Abstract
Obesity is a key correlate of severe SARS-CoV-2 outcomes while the role of obesity on risk of SARS-CoV-2 infection, symptom phenotype, and immune response remain poorly defined. We examined data from a prospective SARS-CoV-2 cohort study to address these questions. Serostatus, body mass index, demographics, comorbidities, and prior COVID-19 compatible symptoms were assessed at baseline and serostatus and symptoms monthly thereafter. SARS-CoV-2 immunoassays included an IgG ELISA targeting the spike RBD, multiarray Luminex targeting 20 viral antigens, pseudovirus neutralization, and T cell ELISPOT assays. Our results from a large prospective SARS-CoV-2 cohort study indicate symptom phenotype is strongly influenced by obesity among younger but not older age groups; we did not identify evidence to suggest obese individuals are at higher risk of SARS-CoV-2 infection; and remarkably homogenous immune activity across BMI categories suggests immune protection across these groups may be similar.
Highlights
Obesity is a key risk factor for severe disease and death from novel coronavirus disease2019 (COVID-19) [1,2], the disease caused by severe acute respiratory syndrome coronavirus2 (SARS-CoV-2)
body mass index (BMI), unbiased to serostatus at study entry to investigate the association between BMI, SARSSARS-CoV-2 serostatus, symptom phenotype, and functional and non-functional immune
We identify an intriguing influence of age on obesity and symptom phenotype, with a compelling association below 40 years of age but near complete absence of effect in older adults
Summary
Obesity is a key risk factor for severe disease and death from novel coronavirus disease2019 (COVID-19) [1,2], the disease caused by severe acute respiratory syndrome coronavirus2 (SARS-CoV-2). After adjusting for age and obesityrelated comorbidities such as diabetes, hypertension, and coronary heart disease, obesity remains a strong independent predictor of excess morbidity and mortality [1,4,5]. These findings are not entirely unexpected [6]. In addition to the relationship between obesity and clinical outcomes, emerging evidence suggests a link between higher body mass index (BMI) and higher incidence rates of COVID-19 or SARS-CoV-2 infection [4,9,10], suggesting increased
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