Fasting insulin resistance affects the prevalence of metabolically healthy obesity in Brazilian adolescents.

AIM: We aimed to assess the influence of fasting insulin resistance on metabolically healthy obesity (MHO) prevalence in adolescents and to identify associated factors. METHODS: This retrospective, registry-based, cross-sectional study included 418 (51.9% girls) 10- to 18-year-old adolescents with obesity from a tertiary outpatient clinic in Sao Paulo, Brazil, between 2009 and 2013. The prevalence of MHO was estimated according to two definitions: (i) no cardiometabolic risk factors (CMRF) by the International Diabetes Federation parameters and (ii) no CMRF and homeostatic model assessment for insulin resistance <3.16. Adjusted prevalence ratios and 95% confidence intervals (CI) evaluated the association of gender, age, pubertal stages, skin colour and degree of obesity with MHO. RESULTS: Metabolically healthy obesity prevalence was lower in definition II than definition I (12.7%; 95% CI 9.1-16.3% versus 43.1%; 95% CI 38.0-48.2%, respectively). Adjusted results showed negative association between severe obesity and MHO by both definitions (p ≤ 0.01). Male and later pubertal stages were also less likely to have MHO, but neither remained significant in definition II. CONCLUSION: Metabolically healthy obesity prevalence decreased when insulin resistance was part of the definition. Detecting pre-clinical insulin resistance may improve the management of treatment-seeking adolescents, especially when they present no CMRF.

Relationship between childhood growth and later outcomes.

Many studies in different settings and times provided us with enough evidence of the association between environmental exposures (mainly nutrition) during pregnancy/infancy and later health outcomes, such as adult non-communicable diseases (NCDs). An individual with a given susceptibility will continue to experience new environmental challenges (e.g. growth), and these later experiences will modulate the early ones. Children that are thin in infancy and then become larger are at greater risk for later NCD. Studies demonstrated that rapid weight gain is a strong predictor of later NCD, independently of the birthweight. But which periods imply a greater risk for developing NCD? Two periods in the first years of life have been linked to the early obesity onset: the first 6 months and between 2 and 5 years of age. And when do these later health outcomes appear? The literature suggests that they start long before adulthood. Children with rapid weight gain have greater risk for hypertension and cardiovascular disease in the first years of life. These lines of evidence suggest that future research should be committed with educational programs and preventive actions focusing on better life behavior in childhood, adolescence and pregnancy.