Weghuber D, Zelzer S, Stelzer I, Paulmichl K, Kammerhofer D, Schnedl W, Molnar D, Mangge H
Department of Pediatrics, Paracelsus Private Medical School Salzburg, Austria.
Exp Clin Endocrinol Diabetes. 2013 Jul;121(7):384-90. doi: 10.1055/s-0033-1341440. Epub 2013 Mar 21.
Since obesity and its associated co-morbidities do not only have effect on the individual patient, but also on society and the health system, it is of great importance to investigate this lifestyle-disease. The rationale of this study was to distinguish metabolically healthy from unhealthy overweight/obese patients as compared to healthy normal weight children and adolescents by means of a comprehensive anthropometric, laboratory and sonomorphological vascular assessment.
299 study participants were derived from the prospective, observational study STYJOBS/EDECTA (STYrian Juvenile Obesity Study/Early DEteCTion of Arteriosclerosis). Standard anthropometric data were obtained for each subject. This study comprised different diagnostic steps: extended anthropometry (Lipometer®), carotid artery ultrasound, various laboratory measurements, blood pressure measurement, oral glucose tolerance test. Ow/ob juveniles were classified as "metabolically healthy" (no laboratory criteria of metabolic syndrome fulfilled) vs. "metabolically unhealthy" (≥ 3 criteria of metabolic syndrome). Results underwent statistical evaluation, including t-test or Mann-Whitney U-test, regression analysis and a p-value < 0.05 was considered statistically significant.
In the study's central European cohort only about 16% (n=48/299) of the overweight/obese juveniles can be regarded as metabolically healthy. About 36% (n=108/299) of the overweight/obese patients fulfilled the criteria for metabolic syndrome. High visceral fat stores (p<0.001) and their clinical surrogate waist circumference (p<0.001) determine an adverse metabolic phenotype. Several parameters, including uric acid (p<0.001), adiponectin (p<0.05), insulin resistance (HOMA-Index, p<0.001), nuchal SAT thickness (p<0.001), arteriosclerosis of the carotids (p<0.001), and others are responsible for the distinction between -metabolically healthy and unhealthy juveniles. Nevertheless, "healthy obesity" only defines a sub-phenotype of a disease effecting rising numbers of young patients.
Since obesity in children and adolescents is not a consistent entity, it remains crucial to differ between metabolically healthy and unhealthy obese children in order to achieve appropriate intervention and prevention for our patients.
由于肥胖及其相关合并症不仅会影响个体患者，还会对社会和卫生系统产生影响，因此对这种生活方式疾病进行调查非常重要。本研究的基本原理是通过全面的人体测量、实验室检查和超声形态学血管评估，将代谢健康的超重/肥胖患者与健康的正常体重儿童及青少年区分开来。
299名研究参与者来自前瞻性观察研究STYJOBS/EDECTA（施蒂利亚青少年肥胖研究/动脉硬化早期检测）。为每位受试者获取标准人体测量数据。本研究包括不同的诊断步骤：扩展人体测量（Lipometer®）、颈动脉超声检查、各种实验室测量、血压测量、口服葡萄糖耐量试验。超重/肥胖青少年被分为“代谢健康”（未满足代谢综合征的实验室标准）和“代谢不健康”（满足≥3项代谢综合征标准）。对结果进行统计评估，包括t检验或曼-惠特尼U检验、回归分析，p值<0.05被认为具有统计学意义。
在该研究的中欧队列中，只有约16%（n = 48/299）的超重/肥胖青少年可被视为代谢健康。约36%（n = 108/299）的超重/肥胖患者符合代谢综合征标准。高内脏脂肪堆积（p<0.001）及其临床替代指标腰围（p<0.001）决定了不良的代谢表型。包括尿酸（p<0.001）、脂联素（p<0.05）、胰岛素抵抗（HOMA指数，p<0.001）、颈部皮下脂肪厚度（p<0.001）、颈动脉粥样硬化（p<0.001）等几个参数可区分代谢健康和不健康的青少年。然而，“健康肥胖”仅定义了一种影响越来越多年轻患者的疾病的亚表型。
由于儿童和青少年肥胖并非一个统一的实体，区分代谢健康和不健康的肥胖儿童对于为我们的患者实现适当的干预和预防仍然至关重要。
