Adipose-inflammatory factors elevated in obese children, correlate with metabolic health and NAFLD severity

This retrospective cohort study analyzed adipose-inflammatory factor profiles in 500 obese children (162 with metabolically healthy obesity [MHO] and 338 with metabolically unhealthy obesity [MUO]) and 162 metabolically healthy lean (MHL) controls. The study compared levels of specific factors—leptin, resistin, RBP-4, PGRN, TNF-α, IL-6, and CCL2—between these groups and examined their associations with non-alcoholic fatty liver disease (NAFLD) severity in the MHO subgroup.

Metabolic parameters and the levels of all seven adipose-inflammatory factors were significantly higher in children with MHO compared to MHL controls, and were further elevated in children with MUO (all reported P < 0.05). Adiponectin showed an inverse trend across the groups. The study also assessed the diagnostic efficacy of these factors for differentiating obesity phenotypes and their relationships with NAFLD activity score (NAS) and steatosis, activity, and fibrosis (SAF) score, though specific numerical results for these secondary outcomes were not reported.

Safety and tolerability data were not reported. Key limitations of the study include its retrospective design, which precludes causal inference, and the lack of reported absolute numbers, effect sizes, or confidence intervals for the main comparisons. The absence of detailed results for the secondary outcomes related to NAFLD severity and diagnostic efficacy limits the interpretability of those findings.

For clinical practice, these findings are observational and highlight associations between inflammatory profiles and metabolic phenotypes in pediatric obesity. They do not establish causality or provide guidance for specific interventions. Clinicians should recognize that inflammatory markers may vary across obesity subtypes, but their clinical utility for risk stratification or management requires prospective validation.