{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:25:57Z","timestamp":1784042757524,"version":"3.55.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004916","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["Edital N\u00ba 038\/2022 - PDPG\/CAPES\/FAPEAM - Coordenador\/Aux\u00edlio Financeiro."],"award-info":[{"award-number":["Edital N\u00ba 038\/2022 - PDPG\/CAPES\/FAPEAM - Coordenador\/Aux\u00edlio Financeiro."]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004916","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["(PR\u00d3-ESTADO-Project 01.02.016301.00649\/2021 - N\u00ba 002\/2008, N\u00ba 007\/2018 and N\u00ba 005\/2019)"],"award-info":[{"award-number":["(PR\u00d3-ESTADO-Project 01.02.016301.00649\/2021 - N\u00ba 002\/2008, N\u00ba 007\/2018 and N\u00ba 005\/2019)"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]},{"name":"XP investimentos","award":["57th work plan of the Unidos Contra a COVID-19 program)."],"award-info":[{"award-number":["57th work plan of the Unidos Contra a COVID-19 program)."]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity significantly increases the risk of severe COVID-19 and mortality. Concerns have emerged regarding the efficacy of COVID-19 vaccines in obese populations due to potential alterations in immune responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between March 2021 and March 2022, 5,071 participants with comorbidities received CoronaVac administered in two doses 28 days (\u00b1\u20097 days) apart and a single subsequent booster dose of ChAdOx1 with an interval of 180 days (\u00b1\u200930 days). Body composition was analyzed using a tetrapolar bioimpedance measurement scale. Anti-RBD IgG was dosed at baseline (D0) and on days 28, 90, 180, 270, and 360.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1,181 participants with obesity (body fat percentage\u2009&gt;\u2009P50), non-immune at baseline, showed significantly lower antibody titers (IgG anti-RBD) until D180 than 576 non-obese individuals. However, there was no difference in the frequency of COVID-19, COVID-19-related hospitalization or death. After the booster, no significant changes were seen. Patients with very excessive body fat (body fat percentage\u2009&gt;\u2009P90) showed even slower seroconversion, with increased COVID-19 after D180. Similar results were observed using the routine body mass index (BMI); however, waning immunity (serology) was observed in individuals classified as having very excessive body fat only when bioimpedance was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Participants with obesity demonstrated weaker and slower seroconversion, which worsened in higher body fat mass. Bioimpedance revealed quicker waning immunity, emphasizing its importance over BMI in assessing vaccine response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-12295-2","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T07:46:29Z","timestamp":1765266389000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of obesity on COVID-19 CoronaVac and ChAdOx1-S vaccine efficacy"],"prefix":"10.1186","volume":"26","author":[{"given":"M\u00e1rcio Valle","family":"Cortez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joabi","family":"Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fab\u00edola Mendon\u00e7a da Silva","family":"Chui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Gabriela Almeida","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talita","family":"Bastos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia Maria","family":"Lemos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Honorato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeca Linhares","family":"Abreu-Netto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salete","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Vilhena","family":"Silva-Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Sachett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Maia","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Santos","family":"Mouta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jady