Are the rise in childhood obesity rates leading an increase in hospitalizations due to dengue?

Background Obesity and diabetes are known risk factors for severe dengue. The prevalence of obesity has markedly increased in many dengue endemic countries and the association of obesity with increased risk of hospitalization has not been previously been studied. Methods and findings Children aged 10 to 20 years (n=5207), were recruited from nine districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index centile (BMI) in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking. For participants aged >18 years of age, BMI was calculated and interpretated as for adults and a BMI of > 23.9 kg/m2 were considered as obese. Although the dengue seropositivity rates were similar in children of the different BMI centiles, 12/66 (18.2%) seropositive children with BMI centile >97th, had been hospitalized for dengue, compared to 103/1086 (9.48%) of children with a BMI centile of <97th. Therefore, those with a BMI centile of >97th, were twice as likely (odds ratio 2.1, 95% CI, 1.1 to 3.9, p=0.03) to have been hospitalized for dengue compared to children with a lower BMI. In those >18 years of age, obese individuals were again significantly more likely to have been hospitalized compared to leaner individuals (odds ratio 2.6, 95% CI, 1.0 to 6.1, p=0.04). Conclusions Obesity appears to increase the risk of hospitalization in those with dengue, highlighting the importance of creating awareness regarding obesity and risk of severe disease and hospitalization in dengue endemic countries. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study has been supported by WHO Unity Studies, a global sero-epidemiological standardization initiative, with funding to WHO and the UK Medical Research Council ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was obtained by the Ethics review committee of University of Sri Jayewardenepura, Sri Lanka I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data is available in manuscript and supplementary files.