title: Strong effect of pubertal status on metabolic health in obese children: a longitudinal study.
abstract: BACKGROUND
  The concept of metabolic healthy obese (MHO) status has been proposed also for children. However, it is unclear whether this is a stable status in childhood.
  
  
  OBJECTIVE
  The aim was to analyze the changes of MHO status over time.
  
  
  METHODS
  This is 1-year longitudinal analysis of our obesity cohort.
  
  
  METHODS
  All obese children of our outpatient obesity clinic with 1-year follow-up were included.
  
  
  METHODS
  Standard care intervention was used.
  
  
  METHODS
  We examined body mass index (BMI), waist circumference, pubertal stage, blood pressure, fasting lipids, glucose, and insulin resistance index homeostasis model assessment (HOMA). MHO status was defined by absence of cardiovascular risk factors.
  
  
  RESULTS
  A total of 2017 obese children (mean age, 11.6 ± 2.8 y; 45% male; BMI, 28.5 ± 5.3 kg/m(2); BMI-z score, 2.4 ±0.5) were enrolled onto the study, and 49.3% of the children were MHO at baseline. After 1 year, the majority of the MHO remained MHO (68.0%). MHO children were significantly younger, more frequently prepubertal, and less overweight compared with metabolic unhealthy obese (MUO) children (all P < .05). In the longitudinal analyses, entering into puberty (OR, 1.9; 95% confidence interval, 1.3-2.8]; P = .004) doubled the risk for switching from MHO to MUO, whereas changing from mid to late puberty nearly tripled the likelihood for switching from MUO to MHO (OR 3.1 [2.1-4.5], P < .001) in multiple logistic regression analyses adjusted for age, sex, and changes of body mass index standard deviation score (BMI-SDS).
  
  
  CONCLUSIONS
  MHO is a stable status in childhood obesity as long as pubertal status remains stable. Due to the strong association between puberty and MUO status, the concept of MHO is questionable, at least in pubertal children.
authors.affiliation: Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine (T.R., B.W., C.K., N.L.), Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, 58448 Witten, Germany; and Institute for Epidemiology and Medical Biometry (R.W.H.), Central Institute for Biomedical Technology, CAQM, University of Ulm, 89081 Ulm, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinehr
authors.forename: Barbara
authors.initials: B
authors.lastname: Wolters
authors.forename: Caroline
authors.initials: C
authors.lastname: Knop
authors.forename: Nina
authors.initials: N
authors.lastname: Lass
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism*; D002648:Child; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D011627:Puberty / Q000378:metabolism*; D012307:Risk Factors; D012741:Sexual Maturation / Q000502:physiology*; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose