Endocrine Abstracts

JOINT2825

Objective: Childhood obesity is a major public health issue worldwide, thus understanding its metabolic heterogeneity is crucial. A subgroup called “metabolically healthy obese”(MHO) shows preserved insulin sensitivity and low cardiovascular risk despite excess adipose tissue. The non-invasive tool SPISE index (Single Point Insulin Sensitivity Estimator) [600×HDL^{0, 185}/Trigliseridler^{0, 2}× BMI^{1, 338}] stands out as an innovative approach to assess insulin sensitivity. It has been shown to be a predictor for both insulin resistance and the risk of developing glucose intolerance or diabetes. In this study, the clinical utility of the SPISE index in assessing metabolic health parameters will be investigated.

Methods: The SPISE index was calculated in 580 obese children (average age of 11.3±3.2 years). The group classified as metabolically unhealthy obese (MUO) had one or more of the following: fasting glucose ≥100 mg/dL, triglycerides ≥150 mg/dL, HDL ≤40 mg/dL, or elevated blood pressure (≥95^th percentile). MHO group had normal values for all these parameters. Correlations were analyzed between the SPISE index, MUO criteria, HOMA-IR, ALT/AST, non-HDL, triglyceride/HDL ratio, and inflammatory markers as neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, systemic inflammatory index, and systemic inflammatory response index.

Results: Five-hundred-eighty children were included in the study, with 58.1% girl and 35.4% morbidly obese. Among these, 45.6% were classified as MUO, with 47.5% of MUO children being morbidly obese. Significant differences in BMI SDS and morbid obesity were found between MUO and MHO groups (p <0.001). The SPISE index was significantly higher in the MUO group (4.8±1.2 vs 3.9±1.1, P = 0.001). As a metabolic health indicator, the SPISE index showed an AUC of 0.737, sensitivity of 72%, and specificity of 68%, with a cut-off value of 4.21 (P = 0.0001). Analyzing metabolic health parameters separately, the SPISE index was significant for identifying lipid (triglyceride>150 and/or HDL<40 mg/dL) and glucose (fasting glucose >100 mg/dL, HOMA-IR>2.5) disorders (P = 0.0001, P = 0.003). However, it failed to discriminate subclinic hepatic steatosis (ALT/AST>1) and hypertension (>95^th percentile) (P = 0.668, P = 0.065). Independent cardiovascular risk parameters such as BMI SDS (r = -0.63, P = 0.0001), triglyceride/HDL (r = -0.50, P = 0.0001), non-HDL (r = -0.29, P = 0.0001) also showed negative correlations with the SPISE index. Compared to other indices, SPISE was identified as the best marker (P = 0.001).

Conclusion: The SPISE index is a best reliable tool for identifying metabolic health disturbances especially disglycemia and dislipidemia in pediatric obesity and serves as a valuable marker for cardiovascular risk. It can be an essential component in early detection and management strategies for metabolic dysfunction in children, particularly in those with obesity