Videira-Silva António, Freira Silvia, Fonseca Helena
Pediatric University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Pediatric Obesity Clinic, Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal.
Ann Pediatr Endocrinol Metab. 2020 Dec;25(4):256-264. doi: 10.6065/apem.2040052.026. Epub 2020 Dec 31.
In adolescents, the definition and clinical implications of metabolically healthy overweight (MHO) status have not been established. This study aimed to investigate the prevalence of MHO according to its most widespread definition, which is based on metabolic syndrome (MS), and to explore further metabolic indicators such as Homeostatic Model Assessment of Insulin Resistance, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and C-reactive protein levels, together with metabolic health predictors in a sample of adolescents attending a pediatric obesity clinic.
Data from 487 adolescents categorized as overweight (52.6% females, 88.1% white), with a mean body mass index (BMI) z-score of 2.74 (±1.07 standard deviation [SD]), and a mean age of 14.4 years (±2.2 SD) were cross-sectionally analyzed. From this original sample, a subsample of 176 adolescents underwent a second assessment at 12 (±6 SD) months for longitudinal analysis.
From the 487 adolescents originally analyzed, 200 (41.1%) were categorized as MHO, but only 93 (19.1%) had none of the metabolic indicators considered in this study. According to longitudinal analysis, 30 of the 68 adolescents (44%) categorized as MHO at baseline became non-MHO over time. BMI z-score was the best predictor of metabolic health both in cross-sectional and longitudinal analyses. Increased BMI z-score reduced the odds of being categorized as MHO (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4-0.9; P=.008) and increased the odds of having hypertension (OR 2.1, 95% CI: 1.4-3.3, P=0.001), insulin resistance (OR, 2.4; 95% CI, 1.4-4.1, P=0.001), or a proinflammatory state (OR, 1.2; 95% CI, 1.1-1.3, P=0.002).
Diagnosis of MHO should not be exclusively based on MS parameters, and other metabolic indicators should be considered. Adolescents categorized as overweight should participate in weight-management lifestyle interventions regardless of their metabolic health phenotype.
在青少年中，代谢健康超重（MHO）状态的定义及临床意义尚未明确。本研究旨在根据基于代谢综合征（MS）的最广泛定义调查MHO的患病率，并在一家儿科肥胖诊所的青少年样本中，进一步探究如胰岛素抵抗稳态模型评估、总胆固醇、低密度脂蛋白胆固醇、丙氨酸转氨酶和C反应蛋白水平等代谢指标，以及代谢健康预测因素。
对487名被归类为超重的青少年（52.6%为女性，88.1%为白人）的数据进行横断面分析，其平均体重指数（BMI）z评分2.74（±1.07标准差[SD]），平均年龄14.4岁（±2.2 SD）。从这个原始样本中，抽取176名青少年的子样本在12（±6 SD）个月时接受第二次评估以进行纵向分析。
在最初分析的487名青少年中，200名（41.1%）被归类为MHO，但只有93名（19.1%）没有本研究中所考虑的任何代谢指标。根据纵向分析，68名在基线时被归类为MHO的青少年中，有30名（44%）随时间推移变为非MHO。在横断面和纵向分析中，BMI z评分都是代谢健康的最佳预测指标。BMI z评分升高会降低被归类为MHO的几率（优势比[OR]，0.6；95%置信区间[CI]，0.4 - 0.9；P = 0.008），并增加患高血压（OR 2.1，95% CI：1.4 - 3.3，P = 0.001）、胰岛素抵抗（OR，2.4；95% CI，1.4 - 4.1，P = 0.001）或促炎状态（OR，1.2；95% CI，1.1 - 1.3，P = 0.002）的几率。
MHO的诊断不应仅基于MS参数，还应考虑其他代谢指标。被归类为超重的青少年无论其代谢健康表型如何，都应参与体重管理生活方式干预。
