Children with obesity experience worse multisystem inflammatory syndrome outcomes

January 10, 2024

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Key Takeaways:

• The prevalence of overweight and obesity was higher among children with multisystem inflammatory syndrome vs. Kawasaki disease.
• Higher BMI was associated with worse outcomes in patients with MIS-C.

Children with obesity demonstrate a greater likelihood of shock, ICU admission and worse laboratory scores in multisystem inflammatory syndrome, but not Kawasaki disease, according to data published in JAMA Network Open.

“While there is an overlap between the clinical presentation of KD and MIS-C, distinct differences exist with respect to their predilection for clinical outcomes,” Michael Khoury, MD, of the University of Alberta, in Edmonton, Canada, and colleagues wrote. “Moreover, the comorbidities and risk factors that may be associated with important clinical outcomes may be different between the two disease processes.

Data derived from Khoury M, et al. JAMA Netw Open. 2023:doi:10.1001/jamanetworkopen.2023.46829.

“Due to the severity of clinical presentation, there has been a strong interest among researchers to identify any associations between various demographic, clinical, and laboratory factors with outcomes in MIS-C,” they added. “Specifically, obesity has been evaluated in multiple studies, in part due to its known role as a risk factor associated with hospitalization, intensive care unit (ICU) admission, and death in children with acute COVID-19 infection. Associations between obesity and MIS-C outcomes, however, have been found inconsistently across studies to date.”

To examine the prevalence of obesity in children with Kawasaki disease vs. multisystem inflammatory syndrome in children (MIS-C), as well as any associations with clinical outcomes, Khoury and colleagues analyzed records for 1,767 children in the International Kawasaki Disease Registry from 42 sites across eight countries. A total of 338 children with Kawasaki disease and 1429 children with MIS-C were included. Most included patients — 89.7% — were from the United States or Canada.

The researchers calculated participants’ BMI z scores to categorize them as either “normal weight” (less than 85th percentile), “overweight” (85th to 95th percentile) and “obese” (95th percentile and higher).

According to the researchers, the prevalence of overweight and obesity was significantly higher among patients with MIS-C compared with patients with Kawasaki disease. In patients with MIS-C, 17.1% demonstrated overweight and 23.7% had obesity. In contrast, among those with Kawasaki disease, 11.5% were overweight and 11.5% had obesity.

Obesity was not associated with clinical presentations or outcomes for patients with Kawasaki disease. However, in patients with MIS-C, higher BMI was associated with greater likelihood of shock, ICU admission and inotrope requirement, as well as increased inflammatory markers, creatinine levels and alanine aminotransferase levels, the researchers wrote. Higher BMI was not associated with coronary artery abnormalities in either group.

“The differing prevalence of obesity and associations with disease severity between KD and MIS-C support the evidence that, while substantial overlap exists, Kawasaki disease and MIS-C represent two distinct inflammatory disease processes,” Khoury and colleagues wrote. “These study findings suggest that obesity as a comorbid factor should be considered at clinical presentation in children with MIS-C.”

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Sources/Disclosures

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Source:

Khoury M, et al. JAMA Netw Open. 2023:doi:10.1001/jamanetworkopen.2023.46829.

Disclosures:
Khoury reports no relevant financial disclosures. Please see the study for a full list of other researchers’ financial disclosures.

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