Fasting insulin resistance affects the prevalence of metabolically healthy obesity in Brazilian adolescents

Abstract

Aim We aimed to assess the influence of fasting insulin resistance on metabolically healthy obesity (MHO) prevalence in adolescents and to identify associated factors. Methods This retrospective, registry‐based, cross‐sectional study included 418 (51.9% girls) 10‐ to 18‐year‐old adolescents with obesity from a tertiary outpatient clinic in Sao Paulo, Brazil, between 2009 and 2013. The prevalence of MHO was estimated according to two definitions: (i) no cardiometabolic risk factors (CMRF) by the International Diabetes Federation parameters and (ii) no CMRF and homeostatic model assessment for insulin resistance <3.16. Adjusted prevalence ratios and 95% confidence intervals (CI) evaluated the association of gender, age, pubertal stages, skin colour and degree of obesity with MHO. Results Metabolically healthy obesity prevalence was lower in definition II than definition I (12.7%; 95% CI 9.1–16.3% versus 43.1%; 95% CI 38.0–48.2%, respectively). Adjusted results showed negative association between severe obesity and MHO by both definitions (p ≤ 0.01). Male and later pubertal stages were also less likely to have MHO, but neither remained significant in definition II. Conclusion Metabolically healthy obesity prevalence decreased when insulin resistance was part of the definition. Detecting pre‐clinical insulin resistance may improve the management of treatment‐seeking adolescents, especially when they present no CMRF.

Insulin Resistance as a Diagnostic Criterion for Metabolically Healthy Obesity in Children

“…Indeed, the area under the ROC curve for the HOMA criterion indicates that the probability of diagnosing a patient more accurately than a randomly chosen healthy child is just 85.4%, whereas for the IDF criteria this is only 65.9%. Consequently, when we considered the four diagnostic criteria, the proportion of children classified with MHO was similar to some studies carried out in adults (32), and the children classified with MHO had clinical and analytical variables similar to those who theoretically have MUO. No statistically significant differences were found in any of the 19 variables analyzed except in the SBP percentile, which is precisely a criterion included in the definition with four criteria.…”

Risk factors, cutoff points, and definition of metabolically healthy/unhealthy obesity in children and adolescents: A scoping review of the literature

“…In addition, 102 full texts were carefully screened, and 39 more studies were removed because they were editorials or reviews and did not evaluate MHO/MUHO in children and/or adolescents. Accordingly, the scoping review included 63 studies 3,9,10,20–79 (Table 1).…”

“…Studies generally identified five groups of MHO definitions (Table 2): Group 1 ( n = 49; 77.8%) included zero risk factor, Group 2 ( n = 13; 20.6%) included ≤1 risk factor, Group 3 ( n = 3; 4.8%) included ≤2 risk factors, Group 4 ( n = 1; 1.6%) included ≤3 risk factors, and within Group 5 ( n = 1; 1.6%), data was defined based on quartile distributions. Some research have described more than one definition of MHO 3,9,23,28–30,32,52,56,61 . Estimates of MHO prevalence varied from 3% to 84.3% across the studies due to heterogeneity across various domains for defining the condition (Table 2).…”

“…Some research have described more than one definition of MHO. 3,9,23,[28][29][30]32,52,56,61 Estimates of MHO prevalence varied from 3% to 84.3% across the studies due to heterogeneity across various domains for defining the condition (Table 2).…”

Can Visceral Adiposity Index Serve as a Simple Tool for Identifying Individuals with Insulin Resistance in Daily Clinical Practice?

“…Liu et al in their study applied five different criteria of MHO in 4757 random adults to find the lowest prevalence of MHO (4.2%) when applying a criterion that included HOMA-IR (≤1.95) [7]. Also in adolescents, MHO prevalence decreases when IR is part of the criteria [24]. Khawaja et al in their study identified a definite disparity in cardiovascular risk between two groups of obese individuals-either with or without IR, along with a correspondingly unfavorable metabolic profile in the latter [25].…”