J Korean Med Sci.  2021 Jan;36(3):e21. 10.3346/jkms.2021.36.e21.

The Impact of the Coronavirus Disease-2019 Pandemic on Childhood Obesity and Vitamin D Status

• Kang HM
• Jeong DC
• Suh BK
• Ahn MB

• KMID: 2510741
• DOI: http://doi.org/10.3346/jkms.2021.36.e21

Abstract

Background
The risk of weight gain as a consequence of school closure in children during the coronavirus disease-2019 (COVID-19) pandemic has been recognized. This study was performed to investigate changes in anthropometric and metabolic parameters in children following a 6-month period of social distancing and school closure due to the pandemic.
Methods
This retrospective cohort study was conducted in school-aged children that were on routine follow-up at the Growth Clinic of Seoul St. Mary's Hospital. Changes in body mass index (BMI) standard deviation scores (z-scores), lipid profiles, and vitamin D levels were investigated. The 1-year period prior to school closure was defined as “pre-COVID-19 period,” and the subsequent 6-month period as “COVID-19 period.”
Results
Overall, 226 children between 4 to 14 years old without comorbidities were assessed. On average, their BMI z-scores increased by 0.219 (95% confidence interval [CI], 0.167–0.271; P < 0.001) in the COVID-19 period compared to the pre-COVID-19 period, and the proportion of overweight or obesity increased from 23.9% in the pre-COVID-19 period to 31.4% in the COVID-19 period. The number of days after school closure ( P = 0.004) and being in the normoweight category in the pre-COVID-19 period ( P = 0.017) were factors associated with an increased BMI in the COVID-19 period. The mean triglyceride (105.8 mg/dL vs. 88.6 mg/dL, P < 0.001) and low-density lipoprotein-cholesterol (100.2 mg/dL vs. 94.0 mg/dL, P = 0.002) levels were higher, whereas the calcidiol level (18.9 mg/dL vs. 23.8 mg/dL, P < 0.001) was lower in the COVID-19 period compared to the pre-COVID-19 period.
Conclusion
Within 6 months, increased childhood obesity and vitamin D deficiencies were observed. The duration of school closure was significantly associated with an increased BMI and being normoweight does not exclude the risks for gaining weight.

Keyword

Calcidiol; Overweight; School Closure; Social Distancing

Figure

• 

  Fig. 1 Flow chart of the cases included in this study. A final 226 cases were included in this study.COVID-19 = coronavirus disease 2019.

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  Fig. 2 BMI z-scores of the cases in the pre-COVID-19 period and COVID-19 period. The mean BMI z-score of the patients in the COVID-19 period was significantly higher compared to the pre-COVID-19 period in the normoweight and underweight group. In the normoweight group, the mean BMI z-scores of this group increased by 0.263 (95% CI, 0.199–0.328; P < 0.001).COVID-19 = coronavirus disease 2019, BMI = body mass index, CI = confidence interval.

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  Fig. 3 Changes in the weight status category from the pre-COVID-19 period to the COVID-19 period. The proportion of overweight or obesity increased from 23.9% in the pre-COVID-19 period to 31.4% in the COVID-19 period.COVID-19 = coronavirus disease 2019.

• 

  Fig. 4 Linear regression model showing the difference in BMI z-score during the pre-COVID -19 period and COVID-19 period. After 47 days of school closure, a positive increase in BMI z-scores of the cases is observed. Each circle represents the difference in BMI z-score (COVID-19 period BMI z-score – pre-COVID-19 period BMI z-score) in each case included. Circles located in the grey area of the graph show weight loss in the COVID-19 period compared to the pre-COVID-19 period, whereas circles in the white area show weight gain.BMI = body mass index, COVID-19 = coronavirus disease 2019.

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