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Letters
October 28, 2009

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

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

In Reply: Dr Fantuzzi and I agree that obesity may provide some protection from tuberculosis1 and that tuberculosis may have affected evolution. She challenges my interpretation, positing that cytokines from adipocytes cannot be important in this arena because they are restricted to areas near their secretion site and do not reach the site of the infection, the lung. However, mycobacteria spread promptly from the primary site of infection via lymphatics and the bloodstream to hilar lymph nodes, apices of both lungs, and sites throughout the body, where they can remain dormant but viable, capable of reactivating disease at any time.2 With chronic tuberculosis, recurrent rounds of hematogenous spread can occur.2

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