Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries

Nusrat J. Epsi; Stephanie A. Richard; Eric D. Laing; Anthony C. Fries; Eugene Millar; Mark P. Simons; Caroline English; Christopher J. Colombo; Rhonda E. Colombo; David A. Lindholm; Anuradha Ganesan; Ryan C. Maves; Nikhil Huprikar; Derek Larson; Katrin Mende; Sharon W. Chi; Cristian Madar; Tahaniyat Lalani; Christopher C. Broder; David Tribble; Brian K. Agan; Timothy H. Burgess; Simon D. Pollett; J. Cowden; A. Markelz; K. Mende; T. Merritt; R. Walter; T. Wellington; Carl R. Darnall; S. Bazan; L. Brandon; N. Dimascio-Johnson; K. Gallagher; D. Larson; Henry M. Jackson; P. Blair; D. Clark; S. Chambers; C. Colombo; R. Colombo; C. Conlon; K. Everson; P. Faestel; T. Ferguson; L. Gordon; S. Grogan; S. Lis; C. Mount; D. Musfeldt; R. Sainato; C. Schofield; C. Skinner; M. Stein; M. Switzer; M. Timlin; S. Wood; G. Atwood; R. Carpenter; C. Eickhoff; K. Kronmann; T. Lalani; T. Lee; T. Warkentien; J. Arnold; C. Berjohn; S. Cammarata; S. Husain; N. Kirkland; A. Lane; R. Maves; J. Parrish; G. Utz; S. Chi; E. Filan; K. Fong; T. Horseman; M. Jones; A. Kanis; A. Kayatani; W. Londeree; C. Madar; J. Masel; M. Mcmahon; G. Murphy; V. Ngauy; E. Schoenman; C. Uyehara; R. Villacorta Lyew; C. Broder; T. Burgess; C. Byrne; K. Chung; C. Coles; C. English; P. Hickey; E. Laing; J. Livezey; A. Malloy; T. Oliver; E. Parmelee; S. Pollett; S. Richard; J. Rozman; J. Rusiecki; M. Sanchez; A. Scher; M. Simons; A. Snow; D. Tribble; A. Fries; A. Ganesan; D. Gunasekera; N. Huprikar; M. Oyeneyin; M. Banda; B. Davis; T. Hunter; O. Ikpekpe-Magege; S. Kemp; R. Mody; R. Resendez; M. Wiggins

doi:10.1093/infdis/jiab396

Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries

Nusrat J. Epsi, Stephanie A. Richard, Eric D. Laing, Anthony C. Fries, Eugene Millar, Mark P. Simons, Caroline English, Christopher J. Colombo, Rhonda E. Colombo, David A. Lindholm, Anuradha Ganesan, Ryan C. Maves, Nikhil Huprikar, Derek Larson, Katrin Mende, Sharon W. Chi, Cristian Madar, Tahaniyat Lalani, Christopher C. Broder, David TribbleBrian K. Agan, Timothy H. Burgess, Simon D. Pollett^*, J. Cowden, A. Markelz, K. Mende, T. Merritt, R. Walter, T. Wellington, Carl R. Darnall, S. Bazan, L. Brandon, N. Dimascio-Johnson, K. Gallagher, D. Larson, Henry M. Jackson, P. Blair, D. Clark, S. Chambers, C. Colombo, R. Colombo, C. Conlon, K. Everson, P. Faestel, T. Ferguson, L. Gordon, S. Grogan, S. Lis, C. Mount, D. Musfeldt, R. Sainato, C. Schofield, C. Skinner, M. Stein, M. Switzer, M. Timlin, S. Wood, G. Atwood, R. Carpenter, C. Eickhoff, K. Kronmann, T. Lalani, T. Lee, T. Warkentien, J. Arnold, C. Berjohn, S. Cammarata, S. Husain, N. Kirkland, A. Lane, R. Maves, J. Parrish, G. Utz, S. Chi, E. Filan, K. Fong, T. Horseman, M. Jones, A. Kanis, A. Kayatani, W. Londeree, C. Madar, J. Masel, M. Mcmahon, G. Murphy, V. Ngauy, E. Schoenman, C. Uyehara, R. Villacorta Lyew, C. Broder, T. Burgess, C. Byrne, K. Chung, C. Coles, C. English, P. Hickey, E. Laing, J. Livezey, A. Malloy, T. Oliver, E. Parmelee, S. Pollett, S. Richard, J. Rozman, J. Rusiecki, M. Sanchez, A. Scher, M. Simons, A. Snow, D. Tribble, A. Fries, A. Ganesan, D. Gunasekera, N. Huprikar, M. Oyeneyin, M. Banda, B. Davis, T. Hunter, O. Ikpekpe-Magege, S. Kemp, R. Mody, R. Resendez, M. Wiggins

