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Risk factors that affect metabolic health status in obese children

  • Selin Elmaogullari EMAIL logo , Fatma Demirel und Nihal Hatipoglu
Veröffentlicht/Copyright: 19. Dezember 2016
Journal of Pediatric Endocrinology and Metabolism
Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 30 Heft 1

Abstract

Background:

While some obese children are metabolically healthy (MHO), some have additional health problems, such as hypertension, dyslipidemia, insulin resistance, and hepatosteatosis, which increase mortality and morbidity related to cardiovascular diseases (CVD) during adulthood. These children are metabolically unhealthy obese (MUO) children. In this study we assessed the factors that affect metabolic health in obesity and the clinical and laboratory findings that distinguish between MHO and MUO children.

Methods:

In total, 1085 patients aged 6–18 years, with age- and sex-matched BMI exceeding the 95th percentile were included in the study (mean 11.1±2.9 years, 57.6% female, 59.7% pubertal). Patients without dyslipidemia, insulin resistance, hepatosteatosis, or hypertension were considered as MHO. Dyslipidemia was defined as total cholesterol level over 200 mg/dL, triglyceride over 150 mg/dL, LDL over 130 mg/dL, or HDL under 40 mg/dL. Insulin resistance was calculated using the homeostasis model of assesment for insulin resistance (HOMA-IR) index. Hepatosteatosis was evaluated with abdominal ultrasound. Duration of obesity, physical activity and nutritional habits, screen time, and parental obesity were questioned. Thyroid and liver function tests were performed.

Results:

Six hundred and forty-two cases (59.2%) were MUO. Older age, male sex, increased BMI-SDS, and sedentary lifestyle were associated with MUO. Excessive junk food consumption was associated with MUO particularly among the prepubertal obese patients.

Conclusions:

Our results revealed that the most important factors that affect metabolic health in obesity are age and BMI. Positive effects of an active lifestyle and healthy eating habits are prominent in the prepubertal period and these habits should be formed earlier in life.

Keywords: children; metabolically healthy obesity; metabolically unhealthy obesity; obesity
Corresponding author: Selin Elmaogullari, MD, Ankara Children’s Hematology and Oncology Training and Research Hospital Department of Pediatric Endocrinology, Ziraat Mahallesi, Irfan Bastug Caddesi, Kurtdereli Sokak No: 10 Ankara, Turkey, Phone: +90 (532) 5808862, Fax: +90 (312) 347-2330

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, et al. Child and adolescent obesity: part of a bigger picture. Lancet 2015;385:2510–20.10.1016/S0140-6736(14)61746-3Suche in Google Scholar

2. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height, and body mass index, United States 1960–2002. Adv Data 2004;347:1–17.Suche in Google Scholar

3. McDowell MA, Fryar CD, Ogden CL, Flegal KM. Anthropometric reference data for children and adults: United States, 2003–2006. Natl Health Stat Report 2008;22:1–48.10.1037/e623932009-001Suche in Google Scholar

4. Olaya B, Moneta MV, Pez O, Bitfoi A, Carta MG, et al. Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries. BMC Public Health 2015;15:475.10.1186/s12889-015-1809-zSuche in Google Scholar PubMed PubMed Central

5. Organization WH. World Health Statistics 2015. 2015.Suche in Google Scholar

6. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 2015;131:e29–322.10.1161/CIR.0000000000000152Suche in Google Scholar PubMed

7. Mørkedal B, Vatten LJ, Romundstad PR, Laugsand LE, Janszky I. Risk of myocardial infarction and heart failure among metabolically healthy but obese Individuals HUNT (Nord-Trøndelag Health Study), Norway. J Am Coll Cardiol 2014;63:1071–8.10.1016/j.jacc.2013.11.035Suche in Google Scholar PubMed

8. Ortega FB, Lee DC, Katzmarzyk PT, Ruiz JR, Sui X, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J 2013;34:389–97.10.1093/eurheartj/ehs174Suche in Google Scholar PubMed PubMed Central

9. 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):S142–9.10.1093/aje/kws236Suche in Google Scholar PubMed PubMed Central

10. Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord 2013;14:219–27.10.1007/s11154-013-9252-xSuche in Google Scholar PubMed

11. Heinzle S, Ball GD, Kuk JL. Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents. Pediatr Obes 2016;11:425–33.10.1111/ijpo.12083Suche in Google Scholar PubMed PubMed Central

12. Choi MK, Han YA, Roh YK. Utility of obesity indicators for metabolically healthy obesity: an observational study using the Korean National Health and Nutrition Examination Survey (2009–2010). BMC Public Health 2014;14:1166.10.1186/1471-2458-14-1166Suche in Google Scholar PubMed PubMed Central