Shayenne Mota","family":"Cordeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djane Clarys","family":"Ba\u00eda-da-Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Diego","family":"Brito-Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina Pinheiro","family":"Pessoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuelton","family":"Monteiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Naveca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanderson","family":"Sampaio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Almeida-Val","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisely","family":"Melo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paula","family":"Mour\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Lacerda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"12295_CR1","unstructured":"WHO(world health organization). Obesity and overweight. 2023. Available: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"12295_CR2","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/S0140-6736(20)30752-2","volume":"396","author":"CJL Murray","year":"2020","unstructured":"Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990\u20132019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396:1223\u201349. https:\/\/doi.org\/10.1016\/S0140-6736(20)30752-2.","journal-title":"Lancet"},{"key":"12295_CR3","doi-asserted-by":"publisher","unstructured":"Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, et al. Individuals with obesity and COVID-19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128. https:\/\/doi.org\/10.1111\/obr.13128.","DOI":"10.1111\/obr.13128"},{"key":"12295_CR4","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1111\/J.1467-789X.2011.00879.X","volume":"12","author":"S Czernichow","year":"2011","unstructured":"Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist\u2013hip ratio: which is the better discriminator of cardiovascular disease mortality risk? evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev. 2011;12:680\u20137. https:\/\/doi.org\/10.1111\/J.1467-789X.2011.00879.X.","journal-title":"Obes Rev"},{"key":"12295_CR5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/EJCN.2009.68;KWRD","volume":"64","author":"R Huxley","year":"2010","unstructured":"Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular riska review of the literature. Eur J Clin Nutr. 2010;64:16\u201322. https:\/\/doi.org\/10.1038\/EJCN.2009.68;KWRD.","journal-title":"Eur J Clin Nutr"},{"key":"12295_CR6","doi-asserted-by":"publisher","first-page":"1544","DOI":"10.1016\/S0140-6736(20)31024-2","volume":"395","author":"DA Kass","year":"2020","unstructured":"Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;395:1544\u20135. https:\/\/doi.org\/10.1016\/S0140-6736(20)31024-2.","journal-title":"Lancet"},{"key":"12295_CR7","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1002\/oby.22831","volume":"28","author":"A Simonnet","year":"2020","unstructured":"Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome Coronavirus-2 (SARS\u2010CoV\u20102) requiring invasive mechanical ventilation. Obesity. 2020;28:1195\u20139. https:\/\/doi.org\/10.1002\/oby.22831.","journal-title":"Obesity"},{"key":"12295_CR8","doi-asserted-by":"publisher","unstructured":"Petrilli CM, Jones SA, Yang J, Rajagopalan H, O\u2019Donnell L, Chernyak Y et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020; m1966. https:\/\/doi.org\/10.1136\/bmj.m1966.","DOI":"10.1136\/bmj.m1966"},{"key":"12295_CR9","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1161\/CIRCULATIONAHA.120.047659","volume":"142","author":"N Sattar","year":"2020","unstructured":"Sattar N, McInnes IB, McMurray JJV. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020;142:4\u20136. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.120.047659.","journal-title":"Circulation"},{"key":"12295_CR10","doi-asserted-by":"publisher","unstructured":"Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, et al. Association of obesity with COVID-19 severity and mortality: an updated systemic review, meta-analysis, and meta-regression. Front Endocrinol (Lausanne). 