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The mechanisms underlying the association between obesity and coronavirus disease 2019 (COVID-19) severity remain unclear. After verifying that obesity was a correlate of severe COVID-19 in US Military Health System (MHS) beneficiaries, we compared immunological and virological phenotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in both obese and nonobese participants. Methods: COVID-19-infected MHS beneficiaries were enrolled, and anthropometric, clinical, and demographic data were collected. We compared the SARS-CoV-2 peak IgG humoral response and reverse-transcription polymerase chain reaction viral load in obese and nonobese patients, stratified by hospitalization, utilizing logistic regression models. Results: Data from 511 COVID-19 patients were analyzed, among whom 24% were obese and 14% severely obese. Obesity was independently associated with hospitalization (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.15-3.18) and need for oxygen therapy (aOR, 3.39; 95% CI, 1.61-7.11). In outpatients, severely obese had a log10 (1.89) higher nucleocapsid (N1) genome equivalents (GE)/reaction and log10 (2.62) higher N2 GE/reaction than nonobese (P = 0.03 and P <. 001, respectively). We noted a correlation between body mass index and peak anti-spike protein IgG in inpatients and outpatients (coefficient = 5.48, P <. 001). Conclusions: Obesity is a strong correlate of COVID-19 severity in MHS beneficiaries. These findings offer new pathophysiological insights into the relationship between obesity and COVID-19 severity.

Original language	English
Pages (from-to)	1462-1472
Number of pages	11
Journal	Journal of Infectious Diseases
Volume	224
Issue number	9
DOIs	https://doi.org/10.1093/infdis/jiab396
State	Published - 1 Nov 2021

Keywords

COVID-19 severity
antibody response
obesity
viral load

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10.1093/infdis/jiab396

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Epsi, N. J., Richard, S. A., Laing, E. D., Fries, A. C., Millar, E., Simons, M. P., English, C., Colombo, C. J., Colombo, R. E., Lindholm, D. A., Ganesan, A., Maves, R. C., Huprikar, N., Larson, D., Mende, K., Chi, S. W., Madar, C., Lalani, T., Broder, C. C., ... Wiggins, M. (2021). Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries. Journal of Infectious Diseases, 224(9), 1462-1472. https://doi.org/10.1093/infdis/jiab396

@article{6f3239664e1841778c528c5711ad16ec,

title = "Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries",

abstract = "Background: The mechanisms underlying the association between obesity and coronavirus disease 2019 (COVID-19) severity remain unclear. After verifying that obesity was a correlate of severe COVID-19 in US Military Health System (MHS) beneficiaries, we compared immunological and virological phenotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in both obese and nonobese participants. Methods: COVID-19-infected MHS beneficiaries were enrolled, and anthropometric, clinical, and demographic data were collected. We compared the SARS-CoV-2 peak IgG humoral response and reverse-transcription polymerase chain reaction viral load in obese and nonobese patients, stratified by hospitalization, utilizing logistic regression models. Results: Data from 511 COVID-19 patients were analyzed, among whom 24% were obese and 14% severely obese. Obesity was independently associated with hospitalization (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.15-3.18) and need for oxygen therapy (aOR, 3.39; 95% CI, 1.61-7.11). In outpatients, severely obese had a log10 (1.89) higher nucleocapsid (N1) genome equivalents (GE)/reaction and log10 (2.62) higher N2 GE/reaction than nonobese (P = 0.03 and P <. 001, respectively). We noted a correlation between body mass index and peak anti-spike protein IgG in inpatients and outpatients (coefficient = 5.48, P <. 001). Conclusions: Obesity is a strong correlate of COVID-19 severity in MHS beneficiaries. These findings offer new pathophysiological insights into the relationship between obesity and COVID-19 severity.",

