Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children
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María Lola Evia-Viscarra
und
Rodolfo Guardado-Mendoza
Abstract
Background
There is no consensus on the definition of metabolically healthy obesity (MHO) and the diagnostic criteria in children.
Objectives
To estimate the prevalence of MHO and compare clinical and biochemical characteristics between MHO and metabolically unhealthy obesity (MUO), and to evaluate the association between MUO and cardiovascular disease (CVD) risk, anthropometrics and family background using different definitions in children.
Methods
This was a cross-sectional study. Participants included 224 obese children between the years 2007 and 2017. MHO was defined by three different criteria: (i) absence of metabolic syndrome (MHO-MS), (ii) no insulin resistance (IR) by homeostatic model assessment (HOMA) <3.16 cut-off (MHO-IR3.16) and (iii) absence of IR at <95th percentile for Mexican children (MHO-95th).
Results
The prevalence of MHO-MS, MHO-IR3.16 and MHO-IR95th was 12.9%, 56.3% and 41.5%, respectively. The prevalence of simultaneous MHO-MS plus MHO-IR95th was 5.36%. Children with MHO-MS vs. MUO-MS showed lower height, weight and body mass index (BMI) percentiles; MHO-IR3.16 vs. MUO-IR3.16 showed lower age, acanthosis, Tanner, waist circumference (WC), waist-to-height ratio (WHtR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and glucose; and MHO-IR95th vs. MUO-IR95th showed lower acanthosis, WC, DBP, glucose and high high-density lipoprotein cholesterol (HDL-C). MUO-MS was associated with WC > 90th, type 2 diabetes mellitus (T2DM) in first-degree relatives and obesity in siblings. MUO-IR3.16 was associated with pubertal stages, WC > 90th, WHtR > 0.55 and fasting hyperglycemia. MUO-IR95th was associated with WHtR > 0.55 and HDL < 10th. MHO-MS and MHO-IR3.16 or MHO-IR95th did not have agreement.
Conclusions
The prevalence of MHO varied depending on the definition, although the real MHO with no MS or IR is very low. Low DBP and high HDL-C in MHO were present in any definition. Association of MUO with anthropometric, biochemical and family background differs across definitions.
Acknowledgments
The authors thank Dr. Luis Fernando Meneses Rojas for the text revision.
Author contributions: All authors have accepted responsibility for the content of this submitted manuscript and approved its submission.
Research funding: HRAEB resources for research were the only funding to carry out this study.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design, data collection, analysis or interpretation; writing of the report, or in the decision to submit the report for publication.
References
1. Karelis AD, St-Pierre DH, Conus F, Rabasa-Lhoret R, Poehlman ET. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab 2004;89:2569–75.10.1210/jc.2004-0165Suche in Google Scholar
2. Stefan N, Häring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol 2013;1:152–62.10.1016/S2213-8587(13)70062-7Suche in Google Scholar
3. Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab 2001;86:1020–5.10.1210/jc.86.3.1020Suche in Google Scholar
4. Blüher 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 PubMed
5. Kelishadi R, Hashemipour M, Sarrafzadegan N, Mohammadifard N, Alikhasy H, et al. Effects of a lifestyle modification trial among phenotypically obese metabolically normal and phenotypically obese metabolically abnormal adolescents in comparison with phenotypically normal metabolically obese adolescents. Matern Child Nutr 2010;6:275–86.10.1111/j.1740-8709.2009.00207.xSuche in Google Scholar PubMed PubMed Central
6. 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;ID 98613:10.10.1155/2013/984613Suche in Google Scholar PubMed PubMed Central
7. Weghuber D, Zelzer S, Stelzer I, Paulmichl K, Kammerhofer D, et al. High risk vs. “metabolically healthy” phenotype in juvenile obesity – neck subcutaneous adipose tissue and serum uric acid are clinically relevant. Exp Clin Endocrinol Diabetes 2013;121:384–90.10.1055/s-0033-1341440Suche in Google Scholar PubMed
8. 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
9. 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
