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Epidemiology and Population Health

Higher intraindividual variability of body mass index is associated with elevated risk of COVID-19 related hospitalization and post-COVID conditions

International Journal of Obesity volume 48, pages 1711–1719 (2024)Cite this article

Subjects

Abstract

Background

Cardiometabolic diseases are risk factors for COVID-19 severity. The extent that cardiometabolic health represents a modifiable factor to mitigate the short- and long-term consequences from SARS-CoV-2 remains unclear. Our objective was to evaluate the associations between intraindividual variability of cardiometabolic health indicators and COVID-19 related hospitalizations and post-COVID conditions (PCC) among a relatively healthy population.

Methods

This retrospective, multi-site cohort study was a post-hoc analysis among individuals with cardiometabolic health data collected during routine blood donation visits in 24 US states (2009-2018) and who responded to COVID-19 questionnaires (2021–2023). Intraindividual variability of blood pressure (systolic, diastolic), total circulating cholesterol, and body mass index (BMI) were defined as the coefficient of variation (CV) across all available donation timepoints (ranging from 3 to 74); participants were categorized into CV quartiles. Associations were evaluated by multivariable binomial regressions.

Results

Overall, 3344 participants provided 42,090 donations (median 9 [IQR 5, 17]). The median age was 48 years (38, 56) at the first study donation. 1.2% (N = 40) were hospitalized due to COVID-19 and 15.5% (N = 519) had PCC. Higher BMI variability was associated with greater risk of COVID-19 hospitalization (4th quartile aRR 4.15 [95% CI 1.31, 13.11], p = 0.02; 3rd quartile aRR 3.41 [95% CI 1.09, 10.69], p = 0.04). Participants with higher variability of BMI had greater risk of PCC (4th quartile aRR 1.29 [95% CI 1.02, 1.64]; p = 0.04). Intraindividual variability of blood pressure (systolic, diastolic) and total circulating cholesterol were not associated with COVID-19 hospitalization or PCC risk (all p > 0.05). From causal mediation analysis, the association between the highest quartiles of BMI variability and PCC was not mediated by hospitalization (p > 0.05).

Conclusions

Higher intraindividual variability of BMI was associated with COVID-19 hospitalization and PCC risk. Our findings underscore the need for further elucidating mechanisms that explain these associations and importance for consistent maintenance of body weight.

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Fig. 1: Visual overview of study design, primary exposures and outcomes.
Fig. 2: Percentages of participants in BMI variability subgroups, and with PCC or COVID-19 related hospitalizationa.
Fig. 3: Summary of adjusted risk ratios of associations between cardiometabolic health variability, COVID-19 hospitalization,a and PCCb probability.
Fig. 4: Comparing prevalence of post-COVID-19 symptoms by BMI intraindividual variability (CV) quartile subgroups, and sensitivity analysis via causal mediation modeling.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval.

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Acknowledgements

We sincerely appreciate all team members of the Repeat Donor Cohort Study including at Vitalant Research Institute, the American Red Cross, Centers for Disease Control and Prevention, and Westat; Dr. Gustaf Edgren for discussion of an earlier iteration of the analysis; and Amber Morris for her assistance with initial exploratory statistics. Figures 1A and 4C were created with BioRender.com. Figure 1B was created with DataWrapper.com.

Funding

This project was supported by the Centers for Disease Control and Prevention (contract number 75D30120C08170) and the National Institute of General Medical Sciences of the National Institutes of Health (R25GM143298 for EAY).

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Authors and Affiliations

  1. Vitalant Research Institute, San Francisco, CA, USA

    Elaine A. Yu, Vivian I. Avelino-Silva, Roberta L. Bruhn, Michael P. Busch & Brian Custer

  2. Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA

    Elaine A. Yu, Roberta L. Bruhn, Michael P. Busch & Brian Custer

  3. Vitalant, Scottsdale, AZ, USA

    Marjorie D. Bravo

  4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Vivian I. Avelino-Silva

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Contributions

EAY designed research (project conception, development of overall research plan, and study oversight). MDB, RLB, MPB, and BC conducted research (data collection) and provided essential materials (databases necessary for this study). EAY, MDB, and VIA analyzed data or performed statistical analysis. EAY wrote the initial manuscript draft and had primary responsibility for final content. All authors (EAY, MDB, VIA, RLB, MPB, BC) provided critical feedback and substantive revisions to the manuscript. All authors (EAY, MDB, VIA, RLB, MPB, BC) have read and approved the final manuscript.

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Correspondence to Elaine A. Yu.

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The authors declare no competing interests.

Ethical approval

All donors provided informed consent for the use of their deidentified data and residual blood samples from routine blood donations for research as part of voluntarily consenting to donate (Advarra protocol # Pro00030878). The COVID-19 survey was approved by an IRB (Advarra protocol # Pro00056783); all individuals provided informed consent prior to participation. All research involving human subjects conducted at Vitalant conform to the principles contained in the Belmont Report and are subject to the Common Rule and subparts B, C, and D of the US Department of Health and Human Services regulations at 45 CFR part 46. We reported study methodology based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines [63].

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Yu, E.A., Bravo, M.D., Avelino-Silva, V.I. et al. Higher intraindividual variability of body mass index is associated with elevated risk of COVID-19 related hospitalization and post-COVID conditions. Int J Obes 48, 1711–1719 (2024). https://doi.org/10.1038/s41366-024-01603-6

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