Li Lujiao, Yin Jinhua, Cheng Hong, Wang Ying, Gao Shan, Li Mingyao, Grant Struan F A, Li Changhong, Mi Jie, Li Ming
Department of Endocrinology (L.L., J.Y., Y.W., Ming.L.), Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China; Department of Epidemiology (H.C., J.M.), Capital Institute of Paediatrics, Beijing 10020, People's Republic of China; Department of Endocrinology (S.G.), Chaoyang Hospital, Capital Medical University, Beijing 100043, China; and Department of Biostatistics and Epidemiology (Mingy.L.), Division of Endocrinology (S.F.A.G., Ming.L.), The Children's Hospital of Philadelphia, Perelman School of Medicine, Division of Human Genetics, (S.F.A.G.), The Children's Hospital of Philadelphia Research Institute, Department of Pediatrics (S.F.A.G.), Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania 19104.
J Clin Endocrinol Metab. 2016 Apr;101(4):1816-25. doi: 10.1210/jc.2015-3760. Epub 2016 Feb 25.
Available data related to the metabolically healthy obesity (MHO) phenotype are mainly derived from studies in adults because studies during childhood are very limited to date.
The objective of the study was to determine the prevalence of MHO in Chinese children and to investigate environmental and genetic factors impacting on MHO status.
This was a cross-sectional study.
A total of 1213 children with a body mass index at the 95th percentile or greater aged 6–18 years were included in this study. Participants were classified as MHO or of metabolically unhealthy obesity based on insulin resistance (IR) or cardiometabolic risk (CR) factors (blood pressure, lipids, and glucose). Twenty-two genetic variants previously reported from genome-wide association studies of obesity and diabetes plus the environmental factors of lifestyle, socioeconomic status, and birth weight was assessed.
The prevalence of MHO-IR and MHO-CR were 27.1% and 37.2%, respectively. Waist circumference was an independent predictor of MHO, regardless of definitions, whereas walking to school and KCNQ1-rs2237897 were independent predictors of MHO-CR. Acanthosis nigricans, birth weight, the frequency of soft drink consumption, the mother's education status, and KCNQ1-rs2237892 were independent predictors of MHO-IR. Multiplicative interaction effects were found between KCNQ1-rs2237897 and walking to school on MHO-CR (odds ratio 1.31 [95% confidence interval 1.05–1.63]) and between rs2237892 and consumption of soft drinks on MHO-IR (odds ratio 0.80 [95% confidence interval 0.68–0.94]).
Approximately one-third of Chinese obese children can be classified as MHO. Both genetic predisposition and environment factors and their interaction contribute to the prediction of MHO status. This study provides novel insights into the heterogeneity of obesity and has the potential to impact the optimization of the intervention options and regimens in the management of pediatric obesity.
目前有关代谢健康型肥胖（MHO）表型的数据主要来自成人研究，因为迄今为止儿童期的研究非常有限。
本研究旨在确定中国儿童中MHO的患病率，并调查影响MHO状态的环境和遗传因素。
这是一项横断面研究。
本研究共纳入1213名6至18岁体重指数处于第95百分位数及以上的儿童。根据胰岛素抵抗（IR）或心脏代谢风险（CR）因素（血压、血脂和血糖）将参与者分为MHO或代谢不健康肥胖。评估了先前肥胖和糖尿病全基因组关联研究报告的22种基因变异以及生活方式、社会经济地位和出生体重等环境因素。
MHO-IR和MHO-CR的患病率分别为27.1%和37.2%。无论采用何种定义，腰围都是MHO的独立预测因素，而步行上学和KCNQ1-rs2237897是MHO-CR的独立预测因素。黑棘皮症、出生体重、软饮料消费频率、母亲的教育状况和KCNQ1-rs2237892是MHO-IR的独立预测因素。发现KCNQ1-rs2237897与步行上学对MHO-CR存在相乘交互作用（比值比1.31[95%置信区间1.05–1.63]），rs2237892与软饮料消费对MHO-IR存在相乘交互作用（比值比0.80[95%置信区间0.68–0.94]）。
约三分之一的中国肥胖儿童可被归类为MHO。遗传易感性、环境因素及其相互作用均有助于预测MHO状态。本研究为肥胖的异质性提供了新见解，有可能影响儿童肥胖管理中干预方案和治疗方法的优化。