13. Bluher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood – does weight status alone matter? Metabolism 2014;63:1084–92.10.1016/j.metabol.2014.06.009Suche in Google Scholar

14. Senechal M, Wicklow B, Wittmeier K, Hay J, MacIntosh AC, et al. Cardiorespiratory fitness and adiposity in metabolically healthy overweight and obese youth. Pediatrics 2013;132:e85–92.10.1542/peds.2013-0296Suche in Google Scholar

15. Karelis AD, Rabasa-Lhoret R. Obesity: can inflammatory status define metabolic health? Nat Rev Endocrinol 2013;9:694–5.10.1038/nrendo.2013.198Suche in Google Scholar

16. Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab 2012;97:2482–8.10.1210/jc.2011-3475Suche in Google Scholar

17. Neyzi O, Bundak R, Gokcay G, Gunoz H, Furman A, et al. Reference values for weight, height, head circumference, and body mass index in Turkish Children. J Clin Res Pediatr Endocrinol 2015;7:280–93.10.4274/jcrpe.2183Suche in Google Scholar

18. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555–76.10.1542/peds.114.S2.555Suche in Google Scholar

19. Organization WH. Global recommendations on physical activity for health. 2010.Suche in Google Scholar

20. Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab 2011;36:59–64; 65–71.10.1139/H11-012Suche in Google Scholar

21. Warnick GR, Knopp RH, Fitzpatrick V, Branson L. Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints. Clin Chem 1990;36:15–9.10.1093/clinchem/36.1.15Suche in Google Scholar

22. Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198–208.10.1542/peds.2008-1349Suche in Google Scholar

23. Tamir I, Heiss G, Glueck C, Christensen B, Kwiterovich P, et al. Lipid and lipoprotein distributions in white children ages 6–19 yr. The Lipid Research Clinics Program Prevalence Study. J Chronic Dis 1981;34:27–39.10.1016/0021-9681(81)90079-5Suche in Google Scholar

24. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.10.1007/BF00280883Suche in Google Scholar PubMed

25. Valerio G, Licenziati MR, Iannuzzi A, Franzese A, Siani P, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis 2006;16:279–84.10.1016/j.numecd.2005.12.007Suche in Google Scholar PubMed

26. Mert A, Kılıç, İ. Karaciğer Ultrasonografisi, Yağlı Karaciğer, Ultrasonografiye Giriş Cilt 11997.Suche in Google Scholar

27. Bokor S, Frelut ML, Vania A, Hadjiathanasiou CG, Anastasakou M, et al. Prevalence of metabolic syndrome in European obese children. Int J Pediatr Obes 2008;(3 Suppl 2):3–8.10.1080/17477160802404509Suche in Google Scholar PubMed

28. Camhi SM, Waring ME, Sisson SB, Hayman LL, Must A. Physical activity and screen time in metabolically healthy obese phenotypes in adolescents and adults. J Obes 2013;2013:984613.10.1155/2013/984613Suche in Google Scholar PubMed PubMed Central

29. Chun S, Lee S, Son HJ, Noh HM, Oh HY, et al. Clinical Characteristics and Metabolic Health Status of Obese Korean Children and Adolescents. Korean J Fam Med 2015;36:233–8.10.4082/kjfm.2015.36.5.233Suche in Google Scholar PubMed PubMed Central

30. Prince RL, Kuk JL, Ambler KA, Dhaliwal J, Ball GD. Predictors of metabolically healthy obesity in children. Diabetes Care 2014;37:1462–8.10.2337/dc13-1697Suche in Google Scholar PubMed

31. Wicklow BA, Wittmeier KD, MacIntosh AC, Sellers EA, Ryner L, et al. Metabolic consequences of hepatic steatosis in overweight and obese adolescents. Diabetes Care 2012;35:905–10.10.2337/dc11-1754Suche in Google Scholar PubMed PubMed Central

32. Marcus MD, Foster GD, El Ghormli L, Baranowski T, Goldberg L, et al. Shifts in BMI category and associated cardiometabolic risk: prospective results from HEALTHY study. Pediatrics 2012;129:e983–91.10.1542/peds.2011-2696Suche in Google Scholar PubMed PubMed Central

33. Vukovic R, Milenkovic T, Mitrovic K, Todorovic S, Plavsic L, et al. Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents. Eur J Pediatr 2015;174:1649–55.10.1007/s00431-015-2587-4Suche in Google Scholar PubMed

34. Mangge H, Zelzer S, Puerstner P, Schnedl WJ, Reeves G, et al. Uric acid best predicts metabolically unhealthy obesity with increased cardiovascular risk in youth and adults. Obesity (Silver Spring). 2013;21:E71–7.10.1002/oby.20061Suche in Google Scholar PubMed

