Correlation between Cardiorespiratory Fitness and Lipid Metabolic Flexibility in Obese Adolescents with Different Metabolic Phenotypes

doi:10.12114/j.issn.1007-9572.2024.0237

Abstract

Abstract:

Background

Currently, the number of obese adolescents in China is increasing dramatically, and adolescent obesity is not only closely related to metabolic diseases, but also a risk factor for coronary heart disease mortality in adulthood. Lipid metabolic flexibility is regarded as an important indicator of the metabolic health of an organism. Studies confirm that cardiorespiratory fitness is associated with lipid metabolic flexibility, but are lacking in obese adolescents with different metabolic phenotypes.

Objective

To investigate the association of cardiorespiratory fitness with lipid metabolic flexibility in metabolically unhealthy obesity (MUO) adolescents and metabolically healthy obesity (MHO) adolescents.

Methods

Ninety-one obese adolescents were selected to participate in the Shenzhen Weight Loss Camp (2022-2023), and were divided into 35 in the MUO group and 56 in the MHO group in accordance with the "Expert Consensus on the Definition and Screening of Metabolically Healthy Obesity in Chinese Children". The gas metabolism data from the resting metabolic test, incremental load treadmill test and heart rate data were collected using a gas metabolism analyzer and a heart rate meter; the maximum oxygen uptake (VO_2max) was estimated based on the heart rate-oxygen uptake relationship; and the third-order polynomial fitting curve was used to obtain the maximal fat oxidation rate (MFO) or the corresponding maximal fat oxidation intensity (FAT_max) to reflect the flexibility of lipid metabolism. The linear regression analysis was used to explore the correlation between VO_2max and MFO and FAT_max.

Results

The overall MFO and FAT_max of the two groups were (5.54±1.37) mg·min^-1·kg^-1 and (4.19±0.87) MET. The BMI, systolic blood pressure, diastolic blood pressure, and triacylglycerol levels in the MUO group were higher than those in the MHO group, and the level of high-density lipoprotein cholesterol was lower than that in the MHO group (P<0.05). Before adjustment, the MFO in the MUO group was lower than that in the MHO group (P<0.05) ; after adjustment for VO_2max, the difference in MFO between the two groups of obese adolescents was not statistically significant (P>0.05) ; before adjustment and after adjusting VO_2max, there was no statistically significant difference between the two groups of obese adolescents when comparing FAT_max (P>0.05). VO_2max was positively correlated with MFO in obese adolescents in the overall (B=0.077, 95%CI=0.011-0.144, P=0.023) and MHO groups (B=0.105, 95%CI=0.027-0.182, P=0.009) ; VO_2max was positively correlated with FAT_max in obese adolescents in the MHO group (B=0.057, 95%CI=0.003-0.111, P=0.041) ; VO_2max was not linearly related to MFO and FAT_max in obese adolescents in the MUO group (P>0.05) .

Conclusion

MUO adolescents have lower MFO than MHO adolescents; during running exercise, obese adolescents with different metabolic phenotypes could reach MFO at (4.19±0.87) MET intensity. Cardiorespiratory fitness is a key factor influencing lipid metabolic flexibility in MHO adolescents, and MUO adolescents may need to be transformed into MHO adolescents to promote lipid metabolic flexibility.

Key words: Obesity, Cardiorespiratory fitness, Lipid metabolic flexibility, Metabolically healthy obesity, Metabolically unhealthy obesity, Adolescents

摘要：

背景

目前，中国肥胖青少年数量急剧增加，青春期肥胖不仅与代谢性疾病密切相关，还是成年期冠心病死亡的危险因素。脂代谢灵活性被视为衡量机体代谢健康水平的重要指标。研究证实心肺耐力与脂代谢灵活性相关，但缺少在不同代谢表型肥胖青少年中的研究。

目的

探究心肺耐力在代谢异常型肥胖（MUO）青少年和代谢健康型肥胖（MHO）青少年中与脂代谢灵活性的关系。

方法

选取参与2022—2023年深圳减肥夏令营的肥胖青少年91名，按照《中国儿童代谢健康型肥胖定义与筛查专家共识》标准划分为MUO组35人，MHO组56人。使用气体代谢分析仪与心率表采集受试者静息代谢测试、递增负荷跑台测试的气体代谢数据和心率数据；根据心率-摄氧量关系推算最大摄氧量（VO_2max）；通过三阶数多项式拟合曲线求得最大脂肪氧化速率（MFO）或与之对应的最大脂肪氧化强度（FAT_max）反映脂代谢灵活性。使用线性回归分析VO_2max与MFO和FAT_max的关系。

