SUN-220 - Prevalence of Metabolic Complications According to Body Mass Index Percentiles in Korean Children and Adolescents: Analysis of Korean National Health and Nutrition Examination Survey.

Background:
Childhood obesity is associated with metabolic complications such as nonalcoholic fatty liver disease (NAFLD), dyslipidemia, dysglycemia, and hypertension. Current screening strategies primarily target children classified as overweight or obese. However, metabolic abnormalities are frequently observed in clinical practice even among youth with body mass index (BMI) below the overweight threshold. Data describing metabolic risk across the full BMI spectrum in Korean children and adolescents remain limited.

Objective:
To investigate the prevalence and risk of major metabolic complications across BMI percentile categories, with particular focus on the upper-normal BMI range, using nationally representative Korean data.

Methods:
This cross-sectional study analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2016-2023. A total of 3,957 children and adolescents aged 10-18 years were included after excluding underweight individuals, insufficient fasting, viral hepatitis, and chronic liver disease. BMI percentiles were defined using the 2017 Korean National Growth Charts and categorized as 5-49th (reference), 50-74th, 75-84th, 85-94th, and =95th percentiles. NAFLD was defined by sex-specific ALT cutoffs (=30 IU/L in boys, =19 IU/L in girls). Dyslipidemia, dysglycemia, and high blood pressure were defined using established pediatric criteria. Survey-weighted logistic regression was performed to estimate odds ratios (ORs) and linear trends, accounting for the complex sampling design.

Results:
The prevalence of all metabolic complications increased progressively with higher BMI percentiles (p for trend < 0.001). Notably, NAFLD risk was already significantly elevated in the upper-normal BMI range. Compared with the reference group, boys in the 50-74th percentile had a 2.7-fold higher odds of NAFLD, increasing to over 15-fold in those =85th percentile. Similarly, girls showed a significant increase in NAFLD risk beginning in the 50-74th percentile (OR 3.1), with over 11-fold higher odds in the obese group. Dyslipidemia, dysglycemia, and high blood pressure demonstrated parallel dose-dependent increases across BMI categories in both sexes. HDL-cholesterol levels declined with increasing BMI, with more pronounced dyslipidemic patterns observed in girls.

Conclusions:
Metabolic complications in Korean children and adolescents increase progressively across the BMI spectrum, with significant risk emerging even within the upper-normal BMI range. These findings indicate that metabolic risk does not abruptly begin at the overweight threshold and underscore the importance of maintaining healthy weight trajectories and sustained lifestyle behaviors throughout childhood and adolescence, rather than focusing exclusively on obesity status.

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