keywords = "COVID-19 severity, antibody response, obesity, viral load",

author = "Epsi, {Nusrat J.} and Richard, {Stephanie A.} and Laing, {Eric D.} and Fries, {Anthony C.} and Eugene Millar and Simons, {Mark P.} and Caroline English and Colombo, {Christopher J.} and Colombo, {Rhonda E.} and Lindholm, {David A.} and Anuradha Ganesan and Maves, {Ryan C.} and Nikhil Huprikar and Derek Larson and Katrin Mende and Chi, {Sharon W.} and Cristian Madar and Tahaniyat Lalani and Broder, {Christopher C.} and David Tribble and Agan, {Brian K.} and Burgess, {Timothy H.} and Pollett, {Simon D.} and J. Cowden and A. Markelz and K. Mende and T. Merritt and R. Walter and T. Wellington and Darnall, {Carl R.} and S. Bazan and L. Brandon and N. Dimascio-Johnson and K. Gallagher and D. Larson and Jackson, {Henry M.} and P. Blair and D. Clark and S. Chambers and C. Colombo and R. Colombo and C. Conlon and K. Everson and P. Faestel and T. Ferguson and L. Gordon and S. Grogan and S. Lis and C. Mount and D. Musfeldt and R. Sainato and C. Schofield and C. Skinner and M. Stein and M. Switzer and M. Timlin and S. Wood and G. Atwood and R. Carpenter and C. Eickhoff and K. Kronmann and T. Lalani and T. Lee and T. Warkentien and J. Arnold and C. Berjohn and S. Cammarata and S. Husain and N. Kirkland and A. Lane and R. Maves and J. Parrish and G. Utz and S. Chi and E. Filan and K. Fong and T. Horseman and M. Jones and A. Kanis and A. Kayatani and W. Londeree and C. Madar and J. Masel and M. Mcmahon and G. Murphy and V. Ngauy and E. Schoenman and C. Uyehara and {Villacorta Lyew}, R. and C. Broder and T. Burgess and C. Byrne and K. Chung and C. Coles and C. English and P. Hickey and E. Laing and J. Livezey and A. Malloy and T. Oliver and E. Parmelee and S. Pollett and S. Richard and J. Rozman and J. Rusiecki and M. Sanchez and A. Scher and M. Simons and A. Snow and D. Tribble and A. Fries and A. Ganesan and D. Gunasekera and N. Huprikar and M. Oyeneyin and M. Banda and B. Davis and T. Hunter and O. Ikpekpe-Magege and S. Kemp and R. Mody and R. Resendez and M. Wiggins",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].",