结果

两组肥胖青少年总体MFO为（5.54±1.37）mg·min^-1·kg^-1，FAT_max为（4.19±0.87）MET。MUO组BMI、收缩压、舒张压、三酰甘油水平高于MHO组，高密度脂蛋白胆固醇水平低于MHO组（P<0.05）。调整前，MUO组的MFO低于MHO组（P<0.05）；调整VO_2max后，两组肥胖青少年MFO比较，差异无统计学意义（P>0.05）；调整前、调整VO_2max后，两组肥胖青少年FAT_max比较，差异均无统计学意义（P>0.05）。总体（B=0.077，95%CI=0.011~0.144，P=0.023）及MHO组（B=0.105，95%CI=0.027~0.182，P=0.009）肥胖青少年的VO_2max与MFO呈正相关；MHO组（B=0.057，95%CI=0.003~0.111，P=0.041）肥胖青少年的VO_2max与FAT_max呈正相关；MUO组肥胖青少年的VO_2max与MFO和FAT_max并无线性关系（P>0.05）。

结论

MUO青少年的MFO低于MHO青少年；跑步运动时，不同代谢表型肥胖青少年在（4.19±0.87）MET强度即可达到MFO。心肺耐力是影响MHO青少年脂代谢灵活性的关键因素，MUO青少年可能需转变为MHO青少年，促进脂代谢灵活性提升。

关键词: 肥胖症, 心肺耐力, 脂代谢灵活性, 代谢健康型肥胖, 代谢异常型肥胖, 青少年

CLC Number:

R 589.25

QIN Yuling,ZHU Lin,CHENG Guodong, et al. Correlation between Cardiorespiratory Fitness and Lipid Metabolic Flexibility in Obese Adolescents with Different Metabolic Phenotypes[J]. Chinese General Practice, 2025, 28(15): 1908-1913. DOI: 10.12114/j.issn.1007-9572.2024.0237.
秦煜玲,朱琳,程国栋等. 心肺耐力与不同代谢表型肥胖青少年脂代谢灵活性的相关性研究[J]. 中国全科医学, 2025, 28(15): 1908-1913. DOI: 10.12114/j.issn.1007-9572.2024.0237.

Figures/Tables 4

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组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
MUO组	35	13.0±1.9	16/19	160.91±5.81	80.51±13.95	30.9±3.9
MHO组	56	12.7±1.8	34/22	161.09±9.40	76.28±13.58	29.2±3.6
t（χ²）值		0.818	1.958a	-0.097	1.429	2.079
P值		0.416	0.162	0.923	0.156	0.041
组别	FPG（mmol/L）	SBP（mmHg）	DBP（mmHg）	TG（mmol/L）	HDL-C（mmol/L）	VO₂max（mL·kg^-1·min^-1）
MUO组	4.70±0.70	120±11	69±9	1.11±0.52	1.12±0.28	34.34±4.24
MHO组	4.47±0.50	108±9	64±7	0.78±0.28	1.42±0.26	35.51±4.10
t（χ²）值	1.846	5.849	2.991	3.780	-5.076	-1.303
P值	0.068	<0.001	0.004	<0.001	<0.001	0.196

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
MUO组	35	13.0±1.9	16/19	160.91±5.81	80.51±13.95	30.9±3.9
MHO组	56	12.7±1.8	34/22	161.09±9.40	76.28±13.58	29.2±3.6
t（χ²）值		0.818	1.958a	-0.097	1.429	2.079
P值		0.416	0.162	0.923	0.156	0.041
组别	FPG（mmol/L）	SBP（mmHg）	DBP（mmHg）	TG（mmol/L）	HDL-C（mmol/L）	VO₂max（mL·kg^-1·min^-1）
MUO组	4.70±0.70	120±11	69±9	1.11±0.52	1.12±0.28	34.34±4.24
MHO组	4.47±0.50	108±9	64±7	0.78±0.28	1.42±0.26	35.51±4.10
t（χ²）值	1.846	5.849	2.991	3.780	-5.076	-1.303
P值	0.068	<0.001	0.004	<0.001	<0.001	0.196

指标	总体	MUO组（n=35）	MHO组（n=56）	模型0		模型1
指标	总体	MUO组（n=35）	MHO组（n=56）	F值	P值	F值	P值
MFO（mg·min^-1·kg^-1）	5.54±1.37	5.19±1.39	5.76±1.15	4.493	0.034	3.283	0.073
FAT_max（MET）	4.19±0.87	4.16±0.92	4.21±0.84	0.079	0.779	0.007	0.932

指标	总体	MUO组（n=35）	MHO组（n=56）	模型0		模型1
指标	总体	MUO组（n=35）	MHO组（n=56）	F值	P值	F值	P值
MFO（mg·min^-1·kg^-1）	5.54±1.37	5.19±1.39	5.76±1.15	4.493	0.034	3.283	0.073
FAT_max（MET）	4.19±0.87	4.16±0.92	4.21±0.84	0.079	0.779	0.007	0.932

项目	B	95%CI	SE	β	t值	P值
VO_2max
总体	0.077	0.011~0.144	0.033	0.253	2.312	0.023
MUO组	0.020	-0.109~0.149	0.063	0.061	0.317	0.754
MHO组	0.105	0.027~0.182	0.039	0.371	2.714	0.009