Cardiovascular risk and metabolomic profile in adolescents: A comparative study between anorexia nervosa, normal weight, and obesity.

INTRODUCTION

Anorexia nervosa (AN) and obesity represent the extremes of the nutritional spectrum, both being associated with an increase in major adverse cardiovascular events (MACE). The objective of this study was to analyze atherosclerotic risk through the determination of advanced lipoprotein profiling (ALP), fatty acids, and inflammatory markers in adolescents with different weight profiles.

METHODOLOGY: A cross-sectional study was conducted in 122 adolescents (aged: 10-17 years), divided into three groups based on their Body Mass Index (BMI): underweight/AN (n=47), normal weight (n=33), and moderate-to-severe obesity (n=42). Clinical evaluations, echocardiography to determine structural changes (left ventricular mass index: LVMI) and both conventional and specialized blood analysis using nuclear magnetic resonance spectroscopy (1H-NMR) were performed to quantify ALP, fatty acids, and plasma glycoproteins (GlycA). Multivariate partial least squares-discriminant analysis (PLS-DA) models were employed.

RESULTS

The AN group presented with bradycardia, systolic hypotension, and a significant decrease in LVMI, whereas obesity was associated with ventricular hypertrophy and a chronic inflammatory state (elevation of GlycA, leukocytes, and ESR). Although the AN group showed higher total cholesterol and LDL-C levels than the normal-weight group, ALP revealed that this increase is due to larger LDL particle size. Furthermore, subjects with AN exhibited elevated levels of medium HDL particles and cardioprotective fatty acids (omega-3 and DHA). In contrast, the obesity group presented the classic high-risk lipid triad: elevated triglycerides, large VLDL, and small dense LDL. PLS-DA analysis confirmed that BMI is the primary determinant of metabolic and cardiovascular segregation between the groups.

CONCLUSIONS

Hypercholesterolemia in adolescents with AN constitutes a low-risk physiological adaptation, whereas obesity manifests an early atherogenic profile and adverse cardiac remodeling. Conventional laboratory testing is insufficient to assess real cardiovascular risk in these populations, with ALP proving to be a superior diagnostic tool.