{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:45:41Z","timestamp":1789595141061,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"intramural Uniformed Services University Military Research Royalty Funds Award"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background: The post-acute sequelae of SARS-CoV-2 infection represent a growing public health concern. While associations between COVID-19 and metabolic disorders have been reported, less is known about this risk in young, healthy populations. This study aimed to quantify the risk of developing new-onset metabolic disorders following SARS-CoV-2 infection among U.S. active-duty service members. Methods: We conducted a propensity score-matched cohort study using U.S. Military Health System data between July 2020 and June 2021 of active-duty service members (ADSM) aged 18 to 65 years old. COVID-19 infections were identified through ICD-10 codes or laboratory results. A 1:2 matched cohort compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes included incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension (HTN), hyperlipidemia (HLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic syndrome (MetS) within one year. Cox proportional hazards models calculated adjusted hazard ratios (aHR) while controlling for obesity and overweight status. Results: The median age for both those with and without COVID-19 infection was 26 years (interquartile range 22\u201333 years), with males comprising the majority of participants (81.1% male, 18.9% female). COVID-19 infection was associated with significantly increased hazards for incident HTN (aHR 1.09; 95% CI, 1.01\u20131.18), HLD (aHR 1.30; 95% CI, 1.10\u20131.54), and MASLD (aHR 1.36; 95% CI, 1.15\u20131.60). However, no significant increased risk was observed for T2DM or MetS. Conclusions: COVID-19 infection was associated with significantly increased risk of developing HTN, HLD, and MASLD, highlighting important long-term metabolic consequences in a young, healthy population.<\/jats:p>","DOI":"10.3390\/metabo15120795","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:46:52Z","timestamp":1765874812000},"page":"795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Metabolic Aftershock: COVID-19 and Metabolic Disease Risk Among U.S. Active-Duty Military Personnel"],"prefix":"10.3390","volume":"15","author":[{"given":"Kyle W.","family":"Sexton","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zella","family":"Berill","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2580-2563","authenticated-orcid":false,"given":"Apryl","family":"Susi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Coene","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"},{"name":"87th Medical Group, Department of Pediatrics, Joint Base McGuire-Dix-Lakehurst, NJ 08641, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristan E.","family":"Madison","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4543-6804","authenticated-orcid":false,"given":"Cade M.","family":"Nylund","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S2213-8587(22)00044-4","article-title":"Risks and burdens of incident diabetes in long COVID: A cohort study","volume":"10","author":"Xie","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/s41586-021-03553-9","article-title":"High-dimensional characterization of post-acute sequelae of COVID-19","volume":"594","author":"Xie","year":"2021","journal-title":"Nature"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2255965","DOI":"10.1001\/jamanetworkopen.2022.55965","article-title":"Association of COVID-19 Vaccination with Risk for Incident Diabetes After COVID-19 Infection","volume":"6","author":"Kwan","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2645","DOI":"10.2337\/dc21-1318","article-title":"COVID-19, hyperglycemia, and new-onset diabetes","volume":"44","author":"Khunti","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1056\/NEJMc2018688","article-title":"New-onset diabetes in COVID-19","volume":"383","author":"Rubino","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20191","DOI":"10.1038\/s41598-022-24185-7","article-title":"Association of COVID-19 with diabetes: A systematic review and meta-analysis","volume":"12","author":"Ssentongo","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.15585\/mmwr.mm7102e2","article-title":"Risk for newly diagnosed diabetes >30 days after SARS-CoV-2 infection among persons aged <18 years: United States, March 1, 2020\u2013June 28, 2021","volume":"71","author":"Barrett","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s00125-022-05670-0","article-title":"Incidence of newly diagnosed diabetes after COVID-19","volume":"65","author":"Rathmann","year":"2022","journal-title":"Diabetol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1111\/dom.14269","article-title":"Proportion of newly diagnosed diabetes in COVID-19 patients: A systematic review and meta-analysis","volume":"23","author":"Sathish","year":"2021","journal-title":"Diabetes Obes. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.cgh.2020.04.040","article-title":"ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection","volume":"18","author":"Liu","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1038\/s42255-021-00407-6","article-title":"Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection","volume":"3","author":"Montefusco","year":"2021","journal-title":"Nat. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14336","DOI":"10.1038\/s41598-023-41523-5","article-title":"Long-term multiple metabolic abnormalities among healthy and high-risk people following nonsevere COVID-19","volume":"13","author":"Washirasaksiri","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41574-022-00778-0","article-title":"SARS-CoV-2 fires up inflammation in adipose tissue","volume":"19","author":"Stefan","year":"2023","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1146\/annurev-med-042220-011857","article-title":"COVID-19 and diabetes","volume":"73","author":"Singh","year":"2022","journal-title":"Annu. Rev. