Body mass index and postacute sequelae of SARS-CoV-2 infection in children and young adults

Zhou, T; Zhang, B; Zhang, D; et al., JAMA Network Open, October 2024

View Publication on PubMed

October 2024
JAMA Network Open

Short Summary

This RECOVER study looked at how a child or young adult’s body weight, measured by body mass index (BMI), might impact their risk of developing Long COVID. Researchers studied medical records from over 172,000 children and young adults across 26 hospitals between March 2020 and May 2023. They found that children and young adults with obesity (a high BMI) were 25% more likely to have long-term health problems after getting COVID-19 than those with a healthy weight. The findings also show that children with severe obesity (a very high BMI) were about 42% more likely to experience these long-term problems. They also checked if these links were different for children and young adults, but did not find significant differences. This study highlights that the BMI of children and young adults before getting COVID-19 is an important factor in their risk for developing Long COVID.

This summary was prepared by the RECOVER Initiative.

Publication Details

DOI: 10.1001/jamanetworkopen.2024.41970

Abstract

Importance: Obesity is associated with increased severity of COVID-19. Whether obesity is associated with an increased risk of post-acute sequelae of SARS-CoV-2 infection (PASC) among pediatric populations, independent of its association with acute infection severity, is unclear.

Objective: To quantify the association of body mass index (BMI) status before SARS-CoV-2 infection with pediatric PASC risk, controlling for acute infection severity.

Design, setting, and participants: This retrospective cohort study occurred at 26 US children's hospitals from March 2020 to May 2023 with a minimum follow-up of 179 days. Eligible participants included children and young adults aged 5 to 20 years with SARS-CoV-2 infection. Data analysis was conducted from October 2023 to January 2024.

Exposures: BMI status assessed within 18 months before infection; the measure closest to the index date was selected. The BMI categories included healthy weight (≥5th to <85th percentile for those aged 5-19 years or ≥18.5 to <25 for those aged >19 years), overweight (≥85th to <95th percentile for those aged 5-19 years or ≥25 to <30 for for those aged >19 years), obesity (≥95th percentile to <120% of the 95th percentile for for those aged 5-19 years or ≥30 to <40 for those aged >19 years), and severe obesity (≥120% of the 95th percentile for those aged 5-19 years or ≥40 for those aged >19 years).

Main outcomes and measures: To identify PASC, a diagnostic code specific for post-COVID-19 conditions was used and a second approach used clusters of symptoms and conditions that constitute the PASC phenotype. Relative risk (RR) for the association of BMI with PASC was quantified by Poisson regression models, adjusting for sociodemographic, acute COVID severity, and other clinical factors.

Results: A total of 172 136 participants (mean [SD] age at BMI assessment 12.6 [4.4] years; mean [SD] age at cohort entry, 13.1 [4.4] years; 90 187 female [52.4%]) were included. Compared with participants with healthy weight, those with obesity had a 25.4% increased risk of PASC (RR, 1.25; 95% CI, 1.06-1.48) and those with severe obesity had a 42.1% increased risk of PASC (RR, 1.42; 95% CI, 1.25-1.61) when identified using the diagnostic code. Compared with those with healthy weight, there was an increased risk for any occurrences of PASC symptoms and conditions among those with obesity (RR, 1.11; 95% CI, 1.06-1.15) and severe obesity (RR, 1.17; 95% CI, 1.14-1.21), and the association held when assessing total incident occurrences among those with overweight (RR, 1.05; 95% CI, 1.00-1.11), obesity (RR, 1.13; 95% CI, 1.09-1.19), and severe obesity (RR, 1.18; 95% CI, 1.14-1.22).

Conclusions and relevance: In this cohort study, elevated BMI was associated with a significantly increased PASC risk in a dose-dependent manner, highlighting the need for targeted care to prevent chronic conditions in at-risk children and young adults.

Authors

Ting Zhou, Bingyu Zhang, Dazheng Zhang, Qiong Wu, Jiajie Chen, Lu Li, Yiwen Lu, Michael J Becich, Saul Blecker, Nymisha Chilukuri, Elizabeth A Chrischilles, Haitao Chu, Leonor Corsino, Carol R Geary, Mady Hornig, Maxwell M Hornig-Rohan, Susan Kim, David M Liebovitz, Vitaly Lorman, Chongliang Luo, Hiroki Morizono, Abu S M Mosa, Nathan M Pajor, Suchitra Rao, Hanieh Razzaghi, Srinivasan Suresh, Yacob G Tedla, Leah Vance Utset, Youfa Wang, David A Williams, Margot Gage Witvliet, Caren Mangarelli, Ravi Jhaveri, Christopher B Forrest, Yong Chen

Keywords

Humans; COVID-19/epidemiology/complications; Body Mass Index; Adolescent; Child; Female; Male; Retrospective Studies; Young Adult; Child, Preschool; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Severity of Illness Index; Risk Factors; Obesity/epidemiology/complications; United States/epidemiology; Pediatric Obesity/epidemiology/complications