1. Why do some #COVID19 cases have severe outcomes while others are mild? Many of the comorbidities associated with poor outcomes are also associated with #obesity. A new paper looks even deeper to find an underlying link ==> chronic inflammation nature.com/articles/s4136…
2. The authors of this paper are familiar with how one size does not fit all with obesity. @DrSharma established the Edmonton Obesity Staging System to help characterize obesity beyond size alone to address physical, mental, and functional health. drsharma.ca/wp-content/upl…
3. The authors identify age-dependent defects in T-cell and B-cell function and the excess production of type 2 cytokines could lead to a deficiency in control of viral replication and more prolonged pro-inflammatory responses, potentially leading to poor outcome
4. An available preprint systematic review of laboratory values associated #COVID19 outcome finds immune markers of poor outcomes include higher innate immune response (neutrophilia, CRP, IL-6) and lower adaptive immune response (lymphopenia, low CD4) medrxiv.org/content/10.110…
5. Another review in @CircAHA proposed the higher severity with obesity and #COVID19 could be attributable to both the immune response and the lower cardiometabolic reserve (lower pulmonary function, higher cardiorenal stress, higher thrombosis potential)
ahajournals.org/doi/pdf/10.116…
ahajournals.org/doi/pdf/10.116…
6. A review from @NatureRevEndo cautioned about limited data while also suggesting multiple paths connecting obesity and poor outcome. The authors concluded, "Measurement of anthropometric characteristics and metabolic parameters is crucial" nature.com/articles/s4157…
7. A preprint describing >50K #COVID_19 cases from Mexico reported obesity was associated with a higher risk for ICU admission and intubation and also that obesity mediated about half of the risk associated with diabetes. medrxiv.org/content/10.110… #epitwitter #statstwitter
8. The idea that we need more data and that it is complicated were also described by @DrSharma et al. They reanalyzed data from a recent study of immune factors in obesity and found no pairwise association between IL-6 and BMI or CRP and BMI
9. One challenge is this dataset only includes individuals with stage 2 or 3 obesity, so it could not identify immune associations w/ BMI when compared to those with a healthy weight, highlighting some of the complexity with how inflammation in obesity is not about weight alone
10. In the end, these models and observations can be used to alert clinicians to be mindful of a patient's weight and associated comorbidities while also considering additional health indicators more specific to COVID19. Obesity is a factor, but it is not the only factor.
11. As @ConscienHealth reminds their readers "Clinicians should pay close attention to patients with obesity, who should be carefully managed with prompt and aggressive treatment." conscienhealth.org/2020/05/adding…
