THE RELEVANCE OF METABOLIC PHENOTYPES OF OBESITY IN CHILDHOOD AND ADOLESCENCE

Abstract

Rationale: The study on specifics of metabolic phenotypes of obesity in children and adolescents seems be highly relevant for a comprehensive assessment of causal and pathophysiological roles of obesity in the atherogenesis. Aim: To identify particulars of metabolic phenotypes of obesity in the population of the school children in the city of Arkhangelsk. Materials and methods: We examined 102 patients aged from 10 to 15 years with obesity, abdominal type (boys, 44.6%, girls, 55.4%). According to the results of a comprehensive clinical and laboratory assessments, the patients were divided into the group of metabolically healthy obese (children and adolescents with obesity, but without any metabolic abnormalities) and the group of metabolically unhealthy obese (having at least 1 metabolic abnormality). The list of metabolic abnormalities included high triglyceride levels, low levels of high density lipoprotein cholesterol (HDL-C), high blood pressure, impaired fasting glucose, increased C-reactive protein levels. Results: The group comparison showed that the mean levels of all studied parameters of pro-atherogenic metabolic abnormalities were significantly higher in the patients with metabolically active obesity (the mean triglyceride levels in the groups of metabolically active and metabolically healthy obesity were 1.31 vs 0.74 mmol/L, glucose levels, 4.92 vs 4.54 mmol/L, C-reactive protein, 3.15 vs 2.30 mg/mL, systolic and diastolic blood pressure, 118.97 vs 110.23 mmHg and 72.90 vs 68.58 mmHg, respectively; p < 0.001), with the exclusion of the mean level of anti-atherogenic HDL-C, which was lower (1.27 vs 1.49 mmol/L; p < 0.001). Also, in addition to abdominal obesity, 21.43% of school children with metabolically active obesity had ≥ 2 atherogenic factors, as well as some pro-inflammatory abnormalities (C-reactive protein levels were higher in one third of children and adolescents of this group, with a borderline significance level). Sixty percent of children and adolescents with obesity and metabolic abnormalities had abnormal lipid parameters. Pro-atherogenic metabolic abnormalities were found in all children and adolescents with increased C-reactive protein levels. Conclusion: Distinctly different phenotypes of obesity with various degrees of metabolic abnormalities were found in the pediatric population. Formation of combination of atherogenic clinical and metabolic abnormalities (dyslipidemia, impaired glucose tolerance, high blood pressure) is possible already in children and adolescents with metabolically active obesity. They can be associated with chronic inflammation, and as such could be the first stage of development of atherosclerosis, metabolic syndrome and cardiovascular disease.