COVID-19 Pandemic
Obesity and Long-term Cardiovascular Outcomes after COVID-19 Infection among Children and Young Adults: Findings from the RECOVER Ting Zhou* Ting Zhou Bingyu Zhang Dazheng Zhang Jiajie Chen Yiwen Lu Qiong Wu Jiayi Tong Yuqing Lei Lu Li Christopher B. Forrest Yong Chen
Background
Current research is focusing on the link between pre-COVID-19 elevated BMI or obesity and long-term cardiovascular issues after infection, especially in children. Obese children, who are at higher risk for severe COVID-19, may face greater long-term cardiovascular complications due to chronic inflammation and metabolic stress. Understanding this association is crucial for developing targeted interventions and improving health outcomes in this vulnerable group.
Methods
To tackle this issue, we utilized one of the largest pediatric Electronic Health Record (EHR) cohorts in the U.S., the pediatric RECOVER program by the National Institutes of Health (NIH). This program studies the long-term effects of COVID-19 and includes data from a national network of academic medical centers, covering approximately 10% of the U.S. pediatric population. Our analysis considered various covariates, including demographic characteristics (age, sex, race/ethnicity), virus-variant predominant periods, healthcare utilization metrics, severity of acute phase COVID-19, Pediatric Medical Complexity Algorithm (PMCA) index, and vaccination status. We fitted a Poisson regression model to estimate relative risks (RRs) and 95% confidence intervals (CIs) and conducted comprehensive sensitivity analyses. To ensure the robustness and generalizability of our findings, we selected a negative control outcome unrelated to pre-COVID-19 BMI or obesity, specifically “foreign body in ear.” This helped us detect residual biases, validate our methods, and strengthen our conclusions, confirming that the associations between elevated BMI and post-acute cardiovascular sequelae are genuine.
Results
Before fitting the model, we applied a cutoff incidence value of 0.1% to avoid overfitting for rare cardiovascular outcomes. Before fitting the model, we applied a cutoff incidence value of 0.1% to prevent overfitting for rare cardiovascular outcomes. This led us to identify six cardiovascular symptoms and disorders from the predefined cardiovascular outcomes provided by clinicians: chest pain, palpitations, syncope, hypertension, ventricular arrhythmias, and thromboembolism, occurring during the post-acute phase (28 to 179 days after cohort entry). Among the 139, 320 participants, 71,901 (51.6%) were female, and 729,52 (52.4%) were non-Hispanic White. Compared to participants with a healthy weight, the risk increased in those with severe obesity for chest pain (RR, 1.180; 95% CI, 1.003-1.388), hypertension (RR, 3.681; 95% CI, 2.651-5.111), composite outcomes, i.e., any cardiovascular disorders (RR, 2.562; 95% CI, 1.928-3.407), and any cardiovascular symptoms or disorders (RR, 1.185; 95% CI, 1.042-1.346).
Conclusion
In this large, retrospective pediatric cohort study, elevated BMI is associated with long-term cardiovascular outcomes after COVID-19 infection in the pediatric population. The takeaway is that thorough consideration of BMI is crucial when assessing the long-term health impacts of COVID-19 in children.