title: Predictors of metabolically healthy obesity in children.
abstract: OBJECTIVE
  To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status.
  
  
  METHODS
  This cross-sectional study included 8-17 year olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005-2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs.
  
  
  RESULTS
  The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18-0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31-0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24-2.62]; P = 0.002) was the strongest independent predictor of MHO-CR.
  
  
  CONCLUSIONS
  Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.
authors.affiliation: Corresponding author: Geoff D.C. Ball, gdball@ualberta.ca.
authors.forename: Rhiannon L
authors.initials: RL
authors.lastname: Prince
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kuk
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Ambler
authors.forename: Jasmine
authors.initials: J
authors.lastname: Dhaliwal
authors.forename: Geoff D C
authors.initials: GD
authors.lastname: Ball
mesh_terms: D050154:Adiposity; D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D055105:Waist Circumference