2022;13. https:\/\/doi.org\/10.3389\/fendo.2022.780872.","DOI":"10.3389\/fendo.2022.780872"},{"key":"12295_CR11","doi-asserted-by":"publisher","first-page":"773","DOI":"10.7326\/M20-3742","volume":"173","author":"SY Tartof","year":"2020","unstructured":"Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med. 2020;173:773\u201381. https:\/\/doi.org\/10.7326\/M20-3742.","journal-title":"Ann Intern Med"},{"key":"12295_CR12","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3892\/mmr.2020.11127","volume":"22","author":"D Petrakis","year":"2020","unstructured":"Petrakis D, Margin\u0103 D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity - a risk factor for increased COVID-19 prevalence, severity and lethality (Review). Mol Med Rep. 2020;22:9\u201319. https:\/\/doi.org\/10.3892\/mmr.2020.11127.","journal-title":"Mol Med Rep"},{"key":"12295_CR13","doi-asserted-by":"publisher","unstructured":"Tadayon Najafabadi B, Rayner DG, Shokraee K, Shokraie K, Panahi P, Rastgou P et al. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database of Syst Rev. 2023;2023. https:\/\/doi.org\/10.1002\/14651858.CD015201.","DOI":"10.1002\/14651858.CD015201"},{"key":"12295_CR14","doi-asserted-by":"publisher","unstructured":"Westheim AJF, Bitorina AV, Theys J, Shiri-Sverdlov R. COVID\u201019 infection, progression, and vaccination: focus on obesity and related metabolic disturbances. Obes Rev. 2021;22. https:\/\/doi.org\/10.1111\/obr.13313.","DOI":"10.1111\/obr.13313"},{"key":"12295_CR15","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1016\/S1473-3099(22)00320-6","volume":"22","author":"OJ Watson","year":"2022","unstructured":"Watson OJ, Barnsley G, Toor J, Hogan AB, Winskill P, Ghani AC. Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect Dis. 2022;22:1293\u2013302. https:\/\/doi.org\/10.1016\/S1473-3099(22)00320-6.","journal-title":"Lancet Infect Dis"},{"key":"12295_CR16","doi-asserted-by":"publisher","unstructured":"Onyango TB, Zhou F, Bredholt G, Brokstad KA, Lartey S, Mohn KG-I, et al. SARS-CoV-2 specific immune responses in overweight and obese COVID-19 patients. Front Immunol. 2023;14. https:\/\/doi.org\/10.3389\/fimmu.2023.1287388.","DOI":"10.3389\/fimmu.2023.1287388"},{"key":"12295_CR17","doi-asserted-by":"publisher","first-page":"996","DOI":"10.3390\/VACCINES11050996\/S1","volume":"11","author":"C Fu","year":"2023","unstructured":"Fu C, Lin N, Zhu J, Ye Q. Association between Overweight\/Obesity and the safety and efficacy of COVID-19 vaccination: a systematic review. Vaccines (Basel). 2023;11:996. https:\/\/doi.org\/10.3390\/VACCINES11050996\/S1.","journal-title":"Vaccines (Basel)"},{"key":"12295_CR18","doi-asserted-by":"publisher","first-page":"974","DOI":"10.12965\/jer.1836400.200","volume":"14","author":"BHM Branco","year":"2018","unstructured":"Branco BHM, Bernuci MP, Marques DC, Carvalho IZ, Barrero CAL, de Oliveira FM, et al. Proposal of a normative table for body fat percentages of Brazilian young adults through bioimpedanciometry. J Exerc Rehabil. 2018;14:974\u20139. https:\/\/doi.org\/10.12965\/jer.1836400.200.","journal-title":"J Exerc Rehabil"},{"key":"12295_CR19","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1126\/science.abd7728","volume":"370","author":"A Wajnberg","year":"2020","unstructured":"Wajnberg A, Amanat F, Firpo A, Altman DR, Bailey MJ, Mansour M, et al. Robust neutralizing antibodies to SARS-CoV-2 infection persist for months. Sci (1979). 2020;370:1227\u201330. https:\/\/doi.org\/10.1126\/science.abd7728.","journal-title":"Sci (1979)"},{"key":"12295_CR20","doi-asserted-by":"publisher","unstructured":"Hou H, Wang T, Zhang B, Luo Y, Mao L, Wang F, et al. Detection of IgM and IgG antibodies in patients with coronavirus disease 2019. Clin Transl Immunol. 2020;9. https:\/\/doi.org\/10.1002\/CTI2.1136.","DOI":"10.1002\/CTI2.1136"},{"key":"12295_CR21","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41591-023-02343-2","volume":"29","author":"AA van der Klaauw","year":"2023","unstructured":"van der Klaauw AA, Horner EC, Pereyra-Gerber P, Agrawal U, Foster WS, Spencer S, et al. Accelerated waning of the humoral response to COVID-19 vaccines in obesity. Nat Med 2023. 