Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children


Michael Khoury, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Ashraf S. Harahsheh, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC.
Geetha Raghuveer, Children's Mercy Hospital, Kansas City, Missouri.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada.
Simon Lee, The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
Marianna Fabi, Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
Elif Seda Selamet Tierney, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California.
Michael A. Portman, Seattle Children's Research Institute, Seattle, Washington.
Nadine F. Choueiter, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
Matthew Elias, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Deepika Thacker, Nemours Children's Hospital, Wilmington, Delaware.
Frédéric Dallaire, Department of Pediatrics, Universite de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
William B. Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Kambiz Norozi, Department of Pediatrics, Pediatric Cardiology, Western University, London, Ontario, Canada.
Dongngan T. Truong, University of Utah and Primary Children's Hospital, Salt Lake City.
Manaswitha Khare, University of California San Diego/Rady Children's Hospital San Diego.
Jacqueline R. Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, California.
Joseph J. Pagano, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland.
Pedrom Farid, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Brian W. McCrindle, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Document Type

Journal Article

Publication Date



JAMA network open








IMPORTANCE: Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. OBJECTIVE: To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. MAIN OUTCOMES AND MEASURES: Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. RESULTS: Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. CONCLUSIONS AND RELEVANCE: In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.