ArticleThe Journal of infection2026
Pre-COVID-19 body mass index and post-acute cardiovascular, gastrointestinal, and neuropsychiatric outcomes among children and young adults with SARS-CoV-2 infection: An EHR-based cohort study from the RECOVER Initiative.
Article in The Journal of infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Immune Cell-Stratified Regulatory Contexts Associated With BMI-Related Multi-System Disease Risk: A Cell-Stratified Mendelian Randomization Study Using Single-Cell eQTL Data.Diabetes, obesity & metabolism · 2026Article
- Artificial Intelligence in Cardiovascular Medicine: A Giant Step in Personalized Medicine?Journal of personalized medicine · 2026Review
- SSRI/SNRI and long COVID in children and adolescents with neuropsychiatric conditions: a cohort study from the RECOVER Initiative.Nature. Mental health · 2026Article
- Post-acute dyslipidemia and abnormal BMI in children and adolescents with COVID-19: An EHR Cohort Study from the RECOVER Initiative.medRxiv : the preprint server for health sciences · 2025Article
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Authors and funding
24 authors.
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Abstract
objectivesPost-acute sequelae of SARS-CoV-2 infection (PASC) can affect multiple organ systems, but the role of preinfectional body mass index (BMI) in these outcomes among children and young adults remains unclear. We aimed to evaluate the association between pre-COVID-19 BMI status and post-acute cardiovascular, gastrointestinal, and neuropsychiatric outcomes in children and young adults.
methodsWe conducted a retrospective cohort study using data from 139,320 individuals aged 5 to 20 years with confirmed SARS-CoV-2 infection between March 2020 and September 2023 across 20 U.S. pediatric health systems participating in the RECOVER Initiative. Pre-infection BMI was defined using measurements obtained within 18 months before the index date and categorized as healthy weight, overweight, obesity, or severe obesity; when multiple values were available, the most recent measurement was selected. We assessed incident post-acute cardiovascular, gastrointestinal, and neuropsychiatric symptoms and conditions occurring 28 to 179 days post-infection. Adjusted relative risks (RRs) were estimated using modified Poisson regression models, comparing elevated BMI categories to the healthy weight.
findingsAmong 139,320 participants (mean [SD] age, 13.0 [4.3] years; 51.6% female), severe obesity was associated with a 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). Associations between BMI and neuropsychiatric outcomes were heterogeneous, with inverse associations observed for some conditions, including anxiety and major depression.
interpretationIn this cohort study, pre-COVID-19 BMI status was associated with the risk and pattern of post-acute cardiovascular and gastrointestinal outcomes among children and young adults. Association between pre-infection BMI and neuropsychiatric outcomes was more variable and should be interpreted with caution. These findings suggest BMI-stratified post-COVID-19 monitoring strategies may help inform long-term care in youth.
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