title: High risk vs. "metabolically healthy" phenotype in juvenile obesity - neck subcutaneous adipose tissue and serum uric acid are clinically relevant.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Paracelsus Private Medical School Salzburg, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Weghuber
authors.forename: S
authors.initials: S
authors.lastname: Zelzer
authors.forename: I
authors.initials: I
authors.lastname: Stelzer
authors.forename: K
authors.initials: K
authors.lastname: Paulmichl
authors.forename: D
authors.initials: D
authors.lastname: Kammerhofer
authors.forename: W
authors.initials: W
authors.lastname: Schnedl
authors.forename: D
authors.initials: D
authors.lastname: Molnar
authors.forename: H
authors.initials: H
authors.lastname: Mangge
mesh_terms: D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D002340:Carotid Artery Diseases / Q000097:blood / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009333:Neck / Q000473:pathology*; D009765:Obesity / Q000097:blood* / Q000473:pathology* / Q000517:prevention & control; D011446:Prospective Studies; D050151:Subcutaneous Fat / Q000378:metabolism* / Q000473:pathology*; D014527:Uric Acid / Q000097:blood*
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D014527:Uric Acid