Hypertension outcomes in metabolically unhealthy normal-weight and metabolically healthy obese children and adolescents.

Metabolically healthy obesity (MHO) begins in childhood and continues into adulthood. However, the association between MHO and the risk of developing hypertension remains controversial. A prospective cohort study was conducted to investigate the risk of hypertension in MHO and metabolically unhealthy normal-weight (MUNW) Chinese children and adolescents. A total of 1183 participants, 6-18 years old at baseline with normal blood pressure values, were studied using follow-up data from the cohort of the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. The participants were classified according to the body mass index and the presence/absence of metabolic abnormality, which was defined by metabolic syndrome (MetS) or insulin resistance (IR). During the 6-year follow-up period, 239 (20.2%) participants developed incident hypertension. After adjusting for age, sex, physical activity, pubertal stage, dietary habits and family history of hypertension, an increased risk for hypertension was observed in the MHO individuals (risk ratio, RRMetS 5.42; 95% confidence interval (CI) 3.19-9.22 and RRIR 7.59; 95% CI 1.64-35.20) compared with their metabolically healthy normal-weight counterparts. Independent of the definition of metabolic abnormality, the MUNW subjects did not have an elevated incidence of hypertension. These results suggest that the risk of developing hypertension is increased in the MHO but not in the MUNW individuals.