Metabolically healthy obesity in children and adolescents: A misleading label?

Authors

Belén Davico, Maximiliano Martin, Laura Gaete, Ezequiel Lozano Chiappe, Leonardo Gómez Rosso, María Luz Muzzio, María Soledad Saez, Patricia Palenque, Viviana Osta, Camila Puma, Agustina Varela, Adriana Roussos, María Gabriela Ballerini, Fernando Brites

Published in

Nutrition, metabolism, and cardiovascular diseases : NMCD. Pages 105011. Sep 25, 2026. Epub Sep 25, 2026.

Abstract

The concept of metabolically healthy obesity (MHO) remains debated, particularly in pediatric populations. Beyond traditional risk factors, evaluating high-density lipoprotein (HDL) functionality may provide further insight into cardiometabolic risk in this population. The aim of this study was to assess cardiometabolic alterations in pediatric MHO, including insulin sensitivity, lipid profile, inflammation, and atheroprotective properties of HDL.
This cross-sectional study included 21 children and adolescents with MHO, 15 with metabolically unhealthy obesity (MUO) and 19 controls. Groups displayed no significant differences in age, sex, and Tanner stage. We measured anthropometrics, insulin resistance [HOMA-IR, QUICKI, non-esterified fatty acids (NEFA)], lipids, systemic and vascular [(lipoprotein-associated phospholipase A₂ (Lp-PLA₂) activity)] inflammation. HDL functionality was assessed by evaluating reverse cholesterol transport [cholesterol efflux capacity (CEC), lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) activities] and its antioxidant capacity (paraoxonase, arylesterase and inhibition of LDL oxidation). Both MHO and MUO groups exhibited multiple alterations compared to controls, including higher insulin, HOMA-IR, NEFA, LDL-C, and apo B, alongside lower QUICKI, HDL-C, and apo A-I (p < 0.05). Notably, Lp-PLA₂ activity was elevated in both MHO and MUO. While HDL antioxidant capacity was preserved, the main steps of reverse cholesterol transport (CEC and LCAT) were significantly impaired in both groups with obesity.
Children and adolescents with both MHO and MUO exhibit significant metabolic impairments compared with controls. Conventional criteria to define "metabolically healthy" may not capture the full spectrum of cardiometabolic abnormalities. Novel markers of cardiovascular risk could be incorporated into MHO definitions.

PMID:
42901844
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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