Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents

Excess body weight and dyslipidemia at well-child visit

OBJECTIVES

Cardiovascular diseases are the main causes of death in the world. They are associated with the presence of risk factors such as obesity and dyslipidemia. Our objectives were to verify association between body mass index (BMI) and abnormalities in children's lipid profile evaluated during well-child visits, seeking to identify the frequency of each disorder in this population.

METHODS

A cross-sectional study examined anthropometric data and laboratory results of children aged 2 to 9 (n=363) at a pediatric clinic between 2014 and 2017. Logistic and linear regression models were employed to assess associations between variables.

RESULTS

Mean age was 6.3 ± 2.2 years; 187 (51.5 %) were male; 253 (69.7 %) were aged between 5 and 9 years old. A total of 114 (31.4 %) presented excess body weight and 53 (14.6 %) had obesity/severe obesity. Dyslipidemia was detected in 114 (34.4 %) children. Triglycerides was the most frequently altered lipid fraction (18.5 %), followed by HDL-c (16.8 %) and LDL-c (9.1 %). There was an association between hypertriglyceridemia (p=0.013) and low HDL-c (p=0.028) with obesity. BMI z-score showed a positive correlation with triglycerides (p=0.011) and a negative correlation with HDL-c (p=0.039). No association was observed between LDL-c and BMI.

CONCLUSIONS

Excess body weight and dyslipidemia were seen in one-third of evaluated children. Elevations in triglycerides concentration were correlated with increased in BMI z-score. These findings point to the importance of monitoring nutritional status in well-child visits and performing universal screening for dyslipidemia in children, regardless of BMI.

Glycemia and associated factors in a pediatric population in Mexico

Aims

In this study, we evaluated the association of sociodemographic, lifestyle and cardiometabolic factors with blood glucose levels in children and adolescents in Mexico.

Methods

An analytical cross-sectional study of 642 children and adolescents aged 6 to 19 years from different educational centers located in municipalities of the state of San Luis Potosí, Mexico, was carried out. Pearson χ2 and Spearman correlation tests and multiple linear regression models were used to evaluate the associations of the variables with glycemia.

Results

The prevalence of prediabetes was 8.0% in both sexes. Male participants were more likely to develop hyperglycemia than female participants (OR 2.7, 95% CI: 1.5-5.0). The variables associated with glucose levels were male sex, high socioeconomic status, inadequate diet, high blood pressure, and increased total cholesterol, LDL cholesterol, and triglycerides, which also explained up to 15.6% (p < 0.05) of the variability in glucose concentrations.

Conclusion

The detection of sociodemographic, lifestyle and cardiometabolic factors in children and adolescents will contribute to the implementation of prevention strategies for cardiometabolic diseases, among which prediabetes is common.

Sleep duration and risk of high blood pressure in Thai adolescents: the Thai National Health Examination Survey V, 2014 (NHES-V)

Background

Sleep duration has been proposed to be associated with high blood pressure. However, nationwide studies regarding this association in adolescents remain limited. This study aimed to explore the national prevalence of high blood pressure among Thai adolescents and to determine the association between sleep duration and high blood pressure.

Methods

Data from adolescents aged 10–19 years from the Thai National Health and Examination Survey V were included. We collected demographic data (including age and gender), height, weight, waist circumference, blood pressure, fasting blood chemistries and sleep duration data. Sleep durations were categorized as short, normal or long for each age group based on the United States National Sleep Foundation’s recommendations. High blood pressure was diagnosed using the 2017 guidelines of the American Academy of Pediatrics. Factors associated with high blood pressure were analyzed using multivariate logistic regression.

Results

A total of 3505 adolescents (1785 female) were included. The prevalence of high blood pressure was 9.4% (95% CI 8.5–10.4%). The high blood pressure group had higher BMI z-score, LDL-C, triglyceride and lower HDL-C than the normotensive group. In the multivariate analysis, BMI z-score, LDL-C and HDL-C were independently associated with high blood pressure. However, there was no association between sleep duration and high blood pressure.

Conclusions

High blood pressure risk was increased in adolescents with high BMI z-score. Neither short nor long sleep duration was associated with an increased risk of high blood pressure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14430-z.

Anthropometric Indicators of Body Composition Associated With Lipid and Glycemic Profiles in Overweight Brazilian Children and Adolescents From 2008 to 2020

Background

Anthropometric indicators have been used to predict health problems. The objective was to determine which indicators present better correlation with dyslipidemia, hyperglycemia and peripheral insulin resistance, as well as the cutoff points capable of predicting lipid and glycemic alterations in Brazilian children and adolescents.

Methods

A cross-sectional study conducted with 568 overweight individuals, aged between 5 and 18 years, living in Southeast and South Brazilian regions, submitted to anthropometric and body composition evaluation by bioimpedance, in addition to fasting laboratory tests [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glycemia, and homeostasis model assessment–insulin resistance (HOMA-IR)]. Pearson's correlation was used to evaluate the association between anthropometric indicators and serum biomarkers. The ROC curve with Youden's J index was used to suggest anthropometric cutoff points with better ability to predict or rule out lipid and glycemic changes.

