COVID-19 and obesity in childhood and adolescence: a clinical review

Abstract

Objective To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. Sources Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. Summary of findings Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. Conclusions The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

Impact of Ethnicity on COVID-19 Related Hospitalizations in Children During the First Pandemic Wave in Northern Italy

“…We describe a higher rate of male patients in this age group as compared to infected adults in Italy ( 14 ) but a slight majority of male children has been described in many national and international pediatric studies ( 18 , 19 , 21 – 23 , 25 – 27 ).…”

“…As obesity is a well-recognized risk-factor for COVID-19 ( 18 , 19 ), we also calculated the Z-score for weight for age for all children and compared the value of Italian children (+0.05) with that of the other ethnicities (+0.45, p = 0.37). Again, the value for the African children (+0.37) did not differ significantly neither from the Italian patients ( p = 0.31), nor from that of the other foreign children (+0.51, p = 0.69).…”

Challenges in COVID-19 drug treatment in patients with advanced liver diseases: A hepatology perspective

“…Fortunately, most pediatric patients develop mild COVID; however, rare cases may develop severe symptoms with multisystem affection[ 90 ]. Obesity is considered a risk factor for severe COVID in pediatric patients[ 91 ]. Red flag signs of disease progression are worsening tachypnea, disturbed conscious level, increasing serum lactate, bilateral lung infiltration, pleural effusion or rapid spread of the lesions, and associated morbidity as congenital heart disease, anemia, and severe malnutrition.…”

Childhood Obesity and Respiratory Diseases: Which Link?

“…The overexpression of the ACE2 receptor has been demonstrated in mouse models subjected to a hyperlipidemic diet and it is also present in obese subjects who take therapy with RAAS system inhibitors for cardiovascular comorbidities associated with obesity. However, we still have few data on the pediatric population and COVID 19 infection and further studies are needed [148].…”