The association between obesity and dengue severity among pediatric patients: A systematic review and meta-analysis

Background: Severe dengue infection often has unpredictable clinical progressions and outcomes. Obesity may play a role in the deterioration of dengue infection due to stronger body immune responses. Several studies found that obese dengue patients have a more severe presentation with a poorer prognosis. However, the association was inconclusive due to the variation in the results of earlier studies. Therefore, we conducted a systematic review and meta-analysis to explore the relationship between obesity and dengue severity. Methods: We performed a systematic search of relevant studies on Ovid (MEDLINE), EMBASE, the Cochrane Library, Web of Science, Scopus and grey literature databases. At least two authors independently conducted the literature search, selecting eligible studies, and extracting data. Meta-analysis using random-effects model was conducted to compute the pooled odds ratio with 95% confidence intervals (CI). Findings: We obtained a total of 13,333 articles from the searches. For the final analysis, we included a total of fifteen studies among pediatric patients. Three cohort studies, two case-control studies, and one cross-sectional study found an association between obesity and dengue severity. In contrast, six cohort studies and three case-control studies found no significant relationship between obesity and dengue severity. Our meta-analysis revealed that there was 38 percent higher odds (Odds Ratio = 1.38; 95% CI:1.10, 1.73) of developing severe dengue infection among obese children compared to non-obese children. We found no heterogeneity found between studies. The differences in obesity classification, study quality, and study design do not modify the association between obesity and dengue severity. Conclusion: This review found that obesity is a risk factor for dengue severity among children. The result highlights and improves our understanding that obesity might influence the severity of dengue infection. Author summary: Dengue fever, an Aedes mosquito-borne viral infection, is a self-limiting or asymptomatic viral infection. In its severe form, severe dengue, the symptoms include organ failure, life-threatening bleeding, and shock. Patients with obesity were found to be at higher risks of developing complications and severe dengue infection compared to non-obese patients. Our systematic review and meta-analysis critically compared the available shreds of evidence related to obesity and severe forms of dengue infection. A total of fifteen studies that include nine cohort studies, five case-control studies, and one cross-sectional study were reviewed to explore the association between obesity and dengue severity. The results indicated that obese patients have higher odds of developing severe dengue infection compared to non-obese patients. This review highlighted the importance of obesity in the progression of dengue infection. With increasing prevalence of obese individual as well as expanding areas that were at high risk for dengue infection, obesity may play a role in increasing the burden and mortality related to dengue infection. Further large-scale prospective studies in regions with high prevalence of dengue infections would provide additional information and some better discernment on the relevance of obesity in dengue infection.