35. Silva JE. Thermogenic mechanisms and their hormonal regulation. Physiol Rev 2006;86:435–64.10.1152/physrev.00009.2005Suche in Google Scholar PubMed

36. Iwen KA, Schroder E, Brabant G. Thyroid hormones and the metabolic syndrome. Eur Thyroid J 2013;2:83–92.10.1159/000351249Suche in Google Scholar PubMed PubMed Central

37. Ichiki T. Thyroid hormone and vascular remodeling. J Atheroscler Thromb 2016;23:266–75.10.5551/jat.32755Suche in Google Scholar PubMed

38. Cordeiro A, Souza LL, Einicker-Lamas M, Pazos-Moura CC. Non-classic thyroid hormone signalling involved in hepatic lipid metabolism. J Endocrinol 2013;216:R47–57.10.1530/JOE-12-0542Suche in Google Scholar PubMed

39. Stanicka S, Vondra K, Pelikanova T, Vlcek P, Hill M, et al. Insulin sensitivity and counter-regulatory hormones in hypothyroidism and during thyroid hormone replacement therapy. Clin Chem Lab Med 2005;43:715–20.10.1515/CCLM.2005.121Suche in Google Scholar PubMed

40. Dekelbab BH, Abou Ouf HA, Jain I. Prevalence of elevated thyroid-stimulating hormone levels in obese children and adolescents. Endocr Pract 2010;16:187–90.10.4158/EP09176.ORSuche in Google Scholar PubMed

41. Marwaha RK, Tandon N, Garg MK, Ganie MA, Narang A, et al. Impact of body mass index on thyroid functions in Indian children. Clin Endocrinol 2013;79:424–8.10.1111/cen.12148Suche in Google Scholar PubMed

42. Ortega FJ, Jilkova ZM, Moreno-Navarrete JM, Pavelka S, Rodriguez-Hermosa JI, et al. Type I iodothyronine 5′-deiodinase mRNA and activity is increased in adipose tissue of obese subjects. Int J Obes (Lond) 2012;36:320–4.10.1038/ijo.2011.101Suche in Google Scholar PubMed

43. Zimmermann-Belsing T, Brabant G, Holst JJ, Feldt-Rasmussen U. Circulating leptin and thyroid dysfunction. Eur J Endocrinol 2003;149:257–71.10.1530/eje.0.1490257Suche in Google Scholar PubMed

44. Nannipieri M, Cecchetti F, Anselmino M, Camastra S, Niccolini P, et al. Expression of thyrotropin and thyroid hormone receptors in adipose tissue of patients with morbid obesity and/or type 2 diabetes: effects of weight loss. Int J Obes (Lond) 2009;33:1001–6.10.1038/ijo.2009.140Suche in Google Scholar PubMed

45. Menendez C, Baldelli R, Camina JP, Escudero B, Peino R, et al. TSH stimulates leptin secretion by a direct effect on adipocytes. J Endocrinol 2003;176:7–12.10.1677/joe.0.1760007Suche in Google Scholar PubMed

46. Burman KD, Latham KR, Djuh YY, Smallridge RC, Tseng YC, et al. Solubilized nuclear thyroid hormone receptors in circulating human mononuclear cells. J Clin Endocrinol Metab 1980;51:106–16.10.1210/jcem-51-1-106Suche in Google Scholar PubMed

47. Ajjan RA, Watson PF, Findlay C, Metcalfe RA, Crisp M, et al. The sodium iodide symporter gene and its regulation by cytokines found in autoimmunity. J Endocrinol 1998;158:351–8.10.1677/joe.0.1580351Suche in Google Scholar PubMed

48. Elmaogullari S, Tepe D, Ucakturk A, Demirel F. Prevalence of dyslipidemia and associated factors among obese Turkish children. 2015;7:228–34.10.4274/jcrpe.1867Suche in Google Scholar PubMed PubMed Central

49. Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P. Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr 2010;64:1043–51.10.1038/ejcn.2010.114Suche in Google Scholar PubMed

50. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, 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;168:1617–24.10.1001/archinte.168.15.1617Suche in Google Scholar PubMed

51. Li L, Shen T, Wen LM, Wu M, He P, et al. Lifestyle factors associated with childhood obesity: a cross-sectional study in Shanghai, China. BMC Res Notes 2015;8:6.10.1186/s13104-014-0958-ySuche in Google Scholar PubMed PubMed Central

52. LeBlanc AG, Katzmarzyk PT, Barreira TV, Broyles ST, Chaput JP, et al. Correlates of total sedentary time and screen time in 9–11 year-old children around the world: the international study of childhood obesity, lifestyle and the environment. PLoS One 2015;10:e0129622.10.1371/journal.pone.0129622Suche in Google Scholar PubMed PubMed Central

