Childhood obesity: Early metabolic mechanisms and cardiometabolic consequences

Abstract

Childhood obesity has emerged as one of the leading global health challenges, due to its rapidly increasing prevalence and strong association with early cardiometabolic disturbances. Beyond immediate health effects, obesity in early life may initiate a cascade of cardiometabolic complications that often persist into adulthood. Recent evidence suggests that the origins of obesity-related metabolic dysfunction may begin already during prenatal and perinatal life through epigenetic programming, induced by maternal metabolic status. In this regard, maternal obesity, gestational diabetes, gestational hypertension and dyslipidemia in pregnancy may induce long-lasting alterations in fetal metabolism, insulin sensitivity and lipid homeostasis, thereby increasing the susceptibility of offspring to obesity and cardiometabolic diseases later in life. The development of childhood obesity is strongly associated with chronic low-grade inflammation, oxidative stress, insulin resistance and ectopic fat accumulation. Excessive deposition of visceral and hepatic fat contributes to dyslipidemia, endothelial dysfunction and metabolic dysfunction-associated steatotic liver disease, which are increasingly recognized even in pediatric populations. Together, these mechanisms create a vicious cycle that promotes the development of type 2 diabetes mellitus and cardiovascular disease later in life. A better understanding of early metabolic programming and timely identification of obesity-associated risk factors through comprehensive biomarker assessment, together with preventive strategies focused on maternal metabolic health before and during pregnancy, as well as the promotion of healthy lifestyle habits during childhood, may help reduce obesity risk and improve long-term cardiometabolic outcomes in future generations.