COVID-19 and obesity in childhood and adolescence: a clinical review

Carlos Alberto Nogueira-de-Almeida, Luiz A Del Ciampo, Ivan S Ferraz, Ieda R L Del Ciampo, Andrea A Contini, Fábio da V Ued, Carlos Alberto Nogueira-de-Almeida, Luiz A Del Ciampo, Ivan S Ferraz, Ieda R L Del Ciampo, Andrea A Contini, Fábio da V Ued

Abstract

Objective: To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences.

Sources: Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases.

Summary of findings: Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response.

Conclusions: The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

Keywords: Adolescent; Adolescente; Child; Coronavirus; Coronavirus infections; Coronavírus; Criança; Infecções por coronavírus; Obesidade; Obesity.

Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Interrelationships between obesity and COVID-19.

References

    1. Cespedes M.D., Souza J. Coronavirus: a clinical update of COVID-19. Rev Assoc Med Bras (1992). 2020;66:116–123.
    1. González J.J.E. SARS-CoV-2 and COVID-19. A pandemic review. Medicina Crítica. 2020;33:53–67.
    1. Gotzinger F., Santiago-Garcia B., Noguera-Julian A., Lanaspa M., Lancella L., Calo Carducci F.I., et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4:653–661.
    1. Mehta N., Kalra A., Nowacki A.S., Anjewierden S., Han Z., Bhat P., et al. Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020 doi: 10.1001/jamacardio.2020.1855. [Epub ahead of print]
    1. Oualha M., Bendavid M., Berteloot L., Corsia A., Lesage F., Vedrenne M., et al. Severe and fatal forms of COVID-19 in children. Arch Pediatr. 2020;27:235–238.
    1. Shekerdemian L.S., Mahmood N.R., Wolfe K.K., Riggs B.J., Ross C.E., McKiernan C.A., et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174:868–873.
    1. Hon K.L., Leung K.K., Leung A.K., Sridhar S., Qian S., Lee S.L., et al. Overview: the history and pediatric perspectives of severe acute respiratory syndromes: novel or just like SARS. Pediatr Pulmonol. 2020;55:1584–1591.
    1. Dong Y., Mo X., Hu Y., Qi X., Jiang F., Jiang Z., et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. J Emerg Med. 2020;58:712–713.
    1. Garg S. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 -COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69
    1. Panahi L., Amiri M., Pouy S. Clinical characteristics of COVID-19 infection in newborns and pediatrics: a systematic review. Arch Acad Emerg Med. 2020;8:e50.
    1. Cai J., Xu J., Lin D., Yang Z., Xu L., Qu Z., et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa198. [Epub ahead of print]
    1. Rajmil L. Role of children in the transmission of the COVID-19 pandemic: a rapid scoping review. BMJ Paediatr Open. 2020;4:e000722.
    1. Zimmermann P., Curtis N. COVID-19 in children, pregnancy and neonates: a review of epidemiologic and clinical features. Pediatr Infect Dis J. 2020;39:469–477.
    1. L’Huillier A.G., Torriani G., Pigny F., Kaiser L., Eckerle I. Culture-competent SARS-CoV-2 in nasopharynx of symptomatic neonates, children, and adolescents. Emerg Infect Dis. 2020;26
    1. Xu Y., Li X., Zhu B., Liang H., Fang C., Gong Y., et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;26:502–505.
    1. Yuan C., Zhu H., Yang Y., Cai X., Xiang F., Wu H., et al. Viral loads in throat and anal swabs in children infected with SARS-CoV-2. Emerg Microbes Infect. 2020;9:1233–1237.
    1. Jones Tc, Mühlemann B., Veith T., Biele G., Zuchowski M., Hoffmann J., et al. An analysis of SARS-CoV-2 viral load by patient age. medRxiv. 2020 doi: 10.1101/2020.06.08.20125484. [Epub ahead of print]
    1. Alzamora M.C., Paredes T., Caceres D., Webb C.M., Valdez L.M., La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37:861–865.
    1. Dong L., Tian J., He S., Zhu C., Wang J., Liu C., et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020;323:1846–1848.