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S2213-8587(20)30152-2","article-title":"Practical recommendations for the management of diabetes in patients with COVID-19","volume":"8","author":"Bornstein","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2568","DOI":"10.1111\/liv.14484","article-title":"Potential implications of COVID-19 in non-alcoholic fatty liver disease","volume":"40","author":"Prins","year":"2020","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/thoraxjnl-2020-215818","article-title":"\u2018Long-COVID\u2019: A cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalization for COVID-19","volume":"76","author":"Mandal","year":"2021","journal-title":"Thorax"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.orcp.2020.05.004","article-title":"Self-quarantine and weight gain related risk factors during the COVID-19 pandemic","volume":"14","author":"Zachary","year":"2020","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_19","first-page":"11","article-title":"Increased Prevalence of Overweight and Obesity and Incidence of Prediabetes and Type 2 Diabetes During the COVID-19 Pandemic, Active Component Service Members, U.S. Armed Forces, 2018 to 2021","volume":"30","author":"Stiegmann","year":"2023","journal-title":"MSMR"},{"key":"ref_20","first-page":"e0386","article-title":"The future of International Classification of Diseases coding in steatotic liver disease: An expert panel Delphi consensus statement","volume":"8","author":"Adams","year":"2024","journal-title":"Hepatol Commun."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance Diagnostics for Comparing the Distribution of Baseline Covariates between Treatment Groups in Propensity-Score Matched Samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat. Med."},{"key":"ref_22","unstructured":"Faries, D., Leon, A., Haro, J., and Obenchain, R. (2010). Analysis of Observational Health Care Data Using SAS, SAS Institute Inc.. Chapter 3."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v042.i08","article-title":"MatchIt: Nonparametric Preprocessing for Parametric Causal Inference","volume":"42","author":"Ho","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_25","unstructured":"Saul, B. (2025, March 03). smd: Compute Standardized Mean Differences. R Package Version 0.7.0, 2024. Available online: https:\/\/CRAN.R-project.org\/package=smd."},{"key":"ref_26","unstructured":"R Core Team (2025, October 03). R: A Language and Environment for Statistical Computing, Available online: https:\/\/www.R-project.org\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e146701","DOI":"10.1172\/jci.insight.146701","article-title":"PD-1 blockade counteracts post-COVID-19 immune abnormalities and stimulates the anti-SARS-CoV-2 immune response","volume":"6","author":"Loretelli","year":"2021","journal-title":"JCI Insight"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1177\/00033197211053903","article-title":"Does COVID-19 Cause Hypertension?","volume":"73","author":"Akpek","year":"2021","journal-title":"Angiology"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bielecka, E., Sielatycki, P., Pietraszko, P., Zapora-Kurel, A., and Zbroch, E. (2024). Elevated Arterial Blood Pressure as a Delayed Complication Following COVID-19\u2014A Narrative Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25031837"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wrona, M., and Skrypnik, D. (2022). New-Onset Diabetes Mellitus, Hypertension, Dyslipidaemia as Sequelae of COVID-19 Infection\u2014Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192013280"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e183777","DOI":"10.1172\/JCI183777","article-title":"A six-year study in a real-world population reveals an increased incidence of dyslipidemia during COVID-19","volume":"134","author":"Trimarco","year":"2024","journal-title":"J. Clin. Investig."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Buchynskyi, M., Kamyshna, I., Oksenych, V., Zavidniuk, N., and Kamyshnyi, A. (2023). The Intersection of COVID-19 and Metabolic-Associated Fatty Liver Disease: An Overview of the Current Evidence. Viruses, 15.","DOI":"10.3390\/v15051072"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jhep.2021.11.014","article-title":"Assessing causal relationships between COVID-19 and non-alcoholic fatty liver disease","volume":"76","author":"Liu","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_34","first-page":"20480040211059374","article-title":"Cardiovascular health and risk of hospitalization with COVID-19: A Mendelian Randomization study","volume":"10","author":"Cecelja","year":"2021","journal-title":"JRSM Cardiovasc Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ho, L., Tan, C., Ng, H., Chay, W., Tan, J., and Goh, S. (2022). A Reflection of Metabolic Syndrome through the Window of COVID-19. Vaccines, 10.","DOI":"10.3390\/vaccines10111966"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"9843","DOI":"10.1096\/fj.202001451","article-title":"COVID--19\u2014Associated dyslipidemia: Implications for mechanism of impaired resolution and novel therapeutic approaches","volume":"34","author":"Sorokin","year":"2020","journal-title":"FASEB J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.bbrc.2008.02.023","article-title":"Lipid rafts are involved in SARS-CoV entry into Vero E6 cells","volume":"369","author":"Lu","year":"2008","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/nri3793","article-title":"Cholesterol, inflammation and innate immunity","volume":"15","author":"Tall","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"684903","DOI":"10.1155\/2013\/684903","article-title":"High-density lipoproteins and the immune system","volume":"2013","author":"Kaji","year":"2013","journal-title":"J. Lipids."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s12079-022-00678-y","article-title":"Bioinformatics analysis reveals molecular connections between non-alcoholic fatty liver disease (NAFLD) and COVID-19","volume":"16","author":"Abolfazli","year":"2022","journal-title":"J. Cell Commun. Signal."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3333","DOI":"10.1007\/s10620-021-07120-0","article-title":"Impact of fibrosis-4 index prior to COVID-19 on outcomes in patients at risk of non-alcoholic fatty liver disease","volume":"67","author":"Elfeki","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_42","unstructured":"US Preventive Services Task Force (2025, August 20). Screening for Hypertension in Adults (Reaffirmation Recommendation). American Academy of Family Physicians. Available online: https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/hypertension-in-adults-screening."},{"key":"ref_43","unstructured":"US Preventive Services Task Force (2025, August 20). Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication (Final Recommendation Statement). USPSTF. Available online: https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/statin-use-in-adults-preventive-medication."},{"key":"ref_44","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2024). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J. Hepatol., 81, 492\u2013542."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/12\/795\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:18:42Z","timestamp":1765876722000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/12\/795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,14]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["metabo15120795"],"URL":"https:\/\/doi.org\/10.3390\/metabo15120795","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,14]]}}}