The Association Between Obesity and COVID-19 Severity in Children Differed Between SARS-CoV-2 Variants: A Multicountry Hospital-Based Observational Study
1
Issued Date
2025-01-01
Resource Type
ISSN
08913668
eISSN
15320987
Scopus ID
2-s2.0-105015516329
Journal Title
Pediatric Infectious Disease Journal
Rights Holder(s)
SCOPUS
Bibliographic Citation
Pediatric Infectious Disease Journal (2025)
Suggested Citation
Zhu Y., Zimmermann P., Yeoh D.K., Xia Y., Sáfadi M.A.P., Semple M.G., Saner C., Rodrigues F., Ritz N., Padmanabhan S., Jarovsky D., Gilks C.F., Cormier S.A., Chokephaibulkit K., Chew K.Y., Burgner D., Buonsenso D., Brizuela M.E., Britton P.N., Bowen A.C., Almeida F.J., Short K.R. The Association Between Obesity and COVID-19 Severity in Children Differed Between SARS-CoV-2 Variants: A Multicountry Hospital-Based Observational Study. Pediatric Infectious Disease Journal (2025). doi:10.1097/INF.0000000000004956 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112139
Title
The Association Between Obesity and COVID-19 Severity in Children Differed Between SARS-CoV-2 Variants: A Multicountry Hospital-Based Observational Study
Author's Affiliation
University of Melbourne
The University of Queensland
University of Liverpool
The University of Western Australia
Universität Basel
Louisiana State University
Università Cattolica del Sacro Cuore, Campus di Roma
University Hospital Bern
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Royal Children's Hospital, Melbourne
Murdoch Children's Research Institute
The University of Sydney School of Medicine
Siriraj Hospital
The Children's Hospital at Westmead
Centro Hospitalar e Universitário de Coimbra
The Kids Research Institute Australia
Pennington Biomedical Research Center
Alder Hey Children's Hospital
Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo
Universität Luzern
Perth Children's Hospital
Elson S. Floyd College of Medicine
Hospital General de Agudos Juan Fernandez
Sabará Hospital Infantil
St Joseph Hospital, Tacoma
The University of Queensland
University of Liverpool
The University of Western Australia
Universität Basel
Louisiana State University
Università Cattolica del Sacro Cuore, Campus di Roma
University Hospital Bern
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Royal Children's Hospital, Melbourne
Murdoch Children's Research Institute
The University of Sydney School of Medicine
Siriraj Hospital
The Children's Hospital at Westmead
Centro Hospitalar e Universitário de Coimbra
The Kids Research Institute Australia
Pennington Biomedical Research Center
Alder Hey Children's Hospital
Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo
Universität Luzern
Perth Children's Hospital
Elson S. Floyd College of Medicine
Hospital General de Agudos Juan Fernandez
Sabará Hospital Infantil
St Joseph Hospital, Tacoma
Corresponding Author(s)
Other Contributor(s)
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.