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Predictive markers of metabolically healthy obesity in children and adolescents: can AST/ALT ratio serve as a simple and reliable diagnostic indicator?

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Abstract

This study aimed to estimate the prevalence of metabolically healthy obesity (MHO) according to two different consensus-based criteria and to investigate simple, measurable predictive markers for the diagnosis of MHO. Five hundred and ninety-three obese children and adolescents aged 6–18 years were included in the study. The frequency of MHO was calculated. ROC analysis was used to estimate the predictive value of AST/ALT ratio, waist/hip ratio, MPV, TSH, and Ft4 cut-off value for the diagnosis of MHO. The prevalence of MHO was 21.9% and 10.2% according to 2018 and 2023 consensus-based MHO criteria, respectively. AST/ALT ratio cut-off value for the diagnosis of MHO was calculated as ≥ 1 with 77% sensitivity and 52% specificity using Damanhoury et al.’s criteria (AUC = 0.61, p = 0.02), and 90% sensitivity and 51% specificity using Abiri et al.’s criteria (AUC = 0.70, p = 0.01). Additionally, using binomial regression analysis, only the AST/ALT ratio is independently and significantly associated with the diagnosis of MHO (p = 0.03 for 2018 criteria and p = 0.04 for 2023 criteria).

Conclusion: The ALT/AST ratio may be a useful indicator of MHO in children and adolescents.

What is Known:

• Metabolically healthy obesity refers to people who are obese but do not have any of the standard cardio-metabolic risk factors.

• Metabolically healthy obesity is not entirely harmless; the metabolic characteristics of individuals with this phenotype are less favorable than those of healthy lean groups. Moreover, it is not a constant state, and there may be a transition to metabolically unhealthy phenotypes over time.

What is New:

• The prevalence of MHO is 21.9% and 10.2% according to 2018 and 2023 consensus-based metabolically healthy obesity criteria, respectively.

• The ALT/AST ratio may be a useful indicator of metabolically healthy obesity in children and adolescents.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code availability

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Abbreviations

AGA:

Appropriate for gestational age

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUC:

Area under the curve

BMI:

Body mass index

DBP:

Diastolic blood pressure

GW:

Gestational week

HC:

Hip circumference

HDL:

High-density lipoprotein

HOMA-IR:

Homeostasis model of insulin resistance

LDL:

Low-density lipoprotein

LGA:

Large for gestational age

MCV:

Mean corpuscular volume

MHO:

Metabolically healthy obesity

MPV:

Mean platelet volume

MUO:

Metabolically unhealthy obesity

ROC:

Receiver operating characteristic

SBP:

Systolic blood pressure

SD:

Standard deviation

SDS:

Standard deviation score

SGA:

Small for gestational age

SHT:

Subclinical hypothyroidism

SPSS:

Statistical Package for Social Sciences

TSH:

Thyroid stimulating hormone

WBC:

White blood cells

WC:

Waist circumference

WHO:

World Health Organization

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Authors and Affiliations

  1. Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey

    Nurullah Çelik

  2. Department of Pediatrics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey

    Gülşah Ünsal & Hüseyin Taştanoğlu

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  1. Nurullah Çelik
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  2. Gülşah Ünsal
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  3. Hüseyin Taştanoğlu
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Contributions

NÇ: conception and design of the study, acquisition of the data, contribution to analysis, interpretation of data, revising it critically for important intellectual content. GÜ: conception and design of the study, acquisition of the data, contribution to analysis, interpretation of data. HT: conception and design of the study, acquisition of the data, revising it critically for important intellectual content.

Corresponding author

Correspondence to Nurullah Çelik.

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The institutional ethics committee approved the study protocol (2023-06/17).

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Written informed assent and consent were obtained from all participants and their parents before any procedures.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Çelik, N., Ünsal, G. & Taştanoğlu, H. Predictive markers of metabolically healthy obesity in children and adolescents: can AST/ALT ratio serve as a simple and reliable diagnostic indicator?. Eur J Pediatr 183, 243–251 (2024). https://doi.org/10.1007/s00431-023-05296-3

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