year = "2021",

month = nov,

day = "1",

doi = "10.1093/infdis/jiab396",

language = "English",

volume = "224",

pages = "1462--1472",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

number = "9",

}

Epsi, NJ, Richard, SA, Laing, ED, Fries, AC, Millar, E, Simons, MP, English, C, Colombo, CJ , Colombo, RE , Lindholm, DA , Ganesan, A, Maves, RC, Huprikar, N, Larson, D, Mende, K, Chi, SW, Madar, C, Lalani, T, Broder, CC, Tribble, D , Agan, BK , Burgess, TH , Pollett, SD, Cowden, J, Markelz, A, Mende, K, Merritt, T, Walter, R, Wellington, T, Darnall, CR, Bazan, S, Brandon, L, Dimascio-Johnson, N, Gallagher, K, Larson, D, Jackson, HM, Blair, P, Clark, D, Chambers, S, Colombo, C, Colombo, R, Conlon, C, Everson, K, Faestel, P, Ferguson, T, Gordon, L, Grogan, S, Lis, S, Mount, C, Musfeldt, D, Sainato, R, Schofield, C, Skinner, C, Stein, M, Switzer, M, Timlin, M, Wood, S, Atwood, G, Carpenter, R, Eickhoff, C, Kronmann, K, Lalani, T, Lee, T, Warkentien, T, Arnold, J, Berjohn, C, Cammarata, S, Husain, S, Kirkland, N, Lane, A, Maves, R, Parrish, J, Utz, G, Chi, S, Filan, E, Fong, K, Horseman, T, Jones, M, Kanis, A, Kayatani, A, Londeree, W, Madar, C, Masel, J, Mcmahon, M, Murphy, G, Ngauy, V, Schoenman, E, Uyehara, C, Villacorta Lyew, R, Broder, C, Burgess, T, Byrne, C, Chung, K, Coles, C, English, C, Hickey, P, Laing, E, Livezey, J, Malloy, A, Oliver, T, Parmelee, E, Pollett, S, Richard, S, Rozman, J, Rusiecki, J, Sanchez, M, Scher, A, Simons, M, Snow, A, Tribble, D, Fries, A, Ganesan, A, Gunasekera, D, Huprikar, N, Oyeneyin, M, Banda, M, Davis, B, Hunter, T, Ikpekpe-Magege, O, Kemp, S, Mody, R, Resendez, R & Wiggins, M 2021, 'Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries', Journal of Infectious Diseases, vol. 224, no. 9, pp. 1462-1472. https://doi.org/10.1093/infdis/jiab396

TY - JOUR

T1 - Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries

AU - Epsi, Nusrat J.

AU - Richard, Stephanie A.

AU - Laing, Eric D.

AU - Fries, Anthony C.

AU - Millar, Eugene

AU - Simons, Mark P.

AU - English, Caroline

AU - Colombo, Christopher J.

AU - Colombo, Rhonda E.

AU - Lindholm, David A.

AU - Ganesan, Anuradha

AU - Maves, Ryan C.

AU - Huprikar, Nikhil

AU - Larson, Derek

AU - Mende, Katrin

AU - Chi, Sharon W.

AU - Madar, Cristian

AU - Lalani, Tahaniyat

AU - Broder, Christopher C.

AU - Tribble, David

AU - Agan, Brian K.

AU - Burgess, Timothy H.

AU - Pollett, Simon D.

AU - Cowden, J.

AU - Markelz, A.

AU - Mende, K.

AU - Merritt, T.

AU - Walter, R.

AU - Wellington, T.

AU - Darnall, Carl R.

AU - Bazan, S.

AU - Brandon, L.

AU - Dimascio-Johnson, N.

AU - Gallagher, K.

AU - Larson, D.

AU - Jackson, Henry M.

AU - Blair, P.

AU - Clark, D.

AU - Chambers, S.

AU - Colombo, C.

AU - Colombo, R.

AU - Conlon, C.

AU - Everson, K.

AU - Faestel, P.

AU - Ferguson, T.

AU - Gordon, L.

AU - Grogan, S.

AU - Lis, S.

AU - Mount, C.

AU - Musfeldt, D.

AU - Sainato, R.

AU - Schofield, C.

AU - Skinner, C.

AU - Stein, M.

AU - Switzer, M.

AU - Timlin, M.

AU - Wood, S.

AU - Atwood, G.

AU - Carpenter, R.

AU - Eickhoff, C.

AU - Kronmann, K.

AU - Lalani, T.

AU - Lee, T.

AU - Warkentien, T.

AU - Arnold, J.

AU - Berjohn, C.

AU - Cammarata, S.

AU - Husain, S.

AU - Kirkland, N.

AU - Lane, A.

AU - Maves, R.

AU - Parrish, J.

AU - Utz, G.

AU - Chi, S.

AU - Filan, E.

AU - Fong, K.

AU - Horseman, T.

AU - Jones, M.

AU - Kanis, A.

AU - Kayatani, A.

AU - Londeree, W.

AU - Madar, C.

AU - Masel, J.

AU - Mcmahon, M.

AU - Murphy, G.

AU - Ngauy, V.

AU - Schoenman, E.

AU - Uyehara, C.

AU - Villacorta Lyew, R.

AU - Broder, C.

AU - Burgess, T.

AU - Byrne, C.

AU - Chung, K.

AU - Coles, C.

AU - English, C.

AU - Hickey, P.