    1. Gordon M., Kagalwala T., Rezk K., Rawlingson C., Ahmed M.I., Guleri A. Rapid systematic review of neonatal COVID-19 including a case of presumed vertical transmission. BMJ Paediatr Open. 2020;4
    1. WHO . World Health Organization; Geneva: 2020. Breastfeeding and COVID-19: scientific brief. Contract No.: WHO/2019-nCoV/Sci_Brief/Breastfeeding/2020.1. [cited 15 Jul 2020]. Available from:
    1. Fox A., Marino J., Amanat F., Krammer F., Hahn-Holbrook J., Zolla-Pazner S., et al. Evidence of a significant secretory-IgA-dominant SARS-CoV-2 immune response in human milk following recovery from COVID-19. medRxiv. 2020 doi: 10.1101/2020.05.04.20089995. [Epub ahead of print]
    1. Li Y., Zhao R., Zheng S., Chen X., Wang J., Sheng X., et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis. 2020;26:1335–1336.
    1. Liu W., Wang J., Li W., Zhou Z., Liu S., Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med. 2020;14:193–198.
    1. Far S., Agora S.A. SARS-CoV-2 infection in neonate: what do we know. Lancet. 2020;395:809–815.
    1. Yang P., Wang X., Liu P., Wei C., He B., Zheng J., et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127
    1. Mantovani A., Rinaldi E., Zusi C., Beatrice G., Saccomani M.D., Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res. 2020:1–6.
    1. Dong Y., Mo X., Hu Y., Qi X., Jiang F., Jiang Z., et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145
    1. Duran P., Berman S., Niermeyer S., Jaenisch T., Forster T., Gomez Ponce de Leon R., et al. COVID-19 and newborn health: systematic review. Rev Panam Salud Publica. 2020;44:e54.
    1. Ludvigsson J.F. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088–1095.
    1. Li B., Yang J., Zhao F., Zhi L., Wang X., Liu L., et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109:531–538.
    1. Shelmerdine S.C., Lovrenski J., Caro-Dominguez P., Toso S., Collaborators of the European Society of Paediatric Radiology Cardiothoracic Imaging Taskforce Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings. Pediatr Radiol. 2020;50:1217–1230.
    1. Balasubramanian S., Rao N.M., Goenka A., Roderick M., Ramanan A.V. Coronavirus disease 2019 (COVID-19) in children-what we know so far and what we do not. Indian Pediatr. 2020;57:435–442.
    1. Dhochak N., Singhal T., Kabra S., Lodha R. Pathophysiology of COVID-19: why children fare better than adults? Indian J Pediatr. 2020;87:537–546.
    1. Patel A.B., Verma A. Nasal ACE2 levels and COVID-19 in children. JAMA. 2020;323:2386–2387.
    1. Netea M.G., Dominguez-Andres J., Barreiro L.B., Chavakis T., Divangahi M., Fuchs E., et al. Defining trained immunity and its role in health and disease. Nat Rev Immunol. 2020;20:375–388.
    1. Miller A., Reandelar M.J., Fasciglione K., Roumenova V., Li Y., Otazu G.H. Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study. MedRxiv. 2020
    1. Caruso C., Buffa S., Candore G., Colonna-Romano G., Dunn-Walters D., Kipling D., et al. Mechanisms of immunosenescence. Immun Ageing. 2009;6:10.
    1. Xie X., Chen J., Wang X., Zhang F., Liu Y. Age- and gender-related difference of ACE2 expression in rat lung. Life Sci. 2006;78:2166–2171.
    1. Imai Y., Kuba K., Rao S., Huan Y., Guo F., Guan B., et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436:112–116.
    1. Diaz E., Rodriguez A., Martin-Loeches I., Lorente L., Del Mar Martin M., Pozo J.C., et al. Impact of obesity in patients infected with 2009 influenza A(H1N1) Chest. 2011;139:382–386.
    1. Green W.D., Beck M.A. Obesity impairs the adaptive immune response to Influenza virus. Ann Am Thorac Soc. 2017;14:S406–S409.
    1. Zachariah P., Johnson C.L., Halabi K.C., Ahn D., Sen A.I., Fischer A., et al. Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York. JAMA Pediatr. 2020 [Epub ahead of print]
    1. Bhatraju P.K., Ghassemieh B.J., Nichols M., Kim R., Jerome K.R., Nalla A.K., et al. COVID-19 in critically Ill patients in the Seattle region—case series. N Engl J Med. 2020;382:2012–2022.
