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Letters | October 28, 2009

Tuberculosis and the Inflammatory Processes of Obesity in Human Evolution

Giamila Fantuzzi, PhD

JAMA. 2009;302(16):1754-1755. doi:10.1001/jama.2009.1514.

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To the Editor: In his Commentary, Dr Roth¹ proposed that the proinflammatory state of obesity might have provided an evolutionary advantage during tuberculosis pandemics. Although tuberculosis is likely to have played an important role in shaping human evolution, I believe the notion that obesity-associated inflammation favors protection or survival from tuberculosis is not well supported.

Roth's statement that the “immune systems [of obese persons] . . . are especially robust and more easily triggered” is not supported by current data, which, although controversial, point toward a state of immunosuppression rather than immune enhancement in obesity.² Furthermore, although levels of proinflammatory cytokines are increased in obesity, this does not necessarily result in increased defenses against tuberculosis for 2 reasons.

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October 28, 2009

Tuberculosis and the Inflammatory Processes of Obesity in Human Evolution—Reply

Jesse Roth, MD

JAMA. 2009;302(16):1754-1755. doi:10.1001/jama.2009.1515.

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Fantuzzi G. Tuberculosis and the Inflammatory Processes of Obesity in Human Evolution. JAMA. 2009;302(16):1754-1755. doi:10.1001/jama.2009.1514.

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