Research Topic

Metabolically Healthy and Unhealthy Obese Children and Adolescents

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With over two billion subjects with overweight/obesity expected worldwide by 2030, cardiovascular disease (CVD) and premature death will undoubtedly continue to represent relevant public health challenges. Indeed, it is well established that obesity has many adverse effects on cardiometabolic parameters and ...

With over two billion subjects with overweight/obesity expected worldwide by 2030, cardiovascular disease (CVD) and premature death will undoubtedly continue to represent relevant public health challenges. Indeed, it is well established that obesity has many adverse effects on cardiometabolic parameters and CV risk factors such as glucose intolerance, type 2 diabetes, atherogenic lipids, blood pressure, and increased levels of inflammation, all of which lead to marked increase in CVD events in adulthood. Therefore, there is a need for an early identification and treatment of youths who are at greater risk of developing these obesity-related complications. In adults, a growing interest has been raised regarding a subgroup of obese individuals who are metabolically healthy, for whom the term “metabolically healthy obese (MHO)” has been proposed. The interest for this subgroup relies upon the fact that they may represent a unique category with low cardiometabolic risk.

While previous prospective studies have reported that MHO adults were not at an increased risk of CV events compared to normal weight individuals, more recent data have shown that adults with a “metabolically healthy phenotype” but with increased adiposity, have an increased risk of developing diabetes and CVD compared to normal weight metabolically healthy individuals, suggesting that MHO is not a benign condition. Comparability of these studies is difficult because of the different definitions used
for MHO. Thus, agreement on a universally accepted definition of MHO would be important to compare studies and would inform the design of future studies.

Far less is known about the health and clinical implications of MHO phenotype in pediatric years. The demonstration that MHO phenotype in childhood may have a similar or differential risk for metabolic and cardiovascular complications, compared to metabolically healthy normal-weight children, might be of crucial importance for targeting preventive strategies in early ages.

Numerous questions and problems associated with MHO phenotype should be discussed in the current Topic in the form of Original Research, Reviews, Opinion, Perspective, and General commentary articles, including the following, non-exclusive, examples:

- Criteria for defining MHO phenotype in childhood
- Assessment of MHO prevalence in children
- Evaluation of demographic, anthropometric and lifestyle predictors of MHO phenotype compared to metabolically unhealthy obese (MUO) phenotype
- Evaluation in the short term of the MHO risk for sub-clinical cardiovascular disease ( including impaired vasoreactivity, abnormalities in left ventricular measures and function, and
carotid artery intima-media thickness), chronic inflammation, nonalcoholic fatty liver disease, and abnormal renal function
- Follow-up of clinical cardiometabolic outcomes associated with changes in weight categories and/or metabolic status


Keywords: Metabolically Healthy Obesity, Children and Adolescents, Sub-clinical Cardiovascular Disease, nonalcoholic fatty liver disease, Abnormal Renal Function


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