Children With Metabolically Healthy Obesity: A Review
Children with “metabolically healthy obesity” (MHO) are a distinct subgroup of youth with obesity, who are less prone to the clustering of cardiometabolic risk factors. Although this phenotype, frequently defined by the absence of metabolic syndrome components or insulin resistance, was first descri...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2019-12-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fendo.2019.00865/full |
| _version_ | 1819237072157802496 |
|---|---|
| author | Rade Vukovic Rade Vukovic Tiago Jeronimo Dos Santos Marina Ybarra Marina Ybarra Muge Atar |
| author_facet | Rade Vukovic Rade Vukovic Tiago Jeronimo Dos Santos Marina Ybarra Marina Ybarra Muge Atar |
| author_sort | Rade Vukovic |
| collection | DOAJ |
| description | Children with “metabolically healthy obesity” (MHO) are a distinct subgroup of youth with obesity, who are less prone to the clustering of cardiometabolic risk factors. Although this phenotype, frequently defined by the absence of metabolic syndrome components or insulin resistance, was first described during the early 1980s, a consensus-based definition of pediatric MHO was introduced only recently, in 2018. The purpose of this review was to concisely summarize current knowledge regarding the MHO phenomenon in youth. The prevalence of MHO in children varies from 3 to 87%, depending on the definition used and the parameters evaluated, as well as the ethnicity and the pubertal status of the sample. The most consistent predictors of MHO in youth include younger age, lower body mass index, lower waist circumference, and lower body fat measurements. Various hypotheses have been proposed to elucidate the underlying factors maintaining the favorable MHO phenotype. While preserved insulin sensitivity and lack of inflammation were previously considered to be the main etiological factors, the most recent findings have implicated adipokine levels, the number of inflammatory immune cells in the adipose tissue, and the reduction of visceral adiposity due to adipose tissue expandability. Physical activity and genetic factors also contribute to the MHO phenotype. Obesity constitutes a continuum-increased risk for cardiometabolic complications, which is less evident in children with MHO. However, some findings have highlighted the emergence of hepatic steatosis, increased carotid intima-media thickness and inflammatory biomarkers in the MHO group compared to peers without obesity. Screening should be directed at those more likely to develop clustering of cardiometabolic risk factors. Lifestyle modifications should include behavioral changes focusing on sleep duration, screen time, diet, physical activity, and tobacco smoke exposure. Weight loss has also been associated with the improvement of insulin sensitivity and inflammation. Further investigative efforts are needed in order to elucidate the mechanisms which protect against the clustering of cardiometabolic risk factors in pediatric obesity, to provide more efficient, targeted treatment approaches for children with obesity, and to identify the protective factors preserving the MHO profile, avoiding the crossover of MHO to the phenotype with metabolically unhealthy obesity. |
| first_indexed | 2024-12-23T13:14:31Z |
| format | Article |
| id | doaj.art-1b032972e6c54edd8308fe96777bc988 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-23T13:14:31Z |
| publishDate | 2019-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-1b032972e6c54edd8308fe96777bc9882022-12-21T17:45:38ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922019-12-011010.3389/fendo.2019.00865505746Children With Metabolically Healthy Obesity: A ReviewRade Vukovic0Rade Vukovic1Tiago Jeronimo Dos Santos2Marina Ybarra3Marina Ybarra4Muge Atar5Department of Pediatric Endocrinology, Mother and Child Healthcare Institute of Serbia “Dr Vukan Cupic”, Belgrade, SerbiaSchool of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, SpainResearch Center of Sainte Justine University Hospital, Université de Montréal, Montreal, QC, CanadaCentre Armand-Frappier, Institut National de la Recherche Scientifique, Université du Québec, Laval, QC, CanadaDepartment of Pediatric Endocrinology, School of Medicine, Demirel University, Isparta, TurkeyChildren with “metabolically healthy obesity” (MHO) are a distinct subgroup of youth with obesity, who are less prone to the clustering of cardiometabolic risk factors. Although this phenotype, frequently defined by the absence of metabolic syndrome components or insulin resistance, was first described during the early 1980s, a consensus-based definition of pediatric MHO was introduced only recently, in 2018. The purpose of this review was to concisely summarize current knowledge regarding the MHO phenomenon in youth. The prevalence of MHO in children varies from 3 to 87%, depending on the definition used and the parameters evaluated, as well as the ethnicity and the pubertal status of the sample. The most consistent predictors of MHO in youth include younger age, lower body mass index, lower waist circumference, and lower body fat measurements. Various hypotheses have been proposed to elucidate the underlying factors maintaining the favorable MHO phenotype. While preserved insulin sensitivity and lack of inflammation were previously considered to be the main etiological factors, the most recent findings have implicated adipokine levels, the number of inflammatory immune cells in the adipose tissue, and the reduction of visceral adiposity due to adipose tissue expandability. Physical activity and genetic factors also contribute to the MHO phenotype. Obesity constitutes a continuum-increased risk for cardiometabolic complications, which is less evident in children with MHO. However, some findings have highlighted the emergence of hepatic steatosis, increased carotid intima-media thickness and inflammatory biomarkers in the MHO group compared to peers without obesity. Screening should be directed at those more likely to develop clustering of cardiometabolic risk factors. Lifestyle modifications should include behavioral changes focusing on sleep duration, screen time, diet, physical activity, and tobacco smoke exposure. Weight loss has also been associated with the improvement of insulin sensitivity and inflammation. Further investigative efforts are needed in order to elucidate the mechanisms which protect against the clustering of cardiometabolic risk factors in pediatric obesity, to provide more efficient, targeted treatment approaches for children with obesity, and to identify the protective factors preserving the MHO profile, avoiding the crossover of MHO to the phenotype with metabolically unhealthy obesity.https://www.frontiersin.org/article/10.3389/fendo.2019.00865/fullobesitychildrenmetabolically healthy obesitymetabolic syndromepediatric obesity |
| spellingShingle | Rade Vukovic Rade Vukovic Tiago Jeronimo Dos Santos Marina Ybarra Marina Ybarra Muge Atar Children With Metabolically Healthy Obesity: A Review Frontiers in Endocrinology obesity children metabolically healthy obesity metabolic syndrome pediatric obesity |
| title | Children With Metabolically Healthy Obesity: A Review |
| title_full | Children With Metabolically Healthy Obesity: A Review |
| title_fullStr | Children With Metabolically Healthy Obesity: A Review |
| title_full_unstemmed | Children With Metabolically Healthy Obesity: A Review |
| title_short | Children With Metabolically Healthy Obesity: A Review |
| title_sort | children with metabolically healthy obesity a review |
| topic | obesity children metabolically healthy obesity metabolic syndrome pediatric obesity |
| url | https://www.frontiersin.org/article/10.3389/fendo.2019.00865/full |
| work_keys_str_mv | AT radevukovic childrenwithmetabolicallyhealthyobesityareview AT radevukovic childrenwithmetabolicallyhealthyobesityareview AT tiagojeronimodossantos childrenwithmetabolicallyhealthyobesityareview AT marinaybarra childrenwithmetabolicallyhealthyobesityareview AT marinaybarra childrenwithmetabolicallyhealthyobesityareview AT mugeatar childrenwithmetabolicallyhealthyobesityareview |