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IntroductionThe prevalence of obesity constantly increases worldwide and definitely increases the risk of premature death in early adulthood. While there is no treatment yet with proven efficacy for the metabolic clamp such as arterial hypertension, dyslipidemia, insulin resistance, diabetes type 2, and fatty liver disease, it is imperative to find a way to decrease cardiometabolic complications. Early prevention strategies beginning in childhood are the most logical step to reduce future cardiovascular morbidity and mortality. Therefore, the aim of the current study is to determine the most sensitive and specific predictive markers of the metabolically unhealthy phenotype with high cardiometabolic risk in overweight/obese adolescent boys.MethodsThis study was carried out at the Ternopil Regional Children's hospital (Western Ukraine) and involved 254 randomly chosen adolescent overweight or obese boys [median age was 16.0 (15.0,16.1) years]. A control group of 30 healthy children with proportional body weight comparable in gender and age to the main group was presented. A list of anthropometrical markers with biochemical values of carbohydrate and lipid metabolism with hepatic enzymes was determined. All overweight/obese boys were divided into three groups: 51.2% of the boys with metabolic syndrome (MetS) based on the IDF criteria; 19.7% of the boys were metabolically healthy obese (MHO) without hypertension, dyslipidemia, and hyperglycemia; and the rest of the boys (29.1%) were classified as metabolically unhealthy obese (MUO) with only one criterion (hypertension, dyslipidemia, or hyperglycemia).ResultsBased on multiple logistic regression analysis that included all anthropometric and biochemical values and calculated indexes in boys from the MHO group and MetS, it was revealed that the maximum likelihood in the prediction of MetS makes the combination of triglyceride glucose index, pediatric nonalcoholic fatty liver disease fibrosis index (PNFI), and triglyceride-to-high-density lipoprotein cholesterol ratio (R2 =0.713, p<0.000). By tracing the receiver operating characteristic curve, the model is confirmed as a good predictor of MetS (AUC=0.898, odds ratio=27.111 percentage correct=86.03%) in overweight and obese boys.ConclusionTriglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are a valuable combination of predictive markers of the metabolically unhealthy phenotype in Ukrainian overweight/obese boys.

Introduction. Childhood obesity and associated metabolic comorbidities is a major global health concern. Metabolic syndrome (MS) is a cluster of metabolic abnormalities that confers a substantial increase in cardiovascular disease risk. In the context of the childhood obesity pandemic, a distinct subgroup of youth with obesity less prone to the development of metabolic disturbances, called “metabolically healthy obese” (MHO), recently has come into focus. However, the diagnostic criteria of both conditions are still controversial in children. Therefore, the purpose of our research is to estimate the prevalence of metabolic syndrome and metabolically healthy obesity in school-age boys using international reference standards and to recognize the most sensitive metabolic markers. Materials and methods. This study was carried out at the Ternopil regional hospital (Western Ukraine) and involved randomly chosen 112 boys from rural and urban population; aged 10–17 years (mean ± SD, 14.6 ± 0.25). Height, weight and waist and hip circumferences were measured by standard methods in each patient. Body mass index (BMI, kg/m2), waist-to-height ratio (WtHR), waist-to-hip ratio (WHR) were calculated by common formulas. Obesity was defined as a BMI  ≥ 2SD for age and gender. Blood pressure was measured and estimated according to European Society of Hypertension guidelines (2016). Biomarkers of carbohydrate and lipid metabolism were tested. Discussion. The study identified prominent physical and metabolic differences in groups of patients with MHO and manifested MS, as well as in the high-risk group for the realization of MS. As a result of this project, MHO and MS were confirmed in 49.11 % and 9.82 % surveyed boys, respectively. The rest of teenagers (32.14 %) based on metabolic disturbances, formed a cluster of the high-risk realization of MS. Moreover, fasting hyperglycemia and glucose intolerance were identified only in patients with manifested MS in 10.91 % and 5.45 % cases, respectively. It was found that the waist-to-height ratio > 0.5 is an informative test of obesity in general, and the waist-to-hip ratio > 0.9 is a sensitive screening tool for abdominal obesity in boys in our population. Based on the results, the triglyceride index is the most sensitive biomarker of insulin resistance compared to triglyceride-to-high density lipids cholesterol ratio and atherogenic coefficient in school-age boys. The results can be applied in pediatric practice for early identification of patients with metabolically unhealthy obesity with WHR and the triglyceride index at the early preclinical stage of MS manifestation. Keywords children, metabolically healthy obesity, metabolic syndrome, triglyceride index.