Yang Lili, Li Menglong, Wang Huan, Zhao Min, Magnussen Costan G, Hu Yifei, Xi Bo
Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China.
Int J Obes (Lond). 2025 May 22. doi: 10.1038/s41366-025-01800-x.
The association between metabolically healthy abdominal obesity (MHO) and subclinical cardiovascular outcomes in the general pediatric population remains largely unexplored. We aimed to investigate the relationship of MHO with left ventricular geometric (LVG) remodeling in Chinese children.
Data were obtained from two school-based cross-sectional studies in China, involving 2866 children aged 6-11 years. Abdominal obesity was defined using waist-to-height ratio (WHtR) or waist circumference references. The metabolically healthy phenotype was defined by the absence of four cardiovascular risk factors: elevated blood pressure, elevated triglycerides, elevated fasting blood glucose, and decreased high-density lipoprotein cholesterol. LVG was categorized into four patterns (normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy) based on two indices including left ventricular mass index and relative wall thickness.
Using WHtR to define abdominal obesity, 543 (18.9%) children were classified as MHO. In the multivariable logistic regression models, compared with children with metabolically healthy normal WHtR, the adjusted odds ratios (95% confidence intervals) of children with MHO were 4.78 (3.44-6.64) for left ventricular hypertrophy, 1.81 (1.33-2.47) for high relative wall thickness, 1.45 (1.01-2.08) for concentric remodeling, 4.37 (3.01-6.33) for eccentric hypertrophy, and 7.50 (3.77-14.91) for concentric hypertrophy. In contrast, children with metabolically unhealthy normal WHtR did not exhibit increased odds of any type of LVG remodeling. Similar results were observed when defining abdominal obesity based on waist circumference.
MHO is associated with a higher likelihood of LVG remodeling, suggesting that this phenotype may not be benign for the heart in children. Due to its simplicity and practicality, WHtR may be a preferable tool for the rapid screening of children with abdominal obesity and associated cardiac risk.
在一般儿科人群中，代谢健康的腹型肥胖（MHO）与亚临床心血管结局之间的关联在很大程度上仍未得到充分研究。我们旨在探讨中国儿童中MHO与左心室几何形态（LVG）重塑之间的关系。
数据来自中国两项基于学校的横断面研究，涉及2866名6至11岁的儿童。使用腰高比（WHtR）或腰围参考值来定义腹型肥胖。代谢健康表型由不存在四种心血管危险因素来定义：血压升高、甘油三酯升高、空腹血糖升高和高密度脂蛋白胆固醇降低。基于左心室质量指数和相对壁厚度这两个指标，将LVG分为四种模式（正常几何形态、向心性重塑、离心性肥厚和向心性肥厚）。
使用WHtR定义腹型肥胖时，543名（18.9%）儿童被归类为MHO。在多变量逻辑回归模型中，与代谢健康且WHtR正常的儿童相比，MHO儿童左心室肥厚的调整优势比（95%置信区间）为4.78（3.44 - 6.64），高相对壁厚度的调整优势比为1.81（1.33 - 2.47），向心性重塑的调整优势比为1.45（1.01 - 2.08），离心性肥厚的调整优势比为4.37（3.01 - 6.33），向心性肥厚的调整优势比为7.50（3.77 - 14.91）。相比之下，代谢不健康且WHtR正常的儿童未表现出任何类型LVG重塑的优势比增加。基于腰围定义腹型肥胖时观察到类似结果。
MHO与LVG重塑的可能性较高相关，表明这种表型对儿童心脏可能并非无害。由于其简单性和实用性，WHtR可能是快速筛查腹型肥胖及相关心脏风险儿童的优选工具。
