Sex-associated differences between BMI and SARS-CoV-2 antibody titers following the BNT162b2 vaccine

Abstract

Objective: This study investigated the sex-associated difference in the impact of obesity on antibody response to a COVID-19 vaccine.

Methods: This study included 2,435 health care workers who received two doses of the BioNTech, Pfizer (BNT162b2) vaccine and participated in a serological survey, during which they were tested for anti-SARS-CoV-2 spike immunoglobin G (IgG) antibodies and asked for information on height, weight, and vaccination history via a questionnaire. Multivariable linear regression analysis was used to estimate the geometric mean titers (GMT) of antibodies for each sex and BMI category.

Results: The relationship between BMI and anti-SARS-CoV-2 spike IgG titers markedly differed by sex (p value for interaction = 0.04). Spike IgG antibody titers tended to decrease with increasing BMI in men (p value for trend = 0.03); GMT (95% CI) were 6,093 (4,874-7,618) and 4,655 (3,795-5,708) for BMI < 18.5 and ≥30 kg/m² , respectively. In contrast, spike IgG antibody titers did not significantly differ across BMI categories in women (p value for for trend = 0.62); GMT (95% CI) were 6,171 (5,714-6,665) and 5,506 (4,404-6,883) for BMI <18.5 and ≥30, respectively.

Conclusions: Higher BMI was associated with lower titers of SARS-CoV-2 spike antibodies in men, but not in women, suggesting the need for careful monitoring of vaccine efficacy in men with obesity, who are at high risk of severe COVID-19 outcomes.

FIGURE 1

Sex‐specific cubic spline curves in the association between estimated GMT of anti‐SARS‐CoV‐2 spike IgG and BMI. Data are shown as geometric means with 95% CI predicted by linear regression model, including the following variables: a cubic polynomial of BMI (continuous); sex; an interaction term of BMI and sex; age (continuous); days after the second vaccination (continuous); and history of COVID‐19. AU, arbitrary units; GMT, geometric mean titers