Obesity as a risk factor for severe influenza infection in children and adolescents: a systematic review and meta-analysis

Abstract

Obesity has been recently identified as a predisposing factor for a worse prognosis in viral illnesses such as SARS-CoV-2; however, its role in children with influenza is not yet clarified. The current systematic review and meta-analysis aims to assess whether obesity is a risk factor for either hospitalization or a worse prognosis when hospitalized among children infected by influenza. We systematically searched the following databases using a structured algorithm: MEDLINE, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Statistical meta-analysis was performed using the “meta” package in R software, and included studies were evaluated using the Newcastle–Ottawa scale. Among children with influenza, obesity increased the odds of hospitalization with a pooled OR of 1.89 (95% CI [1.23, 2.9], I2 = 0, p = 0.003). When hospitalized, children with obesity were also more likely to have a worse outcome than their healthy-weight counterparts, with a pooled OR of 1.24 (95% Cl [1.02; 1.51], I2 = 11, p = 0.03). In an effort to lower heterogeneity, a leave-one-out meta-analysis was conducted. Publication bias was assessed with the visual inspection of funnel plots and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score. Conclusions: The findings of our meta-analysis suggest that obesity in children with influenza is associated with a worse prognosis, both hospitalization and ICU admission/death.What is Known:• Obesity has been identified as a risk factor for non-communicable as well as communicable diseases.• A previous meta-analysis failed to demonstrate a statistically significant association between obesity and influenza infection severity.What is New:• Children with high BMI and influenza infection are more likely to get hospitalized.• Pediatric inpatients with increased BMI and influenza infection may have a worse prognosis.