The Association Between Obesity and COVID-19 Severity in Children Differed Between SARS-CoV-2 Variants: A Multicountry Hospital-based Observational Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Obesity was a risk factor for severe COVID-19 in children during early outbreaks of ancestral SARS-CoV-2 and the Delta variant. However, the relationship between obesity and COVID-19 severity during the Omicron wave remains unclear. METHODS: This multicenter, observational study included polymerase chain r eaction-confirmed SARS-CoV-2-infected children and adolescents from Australia, Brazil, Italy, Portugal, Switzerland, Thailand, the United Kingdom and the United States hospitalized between January 1, 2020, and March 31, 2022. Data were collected across 3 time periods representing dominant SARS-CoV-2 variants: the ancestral strain (T1), pre-Omicron variants (Alpha and Delta; T2) and Omicron (T3). The primary outcome was the need for supplemental oxygen therapy and/or ventilatory support (respiratory support). RESULTS: This study included 6176 hospitalized children and adolescents of 2 to <18 years of age. The median age was 11.0 (interquartile range, 6.0-14.0) years, and 2989 (48.4%) were female. Obesity status was available for 5460 (88.4%), of whom 213 (3.9%) met the criteria for having obesity. Obesity was positively associated with the need for respiratory support during T1 [risk ratio (RR), 3.45 (95% CI: 2.02-5.88)] and T2 [RR, 3.24 (95% CI: 1.57-6.67], but this association was lost during T3 [RR, 3.08 (95% CI: 0.85-11.15)]. These findings were similar for unvaccinated children. CONCLUSIONS: Obesity was associated with more severe COVID-19 during the ancestral and pre-Omicron waves but not during the Omicron wave. Importantly, the same phenomenon was observed in unvaccinated children, suggesting that differences in vaccination did not account for the observed changes in the need for respiratory support over time.
Authors: Yanshan Zhu, Petra Zimmermann, Daniel K. Yeoh, Yao Xia, Marco Aurélio Palazzi Sáfadi, Malcolm G. Semple, Christoph Saner, Fernanda Rodrigues, Nicole Ritz, Srivatsan Padmanabhan, Daniel Jarovsky, Charles F. Gilks, Stephania A. Cormier, Kulkanya Chokephaibulkit, Keng Yih Chew, David Burgner, Danilo Buonsenso, Martin Eduardo Brizuela, Philip N. Britton, Asha C. Bowen, Flávia Jacqueline Almeida, Kirsty R. Short, on behalf of PAEDS Network Investigators, ISARIC4C Investigators
Institutions: The University of Queensland, Royal Children's Hospital, University of Lucerne, The University of Melbourne, Murdoch Children's Research Institute, The Kids Research Institute Australia, The University of Western Australia, Princess Margaret Hospital for Children, Perth Children's Hospital, Faculdade de Ciências Médicas da Santa Casa de São Paulo, University of Liverpool, Alder Hey Children's Hospital, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, University of Bern, University Hospital of Bern, Unidade Local de Saúde de Coimbra, University of Basel, University Children’s Hospital Basel, St. Joseph Medical Center in Tacoma, Washington State University, Pennington Biomedical Research Center, Louisiana State University, Siriraj Hospital, Mahidol University, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Hospital Fernández, The University of Sydney, Children's Hospital at Westmead
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4414084609