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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.

First, with the exception of IL-6, increased levels of proinflammatory cytokines in obesity are restricted to the local microenvironment of inflamed adipose tissue and steatotic organs, rather than being a systemic response.³ Since defenses against tuberculosis . . . [Full Text of this Article]

Giamila Fantuzzi, PhD
giamila@uic.edu
Department of Kinesiology and Nutrition
University of Illinois at Chicago

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Evolutionary Speculation About Tuberculosis and the Metabolic and Inflammatory Processes of Obesity
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