRF in COVID-19 severity. We agree that exercise habits—and perhaps CRF in particular—do likely play an important role. Not only might increased CRF attenuate SARS-CoV-2 binding, but physical activity may reduce systemic inflammation and COVID-19 severity. Although we did not assess exercise in our initial study, we are engaged in a follow-up study on this topic involving more than 40 000 patients with COVID-19 that we expect to be published soon. As such, we agree that physical activity is an important factor to consider in assessing COVID-19 severity.References1. Folsom AR, Lutsey PL, Astor BC, et al. C-reactive protein and venous thromboembolism. A prospective investigation in the ARIC cohort. Thromb Haemost. 2009;102:615-9. [PMID: 19806245] doi:10.1160/TH09-04-0274 CrossrefMedlineGoogle Scholar2. Wang J, Xu Y, Zhang X, et al. Leptin correlates with monocytes activation and severe condition in COVID-19 patients. J Leukoc Biol. 2021. [PMID: 33404078] doi:10.1002/JLB.5HI1020-704R CrossrefGoogle Scholar3. van der Voort PHJ, Moser J, Zandstra DF, et al. Leptin levels in SARS-CoV-2 infection related respiratory failure: a cross-sectional study and a pathophysiological framework on the role of fat tissue. Heliyon. 2020;6:e04696. [PMID: 32844126] doi:10.1016/j.heliyon.2020.e04696 CrossrefMedlineGoogle Scholar4. Lago F, Dieguez C, Gómez-Reino J, et al. Adipokines as emerging mediators of immune response and inflammation. Nat Clin Pract Rheumatol. 2007;3:716-24. [PMID: 18037931] CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Sara Y. Tartof, PhD, MPH; Sameer B. Murali, MD; Debbie E. Malden, DPhil, MScAffiliations: Kaiser Permanente Southern California, Pasadena, CaliforniaSouthern California Permanente Medical Group, Fontana, CaliforniaCenters for Disease Control and Prevention, Atlanta, GeorgiaDisclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-3742. 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 Johannes Burtscher , Grégoire P. Millet , Martin Burtscher 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 Metrics June 2021Volume 174, Issue 6 Page: 887-888 ePublished: 15 June 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...