2023;29:5. https:\/\/doi.org\/10.1038\/s41591-023-02343-2.","journal-title":"Nat Med 2023"},{"key":"12295_CR22","doi-asserted-by":"publisher","unstructured":"Faizo AA, Qashqari FS, El-Kafrawy SA, Barasheed O, Almashjary MN, Alfelali M, et al. A potential association between obesity and reduced effectiveness of COVID-19 vaccine-induced neutralizing humoral immunity. J Med Virol. 2023;95. https:\/\/doi.org\/10.1002\/JMV.28130.","DOI":"10.1002\/JMV.28130"},{"key":"12295_CR23","doi-asserted-by":"publisher","first-page":"4046","DOI":"10.1016\/J.VACCINE.2022.05.059","volume":"40","author":"G Soegiarto","year":"2022","unstructured":"Soegiarto G, Wulandari L, Purnomosari D, Dhia Fahmita K, Ikhwan Gautama H, Tri Hadmoko S, et al. Hypertension is associated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2. Vaccine. 2022;40:4046\u201356. https:\/\/doi.org\/10.1016\/J.VACCINE.2022.05.059.","journal-title":"Vaccine"},{"key":"12295_CR24","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/s41581-022-00617-5","volume":"18","author":"N Babel","year":"2022","unstructured":"Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Reviews Nephrol 2022. 2022;18:11. https:\/\/doi.org\/10.1038\/s41581-022-00617-5.","journal-title":"Nat Reviews Nephrol 2022"},{"key":"12295_CR25","doi-asserted-by":"publisher","first-page":"e28434","DOI":"10.1002\/jmv.28434","volume":"95","author":"H Li","year":"2023","unstructured":"Li H, Cai D, Jiang D, Li X, Liao X, Liu D, et al. Risk of waning humoral responses after inactivated or subunit Recombinant SARS-CoV-2 vaccination in patients with chronic diseases: findings from a prospective observational study in China. J Med Virol. 2023;95:e28434. 10.1002. \/JMV.28434;CTYPE:STRING:JOURNAL.","journal-title":"J Med Virol"},{"key":"12295_CR26","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/J.DSX.2020.12.035","volume":"15","author":"R Pal","year":"2021","unstructured":"Pal R, Sachdeva N, Mukherjee S, Suri V, Zohmangaihi D, Ram S, et al. Impaired anti-SARS-CoV-2 antibody response in non-severe COVID-19 patients with diabetes mellitus: A preliminary report. Diabetes Metabolic Syndrome: Clin Res Reviews. 2021;15:193\u20136. https:\/\/doi.org\/10.1016\/J.DSX.2020.12.035.","journal-title":"Diabetes Metabolic Syndrome: Clin Res Reviews"},{"key":"12295_CR27","doi-asserted-by":"publisher","unstructured":"Honce R, Schultz-Cherry S. Impact of obesity on influenza a virus pathogenesis, immune response, and evolution. Front Immunol. 2019;10. https:\/\/doi.org\/10.3389\/fimmu.2019.01071.","DOI":"10.3389\/fimmu.2019.01071"},{"key":"12295_CR28","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1002\/oby.21383","volume":"24","author":"D Frasca","year":"2016","unstructured":"Frasca D, Ferracci F, Diaz A, Romero M, Lechner S, Blomberg BB. Obesity decreases\u2009<\u2009scp\u2009>\u2009B\u2009cell responses in young and elderly individuals. Obesity. 2016;24:615\u201325. https:\/\/doi.org\/10.1002\/oby.21383.","journal-title":"Obesity"},{"key":"12295_CR29","doi-asserted-by":"publisher","unstructured":"Guo M, Shang S, Li M, Cai G, Li P, Chen X et al. Understanding autoimmune response after SARS-CoV-2 infection and the pathogenesis\/mechanisms of long COVID-19. Medical review (2021). 2024;4: 367\u2013383. https:\/\/doi.org\/10.1515\/MR-2024-0013.","DOI":"10.1515\/MR-2024-0013"},{"key":"12295_CR30","doi-asserted-by":"publisher","unstructured":"Ewing AG, Salamon S, Pretorius E, Joffe D, Fox G, Bilodeau S et al. Review of organ damage from COVID-19 and long COVID-19: a disease with a spectrum of pathology. Medical review (2021). 2024;5: 66\u201375. https:\/\/doi.org\/10.1515\/MR-2024-0030.","DOI":"10.1515\/MR-2024-0030"},{"key":"12295_CR31","doi-asserted-by":"publisher","first-page":"372","DOI":"10.2478\/JTIM-2023-0122","volume":"11","author":"J Xie","year":"2023","unstructured":"Xie J, Ye F, Deng X, Tang Y, Liang JY, Huang X, et al. Circular RNA: a promising new star of vaccine. J Transl Int Med. 2023;11:372\u201381. https:\/\/doi.org\/10.2478\/JTIM-2023-0122.","journal-title":"J Transl Int Med"},{"key":"12295_CR32","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/J.VACCINE.2021.11.008","volume":"40","author":"S Chhabria","year":"2022","unstructured":"Chhabria S, Stanford FC. A long shot: the importance of needle length in vaccinating patients with obesity against COVID-19. Vaccine. 