Ann Pediatr Endocrinol Metab.  2020 Dec;25(4):256-264. 10.6065/apem.2040052.026.

Metabolically healthy overweight adolescents: definition and components

• Videira-Silva A
• Freira S
• Fonseca H

• KMID: 2510897
• DOI: http://doi.org/10.6065/apem.2040052.026

Abstract

Purpose
In adolescents, the definition and clinical implications of metabolically healthy overweight (MHO) status have not been established. This study aimed to investigate the prevalence of MHO according to its most widespread definition, which is based on metabolic syndrome (MS), and to explore further metabolic indicators such as Homeostatic Model Assessment of Insulin Resistance, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and C-reactive protein levels, together with metabolic health predictors in a sample of adolescents attending a pediatric obesity clinic.
Methods
Data from 487 adolescents categorized as overweight (52.6% females, 88.1% white), with a mean body mass index (BMI) z-score of 2.74 (±1.07 standard deviation [SD]), and a mean age of 14.4 years (±2.2 SD) were cross-sectionally analyzed. From this original sample, a subsample of 176 adolescents underwent a second assessment at 12 (±6 SD) months for longitudinal analysis.
Results
From the 487 adolescents originally analyzed, 200 (41.1%) were categorized as MHO, but only 93 (19.1%) had none of the metabolic indicators considered in this study. According to longitudinal analysis, 30 of the 68 adolescents (44%) categorized as MHO at baseline became non-MHO over time. BMI z-score was the best predictor of metabolic health both in cross-sectional and longitudinal analyses. Increased BMI z-score reduced the odds of being categorized as MHO (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4–0.9; P=.008) and increased the odds of having hypertension (OR 2.1, 95% CI: 1.4–3.3, P=0.001), insulin resistance (OR, 2.4; 95% CI, 1.4–4.1, P=0.001), or a proinflammatory state (OR, 1.2; 95% CI, 1.1–1.3, P=0.002).
Conclusion
Diagnosis of MHO should not be exclusively based on MS parameters, and other metabolic indicators should be considered. Adolescents categorized as overweight should participate in weight-management lifestyle interventions regardless of their metabolic health phenotype.

Keyword

Adolescents; Overweight; Weight management; Metabolic health; Metabolic Syndrome

Reference

References

1. Inchley J, Currie D, Jewell J, Breda J, Barnekow V. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002–2014. Geneva (Switzerland): World Health Organization;2017.

2. Sanders RH, Han A, Baker JS, Cobley S. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr. 2015; 174:715–46.

3. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013; 309:71–82.

4. Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008; 168:1609–16.

5. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch Intern Med. 2008; 168:1617–24.

6. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie ME, Messier V, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes (Lond). 2011; 35:971–81.

7. Shea JL, Randell EW, Sun G. The prevalence of metabolically healthy obese subjects defined by BMI and dual-energy X-ray absorptiometry. Obesity (Silver Spring). 2011; 19:624–30.

8. Cadenas-Sanchez C, Ruiz JR, Labayen I, Huybrechts I, Manios Y, González-Gross M, et al. Prevalence of metabolically healthy but overweight/obese phenotype and its association with sedentary time, physical activity, and fitness. J Adolesc Health. 2017; 61:107–14.

9. Heinzle S, Ball GD, Kuk JL. Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents. Pediatr Obes. 2016; 11:425–33.

10. Prince RL, Kuk JL, Ambler KA, Dhaliwal J, Ball GD. Predictors of metabolically healthy obesity in children. Diabetes Care. 2014; 37:1462–8.

11. Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood - does weight status alone matter? Metabolism. 2014; 63:1084–92.

12. Jolliffe CJ, Janssen I. Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol. 2007; 49:891–8.

13. Noronha JA, Medeiros CC, Cardoso AaS, Gonzaga NC, Ramos AT, Ramos AL. C-reactive protein and its relation to high blood pressure in overweight or obese children and adolescents. Rev Paul Pediatr. 2013; 31:331–7.

14. Namburi RP, Ponnala AR, Karthik TS, Rani PR, Maheshwari R. A study on metabolic variables and its association with high sensitive C-reactive protein in obese children and adolescents. Indian J Endocrinol Metab. 2013; 17(Suppl 1):S360–2.