AU - Laing, E.

AU - Livezey, J.

AU - Malloy, A.

AU - Oliver, T.

AU - Parmelee, E.

AU - Pollett, S.

AU - Richard, S.

AU - Rozman, J.

AU - Rusiecki, J.

AU - Sanchez, M.

AU - Scher, A.

AU - Simons, M.

AU - Snow, A.

AU - Tribble, D.

AU - Fries, A.

AU - Ganesan, A.

AU - Gunasekera, D.

AU - Huprikar, N.

AU - Oyeneyin, M.

AU - Banda, M.

AU - Davis, B.

AU - Hunter, T.

AU - Ikpekpe-Magege, O.

AU - Kemp, S.

AU - Mody, R.

AU - Resendez, R.

AU - Wiggins, M.

N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background: The mechanisms underlying the association between obesity and coronavirus disease 2019 (COVID-19) severity remain unclear. After verifying that obesity was a correlate of severe COVID-19 in US Military Health System (MHS) beneficiaries, we compared immunological and virological phenotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in both obese and nonobese participants. Methods: COVID-19-infected MHS beneficiaries were enrolled, and anthropometric, clinical, and demographic data were collected. We compared the SARS-CoV-2 peak IgG humoral response and reverse-transcription polymerase chain reaction viral load in obese and nonobese patients, stratified by hospitalization, utilizing logistic regression models. Results: Data from 511 COVID-19 patients were analyzed, among whom 24% were obese and 14% severely obese. Obesity was independently associated with hospitalization (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.15-3.18) and need for oxygen therapy (aOR, 3.39; 95% CI, 1.61-7.11). In outpatients, severely obese had a log10 (1.89) higher nucleocapsid (N1) genome equivalents (GE)/reaction and log10 (2.62) higher N2 GE/reaction than nonobese (P = 0.03 and P <. 001, respectively). We noted a correlation between body mass index and peak anti-spike protein IgG in inpatients and outpatients (coefficient = 5.48, P <. 001). Conclusions: Obesity is a strong correlate of COVID-19 severity in MHS beneficiaries. These findings offer new pathophysiological insights into the relationship between obesity and COVID-19 severity.

AB - Background: The mechanisms underlying the association between obesity and coronavirus disease 2019 (COVID-19) severity remain unclear. After verifying that obesity was a correlate of severe COVID-19 in US Military Health System (MHS) beneficiaries, we compared immunological and virological phenotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in both obese and nonobese participants. Methods: COVID-19-infected MHS beneficiaries were enrolled, and anthropometric, clinical, and demographic data were collected. We compared the SARS-CoV-2 peak IgG humoral response and reverse-transcription polymerase chain reaction viral load in obese and nonobese patients, stratified by hospitalization, utilizing logistic regression models. Results: Data from 511 COVID-19 patients were analyzed, among whom 24% were obese and 14% severely obese. Obesity was independently associated with hospitalization (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.15-3.18) and need for oxygen therapy (aOR, 3.39; 95% CI, 1.61-7.11). In outpatients, severely obese had a log10 (1.89) higher nucleocapsid (N1) genome equivalents (GE)/reaction and log10 (2.62) higher N2 GE/reaction than nonobese (P = 0.03 and P <. 001, respectively). We noted a correlation between body mass index and peak anti-spike protein IgG in inpatients and outpatients (coefficient = 5.48, P <. 001). Conclusions: Obesity is a strong correlate of COVID-19 severity in MHS beneficiaries. These findings offer new pathophysiological insights into the relationship between obesity and COVID-19 severity.

KW - COVID-19 severity

KW - antibody response

KW - obesity

KW - viral load

UR - http://www.scopus.com/inward/record.url?scp=85121200244&partnerID=8YFLogxK

U2 - 10.1093/infdis/jiab396

DO - 10.1093/infdis/jiab396

M3 - Article

C2 - 34331541

AN - SCOPUS:85121200244

SN - 0022-1899

VL - 224

SP - 1462

EP - 1472

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 9

ER -

Clinical, Immunological, and Virological SARS-CoV-2 Phenotypes in Obese and Nonobese Military Health System Beneficiaries

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Keywords

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