53. Biddle SJ, Gorely T, Marshall SJ. Is television viewing a suitable marker of sedentary behavior in young people? Ann Behav Med 2009;38:147–53.10.1007/s12160-009-9136-1Suche in Google Scholar PubMed

54. Rondanelli M, Klersy C, Perna S, Faliva MA, Montorfano G, et al. Effects of two-months balanced diet in metabolically healthy obesity: lipid correlations with gender and BMI-related differences. Lipids Health Dis 2015;14:139.10.1186/s12944-015-0131-1Suche in Google Scholar PubMed PubMed Central

55. Karelis AD, Messier V, Brochu M, Rabasa-Lhoret R. Metabolically healthy but obese women: effect of an energy-restricted diet. Diabetologia 2008;51:1752–4.10.1007/s00125-008-1038-4Suche in Google Scholar PubMed

Received: 2016-4-1
Accepted: 2016-11-7
Published Online: 2016-12-19
Published in Print: 2017-1-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Disorders of sex development
  4. Original Articles
  5. Fertility and sexual function: a gap in training in pediatric endocrinology
  6. Disorders of sex development in children in KwaZulu-Natal Durban South Africa: 20-year experience in a tertiary centre
  7. Novel mutations of the SRD5A2 and AR genes in Thai patients with 46, XY disorders of sex development
  8. Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?
  9. Anti-hyperglycemic activity of Aegle marmelos (L.) corr. is partly mediated by increased insulin secretion, α-amylase inhibition, and retardation of glucose absorption
  10. Risk factors that affect metabolic health status in obese children
  11. Nocturnal levels of chemerin and progranulin in adolescents: influence of sex, body mass index, glucose metabolism and sleep
  12. Elevated endogenous secretory receptor for advanced glycation end products (esRAGE) levels are associated with circulating soluble RAGE levels in diabetic children
  13. Food exchange estimation by children with type 1 diabetes at summer camp
  14. Usefulness of non-fasting lipid parameters in children
  15. Monitoring steroid replacement therapy in children with congenital adrenal hyperplasia
  16. Clinical and molecular characterization of Beckwith-Wiedemann syndrome in a Chinese population
  17. An analysis of the sequence of the BAD gene among patients with maturity-onset diabetes of the young (MODY)
  18. Case Reports
  19. Hypogonadotropic hypogonadism in a female patient with congenital arhinia
  20. Transdermal testosterone gel for induction and continuation of puberty in adolescent boys with hepatic dysfunction
  21. Long-term response to growth hormone therapy in a patient with short stature caused by a novel heterozygous mutation in NPR2
  22. Three cases of Japanese acromicric/geleophysic dysplasia with FBN1 mutations: a comparison of clinical and radiological features
https://doi.org/10.1515/jpem-2016-0128
Schlagwörter für diesen Artikel
children; metabolically healthy obesity; metabolically unhealthy obesity; obesity

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Disorders of sex development
  4. Original Articles
  5. Fertility and sexual function: a gap in training in pediatric endocrinology
  6. Disorders of sex development in children in KwaZulu-Natal Durban South Africa: 20-year experience in a tertiary centre
  7. Novel mutations of the SRD5A2 and AR genes in Thai patients with 46, XY disorders of sex development
  8. Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?
  9. Anti-hyperglycemic activity of Aegle marmelos (L.) corr. is partly mediated by increased insulin secretion, α-amylase inhibition, and retardation of glucose absorption
  10. Risk factors that affect metabolic health status in obese children
  11. Nocturnal levels of chemerin and progranulin in adolescents: influence of sex, body mass index, glucose metabolism and sleep
  12. Elevated endogenous secretory receptor for advanced glycation end products (esRAGE) levels are associated with circulating soluble RAGE levels in diabetic children
  13. Food exchange estimation by children with type 1 diabetes at summer camp
  14. Usefulness of non-fasting lipid parameters in children
  15. Monitoring steroid replacement therapy in children with congenital adrenal hyperplasia
  16. Clinical and molecular characterization of Beckwith-Wiedemann syndrome in a Chinese population
  17. An analysis of the sequence of the BAD gene among patients with maturity-onset diabetes of the young (MODY)
  18. Case Reports
  19. Hypogonadotropic hypogonadism in a female patient with congenital arhinia
  20. Transdermal testosterone gel for induction and continuation of puberty in adolescent boys with hepatic dysfunction
  21. Long-term response to growth hormone therapy in a patient with short stature caused by a novel heterozygous mutation in NPR2
  22. Three cases of Japanese acromicric/geleophysic dysplasia with FBN1 mutations: a comparison of clinical and radiological features
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