Original article
Prevalence of Metabolically Healthy but Overweight/Obese Phenotype and Its Association With Sedentary Time, Physical Activity, and Fitness

https://doi.org/10.1016/j.jadohealth.2017.01.018Get rights and content

Abstract

Purpose

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.

Section snippets

Study design

The present study is under the framework of the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS; www.helenastudy.com). The HELENA study was performed from 2006 to 2008 in 10 European cities. A total of 3,528 European adolescents aged 12.5–17.5 years participated in the study (participation rate: 61.3%) [10]. Details of recruitment, standardization, and harmonization processes were published elsewhere [11]. Blood samples were collected in one third of

Characteristics of the study sample and prevalence of MHO

Age, anthropometry, prevalence of MHO/non-MHO, FAS, maternal educational level, and puberty stage are shown in Table 1. Briefly, non-MHO adolescents had higher weight, height, and body mass index than MHO (all p ≤ .006). Prevalence of MHO and non-MHO in European adolescents from the HELENA study is shown in Figure 1. Overall, the prevalence of MHO was 80% (n = 190) and 70% (n = 166) for overweight/obese and obese groups, respectively. The prevalence of MHO was roughly 13%–19% higher in girls

Discussion

The main findings of this study show that (1) prevalence of MHO was 80% for overweight/obese and 70% for obese, being higher in girls than in boys; (2) after adjusting for potential covariates and using objective measures, sedentary time was higher in non-MHO adolescents with overweight/obesity than in their MHO peers; (3) MPA and MVPA were higher in MHO than in non-MHO, both in the group with overweight/obesity and only obesity; and (4) no consistent differences were found in health-related

Acknowledgments

The authors thank the children and adolescents who participated in the study and their parents and teachers for their collaboration. The authors also acknowledge the members involved in field work for their efforts. They thank Petra Pickert and Anke Carstensen for their contribution to laboratory work.

References (37)

  • P.K. Wiklund et al.

    Serum metabolic profiles in overweight and obese women with and without metabolic syndrome

    Diabetol Metab Syndr

    (2014)
  • U. Ekelund et al.

    Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents

    JAMA

    (2012)
  • F.B. Ortega et al.

    The intriguing metabolically healthy but obese phenotype: Cardiovascular prognosis and role of fitness

    Eur Heart J

    (2013)
  • L. Beghin et al.

    Main characteristics and participation rate of European adolescents included in the HELENA study

    Arch Public Health

    (2012)
  • L.A. Moreno et al.

    Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study

    Int J Obes

    (2008)
  • T.J. Cole et al.

    Body mass index cut offs to define thinness in children and adolescents: International survey

    BMJ

    (2007)
  • M. de Onis et al.

    Development of a WHO growth reference for school-aged children and adolescents

    Bull World Health Organ

    (2007)
  • M. Gonzalez-Gross et al.

    Sampling and processing of fresh blood samples within a European multicenter nutritional study: Evaluation of biomarker stability during transport and storage

    Int J Obes

    (2008)

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    Conflicts of Interest: The authors have no conflicts of interest to disclose.

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