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. 2025 Mar 10;13(3):78.
doi: 10.3390/diseases13030078.

Lifestyle and Biochemical Parameters That May Hamper Immune Responses in Pediatric Patients After Immunization with the BNT162b2 mRNA COVID-19 Vaccine

Anthie Damianaki  1 , Antonios Marmarinos  2 , Margaritis Avgeris  2 , Dimitrios Gourgiotis  2 , Elpis-Athina Vlachopapadopoulou  3 , Marietta Charakida  1 , Maria Tsolia  1 , Lydia Kossiva  1
Affiliations

Lifestyle and Biochemical Parameters That May Hamper Immune Responses in Pediatric Patients After Immunization with the BNT162b2 mRNA COVID-19 Vaccine

Anthie Damianaki et al. Diseases. .

Abstract

Background: The aim of this study was to evaluate whether increased body mass index (BMI) and biochemical and lifestyle parameters linked to obesity and smoke exposure disrupt immune responses of children and adolescents following vaccination with the mRNA BNT162b2 vaccine.

Methods: A prospective, single-center, cohort study was conducted. Participants were assigned to receive two doses of the mRNA vaccine. Anti-SARS-CoV-2 IgG and neutralizing antibodies (AB) were measured before vaccination (T0) and 14 days after the second dose (T1). BMI and biochemical parameters were evaluated at T0. A questionnaire on lifestyle characteristics was filled in.

Results: IgG optical density (OD) ratio at T1 was lower in the overweight-obese group regardless of COVID-19 disease positive history [p = 0.028 for the seronegative group, p = 0.032 for the seropositive group]. Neutralizing AB were lower in overweight-obese participants in the seronegative group at T1 [p = 0.008]. HDL, fasting glucose/insulin ratio (FGIR), C-reactive protein (CRP), HBA1c, uric acid, and smoke exposure were significantly correlated with BMI [p = 0.006, p < 0.001, p < 0.001, p = 0.006, p = 0.009, p < 0.001, respectively]. The main biochemical parameters that were inversely correlated with IgG and neutralizing AB titers at T1 were uric acid [p = 0.018, p = 0.002], FGIR [p = 0.001, p = 0.008] and HBA1C [p = 0.027, p = 0.038], while smoke exposure negatively affected the humoral immune responses at T0 in the convalescent group [p = 0.004, p = 0.005].

Conclusions: Current data suggests that uric acid, insulin resistance (IR), and smoke exposure could adversely affect the immune responses in overweight-obese vaccinated children, highlighting the need for actions to enhance the protection of this particular subgroup.

Keywords: BMI; humoral immunity; insulin resistance; mRNA vaccine; obesity; uric acid.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
(a) Anti-SARS-CoV-2 IgG ELISA OD ratio at T1 in participants with negative and positive COVID-19 disease history before immunization. (b) SARS-CoV-2 neutralizing AB levels at T1 in participants with negative and positive COVID-19 disease history before immunization. T1: 14 days after BNT162b2 booster dose, AB: antibodies, OD: optical density.
Figure 2
Figure 2
(a) Anti-SARS-CoV-2 IgG ELISA OD ratio at T1 in overweight–obese participants with a positive COVID-19 disease history before immunization divided by gender. (b) Anti-SARS-CoV-2 IgG ELISA OD ratio at T1 in overweight–obese participants with a negative COVID-19 disease history before immunization divided by gender. (c) SARS-CoV-2 neutralizing AB levels at T1 in overweight–obese participants with a negative COVID-19 disease history before immunization divided by age. (d) SARS-CoV-2 neutralizing AB levels at T1 in normal-weight participants with a positive COVID-19 disease history before immunization divided by age. T1: 14 days after BNT162b2 booster dose, AB: antibodies, OD: optical density.
Figure 2
Figure 2
(a) Anti-SARS-CoV-2 IgG ELISA OD ratio at T1 in overweight–obese participants with a positive COVID-19 disease history before immunization divided by gender. (b) Anti-SARS-CoV-2 IgG ELISA OD ratio at T1 in overweight–obese participants with a negative COVID-19 disease history before immunization divided by gender. (c) SARS-CoV-2 neutralizing AB levels at T1 in overweight–obese participants with a negative COVID-19 disease history before immunization divided by age. (d) SARS-CoV-2 neutralizing AB levels at T1 in normal-weight participants with a positive COVID-19 disease history before immunization divided by age. T1: 14 days after BNT162b2 booster dose, AB: antibodies, OD: optical density.
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