October 10, 2014
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Obese children entering puberty more likely to be metabolically unhealthy obese

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In obese children, the onset of puberty appears to be associated with a conversion from metabolically healthy obesity to metabolically unhealthy obesity, according to recent findings.

In the 1-year longitudinal study, researchers evaluated 2,017 obese while children (mean age 11.6 years; 45% male) presented to the outpatient obesity clinic of the Vestische Children’s Hospital between 1999 and 2012. Mean baseline BMI was 28.5 kg/m2.

A baseline and 1 year, the researchers took the following anthropometric measurements: weight, height, waist and hip circumference, fasting insulin, blood pressure, fasting glucose, HDL cholesterol and triglycerides. Homeostasis model assessment (HOMA) was used to determine the extent of insulin resistance. Trained physicians assessed pubertal stage based on the definition by Marshall and Tanner and participants were placed into one of three categories: prepubertal, mid-pubertal and late/post-pubertal.

Metabolically healthy obese (MHO) was defined as the absence of hypertension, dyslipidemia and fasting glucose impairment; conversely, metabolically unhealthy obese (MUO) was defined by at least one of those factors.

At baseline, 49.3% of the participants were classified as MHO; 68% remained MHO at 1 year follow-up. Participants who were MHO were significantly younger than MUO participants and were more likely to be prepubertal and less obese (all P<.05).

In multiple logistic regression analyses adjusted for age, gender and changes in BMI standard deviation score, the risk of switching from MHO to MUO doubled with the onset of early puberty (OR=1.8; 95% CI, 1.3-2.8). The transition from mid- to late-puberty nearly tripled the likelihood of switching from MUO to MHO (OR=3.1; 95% CI, 2.1-4.5).

According to the researchers, the stability of MHO and MUO are contingent on the degree of overweight and stability of pubertal status.

“Therefore, after an initial assessment of cardiovascular risk factors in obese children according to guidelines, repeated screening of these risk factors seems not necessary in stable weight status or without entry into puberty, while reevaluation of cardiovascular risk factors seems meaningful when obese children enter into puberty or if they increase their overweight,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.