    1. Caussy C., Wallet F., Laville M., Disse E. Obesity is associated with severe forms of COVID-19. Obesity (Silver Spring). 2020;28:1175.
    1. Wu J., Li W., Shi X., Chen Z., Jiang B., Liu J., et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19) J Intern Med. 2020;288:128–138.
    1. Simonnet A., Chetboun M., Poissy J., Raverdy V., Noulette J., Duhamel A., et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020;28:1195–1199.
    1. Busetto L., Bettini S., Fabris R., Serra R., Dal Pra C., Maffei P., et al. Obesity and COVID-19: an Italian snapshot. Obesity (Silver Spring). 2020 doi: 10.1002/oby.22918. [Epub ahead of print]
    1. Hajifathalian K., Kumar S., Newberry C., Shah S., Fortune B., Krisko T., et al. Obesity is associated with worse outcomes in COVID-19: analysis of early data from New York City. Obesity (Silver Spring). 2020 doi: 10.1002/oby.22923. [Epub ahead of print]
    1. Yates T., Razieh C., Zaccardi F., Davies M.J., Khunti K. Obesity and risk of COVID-19: analysis of UK biobank. Prim Care Diabetes. 2020 S1751-9918(20)30196-0. [Epub ahead of print]
    1. Newland J.G., Bryant K.A. Children in the eye of the pandemic storm-lessons from New York City. JAMA Pediatr. 2020 doi: 10.1001/jamapediatrics.2020.2438.
    1. Fruhbeck G., Baker J.L., Busetto L., Dicker D., Goossens G.H., Halford J.C.G., et al. European Association for the study of obesity position statement on the Global COVID-19 pandemic. Obes Facts. 2020;13:292–296.
    1. Nogueira-de-Almeida C.A. We need to look at the comorbidities of obesity during childhood and adolescence. Biomed J Sci Tech Res. 2017;1:1931–1932.
    1. Alwarawrah Y., Kiernan K., MacIver N.J. Changes in nutritional status impact immune cell metabolism and function. Front Immunol. 2018;9:1055.
    1. Heialy S.A., Hachim M., Senok A., Tayoun A.A., Hamoudi R., Alsheikh-Ali A., et al. Regulation of angiotensin converting enzyme 2 (ACE2) in obesity: implications for COVID-19. bioRxiv. 2020 doi: 10.1101/2020.04.17.046938. [Epub ahead of print]
    1. Zhang F., Xiong Y., Wei Y., Hu Y., Wang F., Li G., et al. Obesity predisposes to the risk of higher mortality in young COVID-19 patients. J Med Virol. 2020 doi: 10.1002/jmv.26039. [Epub ahead of print]
    1. Kass D.A., Duggal P., Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;395:1544–1545.
    1. Zabarsky G., Beek C., Hagman E., Pierpont B., Caprio S., Weiss R. Impact of severe obesity on cardiovascular risk factors in youth. J Pediatr. 2018;192:105–114.
    1. Nogueira-de-Almeida C.A., Pires L.A., dos Santos R.G. Comparação de indicadores de perfis glicêmico e lipídico entre crianças e adolescentes obesos egressos de serviço público ou privado da cidade de Ribeirão Preto (SP) Medicina (Ribeirao Preto Online). 2016;49:504–510.
    1. Nogueira-de-Almeida C.A., de Mello E.D. Different criteria for the definition of insulin resistance and its relation with dyslipidemia in overweight and obese children and adolescents. Pediatr Gastroenterol Hepatol Nutr. 2018;21:59–67.
    1. Sattar N., McInnes I.B., McMurray J.J. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020;142:4–6.
    1. Korakas E., Ikonomidis I., Kousathana F., Balampanis K., Kountouri A., Raptis A., et al. Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes. Am J Physiol Endocrinol Metab. 2020;319:E105–9.
    1. Bendor C.D., Bardugo A., Pinhas-Hamiel O., Afek A., Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol. 2020;19:79.
    1. Kochli S., Endes K., Bartenstein T., Usemann J., Schmidt-Trucksass A., Frey U., et al. Lung function, obesity and physical fitness in young children: the examin youth study. Respir Med. 2019;159
    1. Umbrello M., Fumagalli J., Pesenti A., Chiumello D. Pathophysiology and management of acute respiratory distress syndrome in obese patients. Semin Respir Crit Care Med. 2019;40:40–56.
