Metabolically healthy overweight adolescents: definition and components

Area of Science:

• Pediatric Endocrinology
• Metabolic Health
• Adolescent Medicine

Background:

• The definition and clinical significance of metabolically healthy overweight (MHO) in adolescents remain unclear.
• Existing definitions often rely on metabolic syndrome (MS) criteria, potentially overlooking other metabolic disturbances.

Purpose of the Study:

• To determine the prevalence of MHO in overweight adolescents using the standard MS definition.
• To investigate additional metabolic indicators and predictors of metabolic health in this population.
• To assess the stability of MHO status over time.

Main Methods:

• Cross-sectional analysis of 487 overweight adolescents (mean BMI z-score 2.74).
• Longitudinal analysis of a subsample (n=176) assessed at 12 months.
• Evaluation of metabolic syndrome components, insulin resistance (HOMA-IR), lipid profiles, ALT, and CRP.

Main Results:

• 41.1% of adolescents were classified as MHO, but only 19.1% had normal levels for all tested metabolic indicators.
• Over 44% of initially MHO adolescents transitioned to a non-MHO state within a year.
• Higher BMI z-score was a significant predictor of poorer metabolic health, increasing risks for hypertension, insulin resistance, and inflammation.

Conclusions:

• MHO assessment in adolescents should incorporate a broader range of metabolic indicators beyond just MS criteria.
• All overweight adolescents, regardless of their current metabolic health phenotype, should be encouraged to engage in weight management programs.