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Life sciences · Journal article
Metabolites · November 3, 2026
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Pediatric obesity is increasingly recognized as a biologically heterogeneous metabolic condition associated with early alterations in cardiometabolic health. Traditional clinical markers provide limited resolution for characterizing this heterogeneity, underscoring the need for more integrative approaches. Metabolomics has emerged as a powerful tool for identifying molecular phenotypes that reflect the interplay between excess adiposity, environmental and lifestyle exposures, and cardiometabolic dysfunction. This narrative review synthesizes current evidence on pediatric obesity and cardiometabolic health, with particular emphasis on metabolomic signatures, potential biological mechanisms, and early-life and lifestyle determinants. Studies using nuclear magnetic resonance spectroscopy and mass spectrometry have identified coordinated alterations in lipoprotein subclasses, triglyceride-rich particles, fatty acids and complex lipids, branched-chain and aromatic amino acids, acylcarnitines, and pathways involved in energy metabolism. These metabolic profiles are associated with insulin resistance and other adverse cardiometabolic traits. Proposed links with adipose tissue dysfunction, inflammation, mitochondrial substrate utilization, and hepatic lipid dysregulation draw partly on adult and experimental mechanistic evidence. Early-life and lifestyle exposures, including maternal health, infant feeding, dietary patterns, physical activity, sleep, and environmental factors, may further shape these metabolic phenotypes. Integrating metabolomic information with clinical and environmental data may improve the characterization of metabolic heterogeneity and help identify biological pathways associated with early cardiometabolic dysfunction. However, classification of current metabolic phenotypes does not establish prediction of future disease. Independent prospective validation, methodological harmonization, and demonstration of incremental clinical utility remain necessary before metabolomic profiling can be incorporated into routine pediatric risk assessment.