{"doi":"10.1093/infdis/jiab396","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.","journal":"The Journal of Infectious Diseases","year":2021,"id":187402,"datarank":0.44166584687496613,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.0,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9463,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":536243,"name":"Stephanie A Richard","orcid":"0000-0002-0530-384X","position":1,"is_corresponding":false},{"id":533696,"name":"Eric D. Laing","orcid":"0000-0002-5574-2584","position":2,"is_corresponding":false},{"id":696869,"name":"Anthony C Fries","orcid":"0000-0001-7556-1353","position":3,"is_corresponding":false},{"id":272088,"name":"Eugene V. Millar","orcid":"0000-0002-2019-6480","position":4,"is_corresponding":false},{"id":272091,"name":"Mark P. Simons","orcid":"0000-0002-4316-9709","position":5,"is_corresponding":false},{"id":558489,"name":"Caroline English","orcid":null,"position":6,"is_corresponding":false},{"id":670630,"name":"Christopher Colombo","orcid":"0000-0001-5499-3368","position":7,"is_corresponding":false},{"id":514704,"name":"Rhonda E Colombo","orcid":"0000-0003-0154-1928","position":8,"is_corresponding":false},{"id":670628,"name":"David A Lindholm","orcid":"0000-0001-5428-7404","position":9,"is_corresponding":false},{"id":588939,"name":"Anuradha Ganesan","orcid":"0000-0001-6214-9677","position":10,"is_corresponding":false},{"id":404704,"name":"Ryan C. Maves","orcid":"0000-0001-6234-6160","position":11,"is_corresponding":false},{"id":671512,"name":"Nikhil Huprikar","orcid":null,"position":12,"is_corresponding":false},{"id":670634,"name":"Derek Larson","orcid":"0000-0002-6147-7182","position":13,"is_corresponding":false},{"id":559650,"name":"Katrin Mende","orcid":null,"position":14,"is_corresponding":false},{"id":690027,"name":"Sharon W Chi","orcid":null,"position":15,"is_corresponding":false},{"id":391920,"name":"Cristian Madar","orcid":null,"position":16,"is_corresponding":false},{"id":426930,"name":"Tahaniyat Lalani","orcid":"0000-0002-9361-2991","position":17,"is_corresponding":false},{"id":533697,"name":"Christopher C. Broder","orcid":"0000-0001-5382-0510","position":18,"is_corresponding":false},{"id":426929,"name":"David R. Tribble","orcid":"0000-0003-3077-9505","position":19,"is_corresponding":false},{"id":404703,"name":"Brian K. Agan","orcid":"0000-0002-5114-1669","position":20,"is_corresponding":false},{"id":103453,"name":"Timothy Burgess","orcid":"0000-0003-1247-8370","position":21,"is_corresponding":false},{"id":650258,"name":"Simon Pollett","orcid":"0000-0003-2643-4213","position":22,"is_corresponding":false},{"id":671513,"name":"EPICC COVID-19 Cohort Study Group","orcid":null,"position":23,"is_corresponding":false},{"id":689163,"name":"John D. Cowden","orcid":"0000-0002-2288-5140","position":24,"is_corresponding":false},{"id":514706,"name":"Ana E Markelz","orcid":"0009-0006-4473-3902","position":26,"is_corresponding":false},{"id":671517,"name":"T Merritt","orcid":null,"position":28,"is_corresponding":false},{"id":696870,"name":"Robert Walter","orcid":"0000-0002-0376-2073","position":29,"is_corresponding":false},{"id":696871,"name":"Trevor Wellington","orcid":"0000-0001-9797-3092","position":30,"is_corresponding":false},{"id":747580,"name":"Carl R Darnall","orcid":null,"position":31,"is_corresponding":false},{"id":671521,"name":"S Bazan","orcid":null,"position":32,"is_corresponding":false},{"id":670632,"name":"Lisa Brandon","orcid":"0000-0001-5833-1986","position":33,"is_corresponding":false},{"id":671523,"name":"N Dimascio-Johnson","orcid":null,"position":34,"is_corresponding":false},{"id":626228,"name":"Kathleen Gallagher","orcid":"0000-0002-6952-7885","position":35,"is_corresponding":false},{"id":747581,"name":"Henry M. Jackson","orcid":null,"position":37,"is_corresponding":false},{"id":391331,"name":"Paul W. Blair","orcid":"0000-0002-3817-5987","position":38,"is_corresponding":false},{"id":249101,"name":"Daniel E. Clark","orcid":"0000-0002-8054-0642","position":39,"is_corresponding":false},{"id":670635,"name":"Susan Chambers","orcid":"0000-0002-8931-3294","position":40,"is_corresponding":false},{"id":555607,"name":"Christopher P. Conlon","orcid":"0000-0002-3531-2464","position":43,"is_corresponding":false},{"id":747582,"name":"Katie Everson","orcid":null,"position":44,"is_corresponding":false},{"id":671527,"name":"P Faestel","orcid":null,"position":45,"is_corresponding":false},{"id":671528,"name":"T Ferguson","orcid":null,"position":46,"is_corresponding":false},{"id":670636,"name":"Lisi