Pediatrics · Medical Literature
Knowledge mapping and bibliometric analysis of metabolic phenotypes in childhood and adolescent obesity: research hotspots and emerging trends from 2000 to 2026.
Abstract
Childhood and adolescent obesity is increasingly understood as a heterogeneous condition in which excess adiposity may be accompanied by distinct cardiometabolic phenotypes. Metabolically healthy obesity and metabolically unhealthy obesity have become important concepts for risk stratification, but the overall knowledge structure and emerging research directions in this field remain insufficiently mapped. Records on metabolic phenotypes in childhood and adolescent obesity published between 1 January 2000 and 20 February 2026 were retrieved from the Web of Science Core Collection and PubMed on 20 February 2026. English-language articles and reviews were independently screened by two researchers. After database merging, deduplication and data cleaning, 4,963 records were retained for bibliometric analysis, including 4,384 WoSCC-retained records and 579 PubMed-only records. CiteSpace 6.4. R1, VOSviewer 1.6.20, R 4.5.2 and bibliometrix 5.4.1 were used to analyze annual publication trends, country and institutional collaboration, author and reference co-citation, keyword co-occurrence, clustering and burst terms. Citation-dependent analyses were based on WoSCC-retained records with complete cited-reference metadata. Publication output increased overall and showed three broad phases: an initial phase centered on BMI criteria, obesity prevalence and metabolic syndrome recognition; a rapid growth phase associated with insulin resistance, glucose-lipid abnormalities and metabolic heterogeneity; and a recent consolidation phase emphasizing phenotype transition, gut microbiota, non-alcoholic fatty liver disease, physical activity, cardiometabolic health and precision intervention. The United States, Spain, China and England were leading contributors, although cross-regional collaboration remained uneven. Co-cited references, author networks and keyword clusters indicated that the field has moved from weight-based classification toward integrated cardiometabolic risk identification, with emerging attention to central adiposity, visceral fat, microbiome-related mechanisms and phenotype-guided management. Research on metabolic phenotypes in childhood and adolescent obesity is shifting from BMI-centered description toward risk-stratified interpretation of metabolic heterogeneity. Future studies should harmonize pediatric phenotype definitions, strengthen multicenter longitudinal cohorts and integrate body composition, fat distribution, insulin sensitivity, liver fat, inflammatory markers, lifestyle exposure and gut microbiota to support early identification and precision prevention of cardiometabolic risk.
Clinical relevance
Childhood and adolescent obesity is a heterogeneous condition encompassing distinct cardiometabolic phenotypes — metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) — that carry substantially different long-term risk profiles, yet no harmonized pediatric classification framework exists. This bibliometric analysis of 4,963 records spanning 2000–2026 maps the global knowledge structure of this field, identifying critical gaps in phenotype definitions, longitudinal data, and precision intervention strategies. Clinicians caring for pediatric patients with obesity must move beyond BMI-based assessment toward integrated cardiometabolic risk stratification to guide early, individualized prevention efforts.
Key findings
1. A total of 4,963 records (4,384 from WoSCC; 579 PubMed-only) published between January 1, 2000, and February 20, 2026, were retained after deduplication and data cleaning — representing the largest bibliometric synthesis of metabolic phenotypes in pediatric obesity to date; no individual effect sizes or p-values were reported in the abstract. 2. Publication output demonstrated three distinct temporal phases: (a) an initial phase focused on BMI criteria, obesity prevalence, and metabolic syndrome recognition; (b) a rapid growth phase centered on insulin resistance, glucose-lipid abnormalities, and metabolic heterogeneity; and (c) a recent consolidation phase emphasizing phenotype transition, gut microbiota, NAFLD, physical activity, cardiometabolic health, and precision intervention. 3. Keyword co-occurrence, co-citation, and burst-term analyses collectively indicated a field-wide paradigm shift from weight-based (BMI-centered) classification toward integrated cardiometabolic risk identification incorporating central adiposity, visceral fat, insulin sensitivity, liver fat, and inflammatory markers. 4. The United States, Spain, China, and England were the leading national contributors to this literature; however, cross-regional collaboration networks remained uneven, suggesting geographic disparities in research capacity and generalizability of findings. 5. Emerging thematic clusters identified gut microbiome-related mechanisms and phenotype-guided (precision) management as the foremost frontier topics, with non-alcoholic fatty liver disease and body composition metrics rising as key outcome and stratification variables. 6. A critical methodological gap was identified: the absence of harmonized pediatric phenotype definitions (MHO vs. MUO criteria) and the paucity of multicenter longitudinal cohort data limit the translation of current evidence into standardized clinical risk-stratification algorithms.
Practice implications
Clinicians should abandon sole reliance on BMI for cardiometabolic risk assessment in pediatric patients with obesity and instead incorporate measures of central adiposity (waist circumference, waist-to-height ratio), visceral fat, insulin sensitivity indices, hepatic fat (via ultrasound or validated surrogates), and inflammatory markers to distinguish MHO from MUO phenotypes and prioritize intervention intensity accordingly. Patients identified as MUO — particularly those with concurrent insulin resistance, dyslipidemia, elevated liver enzymes, or markers of gut dysbiosis — warrant early multidisciplinary intervention including structured physical activity prescription, dietary modification, and consideration of subspecialty referral (endocrinology, hepatology), rather than a 'watch-and-wait' approach based on weight alone. Future institutional practice should support enrollment of pediatric patients with obesity into longitudinal cohort studies using standardized phenotype definitions to generate the robust, multicenter evidence needed for precision prevention guidelines.