Prevalence and Clinical Characteristics of Children and Adolescents with Metabolically Healthy Obesity: Role of Insulin Sensitivity.

Federica Vinciguerra,Alfredo Ferro,Maria Hagnäs,Lucia Frittitta,Salvatore Alaimo,Roberto Baratta,Andrea Tumminia,Marco Graziano,Riccardo Vigneri

doi:10.3390/life10080127

Abstract

Obesity represents a major risk factor for metabolic disorders, but some individuals, “metabolically healthy” (MHO), show less clinical evidence of these complications, in contrast to “metabolically unhealthy” (MUO) individuals. The aim of this cross-sectional study is to assess the prevalence of the MHO phenotype in a cohort of 246 overweight/obese Italian children and adolescents, and to evaluate their characteristics and the role of insulin resistance. Homeostasis model assessment–insulin resistance (HOMA-IR), insulin sensitivity index (ISI), insulinogenic index (IGI) and disposition index (DI) were all calculated from the Oral Glucose Tolerance Test (OGTT). MHO was defined by either: (1) HOMA-IR < 2.5 (MHO-IRes), or (2) absence of the criteria for metabolic syndrome (MHO-MetS). The MHO prevalence, according to MHO-MetS or MHO-IRes criteria, was 37.4% and 15.8%, respectively. ISI was the strongest predictor of the MHO phenotype, independently associated with both MHO-IRes and MHO-MetS. The MHO-MetS group was further subdivided into insulin sensitive or insulin resistant on the basis of HOMA-IR (either < or ≥ 2.5). Insulin sensitive MHO-MetS patients had a better metabolic profile compared to both insulin resistant MHO-MetS and MUO-MetS individuals. These data underscore the relevance of insulin sensitivity to identifying, among young individuals with overweight/obesity, the ones who have a more favorable metabolic phenotype.

Highlights

Overweight and obesity prevalence has tremendously increased in recent years, among adults, and among children and adolescents [1,2]
Regardless of the definition used, both metabolically healthy obesity” (MHO)-IRes and MHO-metabolic syndrome (MetS) patients showed a favorable metabolic profile compared to metabolically unhealthy obese (MUO); lower body mass index (BMI) z-score, waist circumference (WC) and waist to height ratio (WtHR), lower mean systolic and diastolic blood pressure, lower fasting plasma insulin, glycaemia and triglycerides, as well as higher high-density lipoprotein (HDL) cholesterol
Low levels of leptin were found in MHO individuals, they were classified; leptin values were significantly lower in MHO-MetS compared to MUO-MetS (34.0 ± 19.0 vs. 27.9 ± 21.4 ng/mL; p = 0.01), and in MHO-IRes compared to MUO-IRes (20.1 ± 13.9 vs. 33.9 ± 20.4 ng/mL; p < 0.01)

Summary

Introduction

Overweight and obesity prevalence has tremendously increased in recent years, among adults, and among children and adolescents [1,2]. Life 2020, 10, 127 the last two decades (from 4.2% in 1990 to 6.7% in 2010), and it is expected to reach 9.1% by 2020 [3] Such a secular trend has been recently confirmed among Sicilian schoolchildren [4,5]. MHO patients represent a class of subjects who, despite the fat mass excess, show a favorable metabolic profile [9,11]. These individuals seem to be less prone to the traditional metabolic abnormalities that often accompany excess body fat (e.g., insulin resistance, dyslipidemia, hypertension), showing a reduced incidence of several obesity-related comorbidities [9], such as a

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