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Association of Pre–COVID-19 Body Mass Index with Postacute Cardiovascular, Gastrointestinal, and Neuropsychiatric Outcomes Among Children and Young Adults: An EHR-Based Cohort Study from the RECOVER Initiative
30 Pages Posted: 14 May 2025
More...Abstract
Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) can affect multiple organ systems, but the role of preinfection body mass index (BMI) in these outcomes among young populations remains unclear.
Methods: We conducted a retrospective cohort study using data from 139320 individuals aged 5–20 years with confirmed SARS-CoV-2 infection between March 2020 and March 2024 across 20 U.S. children's hospitals participating in the RECOVER initiative. Pre-infection BMI was categorized as healthy weight, overweight, obesity, or severe obesity based on measurements taken within 18 months prior to infection. We assessed incident cardiovascular, gastrointestinal, and neuropsychiatric conditions occurring at least 179 days post-infection. Adjusted relative risks (RRs) were estimated using modified Poisson regression models, comparing elevated BMI categories to the healthy weight group.
Findings: Among 139320 participants (mean [SD] age, 13.0 [4.3] years; 51.6% female), severe obesity was associated with higher risk of cardiovascular disorders (adjusted RR 2.56; 95% CI 1.93-3.41), particularly hypertension (adjusted RR 3.68; 95% CI 2.65-5.11). Severe obesity was also linked with increased risks of diarrhea (adjusted RR 1.34; 95% CI 1.10-1.64) and gastroesophageal reflux disease (adjusted RR 1.29; 95% CI 1.06-1.58). In contrast, higher BMI was inversely associated with some neuropsychiatric outcomes, such as anxiety and major depression.
Interpretation: In this cohort study, pre-COVID-19 BMI status was significantly associated with the risk and pattern of postacute cardiovascular and gastrointestinal outcomes. Associations with neuropsychiatric were more complex and warrants further investigation. These findings suggest BMI-stratified approaches to post–COVID-19 monitoring may be warranted to optimize long-term outcomes in youth. Funding US National Institutes of Health.
Keywords: Electronic health records, long COVID, Pediatrics, BMI
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