The association between metabolically healthy abdominal obesity (MHO) and subclinical cardiovascular outcomes in the general pediatric population remains largely unexplored. We aimed to investigate the relationship of MHO with left ventricular geometric (LVG) remodeling in Chinese children.

Data were obtained from two school-based cross-sectional studies in China, involving 2866 children aged 6–11 years. Abdominal obesity was defined using waist-to-height ratio (WHtR) or waist circumference references. The metabolically healthy phenotype was defined by the absence of four cardiovascular risk factors: elevated blood pressure, elevated triglycerides, elevated fasting blood glucose, and decreased high-density lipoprotein cholesterol. LVG was categorized into four patterns (normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy) based on two indices including left ventricular mass index and relative wall thickness.

Using WHtR to define abdominal obesity, 543 (18.9%) children were classified as MHO. In the multivariable logistic regression models, compared with children with metabolically healthy normal WHtR, the adjusted odds ratios (95% confidence intervals) of children with MHO were 4.78 (3.44–6.64) for left ventricular hypertrophy, 1.81 (1.33–2.47) for high relative wall thickness, 1.45 (1.01–2.08) for concentric remodeling, 4.37 (3.01–6.33) for eccentric hypertrophy, and 7.50 (3.77–14.91) for concentric hypertrophy. In contrast, children with metabolically unhealthy normal WHtR did not exhibit increased odds of any type of LVG remodeling. Similar results were observed when defining abdominal obesity based on waist circumference.

MHO is associated with a higher likelihood of LVG remodeling, suggesting that this phenotype may not be benign for the heart in children. Due to its simplicity and practicality, WHtR may be a preferable tool for the rapid screening of children with abdominal obesity and associated cardiac risk.