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Early signs of fatty liver, subclinical heart disease found in children with metabolically healthy obesity
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Despite a lack of conventional cardiometabolic risk factors, children with so-called metabolically healthy obesity have a higher prevalence of hepatic steatosis and left ventricular hypertrophy, according to findings published in Nutrition, Metabolism & Cardiovascular Diseases.
“A unique obesity subset known as ‘healthy obesity’ has been proposed in adults for those individuals who do not display the typical obesity-associated metabolic disorders,” Procolo Di Bonito, MD, of the department of internal medicine at S. Maria delle Grazie, Pozzuli Hospital in Naples, Italy, and colleagues wrote in the study background. “These individuals are assumed to have lower risk of cardiometabolic complications compared with their counterparts with a metabolically unhealthy phenotype. However, the clinical implications of this metabolically healthy obese phenotype remain controversial.”
In a retrospective study, researchers analyzed data from 1,769 children and adolescents (mean age, 11 years) with overweight or obesity referred to secondary or tertiary centers between 2003 and 2016 for the CARITALY study, a retrospective, cross-sectional study assessing the prevalence of traditional cardiometabolic risk factors in children with overweight or obesity.
Children were measured and weighed, and assessed for blood pressure, pubertal stage, fasting plasma glucose, alanine aminotransferase, triglycerides, HDL cholesterol and insulin.
All participants underwent ultrasound to identify hepatic steatosis. A subsample of 177 children and adolescents were assessed for the presence of left ventricular hypertrophy, characterized by 95th percentile of left ventricular mass per hour for age and sex.
The researchers found the prevalence of hepatic steatosis increased by 23% in children with overweight, by 27.8% in children with obesity and by 45.1% in children with morbid obesity (P < .0001).
Compared with children with overweight, children with obesity were more than twice as likely to have hepatic steatosis after adjustment for study center, age and pubertal stage (OR = 2.18; 95% CI, 1.56-3.05). Risk rose markedly in children with morbid obesity vs. children with overweight, with an OR of 6.2 for hepatic steatosis (95% CI, 4.26-9.03). Results persisted after adjusting for insulin resistance.
Researchers also observed an increase in the prevalence of left ventricular hypertrophy across BMI categories, from 36.8% in children with overweight to 57.9% in children with obesity and 54.5% in children with morbid obesity (P < .05). For left ventricular hypertrophy, ORs vs. children with overweight were 2.46 (95% CI, 1.20-5.06) for children with obesity and 2.79 (95% CI, 11.18-6.61) for children with morbid obesity, with results again persisting after adjusting for insulin resistance.
“Our study showed, for the first time, that children and adolescents with [the metabolically healthy obese] phenotype have target organ involvement, characterized by [hepatic steatosis] or [left ventricular hypertrophy],” the researchers wrote. “The presence of these abnormalities at an early stage of life should alert pediatricians that [the metabolically healthy obese] phenotype is not a safe condition. Given that childhood is a critical period of lifestyle changes, intensive programs addressed to weight control through healthy diet and physical activity should be undertaken in young people with [obesity] and [morbid obesity], independent of the presence of metabolic comorbidities.” – by Jennifer Byrne
Disclosures: The authors report no relevant financial disclosures.
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