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. 2022 Oct 14:13:980332.
doi: 10.3389/fendo.2022.980332. eCollection 2022.

Sex differences in metabolically healthy and metabolically unhealthy obesity among Chinese children and adolescents

Shan Cai  1   2 , Jiajia Dang  1   2 , Panliang Zhong  1   2 , Ning Ma  1   2 , Yunfei Liu  1   2 , Di Shi  1   2 , Zhiyong Zou  1   2 , Yanhui Dong  1   2 , Jun Ma  1   2 , Yi Song  1   2
Affiliations

Sex differences in metabolically healthy and metabolically unhealthy obesity among Chinese children and adolescents

Shan Cai et al. Front Endocrinol (Lausanne). .

Erratum in

Abstract

Objectives: To analyze sex differences in the prevalence of obesity phenotypes and their risk factors among children and adolescents aged 7-18 years in China.

Methods: We enrolled 15,114 children and adolescents aged 7-18 years into the final analysis. Obesity phenotypes were classified by body mass index (BMI) and metabolic status as metabolically healthy or unhealthy obesity. In addition, we collected four possible influencing factors on obesity phenotypes through questionnaires, including demographic, parental, early life, and lifestyle indicators. Multinomial logistic regression analysis in a generalized linear mixed model (GLMM) was selected to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for identifying risk factors and control the cluster effects of schools. More importantly, the interaction terms of sex and each indicator were established to demonstrate the sex differences.

Results: The prevalence of metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically healthy overweight and obesity (MHOO), and metabolically unhealthy overweight and obesity (MUOO) were 3.5%, 5.6%, 11.1%, and 13.0% respectively, with higher prevalence in boys (5.3% vs. 1.6%, 7.9% vs. 3.1%, 14.3% vs. 7.7%, 15.6% vs. 10.1%). In addition, younger ages, single children, parental smoking, parental history of diseases (overweight, hypertension, diabetes), caesarean, premature, and delayed delivery time, high birth weight, insufficient sleep time, and excessive screen time were considered as important risk factors of MHO and MUO among children and adolescents (p < 0.05). More notably, boys were at higher risks of MUO when they were single children (boys: OR = 1.56, 95% CI: 1.24-1.96; girls: OR = 1.12, 95% CI: 0.82-1.54), while girls were more sensitive to MUO with parental smoking (girls: OR = 1.34, 95% CI: 1.02-1.76; boys: OR = 1.16, 95% CI: 0.97-1.39), premature delivery (girls: OR = 3.11, 95% CI: 1.59-6.07; boys: OR = 1.22, 95% CI: 0.67-2.22), high birth weight (girls: OR = 2.45, 95% CI: 1.63-3.69; boys: OR = 1.28, 95% CI: 0.96-1.70), and excessive screen time (girls: OR = 1.47, 95% CI: 1.06-2.04; boys: OR = 0.97, 95% CI: 0.79-1.20), with significant interaction term for sex difference (pinteraction < 0.05).

Conclusions: MHO and MUO are becoming prevalent among Chinese children and adolescents. Significant sex differences in the prevalence of obesity phenotypes as well as their environmental and genetic risk factors suggest it might be necessary to manage obesity phenotypes problems from a sex perspective.

Keywords: children and adolescents; metabolically healthy obesity; metabolically unhealthy obesity; obesity phenotypes; sex differences.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of data. BMI, Body Mass Index.
Figure 2
Figure 2
Association between MHO/MUO prevalence and risk factors stratified by sex. Obesity phenotypes include metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), taking the participants without MHO or MUO as the reference group. Adjusted for age, residence, single-child status, parental education level, parental smoking, parental drinking, parental overweight, parental hypertension, parental diabetes, delivery model, delivery time, birth weight, breastfeeding, fruits, vegetables, beverage, sleep time, screen time, physical activity (PA) time. *Significant interaction with sex in the whole model. NBW, normal birth weight; LBW, low birth weight; LBW, high birth weight.
Figure 3
Figure 3
Association between MHOO/MUOO prevalence and risk factors stratified by sex. Obesity phenotypes include metabolically healthy overweight and obesity (MHOO) and metabolically unhealthy overweight and obesity (MUOO), taking the participants without MHOO or MUOO as the reference group. Adjusted for age, residence, single-child status, parental education level, parental smoking, parental drinking, parental overweight, parental hypertension, parental diabetes, delivery model, delivery time, birth weight, breastfeeding, fruits, vegetables, beverage, sleep time, screen time, physical activity (PA) time. *Significant interaction with sex in the whole model. NBW, normal birth weight; LBW, low birth weight; HBW, high birth weight.
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