Understanding the Link Between Obesity and Severe COVID-19 Outcomes

Abbreviations: BMI, body mass index; CAD, coronary artery disease; IQR, interquartile range; MGH, Massachusetts General Hospital; MI, myocardial infarction.
^aObesity was defined as BMI ≤30 and is missing for 111 patients.
^b P values correspond to a 2-sample test of proportions (for categorical variables) or Wilcoxon rank sum tests for (numeric variables) comparing corresponding characteristic of obese vs nonobese patients.
^cComorbidities—CAD, MI, hypertension, dyslipidemia, pulmonary disease history and type 2 diabetes mellitus—were manually extracted based on admission notes, problem lists from past medical history, and history of present illness.
^dScore: 1—not hospitalized, no limitations on activities; 2—not hospitalized, limitation on activities and/or requiring home oxygen; 3—hospitalized, not requiring oxygen, no longer requiring ongoing medical care; 4—hospitalized, not requiring supplemental oxygen, requiring ongoing medical care; 5—hospitalized requiring supplemental oxygen; 6—hospitalized, on noninvasive ventilation or high flow oxygen; 7—hospitalized, on invasive mechanical ventilation or ECMO; 8—death.
^eN = 85 patients died without being mechanically ventilated.

Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IL-6, interleukin-6; MGH, Massachusetts General Hospital; OR, odds ratio; WBC, white blood cell.
^aPeak biomarkers prior to mechanical ventilation, death, or hospital discharge were used. All values were natural log transformed and standardized for analysis.
^bAll models included terms for obesity and were adjusted for age, sex, race/ethnicity, and number of biomarker measurements. Additional adjustments for type 2 diabetes mellitus, hypertension, dyslipidemia, and pulmonary disease are included in sensitivity analysis. The outcome model included both obesity and the biomarker as predictor variables.
^cThe outcome model had a significant CRP by age interaction and therefore the main effect of CRP was not reported here. See Supplement Table S2 for more detailed results of this model fit.

Abbreviations: CRP, C-reactive protein; CUIMC, Columbia University Irving Medical Center; NYP, New York Presbyterian Hospital; OR, odds ratio.
^aPeak CRP level was determined based on all measurements before and after mechanical ventilation. All values were natural log transformed for analysis.
^bAll models included terms for obesity and were adjusted for age, sex, and race/ethnicity. The outcome model included both obesity and the biomarker as predictor variables.
^cOutcome model had significant CRP by age interaction and therefore the main effect of CRP was not reported.
Alternative Strategies Using the MGH Cohort

Authors and Disclosures

Andrea S. Foulkes^1–3,,*, Caitlin Selvaggi¹, Daniel Shinnick^1,3, Heidi Lumish⁴, Eunyoung Kim⁴, Tingyi Cao^1,3, Tanayott Thaweethai^1,2, Jing Qian⁵, Frances Lu¹, Joyce Yan¹, David Cheng^1,2, Wei He⁶, Kevin J. Clerkin⁴, Mahesh V. Madhavan⁴, James B. Meigs², Virginia A. Triant², Steven A. Lubitz², Aakriti Gupta⁴, Ingrid V. Bassett^2,* and Muredach P. Reilly^4,7,*

¹Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA; ²Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; ³Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; ⁴Division of Cardiology, Columbia University, New York, NY 10027, USA; ⁵Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003, USA; ⁶Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America; and ⁷Irving Institute for Clinical and Translational Research, Columbia University, New York, NY 10032, USA

Correspondence
Andrea S. Foulkes, 50 Staniford Street, Boston, MA 02114, USA. Email: afoulkes@mgh.harvard.edu.

Disclosures
The authors have nothing to disclose. The authors declare no competing financial interests.

*These authors contributed equally to this work.