10. Vukovic R, Mitrovic K, Milenkovic T, Todorovic S, Soldatovic I, et al. Insulin-sensitive obese children display a favorable metabolic profile. Eur J Pediatr 2013;172:201–6.10.1007/s00431-012-1867-5Suche 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. Hernández-Cordero S, Cuevas-Nasu L, Morán-Ruán MC, Méndez-Gómez Humarán I, Ávila-Arcos MA, et al. Overweight and obesity in Mexican children and adolescents during the last 25 years. Nutr Diabetes 2017;7:e247.10.1038/nutd.2016.52Suche in Google Scholar PubMed PubMed Central
13. Evia-Viscarra ML, Rodea-Montero ER, Apolinar-Jiménez E, Quintana-Vargas S. Metabolic syndrome and its components among obese (BMI >=95th) Mexican adolescents. Endocr Connect 2013;2:208–15.10.1530/EC-13-0057Suche in Google Scholar PubMed PubMed Central
14. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat Ser 11 2002;246:1–190.Suche in Google Scholar
15. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004;145:439–44.10.1016/j.jpeds.2004.06.044Suche in Google Scholar PubMed
16. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140:e20171904.10.1542/9781610024310-part03-ch13Suche in Google Scholar
17. Burke JP, Hale DE, Hazuda HP, Stern MP. A quantitative scale of acanthosis nigricans. Diabetes Care 1999;22:1655–9.10.2337/diacare.22.10.1655Suche in Google Scholar PubMed
18. Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198–208.10.1542/peds.2008-1349Suche in Google Scholar PubMed
19. Valaiyapathi B, Sunil B, Ashraf AP. Approach to hypertriglyceridemia in the pediatric population. Pediatr Rev 2017;38:424–34.10.1542/pir.2016-0138Suche in Google Scholar PubMed
20. Cook S, Weitzman M, Auinger P, Michael N, Dietz W. Prevalence of a metabolic syndrome phenotype in adolescents. Arch Pediatr Adolesc Med 2003;157:821–7.10.1001/archpedi.157.8.821Suche in Google Scholar PubMed
21. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500–3.10.1542/peds.2004-1921Suche in Google Scholar PubMed
22. Aradillas-García C, Rodríguez-Morán M, Garay-Sevilla ME, Malacara JM, Rascon-Pacheco RA, et al. Distribution of the homeostasis model assessment of insulin resistance in Mexican children and adolescents. Eur J Endocrinol 2012;166:301–6.10.1530/EJE-11-0844Suche in Google Scholar
23. León-Mimila P, Villamil-Ramírez H, Villalobos-Comparán M, Villarreal-Molina T, Romero-Hidalgo S, et al. Contribution of common genetic variants to obesity and obesity-related traits in Mexican children and adults. PLoS One 2013;8:e70640.10.1371/journal.pone.0070640Suche in Google Scholar
24. Sánchez-Pozos K, Menjívar M. Genetic component of type 2 diabetes in a Mexican population. Arch Med Res 2016;47:496–505.10.1016/j.arcmed.2016.12.007Suche in Google Scholar
25. Tschann JM, Martinez SM, Penilla C, Gregorich SE, Pasch LA, et al. Parental feeding practices and child weight status in Mexican American families: a longitudinal analysis. Int J Behav Nutr Phys Act 2015;12:1–10.10.1201/9781315365732-4Suche in Google Scholar
26. Holloway WR, Collier FM, Aitken CJ, Myers DE, Hodge JM, et al. Leptin inhibits osteoclast generation. J Bone Miner Res 2002;17:200–9.10.1359/jbmr.2002.17.2.200Suche in Google Scholar
27. Shalitin S, Kiess W. Putative effect of obesity on linear growth and puberty. Horm Res Paediatr 2017;88:101–10.10.1159/000455968Suche in Google Scholar
28. Rashid S, Watanabe T, Sakaue T, Lewis GF. Mechanisms of HDL lowering in insulin resistant, hypertriglyceridemic states: the combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity. Clin Biochem 2003;36:421–9.10.1016/S0009-9120(03)00078-XSuche in Google Scholar
29. Wirix AJ, Kaspers PJ, Nauta J, Chinapaw MJ, Kist-van Holthe JE. Pathophysiology of hypertension in obese children: a systematic review. Obes Rev 2015;16:831–42.10.1111/obr.12305Suche in Google Scholar PubMed
30. Elmaogullari S, Demirel F, Hatipoglu N. Risk factors that affect metabolic health status in obese children. J Pediatr Endocrinolog Metab 2017;30:49–55.10.1515/jpem-2016-0128Suche in Google Scholar PubMed
31. Neri C, Edlow AG. Effects of maternal obesity on fetal programming: molecular approaches. Cold Spring Harb Perspect Med 2015;6:a026591.10.1101/cshperspect.a026591Suche in Google Scholar PubMed PubMed Central
