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Body Mass Index and Postacute Sequelae of SARS-CoV-2 Infection in Children and Young Adults
Journal article   Open access   Peer reviewed

Body Mass Index and Postacute Sequelae of SARS-CoV-2 Infection in Children and Young Adults

Ting Zhou, Bingyu Zhang, Dazheng Zhang, Qiong Wu, Jiajie Chen, Lu Li, Yiwen Lu, Michael J Becich, Saul Blecker, Nymisha Chilukuri, …
JAMA network open, Vol.7(10), e2441970
10/01/2024
DOI: 10.1001/jamanetworkopen.2024.41970
PMCID: PMC11581483
PMID: 39466241
url
https://doi.org/10.1001/jamanetworkopen.2024.41970View
Published (Version of record) Open Access

Abstract

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. To quantify the association of body mass index (BMI) status before SARS-CoV-2 infection with pediatric PASC risk, controlling for acute infection severity. 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. 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). 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. 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). 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.
 Adolescent Body Mass Index Child Child, Preschool COVID-19 - complications COVID-19 - epidemiology Female Humans Male Obesity - complications Obesity - epidemiology Pediatric Obesity - complications Pediatric Obesity - epidemiology Post-Acute COVID-19 Syndrome Retrospective Studies Risk Factors SARS-CoV-2 Severity of Illness Index United States - epidemiology Young Adult

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