Indicators of Glucose Metabolism in Children and Adolescents Characterized as Having "Metabolically Healthy" and "Metabolically Unhealthy" Obesity.

Background/objectives: Some individuals with obesity may exhibit fewer metabolic disturbances and face a lower long-term risk of complications; however, the existence of this so-called "metabolically healthy obesity" (MHO) compared to "metabolically unhealthy obesity" (MUO) remains controversial. We hypothesized that children with MHO might have a more favorable profile than children with MUO. Markers of glucose metabolism and insulin sensitivity were compared between children and adolescents diagnosed with MHO and MUO.

Methods: This study recruited prospectively 104 children and adolescents (aged 6-16 years, 47 boys) with obesity. All participants underwent an oral glucose tolerance test (OGTT), and a comparative analysis was performed on HOMA-IR, QUICKI, insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), and oral disposition index (oDI). Glucose metabolism indices were compared in these subgroups according to pubertal status.

Results: Forty-seven children (45.2%) were diagnosed with MHO. The whole-body ISI differed significantly between the MHO and MUO groups (4.02 vs. 2.7, < 0.01). The IGI was statistically lower in the MHO group compared to MUO (1.26 vs. 1.54, < 0.01), while neither the DI nor the oDI differed significantly. A higher ISI (4.5 vs. 3.9, < 0.01) was observed in prepubertal MHO individuals compared to MHO adolescents.

Conclusions: Children classified as MHO according to the more recent criteria exhibit a more favorable metabolic profile than those with MUO. However, a completely healthy profile was not demonstrated in the MHO group, as many crucial metabolic profile parameters were comparable to those observed in the MUO group. The findings of this study indicate that all children with obesity, irrespective of whether they are categorized as having MUO or MHO, necessitate close monitoring.