Preprint Post-acute dyslipidemia and abnormal BMI in children and adolescents with COVID-19: An EHR Cohort Study from the RECOVER Initiative, 2025, Lei et al.

[SNT Gatchaman]

Post-acute dyslipidemia and abnormal BMI in children and adolescents with COVID-19: An EHR Cohort Study from the RECOVER Initiative

Spoiler: Authors

Yuqing Lei; Ting Zhou; Bingyu Zhang; Dazheng Zhang; Huilin Tang; Jiajie Chen; Qiong Wu; Lu Li; L Charles Bailey; Michael J Becich; Saul Blecker; Dimitri A Christakis; Daniel Fort; Sharon J Herring; Wenke Hwang; Amrik Singh Khalsa; Susan Kim; David M Liebovtiz; Abu Saleh Mohammad Mosa; Suchitra Rao; Soumitra Sengupta; Xing Song; Yacob G Tedla; Ravi Jhaveri; Caren Mangarelli; Christopher B Forrest; Yong Chen; the Recover Consortium

BACKGROUND
Adults with SARS-CoV-2 infection have shown higher risks of dyslipidaemia and abnormal body mass index (BMI). Whether similar associations exist in children and adolescents is unclear.

METHOD
We did a retrospective cohort study using the RECOVER paediatric Electronic Health Record (EHR) datasets from 25 US children9s hospitals, covering March 2020 to September 2023. For dyslipidaemia analyses, we included 384,289 patients aged 0-21 years with at least 6 months of follow-up and 1,080,413 COVID-19-negative controls. For BMI analyses, we included 285,559 patients aged 2-21 years and 817,315 controls. Documented infection was defined as a positive PCR, serology, or antigen test, or a clinical diagnosis of COVID-19 or post-acute sequelae of SARS-CoV-2. Outcomes were new diagnoses of dyslipidaemia, defined by laboratory thresholds for total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol, and abnormal BMI (BMI-for-age ≥95th percentile at ages 2-19 years or BMI ≥30 kg/m2 at ages 19-21 years). Adjusted relative risks (aRRs) were estimated using propensity score-stratified Poisson regression. Sensitivity analyses included empirical calibration with negative control outcomes and stratification by baseline obesity.

INTERPRETATION
Children and adolescents with documented COVID-19 were associated with higher risks of new-onset dyslipidaemia and abnormal BMI in the post-acute period compared with COVID-19-negative peers. Associations were consistent across lipid fractions, remained after empirical calibration, and were similar after accounting for baseline obesity.

EVIDENCE BEFORE THIS STUDY
Adults with SARS-CoV-2 infection have been reported to develop dyslipidaemia and abnormal body mass index (BMI) after the acute phase, raising concerns about long-term metabolic health. In children and adolescents, evidence has been scarce. Available studies are small, cross-sectional, or based mainly on diagnosis codes, with few incorporating laboratory lipid values or age-specific BMI thresholds against contemporaneous controls. The risk of post-acute dyslipidaemia and BMI abnormalities in paediatric populations therefore remains uncertain.

ADDED VALUE OF THIS STUDY
Using the Researching COVID to Enhance Recovery (RECOVER) electronic health record (EHR) database from 25 US hospitals, we examined more than 1.6 million children and adolescents with at least 6 months of follow-up. Outcomes were defined using laboratory lipid panels and age-specific BMI measures. With propensity score stratification across hundreds of covariates and calibration using negative control outcomes, documented COVID-19 was associated with higher adjusted risks of abnormal HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides, and BMI. Associations were consistent across sensitivity analyses and stratified by baseline obesity.

IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE
Together with findings from adult studies, our results indicate that metabolic sequelae after SARS-CoV-2 infection are also relevant in paediatric populations. Children and adolescents with documented COVID-19 were more likely to develop dyslipidaemia and abnormal BMI in the early post-acute phase. These findings support routine lipid and BMI monitoring in paediatric follow-up care, which could enable earlier identification of metabolic dysfunction and guide preventive strategies for long-term cardiometabolic health.

Web | PDF | Preprint: MedRxiv | Open Access

 

[SNT Gatchaman]

After propensity score stratification, the documented SARS-CoV-2 infection was significantly associated with higher risks of most lipid abnormalities at the post-acute phase).

aRRs were 1.24 (95% CI 1.18-1.31) for abnormal HDL cholesterol levels, 1.19 (95% CI 1.08-1.30) for abnormal LDL cholesterol levels, 1.14 (95% CI 1.06-1.24) for total cholesterol levels, and 1.28 (95% CI 1.20-1.36) for abnormal triglyceride levels. Non-HDL cholesterol levels showed a nonsignificant trend (aRR 1.03, 95% CI 0.92-1.17). The composite of any abnormal lipid result outcome yielded an aRR of 1.23 (95% CI 1.18-1.29).

For abnormal BMI outcome, the COVID19-positive patients were associated with a 15% higher risk than COVID-19-negative controls, with an aRR of 1.15 (95% CI 1.12-1.18).

 

[SNT Gatchaman]

These findings represent the first large-scale evidence of post-COVID metabolic associations in the pediatric population, underscoring that children and adolescents may experience persistent metabolic consequences despite typically milder acute illness.

While individually modest, our findings may have substantial population-level implications given widespread pediatric COVID-19 exposure. Childhood metabolic abnormalities often persist into adulthood, potentially amplifying lifetime cardiovascular risk These considerations support incorporating enhanced metabolic monitoring into post-COVID pediatric follow-up care.

"Children don't get COVID".
"Children don't get severe COVID"
"Children don't get long COVID."
"Children don't suffer long-term consequences."

"Let it rip."

 

[Hutan]

I guess there could have been a lot of things going on in that Mar 2020 to Sep 2023 period to account for the reported differences. "25 US hospitals" covers a lot of ground and there was almost certainly differences in the rates of spread of Covid-19 and responses such as lockdowns.

For example, in regions where there was less Covid-19 early on, perhaps school sport and even just school continued as normal for much of the study period. Perhaps in regions where there was more Covid-19, schools were shut and children were either at home with the fridge and parents making sourdough bread, or were left at home with easy high calorie food while parents worked long hours stocking supermarket shelves or at the hospital.

Some of the children who got Covid-19 would have had persistent symptoms, and so some of them would have been less active, perhaps resulting in an increase in BMI. Or their parents with persistent symptoms might have been less active, and so less likely to help their children to be active.

I'm not ruling out the possibility of Covid-19 directly causing metabolic disturbances, just noting there could be many things contributing to the findings.