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. 2024 Oct 1;7(10):e2441970.
doi: 10.1001/jamanetworkopen.2024.41970.

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

Ting Zhou  1   2 , Bingyu Zhang  1   3 , Dazheng Zhang  1   2 , Qiong Wu  1   2   4 , Jiajie Chen  1   2 , Lu Li  1   3 , Yiwen Lu  1   3 , Michael J Becich  5 , Saul Blecker  6 , Nymisha Chilukuri  7 , Elizabeth A Chrischilles  8 , Haitao Chu  9   10 , Leonor Corsino  11 , Carol R Geary  12 , Mady Hornig  13   14 , Maxwell M Hornig-Rohan  13 , Susan Kim  15 , David M Liebovitz  16 , Vitaly Lorman  17 , Chongliang Luo  18 , Hiroki Morizono  19 , Abu S M Mosa  20 , Nathan M Pajor  21   22 , Suchitra Rao  23 , Hanieh Razzaghi  17 , Srinivasan Suresh  24   25 , Yacob G Tedla  26 , Leah Vance Utset  27 , Youfa Wang  28 , David A Williams  29 , Margot Gage Witvliet  13   30 , Caren Mangarelli  31 , Ravi Jhaveri  32 , Christopher B Forrest  17 , Yong Chen  1   2   3   33   34   35
Affiliations

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

Ting Zhou et al. JAMA Netw Open. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Reynolds Geary reported receiving grants from the Global Task Force for Health Care outside the submitted work. Dr Pajor reported receiving grants from Janssen Pharmceuticals, Agency for Healthcare Research and Quality, and PEDSnet outside the submitted work. Dr Jhaveri reported receiving personal fees from the AstraZeneca scientific advisory board, Seqirus scientific advisory board, Sanofi scientific advisory board, and Gilead scientific advisory board; grants from GSK; and an editorial stipend from the Pediatric Infectious Diseases Society for serving as editor in chief of the Journal of the Pediatric Infectious Diseases Society outside the submitted work. No other disclosures were reported.

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