Association of Childhood Obesity Phenotypes With Cardiometabolic Outcomes in Adulthood: A Systematic Review and Meta‐Analysis

The association between different metabolic phenotypes of childhood obesity and cardiometabolic outcomes in adulthood is inconsistent. We conducted a systematic review and meta-analysis to synthesize the evidence on the association between childhood obesity phenotypes including metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) and cardiometabolic outcomes in adulthood. Four cohort studies with 8446 participants were included in this review. A meta-analysis of three studies with 7270 participants shows that children in the MHO (pooled RR, 2.72, 95% CI, 1.14-6.48) and MUO (pooled RR, 3.94, 95% CI, 2.77-5.60) groups had a higher risk of diabetes compared with the metabolically healthy normal weight (MHNW) phenotype. Similarly, in a meta-analysis of two studies with 3772 participants, the children with MHO (pooled RR, 2.50, 95% CI, 1.62-3.84) and MUO (pooled RR, 3.33, 95% CI, 2.38-4.67) had a higher risk of metabolic syndrome. After adjustment for adult BMI, the risk of diabetes and metabolic syndrome in the MHO phenotype was substantially reduced, while the risk in MUO decreased somewhat but was still significant. Additionally, the mean carotid intimal thickness of MHO (pooled mean difference, 0.02, 95% CI, -0.01 to 0.05) and MUO (pooled mean difference, 0.05; 95% CI, -0.01 to 0.11) was greater than that of MHNW, in the meta-analysis of three studies with 3924 participants. These findings suggest that weight loss from childhood into adulthood remains a critical strategy to mitigate these long-term health risks. Additionally, regular monitoring of cardiovascular metabolic indicators and timely intervention are essential for children with MUO. Given the few studies conducted on this important topic, further research with large sample sizes is needed to confirm our findings.