Obesity and COVID-19 in children and adolescents: a double pandemic.
Keywords:
SARS-CoV-2 infection, Coronavirus disease-19 (COVID-19), Obesity, Children, AdolescentsAbstract
Background and aim of the study. The high prevalence of obesity and obesity-related comorbidities has reached pandemic proportions, particularly in Western countries. It has been recently recognized as a significant risk factor in severe cases of COVID-19 in children and adolescents. Here, we summarize the existing knowledge regarding the pathophysiology of COVID-19 and consider how its various components may be exacerbated by the presence of obesity to investigate the impact of obesity on disease severity among patients with COVID-19 and collaborate for better clinical care of these patients.
Methods. The literature search was conducted from March 2020 to January 2022. A review of articles was performed via the online database PubMed, combining the terms "obesity," "weight gain," "COVID-19", "children."
Results. Excessive adipose tissue, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines are factors that compromise the functioning of organs and systems in obese patients. In obese patients with COVID-19 these changes can increase the risk of death, need for ventilatory assistance, risk of thromboembolism, and perpetuation of inflammatory response.
Conclusions. Obesity increases the risk for hospitalization, intensive care admission, mechanic ventilation requirement, and death among children and adolescents with COVID-19. These findings emphasize the need for effective actions by health professionals to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.
References
Cava E, Neri B, Carbonelli MG, et al. Obesity pandemic during COVID-19 outbreak: Narrative review and future considerations. Clin Nutr. 2021; 40(4):1637-43.
Brambilla I, Castagnoli R, Caimmi S, et al. COVID-19 in the Pediatric Population Admitted to a Tertiary Referral Hospital in Northern Italy: Preliminary Clinical Data. Pediatr Infect Dis J. 2020;39(7):e160.
Manti S, Licari A, Montagna L, et al. SARS-CoV-2 infection in pediatric population. Acta Biomed. 2020;91(11-S):e2020003.
Preston LE, Chevinsky JR, Kompaniyets L, et al. Characteristics and Disease Severity of US Children and Adolescents Diagnosed With COVID-19. Jama Netw Open. 2021;4(4): e215298.
Gotzinger F, Santiago-Garcia B, Noguera-Julian A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020; 4(9):653-61.
Cianferoni A, Votto M. COVID-19 and allergy: How to take care of allergic patients during a pandemic? Pediatr Allergy Immunol. 2020;31 Suppl 26(Suppl 26):96-101.
Oualha M, Bendavid M, Berteloot L, et al. Severe and fatal forms of COVID-19 in children. Arch Pediatr. 2020; 27(5):235-8.
Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020; 174(9):868-73.
Licari A, Votto M, Brambilla I, et al. Allergy and asthma in children and adolescents during the COVID outbreak: What we know and how we could prevent allergy and asthma flares. Allergy. 2020;75(9):2402-5.
De Filippo M, Votto M, Brambilla I, et al. Allergy and COVID-19. Acta Biomed. 2021;92(S7):e2021522.
Lockhart SM, O'Rahilly S. When Two Pandemics Meet: Why Is Obesity Associated with Increased COVID-19 Mortality? Med (NY). 2020;1(1):33-42.
Brambilla I, Tosca MA, De Filippo M, et al. Special Issues for Coronavirus Disease 2019 in Children and Adolescents. Obesity (Silver Spring). 2020;28(8):1369.
Castagnoli R, Votto M, Licari A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020;174(9):882-9.
Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis J. 2020;39(6):469-77.
Mantovani A, Rinaldi E, Zusi C, et al. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res. 2021;89(4):733-7.
Balasubramanian S, Rao NM, Goenka A, et al. Coronavirus Disease 2019 (COVID-19) in Children - What We Know So Far and What We Do Not. Indian Pediatr. 2020;57(5):435-42.
Dhochak N, Singhal T, Kabra SK, et al. Pathophysiology of COVID-19: Why Children Fare Better than Adults? Indian J Pediatr. 2020;87(7):537-46.
Reilly SM, Saltiel AR. Adapting to obesity with adipose tissue inflammation. Nat Rev Endocrinol. 2017;13(11):633-43.
Ellulu MS, Patimah I, Khaza'ai H, et al. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851-63.
Frydrych LM, Bian G, O'Lone DE, et al. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol. 2018;104(3):525-34.
Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595-607.
Sattar N, McInnes IB, McMurray JJ. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020;142(1):4-6.
Korakas E, Ikonomidis I, Kousathana F, et al. Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes. Am J Physiol Endocrinol Metab. 2020; 319(1):E105-9.
Bendor CD, Bardugo A, Pinhas-Hamiel O, et al. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol. 2020; 19(1):79.
Kirk E, Reeds DN, Finck BN, et al. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology. 2009;136(5):1552-60.
Köchli S, Endes K, Bartenstein T, et al. Lung function, obesity and physical fitness in young children: The EXAMIN YOUTH study. Respir Med. 2019;159:105813.
Umbrello M, Fumagalli J, Pesenti A, et al. Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients. Semin Respir Crit Care Med. 2019;40(1):40-56.
