Mediated Factors Associated with Metabolic Health among Obese Adolescents

background Obesity is highly associated with metabolic risk. Yet, subset of individuals maintains metabolic health despite obesity. This study aims to identify key factors potentially associated with a metabolically healthy obese (MHO) status in adolescents. Methods Cross-sectional study included 31 adolescents with obesity [median age:14 y, median body mass index (BMI) Z-score:2.58] categorized into MHO (n = 16) and metabolically unhealthy obese (MUO, n = 15), based on the presence of at least one metabolic syndrome criteria. A comprehensive evaluation included assessments of abdominal adipose tissue distribution, physiological performance, blood markers, prenatal and sociodemographic characteristics, and dietary habits. Results Compared to the MUO, MHO individuals exhibited significantly lower hepatic fat content (HFC, 14.0 ± 9.8% vs. 6.1 ± 3.2%, p = 0.01), liver enzymes (p = 0.004), and experienced a lower risk of complications during birth (p = 0.03). MHO participants consumed fewer total calories (p = 0.04), animal protein (p = 0.005), red meat (p = 0.02), sodium (p = 0.027), palmitic acid (p = 0.04), stearic acid (p = 0.029), arachidonic acid (p = 0.005) and calories from ultra-processed grains (p = 0.049) compared to their MUO counterparts. Conclusion HFC emerges as a primary mediator of metabolic health, suggesting its potential as a valuable tool for early risk assessment in adolescents with obesity. In addition, dietary composition exerts a notable influence on metabolic health during early stages of life. Trial registration: NCT06032312.