Predictive markers of metabolically healthy obesity in children and adolescents: can AST/ALT ratio serve as a simple and reliable diagnostic indicator?

Abstract

This study aimed to estimate the prevalence of Metabolically Healthy Obesity (MHO) according to two different consensus-based criteria and to investigate simple, measurable predictive markers for the diagnosis of MHO. Five hundred and ninety-three obese children and adolescents aged 6-18 years were included in the study. The frequency of MHO was calculated. ROC analysis was used to estimate the predictive value of AST/ALT ratio, waist/hip ratio, MPV, TSH, and Ft4 cut-off value for the diagnosis of MHO. The prevalence of MHO was 21.9% and 10.2% according to 2018 and 2023 consensus-based MHO criteria, respectively. AST/ALT ratio cut-off value for the diagnosis of MHO was calculated as ≥ 1 with 77% sensitivity and 52% speci city using Damanhoury et al.'s criteria (AUC = 0.61, p = 0.02), and 90% sensitivity and 51% speci city using Abiri et al.'s criteria (AUC = 0.70, p = 0.01). Additionally, using binomial regression analysis, only the AST/ALT ratio is independently and signi cantly associated with the diagnosis of MHO (p = 0.02 for 2018 criteria and p = 0.01 for 2022 criteria). Conclusion:The ALT/AST ratio may be a useful indicator of MHO in children and adolescents. What is knownMetabolically healthy obesity refers to people who are obese but do not have any of the standard cardio-metabolic risk factors.Metabolically healthy obesity is not entirely harmless; The metabolic characteristics of individuals with this phenotype are less favorable than those of healthy lean groups. Moreover, it is not a constant state, and there may be a transition to metabolically unhealthy phenotypes over time What is newThe prevalence of MHO is 21.9% and 10.2 % according to 2018 and 2023 consensusbased Metabolically Healthy Obesity criteria, respectively.The ALT/AST ratio may be a useful indicator of Metabolically Healthy Obesity in children and adolescents.