Gordon","orcid":"0000-0002-4986-1501","position":47,"is_corresponding":false},{"id":671529,"name":"S Grogan","orcid":null,"position":48,"is_corresponding":false},{"id":690041,"name":"S. Bertrán de Lis","orcid":null,"position":49,"is_corresponding":false},{"id":689170,"name":"C Mount","orcid":"0000-0001-5180-2458","position":50,"is_corresponding":false},{"id":671532,"name":"D Musfeldt","orcid":null,"position":51,"is_corresponding":false},{"id":689171,"name":"Rebecca Sainato","orcid":"0000-0002-3798-9989","position":52,"is_corresponding":false},{"id":671535,"name":"C Schofield","orcid":null,"position":53,"is_corresponding":false},{"id":671536,"name":"Clare Skinner","orcid":null,"position":54,"is_corresponding":false},{"id":670637,"name":"Michael Ashley Stein","orcid":"0000-0001-9564-7461","position":55,"is_corresponding":false},{"id":690045,"name":"Mary E. Switzer","orcid":null,"position":56,"is_corresponding":false},{"id":671538,"name":"M Timlin","orcid":null,"position":57,"is_corresponding":false},{"id":697457,"name":"S Wood","orcid":null,"position":58,"is_corresponding":false},{"id":671540,"name":"Gerald F. Atwood","orcid":null,"position":59,"is_corresponding":false},{"id":59340,"name":"Rebecca M. Carpenter","orcid":null,"position":60,"is_corresponding":false},{"id":670639,"name":"C Eickhoff","orcid":"0000-0002-3529-0613","position":61,"is_corresponding":false},{"id":514705,"name":"Karl Kronmann","orcid":"0000-0003-1783-7061","position":62,"is_corresponding":false},{"id":697458,"name":"T Lee","orcid":null,"position":64,"is_corresponding":false},{"id":690049,"name":"Tyler Warkentien","orcid":null,"position":65,"is_corresponding":false},{"id":670640,"name":"John Arnold","orcid":"0000-0002-8623-8057","position":66,"is_corresponding":false},{"id":670641,"name":"Catherine M Berjohn","orcid":"0000-0001-5655-8183","position":67,"is_corresponding":false},{"id":689176,"name":"S. Cammarata","orcid":"0000-0002-9000-0973","position":68,"is_corresponding":false},{"id":670642,"name":"Sufia Husain","orcid":"0000-0003-3486-9356","position":69,"is_corresponding":false},{"id":671545,"name":"N Kirkland","orcid":null,"position":70,"is_corresponding":false},{"id":670643,"name":"Aoife Lane","orcid":"0000-0001-9991-554X","position":71,"is_corresponding":false},{"id":670644,"name":"Scott Parrish","orcid":"0000-0002-5135-922X","position":73,"is_corresponding":false},{"id":670645,"name":"Gregory Utz","orcid":"0000-0003-4575-4060","position":74,"is_corresponding":false},{"id":670646,"name":"Serena Chi","orcid":"0009-0001-3623-3370","position":75,"is_corresponding":false},{"id":671546,"name":"E Filan","orcid":null,"position":76,"is_corresponding":false},{"id":671547,"name":"K Fong","orcid":null,"position":77,"is_corresponding":false},{"id":671548,"name":"Timothy S. Horseman","orcid":null,"position":78,"is_corresponding":false},{"id":746928,"name":"Matthew Jones","orcid":"0000-0002-4824-9724","position":79,"is_corresponding":false},{"id":671549,"name":"A Kanis","orcid":null,"position":80,"is_corresponding":false},{"id":671550,"name":"A Kayatani","orcid":null,"position":81,"is_corresponding":false},{"id":670647,"name":"William Londeree","orcid":"0000-0001-7395-9800","position":82,"is_corresponding":false},{"id":328805,"name":"Joanna Masel","orcid":"0000-0002-7398-2127","position":84,"is_corresponding":false},{"id":746929,"name":"Maureen McMahon","orcid":"0000-0002-2910-7640","position":85,"is_corresponding":false},{"id":671552,"name":"G F Murphy","orcid":null,"position":86,"is_corresponding":false},{"id":671553,"name":"Viseth Ngauy","orcid":null,"position":87,"is_corresponding":false},{"id":697459,"name":"E Schoenman","orcid":null,"position":88,"is_corresponding":false},{"id":697460,"name":"Catherine Uyehara","orcid":null,"position":89,"is_corresponding":false},{"id":697461,"name":"R Villacorta Lyew","orcid":null,"position":90,"is_corresponding":false},{"id":420631,"name":"Celia Byrne","orcid":"0000-0001-8289-4252","position":94,"is_corresponding":false},{"id":747583,"name":"K Chung","orcid":null,"position":95,"is_corresponding":false},{"id":747584,"name":"C Coles","orcid":null,"position":96,"is_corresponding":false},{"id":746930,"name":"C English","orcid":"0000-0002-4426-5786","position":97,"is_corresponding":false},{"id":453670,"name":"Patrick W. Hickey","orcid":"0000-0003-4500-4403","position":98,"is_corresponding":false},{"id":557984,"name":"Nusrat J Epsi","orcid":"0000-0001-5363-075X","position":0,"is_corresponding":true}],"reference_count":49,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:48:55.420619Z","pmid":"34331541","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}