title: Prevalence of Metabolically Healthy but Overweight/Obese Phenotype and Its Association With Sedentary Time, Physical Activity, and Fitness.
abstract: OBJECTIVE
  Childhood obesity is one of the major concerns in the last years due to the association with future health problems and all-cause mortality. However, there is a subset of adolescents with overweight/obesity who present a metabolic healthy profile. Therefore, the aim of this study was to examine the prevalence of metabolically healthy but overweight/obese adolescents and whether sedentary time, physical activity, and fitness differ between metabolically healthy and nonmetabolically healthy phenotypes.
  
  
  METHODS
  A subsample of 237 European adolescents from the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (n = 3,528, participation rate: 61.3%) with overweight/obesity were included. The study sample was not fully representative for the European adolescent population. Based on sex- and age-specific metabolic syndrome cutoff points for triglycerides, glucose, blood pressure, and high-density cholesterol participants were classified as metabolically healthy or nonmetabolically healthy. Sedentary time, physical activity, and fitness were assessed by accelerometry and the Alpha battery, respectively.
  
  
  RESULTS
  The prevalence of metabolically healthy status in adolescents with overweight and obesity was higher in girls (87%) than in boys (74%, p = .019), being similar when only obesity was considered. Sedentary time was lower in metabolically healthy overweight/obese than in nonmetabolically healthy participants (mean difference = 48.0 minutes, p = .012). Moderate and moderate-to-vigorous physical activity were higher (p's < .05) in metabolically healthy than in nonmetabolically healthy adolescents with overweight/obesity (mean difference = 7.9 min/day and 10.9 min/day, respectively). No significant differences were found in fitness. Overall, these results persisted when only adolescents with obesity were included in the analyses.
  
  
  CONCLUSIONS
  Metabolically healthy adolescents with overweight/obesity are less sedentary and more active than their nonmetabolically healthy peers with overweight/obesity, yet consistent differences in fitness were not observed.
authors.affiliation: Faculty of Sport Sciences, Department of Physical Education and Sports, PROFITH "PROmoting FITness and Health through physical activity" research group, University of Granada, Granada, Spain. Electronic address: cadenas@ugr.es.
authors.forename: Cristina
authors.initials: C
authors.lastname: Cadenas-Sanchez
authors.affiliation: Faculty of Sport Sciences, Department of Physical Education and Sports, PROFITH "PROmoting FITness and Health through physical activity" research group, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Jonatan R
authors.initials: JR
authors.lastname: Ruiz
authors.affiliation: Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria, Spain.
authors.forename: Idoia
authors.initials: I
authors.lastname: Labayen
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium; International Agency for Research on Cancer, Nutrition and Metabolism Section, Lyon, France.
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.affiliation: ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Technical University of Madrid, Madrid, Spain; CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Gross
authors.affiliation: ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Technical University of Madrid, Madrid, Spain; Universität Bonn, Institut für Ernährungs- und Lebensmittelwissenschaften Ernährungsphysiologie, Rheinische Friedrich Wilhelms, Bonn, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Breidenassel
authors.affiliation: University of Crete School of Medicine, Department of Social Medicine, Preventive Medicine & Nutrition Unit, Heraklion, Crete, Greece.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: De Henauw
authors.affiliation: Univ. Lille, Inserm, CHU Lille, UMR995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France & Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, F-59000 Lille, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Vanhelst
authors.affiliation: Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
authors.affiliation: Department of Pediatrics, Clinical Centre, University of Pécs, Pécs, Hungary.
authors.forename: Denes
authors.initials: D
authors.lastname: Molnar
authors.affiliation: CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Bueno
authors.affiliation: Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Censi
authors.affiliation: University of Crete School of Medicine, Department of Social Medicine, Preventive Medicine & Nutrition Unit, Heraklion, Crete, Greece.
authors.forename: María
authors.initials: M
authors.lastname: Plada
authors.affiliation: Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.affiliation: CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
authors.affiliation: Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Castillo
authors.affiliation: Faculty of Sport Sciences, Department of Physical Education and Sports, PROFITH "PROmoting FITness and Health through physical activity" research group, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Francisco B
authors.initials: FB
authors.lastname: Ortega
mesh_terms: D000293:Adolescent; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D063766:Pediatric Obesity / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D010641:Phenotype; D010809:Physical Fitness; D015995:Prevalence; D057185:Sedentary Behavior
keywords: Children; MHO; Metabolic status; Nonmetabolically healthy; Youth; non-MHO