Fearnbach SN, Johannsen NM, Martin CK, et al. A pilot study of cardiorespiratory fitness, adiposity, and cardiometabolic health in youth with overweight and obesity. Pediatr Exerc Sci. 2020; 32(3):124-31.
Rychter AM, Zawada A, Ratajczak AE, et al. Should patients with obesity be more afraid of COVID-19? Obes Rev. 2020; 21(9):e13083.
De A, Rastogi D. Association of pediatric obesity and asthma, pulmonary physiology, metabolic dysregulation, and atopy; and the role of weight management. Expert Rev Endocrinol Metab. 2019; 14(5):335-49.
He L, Mäe MA, Muhl L, et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19. bioRxiv; 2020. doi: 10.1101/2020.05.11.088500.
Foster DJ, Ravikumar P, Bellotto DJ, et al. Fatty diabetic lung: altered alveolar structure and surfactant protein expression. Am J Physiol Lung Cell Mol Physiol. 2010;298(3):L392-403.
Lo MH, Lin IC, Lu PC, et al. Evaluation of endothelial dysfunction, endothelial plasma markers, and traditional metabolic parameters in children with adiposity. J Formos Med Assoc. 2019;118(1):83-91.
Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020; 21(6):e13034.
Nogueira-de-Almeida CA, Ciampo LA, Ferraz IS, et al. COVID-19 and obesity in childhood and adolescence: a clinical review. J Pediatr (Rio J). 2020; 96(5):546-58
Belančić A, Kresović A, Rački V. Potential pathophysiological mechanisms leading to increased COVID-19 susceptibility and severity in obesity. Obes Med. 2020;19:100259.
Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020; 57(6):759-64.
Marques-Vidal P, Bastardot F, von Känel R, et al. Association between circulating cytokine levels, diabetes and insulin resistance in a population-based sample (CoLaus study). Clin Endocrinol (Oxf). 2013;78(2):232-41.
Um JY, Chung HS, Song MY, et al. Association of interleukin-1beta gene polymorphism with body mass index in women. Clin Chem. 2004;50(3):647-50.
Umano GR, Pistone C, Tondina E, et al. Pediatric Obesity and the Immune System. Front Pediatr. 2019;7:487.
Foster DJ, Ravikumar P, Bellotto DJ, et al. Fatty diabetic lung: altered alveolar structure and surfactant protein expression. Am J Physiol Lung Cell Mol Physiol. 2010;298(3):L392-403.
Scherer PE. The many secret lives of adipocytes: implications for diabetes. Diabetologia. 2019;62(2):223-32.
Vlaicu SI, Tatomir A, Boodhoo D, et al. The role of complement system in adipose tissue-related inflammation. Immunol Res. 2016;64(3):653-64.
Xin Y, Hertle E, van der Kallen CJH, et al. Longitudinal associations of the alternative and terminal pathways of complement activation with adiposity: The CODAM study. Obes Res Clin Pract. 2018;12(3):286-92.
Wlazlo N, van Greevenbroek MM, Ferreira I, et al. Complement factor 3 is associated with insulin resistance and with incident type 2 diabetes over a 7-year follow-up period: the CODAM Study. Diabetes Care. 2014;37(7):1900-9.
Gavriilaki E, Brodsky RA. Severe COVID-19 infection and thrombotic microangiopathy: success does not come easily. Br J Haematol. 2020;189(6):e227-30.
Kim J, Nam JH. Insight into the relationship between obesity-induced low-level chronic inflammation and COVID-19 infection. Int J Obes (Lond). 2020; 44(7):1541-2.
Fegert JM, Vitiello B, Plener PL, et al. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health. 2020;14:20.
Votto M, De Filippo M; Pediatric Residents of the University of Pavia, Italy. How pediatric resident's life has changed during the COVID-19 pandemic. Ital J Pediatr. 2020;46(1):156.
Condon EM, Sadler LS, Mayes LC. Toxic stress and protective factors in multi-ethnic school age children: A research protocol. Res Nurs Health. 2018;41(2):97-106.
Adams EL, Caccavale LJ, Smith D, et al. Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID-19. Obesity (Silver Spring). 2020;28(11):2056-63.
An R. Projecting the impact of the coronavirus disease-2019 pandemic on childhood obesity in the United States: A microsimulation model. J Sport Health Sci. 2020;9(4):302-12.
Buzzi C, Tucci M, Ciprandi R, et al. The psycho-social effects of COVID-19 on Italian adolescents' attitudes and behaviors. Ital J Pediatr. 2020;46(1):69.
Dunton GF, Do B, Wang SD. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S. BMC Public Health. 2020;20(1):1351.
Van Lancker W, Parolin Z. COVID-19, school closures, and child poverty: a social crisis in the making. Lancet Public Health. 2020;5(5):e243-4.
Hoffman JA, Miller EA. Addressing the Consequences of School Closure Due to COVID-19 on Children's Physical and Mental Well-Being. World Med Health Policy. 2020 Aug:10.1002/wmh3.365.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Ilaria Brambilla, Francesco Delle Cave, Carmen Guarracino, Maria De Filippo, Martina Votto, Amelia Licari, Carmelo Pistone, Enrico Tondina
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