    1. Fearnbach S.N., Johannsen N.M., Martin C.K., Katzmarzyk P.T., Beyl R.A., Hsia D.S., et al. A pilot study of cardiorespiratory fitness, adiposity, and cardiometabolic health in youth with overweight and obesity. Pediatr Exerc Sci. 2020;1:1–8.
    1. Rychter A.M., Zawada A., Ratajczak A.E., Dobrowolska A., Krela-Kazmierczak I. Should patients with obesity be more afraid of COVID-19? Obes Rev. 2020;21:e13083.
    1. De A., Rastogi D. Association of pediatric obesity and asthma, pulmonary physiology, metabolic dysregulation, and atopy; and the role of weight management. Expert Rev Endocrinol Metab. 2019;14:335–349.
    1. Samuels J.D. Obesity phenotype is a predictor of COVID-19 disease susceptibility. Obesity (Silver Spring). 2020;28:1368.
    1. Al-Ayed M., Alshaybari K., Alshehri D., Jamaan A., Nasser I., Alaamri H., et al. Obesity and childhood asthma in male schoolchildren in Saudi Arabia: is there a role for leptin, interleukin-4, interleukin-5, and interleukin-21? Ann Saudi Med. 2019;39:295–301.
    1. Durbin C., Egan R., Gervasi K., Nadeau N., Neal E., Reich S., et al. The effects of obesity on pulmonary function in children. JAAPA. 2017;30:30–33.
    1. Mauad Filho F., Caixe S.H., Benedetia A.C., Garcia J., WdP Martins, Del Ciampo L.A., et al. Evaluation of echocardiography as a marker of cardiovascular risk in obese children and adolescents. Int J Clin Pediatr. 2014;3:72–78.
    1. Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020;21
    1. Sommer A., Twig G. The impact of childhood and adolescent obesity on cardiovascular risk in adulthood: a systematic review. Curr Diab Rep. 2018;18:91.
    1. Garcia J., Benedeti A., Caixe S.H., Mauad F., Nogueira-de-Almeida C.A. Ultrasonographic evaluation of the common carotid intima-media complex in healthy and overweight/obese children. J Vasc Bras. 2019;18:e20190003.
    1. Al-Shorman A., Al-Domi H., Faqih A. Markers of subclinical atherosclerosis in schoolchildren with obesity and metabolic syndrome. Swiss Med Wkly. 2017;147
    1. Varga Z., Flammer A.J., Steiger P., Haberecker M., Andermatt R., Zinkernagel A.S., et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417–1418.
    1. Belancic A., Kresovic A., Racki V. Potential pathophysiological mechanisms leading to increased COVID-19 susceptibility and severity in obesity. Obes Med. 2020;19
    1. Kim J., Nam J.H. Insight into the relationship between obesity-induced low-level chronic inflammation and COVID-19 infection. Int J Obes (Lond). 2020;44:1541–1542.
    1. Wu H., Ballantyne C.M. Metabolic inflammation and insulin resistance in obesity. Circ Res. 2020;126:1549–1564.
    1. Luzi L., Radaelli M.G. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020;57:759–764.
    1. Marchandot B., Sattler L., Jesel L., Matsushita K., Schini-Kerth V., Grunebaum L., et al. COVID-19 related coagulopathy: a distinct entity? J Clin Med. 2020;9:1651.
    1. Lavie C.J., Sanchis-Gomar F., Henry B.M., Lippi G. COVID-19 and obesity: links and risks. Expert Rev Endocrinol Metab. 2020;15:215–216.
    1. D’Agati V.D., Chagnac A., de Vries A.P., Levi M., Porrini E., Herman-Edelstein M., et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol. 2016;12:453–471.
    1. Kelly C., Geraghty R.M., Somani B.K. Nephrolithiasis in the obese patient. Curr Urol Rep. 2019;20:36.
    1. Gai Z., Wang T., Visentin M., Kullak-Ublick G.A., Fu X., Wang Z. Lipid accumulation and chronic kidney disease. Nutrients. 2019;11:722.
    1. Yang S., Cao C., Deng T., Zhou Z. Obesity-related glomerulopathy: a latent change in obesity requiring more attention. Kidney Blood Press Res. 2020;4:1–13.
