Obesity May Put Children Hospitalized with COVID-19 at Higher Risk for Severe Disease, Suggests New Study

For children hospitalized for symptomatic SARS-CoV-2 infection, being overweight or obese was significantly associated with having pneumonia and requiring oxygen, according to new research presented at IDWeek 2021, held virtually September 29 to October 3, 2021.

Obesity is one of multiple additional risk factors that are known to increase the severity of COVID-19 in adults, but research on this association in children is lacking. As COVID-19 cases and adolescent obesity rates continue to rise in the US, it is important to identify children who might be at higher risk of more severe disease, noted study authors led by Catherine Foster, MD, assistant professor of pediatrics, Baylor College of Medicine, Houston, Texas.

Foster and colleagues conducted a retrospective cohort study of children with obesity or overweight (OW) compared to those with normal weight (NW) to analyze if an elevated body mass index is a marker of increased risk of severe COVID-19 outcomes.

Children aged between 2 and 18 years who were admitted to Texas Children’s Hospital between April and December 2020 with a positive SARS-CoV-2 polymerase chain reaction test were included in the study. Demographic and clinical information was obtained from the electronic medical record.

Researchers identified 145 children who met inclusion criteria, of whom 55 (38%) were NW and 90 (62%) were OW. The children in the OW group were older, with a median age of 13 years compared to 10 years in the NW group. Underlying asthma or chronic lung disease was present in 13 (24%) participants in the NW group compared with 31 (34%) in the OW group (P=0.17). More than half of the children in both groups were Hispanic.

Children in the OW group were more likely to have pneumonia than the NW group (relative risk [RR], 1.6; 95% CI, 1.4-2.45). Also, participants in the OW group were more likely to require oxygen than the NW group (RR, 1.4; 95% CI, 1.03-1.96).

The median length of hospitalization was 4 days for children in the NW group compared with 5 days for the OW group (P=0.6). Admission to the intensive care unit was similar between the groups (P=0.6), according to the study abstract.

Researchers did not observe a significant difference in treatments administered to children in either group, but they did note a trend towards increased steroid (29 [53%] vs 59 [67%], P=0.13) and remdesivir (12 [22%] vs 30 [33%], P=0.14) use in the OW group.

“Larger, multi-site studies are needed to further evaluate the role of obesity on COVID-19 outcomes in children,” concluded researchers. “Obesity prevention along with vaccination efforts may prevent COVID-19 related morbidity in this group.”

Source: Foster C, Kumar S, Tocco E, et al. SARS-CoV-2 infection in hospitalized children: An elevated body mass index is a marker of increased risk of acute respiratory failure. Abstract (481) presented at: IDWeek 2021; held online September 29-October 3, 2021.