COVID-19 Pandemic
Is BMI Status Prior to SARS-CoV-2 Infection Associated with Post-acute Sequelae of SARS-Cov-2 Infection? Findings from 172,136 Pediatric Individuals in the RECOVER Initiative TING ZHOU* TING ZHOU Bingyu Zhang Dazheng Zhang Qiong Wu Michael J. Becich Saul B. Blecker Jiajie Chen Nymisha Chilukuri Haitao Chu Elizabeth A. Chrischilles Leonor Corsino Carol R. Geary Susan Kim David M. Liebovitz Yiwen Lu Chongliang Luo Hiroki Morizono Abu SM. Mosa Nathan M. Pajor Suchitra Rao Srinivasan Suresh Yacob G. Tedla Leah Vance Utset David A. Williams Caren Mangarelli Ravi Jhaveri Christopher B. Forrest Yong Chen
BACKGROUND The role of elevated body mass index (BMI) as a modifiable risk factor for post-acute sequelae of SARS-CoV-2 infection (PASC) among the pediatric population is not rigorously investigate. We aim to quantify the association between BMI status prior to SARS-CoV-2 infection and the risk of PASC among the pediatric population.
METHODS In this retrospective cohort study spanning from March 1, 2020, to May 31, 2023, using data from 26 children’s hospitals and health institutions in the US, a total of 172,136 individuals aged 5 to 21 years who were diagnosed with SARS-CoV-2 infection were followed up through 179 days. We used both ICD-10 code U09.9 for post-COVID-19 condition, unspecified and potential computable PASC phenotypes as the PASC outcomes and examined their incident occurrences among the pediatric population within 28 to 179 days following the initial SARS-CoV-2 infection. BMI status prior to SARS-Cov-2 infection (healthy weight, overweight, obesity, and severe obesity) was assessed within 18 months prior to SARS-CoV-2 infection and the latest measure was selected if there were multiple measures. Among participants with SARS-CoV-2 infection, we estimated a relative risk (RR) for the association between BMI status and PASC using Poisson regression and modified Poisson regression adjusting for sociodemographic and clinical factors, i.e., age, sex, race and ethnicity, predominant variant, healthcare utilization metrics prior to cohort entry, the Pediatric Medical Complexity Algorithm (PMCA) index, and severity of acute phase COVID-19. We performed sensitivity analyses to validate our findings by accounting for the time of BMI status assessment, release date of the U09.9 ICD-10 code, time of taking serology testing, severity of the acute phase of COVID-19, COVID-19 vaccination status, type of health insurance, diabetes as a comorbidity, and use of weight loss drugs.
RESULTS Among 172,136 participants with SARS-CoV-2 infection, the median age of BMI status assessment was 12.8 years, the median age of cohort entry was 13.2 years, and the median time from BMI status assessment to COVID-19 infection was 4.1 months. Among all participants, 90,187 (52.4%) were female, 87,275 (50.7%) were non-Hispanic White, 42,982 (25.0%) were Hispanic, 33,065 (19.2%) were Non-Hispanic Black, 8,814 (5.1%) were Asian American/Pacific Islander, and 85,613 (49.7%) had obesity or severe obesity. A total of 1,385 (0.8%) participants were identified as having PASC with a U09.9 diagnosis code, and 74,317 (43.2%) had at least one incident occurrence of the potential PASC phenotypes during the follow-up period. Compared with participants with a healthy weight, those who had overweight, obesity, and severe obesity had 4.0% (RR, 1.040; 95% CI, 0.861-1.255), 25.2% (RR, 1.252; 95% CI, 1.062-1.477) and 40.8% (RR, 1.408; 95% CI, 1.241-1.598) higher risk of PASC when identified using U09.9, respectively. For potential PASC phenotypes, the RRs of any occurrence in the categories of overweight, obesity, and severe obesity compared to the healthy BMI category were 1.030 (95% CI, 0.982-1.080), 1.108 (95% CI, 1.064-1.109), and 1.174 (95% CI, 1.138-1.213), while the corresponding estimates of total occurrence were 1.053 (95% CI, 1.000-1.109), 1.137 (95% CI, 1.088-1.188), and 1.182 (95% CI, 1.142-1.223), respectively. Results were comparable in the sensitivity analyses.
CONCLUSIONS In this large, retrospective pediatric cohort study, overweight, obesity, and severe obesity was associated with a higher risk of PASC in a dose-dependent manner. Future research endeavors should expand the spectrum of PASC outcomes by incorporating newly elucidated PASC phenotypes.