# Lifestyle and Biochemical Parameters That May Hamper Immune Responses in Pediatric Patients After Immunization with the BNT162b2 mRNA COVID-19 Vaccine

## TL;DR

Overweight and obese children may have weaker immune responses to the BNT162b2 vaccine due to factors like high uric acid, insulin resistance, and smoking exposure.

## Contribution

Identifies specific biochemical and lifestyle factors that impair vaccine-induced immunity in overweight–obese pediatric patients.

## Key findings

- Overweight–obese children had lower IgG and neutralizing antibody levels after vaccination.
- Uric acid, insulin resistance, and smoking were linked to reduced immune responses.
- Smoke exposure negatively affected humoral immunity in the convalescent group.

## Abstract

Background: The aim of this study was to evaluate whether increased body mass index (BMI) and biochemical and lifestyle parameters linked to obesity and smoke exposure disrupt immune responses of children and adolescents following vaccination with the mRNA BNT162b2 vaccine. Methods: A prospective, single-center, cohort study was conducted. Participants were assigned to receive two doses of the mRNA vaccine. Anti-SARS-CoV-2 IgG and neutralizing antibodies (AB) were measured before vaccination (T0) and 14 days after the second dose (T1). BMI and biochemical parameters were evaluated at T0. A questionnaire on lifestyle characteristics was filled in. Results: IgG optical density (OD) ratio at T1 was lower in the overweight–obese group regardless of COVID-19 disease positive history [p = 0.028 for the seronegative group, p = 0.032 for the seropositive group]. Neutralizing AB were lower in overweight–obese participants in the seronegative group at T1 [p = 0.008]. HDL, fasting glucose/insulin ratio (FGIR), C-reactive protein (CRP), HBA1c, uric acid, and smoke exposure were significantly correlated with BMI [p = 0.006, p < 0.001, p < 0.001, p = 0.006, p = 0.009, p < 0.001, respectively]. The main biochemical parameters that were inversely correlated with IgG and neutralizing AB titers at T1 were uric acid [p = 0.018, p = 0.002], FGIR [p = 0.001, p = 0.008] and HBA1C [p = 0.027, p = 0.038], while smoke exposure negatively affected the humoral immune responses at T0 in the convalescent group [p = 0.004, p = 0.005]. Conclusions: Current data suggests that uric acid, insulin resistance (IR), and smoke exposure could adversely affect the immune responses in overweight–obese vaccinated children, highlighting the need for actions to enhance the protection of this particular subgroup.