Risk factors, cutoff points, and definition of metabolically healthy/unhealthy obesity in children and adolescents: A scoping review of the literature

Abstract

Diagnosis of metabolically healthy obesity (MHO) and its definition do not have universal criteria in the pediatric age group. Hence, this scoping review aims to identify the components, the cutoff points, and the definition of MHO in children and adolescents. A comprehensive, systematic search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases. A consensus-based definition of MHO was developed through a Delphi process involving an international panel of 23 experts. This review included a total of 63 non-randomized studies, published between 2007 and 2022. According to our consensus (≥80% agreement), the proposed definition for MHO included the following components: high-density lipoprotein cholesterol >40 mg/dl (or >1.03 mmol/l), triglycerides ≤150 mg/dl (or ≤1.7 mmol/l), fasting plasma glucose <100 mg/dl (or <5.6 mmol/l), a measure of insulin, and systolic and diastolic blood pressure ≤90th percentile. Therefore, MHO was defined as the absence of the above metabolic risk factors; and those children and adolescents with one or more criteria were considered as metabolically unhealthy. A universal definition of MHO will allow comparisons between studies in the field of childhood obesity and can be useful in clinical practice.

Metabolic health's central role in chronic kidney disease progression: a 20-year study of obesity-metabolic phenotype transitions

“…Aligned with previous research, we identified being overweight as a precursor to CKD, underscoring the importance of early intervention 17 . We established that three abnormal indices constitute the optimal threshold for identifying at-risk patients, in line with our scoping review and panel discussion outcomes 15 , 22 .…”

“…The definition of metabolic health varies across studies and is subject to debate 15 . In this study, we utilized our previously validated definition of metabolic health, which is based on an evidence-based approach combined with expert opinions using the Delphi method 15 .…”

“…The definition of metabolic health varies across studies and is subject to debate 15 . In this study, we utilized our previously validated definition of metabolic health, which is based on an evidence-based approach combined with expert opinions using the Delphi method 15 . The consensus among experts to exclude Waist Circumference (WC) from the metabolic health definition aligns with the National Cholesterol Education Program Adult Treatment Panel III 22 .…”

“…This syndrome, defined by metabolic abnormalities such as central obesity, hypertension, elevated triglycerides, reduced High-Density Lipoprotein (HDL), and high blood glucose, independently heightens the risk for diseases including CKD 5 , 13 . While the initial proposal of MetS sparked debates over its cumulative risk impact on CVD and CKD, contemporary consensus leans towards recognizing a synergistic effect among its components 14 , 15 .…”

“…In this evolving landscape, the concept of metabolic health has garnered attention, offering a holistic view of the body’s metabolic processes and overall physiological health 15 . This emerging paradigm appreciates the complex interplay among diverse metabolic functions and their cumulative impact on health, extending beyond traditional metrics like weight indices 13 .…”