Metabolically Healthy and Unhealthy Obesity in Children From the Point of View of Evidence-Based Medicine

Abstract

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.