ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Lancet 2020;395(10236):1544–45.

This study tested the association between age and BMI using data from patients (n =265) with COVID-19 infection treated at the intensive care units at 6 US University Hospitals. Results show a significant inverse correlation between age and BMI in this sample. Interestingly, adolescents and young adults were more likely to be obese than older COVID-19 patients. This observation leads to the assumption that in populations with a high prevalence of obesity, COVID-19 will affect younger populations more than previously reported.

Risk factors for critical illness with COVID-19 in children include obesity, as found in 2143 pediatric patients in China (1). Earlier reports from China have already shown that obesity was associated with a 142% higher risk of the occurrence of severe pneumonia in patients with COVID-19 infection in patients treated in Shenzhen (2). BMI >40 kg/m² was one of the strongest risk factors for hospitalization in 5,279 patients with COVID-19 infection as reported by the health system in New York City <(3). These data which are further supported by data published in the past weeks clearly indicate that obesity and the obesity-related comorbidities not only predispose to a severe course of COVID-19 disease but also increase the risk for a severe COVID-19 disease in youth.

Even children and adolescents with obesity often have respiratory dysfunction, which is characterized by alterations in respiratory mechanisms, increased airway resistance, impaired gas exchange and low lung volume and muscle strength (4). In patients with abdominal obesity, pulmonary function is also compromised by decreased diaphragmatic excursion. Obese people are therefore predisposed to hypoventilation-associated pneumonia and pulmonary hypertension (5). Furthermore, metabolic disturbances in obesity, mainly insulin resistance and chronic subclinical inflammation, are considered to result in increased vulnerability to pneumonia-associated organ failures. Increased inflammatory cytokines present in patients with obesity contribute to a more severe course of the infection.

It is interesting to remember the H1N1 influenza virus epidemic 10 years ago. The CDC estimated that 41–85 million people were infected, between 180 000 and 370 000 were hospitalized and 8000 to 17 000 died due to the infection (6). Also, here obesity was shown to be a major risk factor for a severe course of the disease.

In conclusion, obesity is a main risk factor for a severe course of COVID-19 infection and increases the risk for critical illness at young age. Measurement of anthropometric and metabolic parameters is crucial to better estimate the risk of complications in patients with COVID-19.

References:

1. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020;145 (6):e20200702. doi: 10.1542/peds.2020-0702. Epub 2020 Mar 16.

2. Qingxian C, Chen F, Fang L, Xiaohui L, Tao W, Qikai W, Qing H, Zhaoqin W, Yingxia L, Jun C, Lei L, Lin X. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China (3/13/2020). Preprint at SSRN: https://ssrn.com/abstract=3556658 or http://dx.doi.org/10.2139/ssrn.3556658.

3. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O´Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5,279 people with coronavirus disease in New York City. Prospective Cohort Study. BMJ 2020;369:m1966. doi: 10.1136/bmj.m1966.

4. Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and Impaired Metabolic Health in Patients With COVID-19. Nat Rev Endocrinol. 2020;16 (7):341–342. doi: 10.1038/s41574-020-0364-6.

5. Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity (Silver Spring). 2020;28 (6):1005. doi: 10.1002/oby.22818. Epub 2020 Apr 18.

6. Venkata C, Sampathkumar P, Afessa B. Hospitalized Patients with 2009 H1N1 Influenza Infection: The Mayo Clinic Experience. Mayo Clin Proc. 2010;85 (9):798–805. doi: 10.4065/mcp.2010.0166.