Nutritional Status and COVID - 19 in Children: A Caribbean Inpatient Survey

Objective: The objectives are to determine the incidence of malnutrition and anemia and evaluate the association of nutritional status and COVID-19-related clinical outcomes in children hospitalized for COVID-19. Method(s): This multi-island inpatient survey presents data from nine hospitals in three Caribbean islands in children from birth to 17 years from September 2020 to July 2021. We explore statistical associations with inpatient characteristics and potential differences between malnourished and well-nourished children. Result(s): Among children hospitalized for COVID-19, 6.8% were stunted, 6.6% were underweight, 13.6% were overweight/ obese, and 30% had anemia. Anemia was associated with multi-system inflammatory syndrome (MIS-C) in children but not with malnutrition. The prevalence of underweight children exceeded the 4.4% prevalence in the general pediatric population in islands and there was a greater-than-expected prevalence of overweight children hospitalized with COVID-19. No clear associations were detected between malnutrition and indicator outcomes. There were two deaths in children with severe malnutrition, COVID and septicemia identified after the study window. Conclusion(s): Hospitalizations exceeded baseline population rates of undernutrition but no significant associations were detected possibly due to small numbers. T cell activity is associated with less disease severity in SARS-CoV-2 infection and the diverse repertoire of naive T lymphocytes in children may confer protection to undernourished children. The deaths in two children with severe malnutrition and sepsis may suggest a compound effect on immunity by nutrition severity and COVID-19 disease. Overweight children in this cohort may reflect an increased prevalence of overweight children in the general population that requires further evaluation and intervention.