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Exp Clin Endocrinol Diabetes 2013; 121(07): 384-390
DOI: 10.1055/s-0033-1341440
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

High Risk vs. “Metabolically Healthy” Phenotype in Juvenile Obesity – Neck Subcutaneous Adipose Tissue and Serum Uric Acid are Clinically Relevant

D. Weghuber
1   Department of Pediatrics, Paracelsus Private Medical School Salzburg, Austria
,
S. Zelzer
2   Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
,
I. Stelzer
2   Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
,
K. Paulmichl
1   Department of Pediatrics, Paracelsus Private Medical School Salzburg, Austria
,
D. Kammerhofer
1   Department of Pediatrics, Paracelsus Private Medical School Salzburg, Austria
,
W. Schnedl
3   General Practice for Internal Medicine, Bruck an der Mur, Austria
,
D. Molnar
4   Department of Pediatrics, University of Pécs, Pécs, Hungary
,
H. Mangge
2   Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
› Author Affiliations
Further Information

Publication History

received 19 June 2012
first decision 16 October 2012

accepted 06 March 2013

Publication Date:
21 March 2013 (online)

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Abstract

Background:

Since obesity and its associated co-morbidities do not only have effect on the individual patient, but also on society and the health system, it is of great importance to investigate this lifestyle-disease. The rationale of this study was to distinguish metabolically healthy from unhealthy overweight/obese patients as compared to healthy normal weight children and adolescents by means of a comprehensive anthropometric, laboratory and sonomorphological vascular assessment.

Material and methods:

299 study participants were derived from the prospective, observational study STYJOBS/EDECTA (STYrian Juvenile Obesity Study/Early DEteCTion of Arteriosclerosis). Standard anthropometric data were obtained for each subject. This study comprised different diagnostic steps: extended anthropometry (Lipometer®), carotid artery ultrasound, various laboratory measurements, blood pressure measurement, oral glucose tolerance test. Ow/ob juveniles were classified as “metabolically healthy” (no laboratory criteria of metabolic syndrome fulfilled) vs. “metabolically unhealthy” (≥ 3 criteria of metabolic syndrome). Results underwent statistical evaluation, including t-test or Mann-Whitney U-test, regression analysis and a p-value < 0.05 was considered statistically significant.

Results and Discussion:

In the study’s central European cohort only about 16% (n=48/299) of the overweight/obese juveniles can be regarded as metabolically healthy. About 36% (n=108/299) of the overweight/obese patients fulfilled the criteria for metabolic syndrome. High visceral fat stores (p<0.001) and their clinical surrogate waist circumference (p<0.001) determine an adverse metabolic phenotype. Several parameters, including uric acid (p<0.001), adiponectin (p<0.05), insulin resistance (HOMA-Index, p<0.001), nuchal SAT thickness (p<0.001), arteriosclerosis of the carotids (p<0.001), and others are responsible for the distinction between ­metabolically healthy and unhealthy juveniles. Nevertheless, “healthy obesity” only defines a sub-phenotype of a disease effecting rising numbers of young patients.

Conclusion:

Since obesity in children and adolescents is not a consistent entity, it remains crucial to differ between metabolically healthy and unhealthy obese children in order to achieve appropriate intervention and prevention for our patients.

Key words

metabolic features - obesity - cardiovascular incidences
 

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