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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Body Mass Index and Postacute Sequelae of SARS-CoV-2 Infection in Children and Young Adults
Ting Zhou1,2, Bingyu Zhang1,3, Dazheng Zhang1,2
1The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia.
Insights
Children and young adults with obesity face a higher risk of developing post-acute sequelae of SARS-CoV-2 infection (PASC). This risk increases with the severity of obesity, emphasizing the need for targeted interventions to prevent long-term health issues.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Public Health
Background:
- Obesity is a known risk factor for severe COVID-19.
- The association between obesity and post-acute sequelae of SARS-CoV-2 infection (PASC) in children is not well understood.
- Understanding this link is crucial for managing pediatric health outcomes post-infection.
Purpose of the Study:
- To determine if pre-infection body mass index (BMI) status is associated with an increased risk of PASC in pediatric populations.
- To quantify this association independently of acute COVID-19 severity.
- To investigate a potential dose-dependent relationship between BMI and PASC risk.
Main Methods:
- Retrospective cohort study involving over 172,000 children and young adults (ages 5-20) across 26 US children's hospitals.
- BMI status was categorized (healthy weight, overweight, obesity, severe obesity) based on measurements within 18 months prior to SARS-CoV-2 infection.
- PASC was identified using diagnostic codes and symptom clusters; statistical analysis employed Poisson regression models adjusting for confounders.
Main Results:
- Compared to healthy-weight peers, participants with obesity had a 25.4% increased risk of PASC, and those with severe obesity had a 42.1% increased risk, when using diagnostic codes.
- Analysis of symptom occurrences showed increased PASC risk for overweight (1.05 RR), obesity (1.13 RR), and severe obesity (1.18 RR) compared to healthy weight.
- A dose-dependent relationship was observed, with higher BMI categories correlating with greater PASC risk.
Conclusions:
- Elevated BMI in children and young adults is significantly associated with an increased risk of PASC.
- The risk of PASC demonstrates a dose-dependent relationship with increasing BMI severity.
- These findings underscore the importance of addressing obesity to mitigate long-term health consequences in pediatric populations post-SARS-CoV-2 infection.
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.
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