    1. Vaneckova I., Hojna S., Kadlecova M., Vernerova Z., Kopkan L., Cervenka L., et al. Renoprotective effects of ET(A) receptor antagonists therapy in experimental non-diabetic chronic kidney disease: is there still hope for the future? Physiol Res. 2018;67:S55–67.
    1. Gabarre P., Dumas G., Dupont T., Darmon M., Azoulay E., Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46:1339–1348.
    1. Alexandre J., Cracowski J.L., Richard V., Bouhanick B. Drugs, COVID-19’ working group of the French Society of Pharmacology, Therapeutics. Renin-angiotensin-aldosterone system and COVID-19 infection. Ann Endocrinol (Paris). 2020;81:63–67.
    1. Martinez-Rojas M.A., Vega-Vega O., Bobadilla N.A. Is the kidney a target of SARS-CoV-2? Am J Physiol Renal Physiol. 2020;318:F1454–62.
    1. Adapa S., Chenna A., Balla M., Merugu G.P., Koduri N.M., Daggubati S.R., et al. COVID-19 pandemic causing acute kidney injury and impact on patients with chronic kidney disease and renal transplantation. J Clin Med Res. 2020;12:352–361.
    1. Abenavoli L., Scarpellini E., Colica C., Boccuto L., Salehi B., Sharifi-Rad J., et al. Gut microbiota and obesity: a role for probiotics. Nutrients. 2019;11:2690.
    1. Indiani C., Rizzardi K.F., Castelo P.M., Ferraz L.F.C., Darrieux M., Parisotto T.M. Childhood obesity and firmicutes/bacteroidetes ratio in the gut microbiota: a systematic review. Child Obes. 2018;14:501–509.
    1. Xu K., Cai H., Shen Y., Ni Q., Chen Y., Hu S., et al. Management of COVID-19: the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49:147–157.
    1. Kelishadi R., Roufarshbaf M., Soheili S., Payghambarzadeh F., Masjedi M. Association of childhood obesity and the immune system: a systematic review of reviews. Child Obes. 2017;13:332–346.
    1. Magrone T., Jirillo E. Childhood obesity: immune response and nutritional approaches. Front Immunol. 2015;6:76.
    1. Rogero M.M. In: Biodisponibilidade de nutrientes. Cozzolino S.M.F., editor. Manole; Barueri, SP: 2016. Nutrição e sistema imune; pp. 991–1021.
    1. Zhang L., Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol. 2020;92:479–490.
    1. López Plaza B., Bermejo López L.M. Nutrición y trastornos del sistema inmune. Nutrición hospitalaria. 2017;34:68–71.
    1. Cigerli O., Parildar H., Dogruk Unal A., Tarcin O., Kut A., Eroglu H., et al. Vitamin deficiency and insulin resistance in nondiabetic obese patients. Acta Endocrinol (Buchar). 2016;12:319–327.
    1. Dura-Trave T., Gallinas-Victoriano F., Chueca-Guindulain M.J., Berrade-Zubiri S. Prevalence of hypovitaminosis D and associated factors in obese Spanish children. Nutr Diabetes. 2017;7:e248.
    1. Carter S.J., Baranauskas M.N., Fly A.D. Considerations for obesity, vitamin D, and physical activity amid the COVID-19 pandemic. Obesity (Silver Spring). 2020;28:1176–1177.
    1. Sadeghi K., Wessner B., Laggner U., Ploder M., Tamandl D., Friedl J., et al. Vitamin D3 down-regulates monocyte TLR expression and triggers hyporesponsiveness to pathogen-associated molecular patterns. Eur J Immunol. 2006;36:361–370.
    1. Grant W.B., Lahore H., McDonnell S.L., Baggerly C.A., French C.B., Aliano J.L., et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12:988.
    1. Wojcik M., Janus D., Kalicka-Kasperczyk A., Sztefko K., Starzyk J.B. The potential impact of the hypovitaminosis D on metabolic complications in obese adolescents– preliminary results. Ann Agric Environ Med. 2017;24:636–639.
    1. Calder P.C. Dietary modification of inflammation with lipids. Proc Nutr Soc. 2002;61:345–358.
    1. Simopoulos A.P. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2002;56:365–379.
    1. Takeuchi H., Ikeuchi S., Kawaguchi Y., Kitagawa Y., Isobe Y., Kubochi K., et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg. 2007;31:2160–2167.
