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We included 1550 children with obesity from the National Health and Nutrition Examination Survey. Cluster analysis identified obesity subtypes based on four lifestyle factors (physical activity, diet quality, sedentary time and smoking). Multiple linear regression assessed their association with cardiometabolic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five subtypes of childhood obesity were identified: unhealthy subtype (<jats:italic>n<\/jats:italic>\u2009=\u2009571; 36.8%), physically active subtype (<jats:italic>n<\/jats:italic>\u2009=\u2009185; 21.1%), healthy diet subtype (<jats:italic>n<\/jats:italic>\u2009=\u2009404; 26.1%), smoking subtype (<jats:italic>n<\/jats:italic>\u2009=\u2009125; 8.1%) and non\u2010sedentary subtype (<jats:italic>n<\/jats:italic>\u2009=\u2009265; 17.1%). Compared with the unhealthy subtype, the physically active subtype had lower insulin and HOMA\u2010IR levels, and smoking subtype was associated with lower HDL levels. When compared with children with normal weight, all obesity subtypes had worse cardiometabolic profile, except the physically active subtype who had similar DBP, HbA1c and TC levels; smoking subtype who had similar TC levels; and healthy diet and non\u2010sedentary subtypes who had similar DBP levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children of different lifestyle\u2010based obesity subtypes might have different cardiometabolic risks. Our new classification system might help personalize assessment of childhood obesity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijpo.13127","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T09:58:25Z","timestamp":1715767105000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Lifestyle\u2010based subtypes of childhood obesity and their association with cardiometabolic factors: A cluster analysis"],"prefix":"10.1111","volume":"19","author":[{"given":"Jia\u2010Shuan","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Birth Cohort Study Guangzhou Women and Children's Medical Center, Guangzhou Medical University  Guangzhou China"},{"name":"The First Affiliated Hospital of Sun Yat\u2010Sen University, Sun Yat\u2010Sen University  Guangzhou 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