15. Haney EM, Huffman LH, Bougatsos C, Freeman M, Steiner RD, Nelson HD. Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force. Pediatrics. 2007; 120:e189–214.

16. Sun M, Huang X, Jiang L, Yan Y, Li B, Zhong W, et al. Characterization of β-cell function and insulin resistance in overweight Chinese adolescents with normal glucose tolerance. Exp Ther Med. 2013; 6:547–51.

17. Manton ND, Lipsett J, Moore DJ, Davidson GP, Bourne AJ, Couper RT. Non-alcoholic steatohepatitis in children and adolescents. Med J Aust. 2000; 173:476–9.

18. Dâmaso AR, do Prado WL, de Piano A, Tock L, Caranti DA, Lofrano MC, et al. Relationship between nonalcoholic fatty liver disease prevalence and visceral fat in obese adolescents. Dig Liver Dis. 2008; 40:132–9.

19. Dansethakul P, Thapanathamchai L, Saichanma S, Worachartcheewan A, Pidetcha P. Determining a new formula for calculating low-density lipoprotein cholesterol: data mining approach. EXCLI J. 2015; 14:478–83.

20. Vanlancker T, Schaubroeck E, Vyncke K, Cadenas-Sanchez C, Breidenassel C, González-Gross M, et al. Comparison of definitions for the metabolic syndrome in adolescents. The HELENA study. Eur J Pediatr. 2017; 176:241–52.

21. Barja S, Arnaiz P, Domínguez A, Villarroel L, Cassis B, Castillo O, et al. Normal plasma insulin and HOMA values among Chilean children and adolescents. Rev Med Chil. 2011; 139:1435–43.

22. García Cuartero B, García Lacalle C, Jiménez Lobo C, González Vergaz A, Calvo Rey C, Alcázar Villar MJ, et al. The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children. An Pediatr (Barc). 2007; 66:481–90.

23. Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012; 54:700–13.

24. Lande MB, Pearson TA, Vermilion RP, Auinger P, Fernandez ID. Elevated blood pressure, race/ethnicity, and C-reactive protein levels in children and adolescents. Pediatrics. 2008; 122:1252–7.

25. Naing L, Winn T, Nordin R. Pratical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci. 2006; 1:9–14.

26. Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2009; 119:628–47.

27. Deivanayagam S, Mohammed BS, Vitola BE, Naguib GH, Keshen TH, Kirk EP, et al. Nonalcoholic fatty liver disease is associated with hepatic and skeletal muscle insulin resistance in overweight adolescents. Am J Clin Nutr. 2008; 88:257–62.

28. Berrahmoune H, Herbeth B, Samara A, Marteau JB, Siest G, Visvikis-Siest S. Five-year alterations in BMI are associated with clustering of changes in cardiovascular risk factors in a gender-dependant way: the Stanislas study. Int J Obes (Lond). 2008; 32:1279–88.

29. Li S, Chen W, Srinivasan SR, Xu J, Berenson GS. Relation of childhood obesity/cardiometabolic phenotypes to adult cardiometabolic profile: the Bogalusa Heart Study. Am J Epidemiol. 2012; 176 Suppl 7:S142–9.

30. Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord. 2013; 14:219–27.

31. Harding SK, Page AS, Falconer C, Cooper AR. Longitudinal changes in sedentary time and physical activity during adolescence. Int J Behav Nutr Phys Act. 2015; 12:44.

32. Cooper AR, Goodman A, Page AS, Sherar LB, Esliger DW, van Sluijs EM, et al. Objectively measured physical activity and sedentary time in youth: the International children's accelerometry database (ICAD). Int J Behav Nutr Phys Act. 2015; 12:113.

33. Crews F, He J, Hodge C. Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol Biochem Behav. 2007; 86:189–99.

34. Barlow SE, Committee E. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007; 120 Suppl 4:S164–92.

35. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric obesity-assessment, treatment, and prevention: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102:709–57.

36. eaven G. All obese individuals are not created equal: insulin resistance is the major determinant of cardiovascular disease in overweight/obese individuals. Diab Vasc Dis Res. 2005; 2:105–12.