    1. Simopoulos A. An increase in the omega-6/omega-3 fatty acid ratio increases the risk for obesity. Nutrients. 2016;8:128.
    1. Silva Figueiredo P., Carla Inada A., Marcelino G., Maiara Lopes Cardozo C., de Cassia Freitas K., de Cassia Avellaneda Guimaraes R., et al. Fatty acids consumption: the role metabolic aspects involved in obesity and its associated disorders. Nutrients. 2017;9
    1. Czerwonogrodzka-Senczyna A., Janusz M., Jeznach-Steinhagen A., Demkow U., Pyrzak B. Advances in Clinical Science. Springer; 2015. Nutrition and immune system in children with simple obesity; pp. 49–56.
    1. Vuholm S., Rantanen J.M., Teisen M.N., Stark K.D., Molgaard C., Christensen J.H., et al. Effects of oily fish intake on cardiometabolic markers in healthy 8- to 9-y-old children: the FiSK Junior randomized trial. Am J Clin Nutr. 2019;110:1296–1305.
    1. Garipagaoglu M., Sahip Y., Budak N., Akdikmen O., Altan T., Baban M. Food types in the diet and the nutrient intake of obese and non-obese children. J Clin Res Pediatr Endocrinol. 2008;1:21–29.
    1. Wu D., Lewis E.D., Pae M., Meydani S.N. Nutritional modulation of immune function: analysis of evidence, mechanisms, and clinical relevance. Front Immunol. 2018;9:3160.
    1. Rizvi S., Raza S.T., Ahmed F., Ahmad A., Abbas S., Mahdi F. The role of vitamin E in human health and some diseases. Sultan Qaboos Univ Med J. 2014;14:e157–65.
    1. Huang Z., Liu Y., Qi G., Brand D., Zheng S.G. Role of vitamin A in the immune system. J Clin Med. 2018;7
    1. Carr A.C., Maggini S. Vitamin C and immune function. Nutrients. 2017;9:1211.
    1. Huijskens M.J., Walczak M., Koller N., Briede J.J., Senden-Gijsbers B.L., Schnijderberg M.C., et al. Technical advance: ascorbic acid induces development of double-positive T cells from human hematopoietic stem cells in the absence of stromal cells. J Leukoc Biol. 2014;96:1165–1175.
    1. Gombart A.F., Pierre A., Maggini S. A review of micronutrients and the immune system-working in harmony to reduce the risk of infection. Nutrients. 2020;12:236.
    1. Nead K.G., Halterman J.S., Kaczorowski J.M., Auinger P., Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics. 2004;114:104–108.
    1. Shubham K., Anukiruthika T., Dutta S., Kashyap A.V., Moses J.A., Anandharamakrishnan C. Iron deficiency anemia: a comprehensive review on iron absorption, bioavailability and emerging food fortification approaches. Trends Food Sci Technol. 2020;99:58–75.
    1. Sypes E.E., Parkin P.C., Birken C.S., Carsley S., MacArthur C., Maguire J.L., et al. Higher body mass index is associated with iron deficiency in children 1 to 3 years of age. J Pediatr. 2019;207:198–204.
    1. Sal E., Yenicesu I., Celik N., Pasaoglu H., Celik B., Pasaoglu O.T., et al. Relationship between obesity and iron deficiency anemia: is there a role of hepcidin? Hematology. 2018;23:542–548.
    1. do Nascimento Marreiro D., Fisberg M., Cozzolino S.M. Zinc nutritional status and its relationships with hyperinsulinemia in obese children and adolescents. Biol Trace Elem Res. 2004;100:137–149.
    1. Sandoval D.A., Davis S.N. Leptin: metabolic control and regulation. J Diabetes Complications. 2003;17:108–113.
    1. Powell S.R. The antioxidant properties of zinc. J Nutr. 2000;130:S1447–54.
    1. Sena , Pedrosa Ld F.C. Efeitos da suplementação com zinco sobre o crescimento, sistema imunológico e diabetes. Rev Nutr. 2005;18:251–259.
