title: Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents.
abstract: Available data on metabolically healthy obese (MHO) phenotype in children suggest that gender, puberty, waist circumference, insulin sensitivity, and other laboratory predictors have a role in distinguishing these children from metabolically unhealthy obese (MUO) youth. The goal of this study was to identify predictors of MHO phenotype and to analyze glucose and insulin metabolism during oral glucose tolerance test (OGTT) in MHO children. OGTT was performed in 244 obese children and adolescents aged 4.6-18.9 years. Subjects were classified as MHO in case of no fulfilled criterion of metabolic syndrome except anthropometry or as MUO (≥2 fulfilled criteria). Among the subjects, 21.7 % had MHO phenotype, and they were more likely to be female, younger, and in earlier stages of pubertal development, with lower degree of abdominal obesity. Insulin resistance was the only independent laboratory predictor of MUO phenotype (OR 1.59, CI 1.13-2.25), with 82 % sensitivity and 60 % specificity for diagnosing MUO using HOMA-IR cutoff point of ≥2.85. Although no significant differences were observed in glucose regulation, MUO children had higher insulin demand throughout OGTT, with 1.53 times higher total insulin secretion.
  
  
  CONCLUSIONS
  Further research is needed to investigate the possibility of targeted treatment of insulin resistance to minimize pubertal cross-over to MUO in obese children.
  
  
  BACKGROUND
  • Substantial proportion of the obese youth (21-68 %) displays a metabolically healthy (MHO) phenotype. • Gender, puberty, waist circumference, insulin sensitivity, and lower levels of uric acid and transaminases have a possible role in distinguishing MHO from metabolically unhealthy obese (MUO) children.
  
  
  BACKGROUND
  • Insulin resistance was found to be the only significant laboratory predictor of MUO when adjusted for gender, puberty, and the degree of abdominal obesity. • Besides basal insulin resistance, MUO children were found to have a significantly higher insulin secretion throughout OGTT in order to maintain glucose homeostasis.
authors.affiliation: Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. radevukovic9@gmail.com.
authors.forename: Rade
authors.initials: R
authors.lastname: Vukovic
authors.affiliation: Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. tanjamil5e@gmail.com.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Milenkovic
authors.affiliation: Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. mitrovic.sky@gmail.com.
authors.forename: Katarina
authors.initials: K
authors.lastname: Mitrovic
authors.affiliation: Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. sladjat71@gmail.com.
authors.forename: Sladjana
authors.initials: S
authors.lastname: Todorovic
authors.affiliation: Family Planning Center, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. l.plavsic@hotmail.com.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Plavsic
authors.affiliation: Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Dr Subotica 11, 11000, Belgrade, Serbia. ana.vukovic@stomf.bg.ac.rs.
authors.forename: Ana
authors.initials: A
authors.lastname: Vukovic
authors.affiliation: Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. draganz@eunet.rs.|School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia. draganz@eunet.rs.
authors.forename: Dragan
authors.initials: D
authors.lastname: Zdravkovic
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000503:physiopathology; D010641:Phenotype; D012680:Sensitivity and Specificity
keywords: Children; Insulin resistance; Insulin sensitive obese; Metabolic syndrome; Metabolically healthy obese; Pediatric obesity