Hypertension outcomes in metabolically unhealthy normal-weight and metabolically healthy obese children and adolescents

Abstract

Metabolically healthy obesity (MHO) begins in childhood and continues into adulthood. However, the association between MHO and the risk of developing hypertension remains controversial. A prospective cohort study was conducted to investigate the risk of hypertension in MHO and metabolically unhealthy normal-weight (MUNW) Chinese children and adolescents. A total of 1183 participants, 6-18 years old at baseline with normal blood pressure values, were studied using follow-up data from the cohort of the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. The participants were classified according to the body mass index and the presence/absence of metabolic abnormality, which was defined by metabolic syndrome (MetS) or insulin resistance (IR). During the 6-year follow-up period, 239 (20.2%) participants developed incident hypertension. After adjusting for age, sex, physical activity, pubertal stage, dietary habits and family history of hypertension, an increased risk for hypertension was observed in the MHO individuals (risk ratio, RRMetS 5.42; 95% confidence interval (CI) 3.19-9.22 and RRIR 7.59; 95% CI 1.64-35.20) compared with their metabolically healthy normal-weight counterparts. Independent of the definition of metabolic abnormality, the MUNW subjects did not have an elevated incidence of hypertension. These results suggest that the risk of developing hypertension is increased in the MHO but not in the MUNW individuals.

Serum Uric Acid Levels as an Indicator for Metabolically Unhealthy Obesity in Children and Adolescents

“…For instance, a recent study examining Chinese children and adolescents aged 6–18 years found that prevalence rates were 3.9 and 36.7% using 2 different MHO criteria defined by insulin resistance and cardiometabolic parameters, respectively [37]. Using the same MHO criteria as in the present study, a recently published German study on the effect of pubertal status revealed that a large proportion of obese children (49.3%) exhibited a MHO status [38].…”

The association of incident hypertension with metabolic health and obesity status: definition of metabolic health does not matter

“…MHNO subjects; Table ). Although hypertension is one of the most important predictors of CVD mortality, few studies investigated the association between the MHO phenotype and the risk of incident hypertension . A Korean prospective study reported that the MHO phenotype defined by ATP‐III criteria was associated with a higher risk of incident hypertension, and a Chinese study group reported similar findings in MHO children and adolescents .…”

“…Because hypertension is one of the most important predictors of CVD mortality, an investigation of the association between each obesity phenotype and incident hypertension might resolve this controversy. However, few studies have investigated the association between incident hypertension and different obesity phenotypes .…”

“…Because hypertension is one of the most important predictors of CVD mortality, an investigation of the association between each obesity phenotype and incident hypertension might resolve this controversy. However, few studies have investigated the association between incident hypertension and different obesity phenotypes . These studies concluded that MHO phenotypes do not protect against hypertension; however, one study enrolled only children and adolescents in China, whilst the other involved a relatively small number of subjects .…”

Metabolically healthy obesity: a friend or foe?

“…Some studies have concluded that MHO phenotypes are not protected against hypertension; however, one of these studies enrolled only children and adolescents in China [49] and the other involved a relatively small number of subjects [26]. We recently demonstrated that individuals with MHO had an approximately 1.5-fold higher association with the incidence of hypertension over a relatively short period of time (median follow-up period, 35.0 months), regardless of the definition used for metabolic health (i.e., NCEP-ATP III, Wildman, Karelis, and HOMA criteria) [50].…”