2022;40:9\u201310. https:\/\/doi.org\/10.1016\/J.VACCINE.2021.11.008.","journal-title":"Vaccine"},{"key":"12295_CR33","doi-asserted-by":"publisher","first-page":"2690","DOI":"10.1016\/J.VACCINE.2023.03.018","volume":"41","author":"M Doppen","year":"2023","unstructured":"Doppen M, Kearns C, Weatherall M, Kearns N, McIntyre P, Hills T, et al. When should a longer needle be used for intramuscular injection in obese patients? a combined analysis of new Zealand data. Vaccine. 2023;41:2690\u20135. https:\/\/doi.org\/10.1016\/J.VACCINE.2023.03.018.","journal-title":"Vaccine"},{"key":"12295_CR34","doi-asserted-by":"publisher","first-page":"e0287128","DOI":"10.1371\/journal.pone.0287128","volume":"18","author":"M Golec","year":"2023","unstructured":"Golec M, Zembala-John J, Fronczek M, Konka A, Bochenek A, Wystyrk K, et al. Relationship between anthropometric and body composition parameters and anti-SARS-CoV-2 specific IgG titers in females vaccinated against COVID-19 according to the heterologous vaccination course: a cohort study. Ito E, editor. PLoS ONE. 2023;18:e0287128. https:\/\/doi.org\/10.1371\/journal.pone.0287128.","journal-title":"PLoS ONE"},{"key":"12295_CR35","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.clnesp.2022.07.003","volume":"51","author":"E Graziano","year":"2022","unstructured":"Graziano E, Peghin M, De Martino M, De Carlo C, Da Porto A, Bulfone L, et al. The impact of body composition on mortality of COVID-19 hospitalized patients: a prospective study on abdominal fat, obesity paradox and sarcopenia. Clin Nutr ESPEN. 2022;51:437\u201344. https:\/\/doi.org\/10.1016\/j.clnesp.2022.07.003.","journal-title":"Clin Nutr ESPEN"},{"key":"12295_CR36","doi-asserted-by":"publisher","unstructured":"Frasca D, Reidy L, Cray C, Diaz A, Romero M, Kahl K et al. Influence of obesity on serum levels of SARS-CoV-2-specific antibodies in COVID-19 patients. Ansari AA, editor. PLoS ONE. 2021;16: e0245424. https:\/\/doi.org\/10.1371\/journal.pone.0245424.","DOI":"10.1371\/journal.pone.0245424"},{"key":"12295_CR37","doi-asserted-by":"publisher","first-page":"996","DOI":"10.3390\/vaccines11050996","volume":"11","author":"C Fu","year":"2023","unstructured":"Fu C, Lin N, Zhu J, Ye Q. Association between Overweight\/Obesity and the safety and efficacy of COVID-19 vaccination: A systematic review. Vaccines (Basel). 2023;11:996. https:\/\/doi.org\/10.3390\/vaccines11050996.","journal-title":"Vaccines (Basel)"},{"key":"12295_CR38","doi-asserted-by":"publisher","first-page":"410","DOI":"10.2478\/JTIM-2023-0118","volume":"11","author":"JH Choi","year":"2023","unstructured":"Choi JH, Jun MS, Jeon JY, Kim HS, Kim YK, Jeon CH, et al. Global lineage evolution pattern of SARS-CoV-2 in Africa, America, Europe, and Asia: a comparative analysis of variant clusters and their relevance across continents. J Transl Int Med. 2023;11:410. https:\/\/doi.org\/10.2478\/JTIM-2023-0118.","journal-title":"J Transl Int Med"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12295-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-12295-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12295-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:11:51Z","timestamp":1781622711000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-025-12295-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["12295"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-12295-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,9]]},"assertion":[{"value":"26 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Brazilian National Research Ethics Commission (CONEP) under the identifiers 44076721.5.0000.0005 and 51701821.6.0000.0005. Informed consent was obtained from all subjects involved in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"57"}}