    1. Woo Baidal J.A., Chang J., Hulse E., Turetsky R., Parkinson K., Rausch J.C. Zooming towards a telehealth solution for vulnerable children with obesity during COVID-19. Obesity (Silver Spring, Md). 2020;28:1184–1186.
    1. Dooley D.G., Bandealy A., Tschudy M.M. Low-income children and coronavirus disease 2019 (COVID-19) in the US. JAMA Pediatr. 2020 doi: 10.1001/jamapediatrics.2020.2065. [Epub ahead of print]
    1. An R. Projecting the impact of the coronavirus disease-19 pandemic on childhood obesity in the United States: a microsimulation model. J Sport Health Sci. 2020;9:302–312.
    1. Pietrobelli A., Pecoraro L., Ferruzzi A., Heo M., Faith M., Zoller T., et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity (Silver Spring). 2020;28:1382–1385.
    1. Simpson R.J., Campbell J.P., Gleeson M., Krüger K., Nieman D.C., Pyne D.B., et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev. 2020;26:8–22.
    1. Turel O., Romashkin A., Morrison K.M. A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth. Clin Obes. 2017;7:191–198.
    1. Kenney E.L., Gortmaker S.L. United States adolescents’ television, computer, videogame, smartphone, and tablet use: associations with sugary drinks, sleep, physical activity, and obesity. J Pediatr. 2017;182:144–149.
    1. Felső R., Lohner S., Hollódy K., Erhardt É, Molnár D. Relationship between sleep duration and childhood obesity: systematic review including the potential underlying mechanisms. Nutr Metab Cardiovasc Dis. 2017;27:751–761.
    1. Khedri M., Samei A., Fasihi-Ramandi M., Taheri R.A. The immunopathobiology of T cells in stress condition: a review. Cell Stress Chaperones. 2020;25:743–752.
    1. Abbas A.M., Fathy S.K., Fawzy A.T., Salem A.S., Shawky M.S. The mutual effects of COVID-19 and obesity. Obes Med. 2020;19
    1. Santoli J.M., Lindley M.C., DeSilva M.B., Kharbanda E.O., Daley M.F., Galloway L., et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration – United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:591–593.
    1. Takemoto M.L., Menezes M.O., Andreucci C.B., Nakamura-Pereira M., Amorim M.M., Katz L., et al. The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting. Int J Gynaecol Obstet. 2020;151:154–156.
    1. Anderson C.E., Whaley S.E., Crespi C.M., Wang M.C., Chaparro M.P. Every month matters: longitudinal associations between exclusive breastfeeding duration, child growth and obesity among WIC-participating children. J Epidemiol Community Health. 2020;74:785–791.
    1. Rasmussen S.A., Thompson L.A. Coronavirus disease 2019 and children: what pediatric health care clinicians need to know. JAMA Pediatr. 2020;174:743–744.
    1. Yazdanpanah F., Hamblin M.R., Rezaei N. The immune system and COVID-19: Friend or foe? Life Sci. 2020;256
    1. Das L.T., Abramson E.L., Kaushal R., editors. Reopening US schools in the era of COVID-19: practical guidance from other nations. JAMA Health Forum. American Medical Association; 2020.
    1. Riphagen S., Gomez X., Gonzalez-Martinez C., Wilkinson N., Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607–1608.
    1. Whittaker E., Bamford A., Kenny J., Kaforou M., Jones C.E., Shah P., et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324:259–269.
    1. Fuenzalida L., Garcia-Diaz D.F. Obesity as a risk factor for complications during acute respiratory infections in children. Rev Med Chil. 2016;144:1177–1184.
    1. Donoso A., Córdova P., Hevia Juricic Md P., Arriagada D. The obese child in the intensive care unit. Arch Argent Pediatr. 2016;114:258–666.
    1. Ewens B., Kemp V., Towel-Barnard A., Whitehead L. What evidence informs the nursing care of people with class iii obesity in an acute care setting? A scoping review. 2020. Res Square. 2020 doi: 10.21203/-31488/v1. [Epub ahead of print]
    1. Oosterhoff B., Palmer C.A. Attitudes and psychological factors associated with news monitoring, social distancing, disinfecting, and hoarding behaviors among US adolescents during the coronavirus disease 2019 pandemic. JAMA Pediatr. 2020 doi: 10.1001/jamapediatrics.2020.1876. [Epub ahead of print]

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa