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Meta-Analysis
. 2023 Jan;182(1):363-374.
doi: 10.1007/s00431-022-04689-0. Epub 2022 Nov 11.

Obesity as a risk factor for severe influenza infection in children and adolescents: a systematic review and meta-analysis

Dimitra-Irinna Vitoratou  1 , Gerasimos-Panagiotis Milas  2 , Paraskevi Korovessi  1 , Stavroula Kostaridou  1 , Patra Koletsi  1
Affiliations
Meta-Analysis

Obesity as a risk factor for severe influenza infection in children and adolescents: a systematic review and meta-analysis

Dimitra-Irinna Vitoratou et al. Eur J Pediatr. 2023 Jan.

Abstract

Obesity has been recently identified as a predisposing factor for a worse prognosis in viral illnesses such as SARS-CoV-2; however, its role in children with influenza is not yet clarified. The current systematic review and meta-analysis aims to assess whether obesity is a risk factor for either hospitalization or a worse prognosis when hospitalized among children infected by influenza. We systematically searched the following databases using a structured algorithm: MEDLINE, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Statistical meta-analysis was performed using the "meta" package in R software, and included studies were evaluated using the Newcastle-Ottawa scale. Among children with influenza, obesity increased the odds of hospitalization with a pooled OR of 1.89 (95% CI [1.23, 2.9], I2 = 0, p = 0.003). When hospitalized, children with obesity were also more likely to have a worse outcome than their healthy-weight counterparts, with a pooled OR of 1.24 (95% Cl [1.02; 1.51], I2 = 11, p = 0.03). In an effort to lower heterogeneity, a leave-one-out meta-analysis was conducted. Publication bias was assessed with the visual inspection of funnel plots and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score.

Conclusions: The findings of our meta-analysis suggest that obesity in children with influenza is associated with a worse prognosis, both hospitalization and ICU admission/death.

What is known: • Obesity has been identified as a risk factor for non-communicable as well as communicable diseases. • A previous meta-analysis failed to demonstrate a statistically significant association between obesity and influenza infection severity.

What is new: • Children with high BMI and influenza infection are more likely to get hospitalized. • Pediatric inpatients with increased BMI and influenza infection may have a worse prognosis.

Keywords: Hospitalization; Influenza; Obesity; Risk factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram 2020
Fig. 2
Fig. 2
Forest plot of the analysis regarding obesity as a risk factor for hospitalization of children with influenza infection
Fig. 3
Fig. 3
Forest plot of the analysis regarding obesity as a risk factor for poor prognosis after hospitalization
Fig. 4
Fig. 4
Funnel plot of the analysis regarding obesity as a risk factor for hospitalization
Fig. 5
Fig. 5
Funnel plot of the analysis regarding obesity as a risk factor for poor prognosis after hospitalization
See this image and copyright information in PMC

References

    1. Tsankov BK, Allaire JM, Irvine MA, et al. Severe COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int J Infect Dis. 2021;103:246–256. doi: 10.1016/J.IJID.2020.11.163. - DOI - PMC - PubMed
    1. Kompaniyets L, Goodman AB, Belay B et al (2021) Body mass index and risk for COVID-19-related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death - United States, March-December 2020. MMWR Morb Mortal Wkly Rep 70:355–361. 10.15585/MMWR.MM7010E4 - PMC - PubMed
    1. Lange SJ, Kompaniyets L, Freedman DS et al (2021) Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 70:1278–1283. 10.15585/MMWR.MM7037A3 - PMC - PubMed
    1. Smith M, Honce R, Schultz-Cherry S (2020) Metabolic syndrome and viral pathogenesis: lessons from influenza and coronaviruses. J Virol 94:. 10.1128/JVI.00665-20/ASSET/0A33F693-06C6-4157-9A4A-FAAB4DABB07D/ASSETS/GRAPHIC/JVI.00665-20-F0001.JPEG - PMC - PubMed
    1. Robinson PD. Obesity and its impact on the respiratory system. Paediatr Respir Rev. 2014;15:219–226. doi: 10.1016/J.PRRV.2014.06.003. - DOI - PubMed