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 journalArticlepeer-review

13 Scopus citations


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 languageEnglish
Pages (from-to)1462-1472
Number of pages11
JournalJournal of Infectious Diseases
Issue number9
StatePublished - 1 Nov 2021


  • COVID-19 severity
  • antibody response
  • obesity
  • viral load


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