32. McMorrow AM, Connaughton RM, Lithander FE, Roche HM. Adipose tissue dysregulation and metabolic consequences in childhood and adolescent obesity: potential impact of dietary fat quality. Proc Nutr Soc 2015;74:67–82.10.1017/S002966511400158XSuche in Google Scholar
33. Reinehr T, Wolters B, Knop C, Lass N, Holl RW. Strong effect of pubertal status on metabolic health in obese children: a longitudinal study. J Clin Endocrinol Metab 2015;100:301–8.10.1210/jc.2014-2674Suche in Google Scholar
34. Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, et al. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol 2018;6:714–24.10.1016/S2213-8587(18)30137-2Suche in Google Scholar
©2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Air occlusion in insulin pumps of children and adolescents with type 1 diabetes
- Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus
- Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication
- Ghrelin, obestatin and the ghrelin/obestatin ratio as potential mediators for food intake among obese children: a case control study
- Association between neck circumference and non-alcoholic fatty liver disease in Mexican children and adolescents with obesity
- Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children
- Evidence in obese children: contribution of tri-ponderal mass index or body mass index to dyslipidemia, obesity-inflammation, and insulin sensitivity
- Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents
- Cortisol secretion pattern in overweight/obese and normal-weight infants: a cross-sectional study
- Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity
- Relative leptin deficiency in children with severe early-onset obesity (SEOO) – results of the Early-onset Obesity and Leptin – German-Polish Study (EOL-GPS)
- Novel associations of serum adropin and lipopolysaccharide-binding protein versus lipid profiles in childhood obesity
- The trade-off between the olfactory bulb and eyeball volume in precocious puberty
- Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents
- Presentation of 14 alkaptonuria patients from Turkey
- Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia
- Case Reports
- Familial hypophosphatemic rickets caused by a PHEX gene mutation accompanied by a NPR2 missense mutation
- Cinacalcet treatment experience in hereditary vitamin D resistant rickets
- Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? – case report and literature review
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Air occlusion in insulin pumps of children and adolescents with type 1 diabetes
- Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus
- Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication
- Ghrelin, obestatin and the ghrelin/obestatin ratio as potential mediators for food intake among obese children: a case control study
- Association between neck circumference and non-alcoholic fatty liver disease in Mexican children and adolescents with obesity
- Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children
- Evidence in obese children: contribution of tri-ponderal mass index or body mass index to dyslipidemia, obesity-inflammation, and insulin sensitivity
- Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents
- Cortisol secretion pattern in overweight/obese and normal-weight infants: a cross-sectional study
- Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity
- Relative leptin deficiency in children with severe early-onset obesity (SEOO) – results of the Early-onset Obesity and Leptin – German-Polish Study (EOL-GPS)
- Novel associations of serum adropin and lipopolysaccharide-binding protein versus lipid profiles in childhood obesity
- The trade-off between the olfactory bulb and eyeball volume in precocious puberty
- Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents
- Presentation of 14 alkaptonuria patients from Turkey
- Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia
- Case Reports
- Familial hypophosphatemic rickets caused by a PHEX gene mutation accompanied by a NPR2 missense mutation
- Cinacalcet treatment experience in hereditary vitamin D resistant rickets
- Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? – case report and literature review
