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Disclosures: The authors report no relevant financial disclosures.
June 15, 2021
2 min read

Smoking, central obesity, hypertension may lower antibody response to COVID-19 vaccine

Disclosures: The authors report no relevant financial disclosures.
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Compared with healthy adults, those who smoke or have central obesity or hypertension may produce fewer antibodies following Pfizer-BioNTech COVID-19 vaccination, according to a study published in Diabetes/Metabolism Research and Reviews.

Mikiko Watanabe

“Patients with central obesity, hypertension and smoking habit respond in a different way to Pfizer-BioNTech COVID-19 vaccine, where antibody titers are significantly lower compared to healthy subjects,” Mikiko Watanabe, MD, PhD, a specialist in endocrinology and metabolism at Sapienza University in Rome, told Healio. “Although lower antibody titers do not necessarily mean that protection against COVID-19 is hampered, it is necessary to plan follow-up studies to investigate this aspect, also considering the possibility that these patients might require earlier vaccine boosters over time.”

Central obesity, smoking, hypertension and dislipidemia were associated with fewer COVID-19 antibodies in people receiving the Pfizer-BioNTech COVID-19 vaccine. Data were derived from Watanabe M, et al. Diabetes Metab Res Rev. 2021;doi:10.1002/dmrr.3465.

Watanabe and colleagues conducted an observational study of 86 health care workers (mean age, 29 years; 39.5% men) at Policlinico Umberto I in Rome who received the Pfizer-BioNTech COVID-19 vaccine in January and February. All participants were older than 18 years, had stable body weight during the previous 3 months, had no previous COVID-19 infection, did not have immunodepression or use any medications known to affect the immune system and were not pregnant. Two doses of the vaccine were administered 21 days apart. Participants had blood drawn before the first dose and again 1 to 4 weeks after the second dose.

No major adverse events requiring hospitalization were reported after vaccination. Waist circumference, waist-to-hip ratio, BMI and body fat were not associated with more adverse events.

After the second dose, larger waist circumference was associated with fewer antibody titers (P = .004). Adults with hypertension had fewer antibodies compared with those without hypertension (650 U/mL vs. 1,911 U/mL; P = .001). Participants who habitually smoked had fewer antibodies vs. nonsmokers (1,099 U/mL vs. 1,921 U/mL; P = .007). Those with dyslipidemia also had fewer antibodies compared with those who had a normal lipid profile and were not on lipid-lowering drugs (534 U/mL vs. 1,872 U/mL; P = .005).

“We did not expect smoking to be a risk factor for lower antibody titers, as there is virtually zero available evidence suggesting that smoking is associated with reduced response to vaccines,” Watanabe said. “Conversely, we expected patients with central obesity being less protected similar to what observed by our team in a previous study regarding the association between central obesity and need of intubation in patients with COVID-19.”

In a multivariate model adjusting for sex, age and BMI, waist circumference, time since last vaccination, hypertension and smoking were significantly associated with fewer COVID-19 antibodies after vaccination.

Watanabe said more studies with a larger sample size and participants with more diverse BMI are needed, and cell-mediated immunity must be examined to confirm the study’s findings.

“Should these preliminary data be confirmed, identifying ways to boost the immune system so that these patients respond better to the vaccine is definitely advisable,” Watanabe said.

For more information:

Mikiko Watanabe, MD, PhD, can be reached at