Association between obesity phenotypes in adolescents and adult metabolic syndrome: Tehran Lipid and Glucose Study

Abstract

Obesity phenotypes can be regarded as an indicator of CVD risk factors. The aim of the present study was to determine the prevalence of adolescents with different obesity phenotypes and the role of obesity phenotypes in prediction of the metabolic syndrome (MetS) in adults. For this population-based cohort study, 2159 adolescents aged 11–18 years were included. Subjects were divided into four obesity phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Cox proportional hazard modelling was used to estimate the incidence of the MetS in adults after a median follow-up of 11·3 years. The incidence rate of the MetS in early adulthood was 111·6 (95 % CI 98·7, 126·3) per 10 000 person-years, with higher values in boys (210·1 (95 % CI 183·0, 241·3)), compared with girls (39·7 (95 % CI 30·2, 52·1)). In the age- and adult BMI-adjusted model, the hazard ratio of the MetS in adulthood for boys was 3·33 (95 % CI 2·08, 5·32) among MUO phenotype followed less than 6 years, 1·71 (95 % CI 1·01, 2·90) among MHO, and 2·52 (95 % CI 1·72, 3·68) among MUNW. All associations were attenuated in girls except for MUO phenotype followed less than 6 years (5·72 (95 % CI 2·14, 15·3)). In conclusion, MUNW and MHO phenotypes in boys, but not in girls, and MUO phenotype in both sexes with less than 6 years of follow-up increased the risk of adult MetS compared with MHNW. It seems that lack of obesity at least in boys does not protect them from MetS development in adulthood.

Defining metabolically healthy obesity in children: a scoping review

“…A universal MHO definition is crucial to advance this field and limit the variability in definitions ; further, consistency in MHO definition will facilitate comparisons across studies . However, our definition lacked consensus on what measure of glycemia should be used, although most of the studies we included used FG ≤ 100 mg/dL (or ≤ 5.6 mmol/L) . Moreover, our panel did not achieve consensus on including insulin in the MHO definition.…”

“…First, there is no fixed set of risk factors to define MHO in children. For instance, some studies used a combination of cardiometabolic risk factors plus a measure of insulin , while others used either insulin alone or cardiometabolic risk factors alone . Although there were several combinations of risk factors, most of the criteria used to define MHO were based on definitions that have been applied to define the metabolic syndrome .…”

Anthropometric and body composition parameters in adolescents with the metabolically obese normal-weight phenotype

“…To evaluate the associations of anthropometric and body composition parameters (explanatory variables) with the MONW phenotype (outcome variable), Poisson regression with robust variance was employed, and prevalence ratios (PR) with 95% confidence interval (CI) were estimated. Two independent models were built for each explanatory variable, one crude and one adjusted for potential confounding factors defined according to the literature [6][7][8][9][10][11][12][13][14][15][16][17] (age, sex, physical activity level, socioeconomic condition, and fruit, vegetable, and legume consumption). Regression analysis was used in the total sample, and there was also stratification by sex and age (10 to 13 years old, 14 to 16 years old, and 17 to 19 years old).…”

“…Although the researches did already contribute with knowledge about the MONW phenotype, few studies on this subject have been performed with adolescents [11][12][13][14][15][16]. Besides, the phenotype can often be underdiagnosed in adolescents, due to normal body weight and young age [17].…”

Children’s Lipid Accumulation Product Combining Visceral Adiposity Index is a Novel Indicator for Predicting Unhealthy Metabolic Phenotype Among Chinese Children and Adolescents

“…However, some obese individuals with good metabolic characteristics, which were defined as metabolically healthy obesity, 3 individuals with normal-weight may develop metabolic disorders, which were defined as metabolically unhealthy normal-weight (MUNW). 4 Due to the different criteria used to define the metabolic phenotype, the prevalence of MUNW and metabolically unhealthy obesity ranged from 10.6% to 18.8% [5][6][7] and 1.3% to 14.3%, respectively, 5,6,8,9 among children and adolescents. Studies reported that unhealthy metabolic phenotype were associated with increased risk of cardiovascular risk factors.…”