OBJECTIVE To investigate 1) differences in cardiometabolic risk and HOMA of insulin resistance (HOMA-IR) across BMI categories (underweight to morbid obesity), 2) whether fit children have lower cardiometabolic risk/HOMA-IR than unfit children in each BMI category, and 3) differences in cardiometabolic risk/HOMA-IR in normal-weight unfit children and obese fit children.

RESEARCH DESIGN AND METHODS A pooled study including cross-sectional data from three projects (n = 1,247 children aged 8–11 years). Cardiometabolic risk was assessed using the sum of the sex- and age-specific z scores for triglycerides, HDL cholesterol, glucose, and the average of systolic and diastolic blood pressure and HOMA-IR.

RESULTS A significant linear association was observed between the risk score and BMI categories (P trend ≤0.001), with every incremental rise in BMI category being associated with a 0.5 SD higher risk score (standardized β = 0.474, P < 0.001). A trend was found showing that as BMI categories rose, cardiorespiratory fitness (CRF) attenuated the risk score, with the biggest differences observed in the most obese children (−0.8 SD); however, this attenuation was significant only in mild obesity (−0.2 SD, P = 0.048). Normal-weight unfit children had a significantly lower risk score than obese fit children (P < 0.001); however, a significant reduction in the risk score was found in obese fit compared with unfit children (−0.4 SD, P = 0.027). Similar results were obtained for HOMA-IR.

CONCLUSIONS As BMI categories rose so did cardiometabolic risk and HOMA-IR, which highlights the need for obesity prevention/treatment programs in childhood. Furthermore, CRF may play an important role in lowering the risk of cardiometabolic diseases in obese children.

目的要研究1）BMI类别（体重过轻到病态肥胖）的心脏代谢风险和胰岛素抵抗HOMA（IRMA）的差异，2）在每个BMI类别中，适合的儿童是否比不适合的儿童具有更低的心脏代谢风险/ HOMA-IR，和3）在正常体重儿童不宜和肥胖儿童适合在心脏代谢风险/ HOMA-IR差异。

研究设计与方法一项汇总研究，包括来自三个项目的横断面数据（n = 1,247名8-11岁的儿童）。使用甘油三酸酯，HDL胆固醇，葡萄糖，按性别和年龄的z分数总和，收缩压和舒张压的平均值以及HOMA-IR评估心脏代谢风险。

结果观察到风险评分与BMI类别之间存在显着的线性关联（P趋势≤0.001），BMI类别的每增加一次升高都伴随着0.5 SD更高的风险评分（标准β= 0.474，P <0.001）。发现趋势表明，随着BMI类别的增加，心肺适应（CRF）降低了风险评分，在大多数肥胖儿童中观察到的差异最大（-0.8 SD）；然而，这种衰减仅在轻度肥胖中显着（-0.2 SD，P = 0.048）。体重正常的不健康儿童的风险得分明显低于肥胖的儿童（P<0.001）; 然而，与不健康的儿童相比，肥胖健康的风险评分显着降低（-0.4 SD，P = 0.027）。对于HOMA-IR，获得了相似的结果。

结论随着BMI类别的增加，心脏代谢风险和HOMA-IR也随之增加，这突显了儿童期肥胖症预防/治疗计划的必要性。此外，CRF可能在降低肥胖儿童患心脏代谢疾病的风险中起重要作用。