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Epidemiology and Population Health

Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Objective

To study body mass index (BMI) changes among individuals aged 18–99 years with and without SARS-CoV-2 infection.

Subjects/Methods

Using real-world data from the OneFlorida+ Clinical Research Network of the National Patient-Centered Clinical Research Network, we compared changes over time in BMI in an Exposed cohort (positive SARS-CoV-2 test between March 2020–January 2022), to a contemporary Unexposed cohort (negative SARS-CoV-2 tests), and an age/sex-matched Historical control cohort (March 2018–January 2020). BMI (kg/m2) was retrieved from objective measures of height and weight in electronic health records. We used target trial approaches to estimate BMI at start of follow-up and change per 100 days of follow-up for Unexposed and Historical cohorts relative to the Exposed cohort by categories of sex, race & ethnicity, age, and hospitalization status.

Results

The study sample consisted of 249,743 participants (19.2% Exposed, 61.5% Unexposed, 19.3% Historical cohort) of whom 62% were women, 21.5% Non-Hispanic Black, 21.4% Hispanic and 5.6% Non-Hispanic other and had an average age of 51.9 years (SD: 18.9). At start of follow-up, relative to the Unexposed cohort (mean BMI: 29.3 kg/m2 [95% CI: 29.1, 29.4]), the Exposed (0.07 kg/m2 [95% CI; 0.01, 0.12]) had higher mean BMI and Historical controls (−0.20 kg/m2 [95% CI; −0.25, −0.15]) had lower mean BMI. Over 100 days, BMI did not change (0 kg/m2 [95% CI: −0.03, 0.03]) for the Exposed cohort, decreased (−0.04 kg/m2 [95% CI; −0.05, −0.02]) for the Unexposed cohort and increased (0.03 kg/m2 [95% CI; 0.01, 0.04]) for the Historical cohort. Observed differences in BMI at start of follow-up and over 100 days were consistent between Unexposed and Exposed cohorts for most subgroups, except at start of follow-up period among Males and those 65 years or older who had lower BMI among Exposed.

Conclusions

In a diverse real-world cohort of adults, mean BMI of those with and without SARS-CoV2 infection varied in their trajectories. The mechanisms and implications of weight retention following SARS-CoV-2 infection remain unclear.

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Fig. 1: All estimates are from the marginal structural model with statistical interaction of exposure group, effect modifier (i.e., sex, age, race-ethnicity, hospitalization status) and time.

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Data availability

The code for the analysis is available on https://github.com/jvargh7/pasc_cardiometabolic_risk. Information of the OneFlorida+ CRN is provided at https://onefloridaconsortium.org/, and OneFlorida+ data are made available to researchers with an approved study protocol at https://onefloridaconsortium.org/front-door/prep-to-research-data-query/. For questions regarding OneFlorida+, email: OneFloridaOperations@health.ufl.edu.

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Acknowledgements

This research was supported by the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, award number 3R01DK120814-05S1. MKA was partially supported by the Georgia Center for Diabetes Translation Research which is funded by the National Institutes of Health (P30DK111024). The authors thank the OneFlorida+ Data Trust team (Kathryn Shaw, Meggen Kaufman, Jiang Bian, Elizabeth Shenkman) for support on query development and data extraction. The authors thank Shihab Chowdhury for administrative support.

Author information

Authors and Affiliations

  1. Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA

    Jithin Sam Varghese, Mohammed K. Ali & Rosette J. Chakkalakal

  2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jithin Sam Varghese & Mohammed K. Ali

  3. Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA

    Yi Guo

  4. Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA

    Mohammed K. Ali & Rosette J. Chakkalakal

  5. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine University of Florida, Gainesville, FL, USA

    W. Troy Donahoo

  6. Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA

    Rosette J. Chakkalakal

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Contributions

RJC, WTD and JSV conceptualized the study with inputs from MKA and YG. JSV conducted the analysis. JSV wrote the first draft with inputs from RJC. All authors reviewed and edited subsequent drafts.

Corresponding author

Correspondence to Rosette J. Chakkalakal.

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The authors declare no competing interests.

Ethics approval and consent to participate

The Institutional Review Board of Emory University determined the study (IRB ID: STUDY00004932) met criteria for exemption under 45 CFR 46.104(d). This study followed the REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement [36]. All methods were performed in accordance with relevant guidelines and regulations. The research involved no more than minimal risk, could not be practicably carried out without waiver of informed consent, and does not involve identifiable private information of included individuals.

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Varghese, J.S., Guo, Y., Ali, M.K. et al. Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01628-x

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