Post-Acute Dyslipidemia and Abnormal Body Mass Index in Children and Adolescents with COVID-19: A Cohort Study from the RECOVER Initiative.

OBJECTIVE

To evaluate the risks of incident dyslipidemia and abnormal body mass index (BMI) during the 28-179-day postacute phase after documented SARS-CoV-2 infection in a large pediatric sample.

STUDY

DESIGN

A retrospective cohort study using the Researching COVID to Enhance Recovery pediatric electronic health record datasets from 25 US children's hospitals and health institutions, from March 2020 to September 2023. This study included 384 289 COVID-19-positive patients aged 0-21 years for dyslipidemia analyses and 285 559 aged 2-21 years for BMI analyses, each with at least 6 months of follow-up. COVID-19-negative controls included 1 080 413 and 817 315 patients, respectively. SARS-CoV-2 infection was defined by a positive polymerase chain reaction, antigen, or serologic test; a clinical diagnosis of COVID-19; or a documented diagnosis of post-acute sequelae of SARS-CoV-2. Incident dyslipidemia and abnormal BMI were identified using age-specific laboratory or anthropometric thresholds. Adjusted relative risks (aRRs) were estimated using propensity-score-stratified modified Poisson regression with multiple sensitivity analyses.

RESULTS

During the postacute phase, the COVID-19-positive cohort had higher rates of new-onset composite dyslipidemia (aRR 1.24; 95% CI 1.18-1.29) and abnormal BMI (aRR 1.15; 95% CI, 1.12-1.18). Results were robust to sensitivity and stratified analyses.

CONCLUSIONS

Children and adolescents with documented COVID-19 infection were associated with an increased risk of new-onset dyslipidemia and abnormal BMI during the postacute phase, highlighting the need for metabolic monitoring after infection.