Ingram School of Nursing, McGill University, Montreal, QC, Canada.
CHU Sainte-Justine Research Centre, Montreal, QC, Canada.
Int J Obes (Lond). 2020 Apr;44(4):781-789. doi: 10.1038/s41366-019-0483-0. Epub 2019 Nov 25.
To identify determinants for the development of "normal weight metabolically unhealthy" (NWMU) profiles among previously metabolically healthy normal weight children.
The QUALITY cohort comprises youth 8-10 years of age with a parental history of obesity (n = 630). Of these, normal weight children with no metabolic risk factors were identified and followed up 2 years later (n = 193). Children were classified as NWMU if they remained normal weight but developed at least one cardiometabolic risk factor. They were classified as normal weight metabolically healthy otherwise. Multivariable logistic regression models were used to identify whether adiposity (anthropometrics and DXA), lifestyle habits (physical activity, screen time, vegetables, and fruit- and sugar-sweetened beverages intake), fitness, and family history of cardiometabolic disease were associated with new onset NWMU.
Of the 193 normal weight and metabolically healthy children at baseline, 45 (23%) became NWMU 2 years later (i.e., 48% had elevated HDL cholesterol, 13% had elevated triglycerides, and 4% had impaired fasting glucose). Changes in adiposity between baseline and follow-up were associated with an increased risk of NWMU for all adiposity measures examined (e.g., for ∆zBMI OR = 3.95; 95% CI: 1.76, 8.83). Similarly, a 2-year change in screen time was associated with incident NWMU status (OR = 1.24; 95% CI 1.04, 1.49).
Children who increase their adiposity levels as they enter puberty, despite remaining normal weight, are at risk of developing cardiometabolic risk factors. Studies examining long-term consequences of NWMU profiles in pediatrics are needed to determine whether changes in screening practice are warranted.
确定先前代谢健康的正常体重儿童中出现“正常体重代谢不健康”（NWMU）表型的决定因素。
QUALITY 队列包括有肥胖家族史的 8-10 岁青少年（n=630）。在这些人中，确定了没有代谢危险因素的正常体重儿童，并在 2 年后进行了随访（n=193）。如果儿童体重仍正常但至少出现一种心血管代谢危险因素，则将其归类为 NWMU。否则，将其归类为正常体重代谢健康。使用多变量逻辑回归模型来确定肥胖（人体测量学和 DXA）、生活方式习惯（体力活动、屏幕时间、蔬菜、水果和含糖饮料摄入）、体能和心血管代谢疾病家族史是否与新出现的 NWMU 相关。
在基线时，193 名体重正常且代谢健康的儿童中，有 45 名（23%）在 2 年后成为 NWMU（即，48%的儿童高密度脂蛋白胆固醇升高，13%的儿童甘油三酯升高，4%的儿童空腹血糖受损）。与所有检查的肥胖指标相比，基线和随访期间的肥胖变化与 NWMU 的风险增加相关（例如，∆zBMI 的 OR=3.95；95%CI：1.76，8.83）。同样，屏幕时间在 2 年内的变化与新出现的 NWMU 状态相关（OR=1.24；95%CI 1.04，1.49）。
尽管体重仍正常，但在进入青春期时增加其肥胖水平的儿童有患心血管代谢危险因素的风险。需要研究儿科中 NWMU 表型的长期后果，以确定是否需要改变筛查实践。
