Fort Hood soldiers are tested for COVID-19 on Fort Hood, Texas, Feb. 5, 2021. Soldiers are required to exercise COVID-19 safety procedures while being tested for the virus. (U.S. Army photo by Pfc. Kyler Hembree)
BETHESDA, MD — In U.S. active-duty servicemembers, COVID-19 infection was associated with significantly increased risk of developing hypertension, hyperlipidemia and metabolic dysfunction-associated steatotic liver disease, according to a recent study.
The lasting impact of SARS-CoV-2 infections extends beyond the acute phase, and growing evidence highlights a significant potential for long-term morbidity, according to the study published in Metabolites. Metabolic sequelae, such as obesity, cardiovascular disease and hyperlipidemia, have emerged as common consequences of COVID-19 infection, and studies also have found a concerning rise in Type 2 diabetes mellitus during the COVID-19 pandemic. Little research has explored the associations between COVID-19 and metabolic disorders in young, healthy populations, however, so the researchers sought to study COVID-19 and metabolic disease risk in U.S. active-duty military personnel.1
“In the clinic, we have observed a subjective increase in metabolic-dysfunction-associated liver disease, which made us question the possible connection between COVID-19 infections and subsequent risk of metabolic conditions,” explained Lt. Cmdr. Kristan E. Madison, MD, MS, of the Navy at Uniformed Services University of the Health Sciences School of Medicine. “The COVID-19 pandemic changed the landscape of not only healthcare, but society. During this transition to life after the COVID-19 pandemic, we felt it was important for us to continue to question how COVID-19 infections have continued to affect the health and wellness of military personnel.”
In addition to the Uniformed Services University of the Health Sciences in Bethesda, MD, the study authors are affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine in Bethesda, MD; Joint Base McGuire-Dix-Lakehurst, NJ; and Tripler Army Medical Center in Honolulu.
In this propensity score-matched cohort study, the researchers used MHS data between July 2020 and June 2021 of active-duty service members aged 18 to 65 years old. They identified COVID-19 infections through ICD-10 codes or laboratory results and developed a 1:2 matched cohort that compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes evaluated in the study included incident diagnoses of Type 2 diabetes mellitus, hypertension, hyperlipidemia, metabolic dysfunction-associated steatotic liver disease and metabolic syndrome within 1 year. Statistical analyses were used to calculate adjusted hazard ratios while controlling for obesity and overweight status.
The study found that COVID-19 infection was associated with significantly increased risk of developing hypertension, hyperlipidemia and metabolic dysfunction-associated steatotic liver disease, highlighting the important lasting metabolic consequences in a young, healthy population. The association remained significant after adjusting for a prior diagnosis of overweight or obesity. The findings strengthen the evidence for a direct association between SARS-CoV-2 infection and long-term metabolic consequences, the researchers pointed out.
“COVID-19 can put our active-duty servicemembers at risk months after a COVID-19 infection, potentially decreasing their long-term readiness and quality of life,” Madison told U.S. Medicine. “It is important to follow through with routine recommended screening such as blood pressure, body mass index and serum lipids as currently recommended. Additional liver enzyme screening may be indicated especially in those who are overweight or obese.”
The servicemembers in the study, with and without COVID-19 infection, had a median age of 26 years old, and most participants were male (81.1%). The investigators determined that COVID-19 infection was associated with significantly increased hazards for incident hypertension (aHR 1.09; 95% CI, 1.01-1.18), hyperlipidemia (aHR 1.30; 95% CI, 1.10-1.54) and metabolic dysfunction-associated steatotic liver disease (aHR 1.36; 95% CI, 1.15–1.60).
No significant increased risk was observed for Type 2 diabetes mellitus or metabolic syndrome, however. These findings likely reflect the younger age and generally healthy baseline health of the active-duty servicemember cohort. Lower numbers or lack of formal diagnosis could explain the lack of association between COVID-19 and metabolic syndrome in this population, the authors suggested.
“As a military clinician in conjunction with being a researcher, the study results, most importantly the increased risk of high blood pressure, high cholesterol and liver disease in an otherwise young, healthy population following COVID-19 infections, suggests that we as a medical community may need to monitor and screen active-duty service members for these metabolic conditions to minimize long-term complications,” Madison said.
Young, healthy and athletic individuals are often considered low risk, which might lead to standard yearly screening for most metabolic diseases. However, these study results suggest that clinicians should reevaluate risk and increase screenings for those affected by COVID-19 or who are overweight or have obesity, allowing for earlier intervention to prevent long-term chronic disease, Madison suggested.
The researchers explained that the link between COVID-19 and metabolic syndrome arises from the ability of the virus to use the ACE2 receptor to trigger inflammation in key metabolic organs, which leads to secondary hypertension, dyslipidemia and steatotic liver disease. In this study, they discovered that, while COVID-19 increased the risk of these metabolic conditions, it didn’t significantly shorten the median time to diagnosis, which consistently remained around 6 to 7 months for all conditions. The findings suggest that COVID-19 is a risk factor that increases the overall incidence of these diagnoses without altering the underlying latency period.
The results in this population could shift the paradigm of risk factors for metabolic disease, such as age and sedentary lifestyle, to include anyone infected with COVID-19. The study didn’t explore the effects of COVID-19 vaccination or long-term effects beyond a year, but it might be reasonable to consider that methods to prevent COVID-19 infections may also prevent secondary metabolic dysfunction and cardiovascular disease, the researchers noted.
Continued surveillance and targeted research are critical to understanding the long-term health consequences of COVID-19 and to advise appropriate preventative and management strategies, the investigators recommended.
Limitations of the study include the 1-year follow-up period, which may be a short interval to capture all long-term metabolic consequences of COVID-19, such as Type 2 diabetes mellitus or metabolic syndrome. The study also was unable to fully account for undiagnosed preexisting conditions or genetic predispositions that could influence metabolic outcomes. Other limitations were that using ICD-10 diagnosis codes could lead to misclassification bias. The findings may also have limited generalizability to the U.S. population because of the unique circumstances involved with military personnel, including health profile, living environments, rigorous physical training standards and universal healthcare access. Lastly, the study didn’t adjust for disease severity due to limited measures for assessing this through the study design, which primarily used ICD-10 codes and COVID-19 diagnostic laboratory testing.
- Sexton KW, Berill Z, Susi A, Coene J, Madison KE, Nylund CM. The Metabolic Aftershock: COVID-19 and Metabolic Disease Risk Among U.S. Active-Duty Military Personnel. Metabolites. 2025 Dec 14;15(12):795. doi: 10.3390/metabo15120795. PMID: 41441037; PMCID: PMC12734589.