Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium

Abstract

OBJECTIVEIt has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents. RESEARCH DESIGN AND METHODSData were available for 3,497 children and adolescents aged 6-17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ‡90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center. RESULTSIn comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58-3.32) for metabolically healthy overweight and 3.91 (2.46-6.21) for MHO. ORs for high cIMT were 1.44 (1.03-2.02) for unhealthy normal weight, 3.49 (2.51-4.85) for unhealthy overweight, and 6.96 (5.05-9.61) for unhealthy obesity. CONCLUSIONSAmong children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status.

The Effect of Long-Term Atorvastatin Therapy on Carotid Intima-Media Thickness of Children With Dyslipidemia

“…42,44 In a recent study including results from 5 countries (Brazil, China, Greece, Italy, and Spain), metabolically healthy obese/overweight children and adolescents (n = 158/388) had an increased cIMT compared with metabolically healthy normal weight ones (n = 1393). 45 Moreover, obese children were shown to have a higher cIMT as adults. 46…”

Children With Metabolically Healthy Obesity: A Review

“…Although children with MHO are usually defined as being without traditional cardiometabolic risk factors within the MS definition, several studies have detected the presence of other features among this population, such as: hepatic steatosis, increased carotid intima-media thickness, and inflammatory biomarkers, as well as higher degree of visceral fat accumulation, higher birth weight, adipose cell size, and different gene expression-encoding markers in adipose tissue (4,8,(130)(131)(132)(133)(134). The diverse characteristics found in children with MHO may indicate they pursue a different metabolic phenotype compared to their peers of normal weight (7,18).…”

Prevalence and Clinical Characteristics of Children and Adolescents with Metabolically Healthy Obesity: Role of Insulin Sensitivity

“…These individuals seem to be less prone to the traditional metabolic abnormalities that often accompany excess body fat (e.g., insulin resistance, dyslipidemia, hypertension), showing a reduced incidence of several obesity-related comorbidities [9], such as a 50% decreased risk of developing type 2 diabetes (T2D) compared with metabolically unhealthy obese (MUO) subjects [12]. Conversely, a significantly higher cardiovascular risk has been reported, compared to lean subjects [13][14][15].…”