Adipose-inflammatory factor profiles in children with metabolically healthy obesity and their correlation with NAFLD severity

Objective: To compare adipose-inflammatory factor profiles between children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and analyze their associations with non-alcoholic fatty liver disease (NAFLD) severity in MHO. Methods: This retrospective study included 500 obese children (162 MHO, 338 MUO) and 162 metabolically healthy lean (MHL) controls. Anthropometric, metabolic parameters, and serum levels of key adipose-inflammatory factors (including adiponectin, leptin, resistin, RBP-4, PGRN, TNF-α, IL-6, and CCL2) were compared. ROC curve analysis was used to evaluate diagnostic efficacy of adipose-inflammatory factors for differentiating phenotypes. NAFLD prevalence was assessed, and relationships of adipose-inflammatory factors with NAFLD activity score (NAS) and steatosis, activity, and fibrosis (SAF) score in MHO children with NAFLD were analyzed by Spearman's correlation analysis. Results: < 0.001). Conclusion: MHO children exhibit dysregulation of adipose-inflammatory factors and a considerable risk for NAFLD. These factors, especially adiponectin and leptin, effectively discriminate metabolic phenotypes and correlate with liver injury severity in MHO, suggesting their potential utility as early biomarkers and therapeutic targets.