Beyond Cardiometabolic: Health Disorders Risk in Metabolically Healthy Obese Children – A Systematic Review and Meta-Analysis of 19,119 Children

Richard Christophorus Kurniawan,1,* Frederick Suhamdy,1,* Muhammad Makarimal Akhlaq,1 Eko Fuji Ariyanto2,3 1Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 2Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 3Study Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia*These authors contributed equally to this workCorrespondence: Richard Christophorus Kurniawan, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia, Email [email protected] and Objectives: Childhood obesity is associated with both short-term and long-term health complications, yet a new obesity phenotype called metabolically healthy obesity (MHO) has emerged. While MHO is often perceived as a “benign” form of obesity, research specifically examining health disorders risks in children with MHO remains limited. This systematic review and meta-analysis aimed to evaluate health disorders in children with MHO.Methods: Following PRISMA 2020 guidelines, we systematically searched five databases (PubMed, Scopus, Google Scholar, EBSCO, and ScienceDirect) for observational studies examining MHO children aged 0– 18 years. The studies were analyzed using R and R Studio software, with study quality assessed using the Newcastle Ottawa Scale.Results: Ten studies with a total of 19,119 children were included in this review. Children with MHO demonstrated significantly higher overall health disorders risk compared to MHNW children (pooled OR 2.88, 95% CI [1.64; 5.06]). This trend aligns with the subgroups analysis of left ventricle hypertrophy, hypertension, and kidney damage. However, some of the subgroup analyses showed insignificant results. Additionally, MHO children showed lower risks of experiencing health disorders compared to MUO children (pooled OR 0.56, 95% CI [0.23; 1.34]). The underlying mechanism of the increased health risk is excess adipokines causing systemic inflammation and leading to increased various health risks.Conclusion: Despite metabolically “healthy” status, children with MHO remain at increased risk for health disorders compared to normal-weight peers. This systematic review and meta-analysis is the first one discussing the health disorders in children with MHO. More studies are required in the future to reinforce these findings in order to produce much more comprehensive insights.Keywords: children, disorders, metabolically healthy obesity, obesity