Results

Cutoff points obtained for the z-score of body mass index (BMI), waist circumference (WC), and waist circumference for height (WC/H) showed high specificity (52 to 87%) and low sensitivity (23 to 59%), indicating greater ability to exclude changes in HDL-c, TG, and HOMA-IR levels. Cutoff points suggested for BMI ranged from +1.86 to +2.20 z-score. WC cutoff points ranged from +1.29 to +1.72, and, for the WC/H index, from +1.21 to +1.25. It was suggested the use of the following cutoff points to rule out changes in HDL-c, TG, and HOMA-IR values in clinical practice: BMI < z-score +2 and WC/H < z-score +1.29. In body fat percentage (BFP) analyses, the cutoff point < of 34% may be able to rule out changes in HDL-c (specificity of 70%), while the cutoff point > 36.6% may be able to predict changes in the HOMA-IR index (sensitivity of 76%).

Conclusion

It is not yet possible to state which anthropometric parameter has the best correlation with lipid and glycemic alterations in overweight children and adolescents. We suggest considering BMI, WC, and WC/H cutoff points together to rule out changes in HDL-c, TG, and HOMA-IR, and use the BFP cutoff point to predict changes in HOMA-IR.

Effectiveness of Self-concept Management of Patients with Depression in Diabetic Ulcer

BACKGROUND

This study explores the management of self-concept in improving the quality of life of diabetic ulcer patients. Low confidence in the quality of life is a factor causing patients with long-term diabetes to believe they cannot be cured properly. Ulcers result from diabetes mellitus complications due to the nervous system and blood vessel damage. Patients with diabetic ulcers experience depression and feel acute stress when the disease has been categorized as a chronic condition.

METHODS

This study uses quantitative methods with a cross-sectional study design approach. The data collection techniques used purposive sampling and had 82 diabetic ulcer sufferers as respondents in the study.

RESULTS

This study empirically proves that (p-value ≤ α=0.05) where there is effective management of the concept of self-health applied by diabetic ulcer patients in reducing the level of depression and sufferers can increase their confidence in better health factors.

CONCLUSION

The effectiveness of self-care management is an important indicator in overcoming diabetic ulcer disease. The low management of self-concept for people with diabetes will certainly impact increasing depression and acute stress, decreasing the quality of life for sufferers.

A correlation study of the relationships between nonalcoholic fatty liver disease and serum triglyceride concentration after an oral fat tolerance test

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases worldwide. Triglyceride (TG) accumulation is central to NAFLD development. People now spend most of their day in the postprandial state, and the measurement of postprandial blood lipid concentration can make up for the lack of simple detection of fasting blood lipids. Postprandial triglyceride (PTG) is commonly used as a surrogate for postprandial blood lipid concentrations, and many studies have shown that PTG is a risk factor for NAFLD. The aim of the present study was to investigate the relationship between PTG concentration during oral fat tolerance testing (OFTT) and NAFLD.

METHODS

A total of 472 Chinese adults, aged 25 to 65 years, were enrolled in the study. All the participants underwent OFTT. The serum concentrations of TG and other lipids were measured, and their relationships with NAFLD were analyzed.

RESULTS

Of the 472 participants, 155 were diagnosed with NAFLD. The fasting and postprandial TG concentrations of the participants with NAFLD were higher than those of healthy participants (P < 0.05). The TG concentrations of the healthy participants peaked 4 h postprandially, whereas those of the participants with NAFLD peaked 6 h postprandially and reached higher peak values. Postprandial TG concentration was significantly associated with a higher risk of NAFLD.

CONCLUSIONS

High PTG is positively related to a higher risk of NAFLD, and the PTG concentrations of patients with NAFLD are higher than in healthy individuals, with a delayed peak. Therefore, 4-h PTG may represent a potential marker of NAFLD.

TRIAL REGISTRATION

ChiCTR1800019514 .

Food addiction symptoms and metabolic changes in children and adolescents with the double burden of malnutrition

The double burden of malnutrition (DBM) has been described in many low-/middle-income countries. We investigated food addiction, thyroid hormones, leptin, the lipid/glucose profile and body composition in DBM children/adolescents. Subjects were allocated into groups according to nutritional status: control (C, n 28), weight excess (WE, n 23) and DBM (WE plus mild stunting, n 22). Both the DBM and WE groups showed higher mean insulin concentrations than the control (DBM = 57·95 (95 % CI 47·88, 70·14) pmol/l, WE = 74·41 (95 % CI 61·72, 89·80) pmol/l, C = 40·03 (95 % CI 34·04, 47·83) pmol/l, P < 0·001). WE and DBM showed more food addiction symptoms than the control (3·11 (95 % CI 2·33, 3·89), 3·41 (95 % CI 2·61, 4·20) and 1·66 (95 % CI 0·95, 2·37)). In DBM individuals, addiction symptoms were correlated with higher body fat and higher insulin and leptin levels. These data provide preliminary evidence consistent with the suggestion that DBM individuals have a persistent desire to eat, but further studies are required to confirm these results in a larger study. These hormonal changes and high body fat contribute to the development of diabetes in long term.

TRI-PONDERAL MASS INDEX IS USEFUL FOR SCREENING CHILDREN AND ADOLESCENTS WITH INSULIN RESISTANCE

Objective:

To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance.

Methods:

Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR).

Results:

The HOMA-IR was higher in the 4^th quartile of body mass index Z scores and tri-ponderal mass index compared to 1^st and 2^nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R²=0.269; tri-ponderal mass index: R²=0.289; p<0.001) and boys (body mass index Z scores: R²=0.175; tri-ponderal mass index: R²=0.210; p<0.001).

Conclusions:

The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

Association between body fat mass and cardiometabolic risk in children and adolescents in Bucaramanga, Colombia

BACKGROUND

Obesity is common among children and teenagers and is associated with cardiometabolic risk factors in the adult age. The objective of this paper was to evaluate the association between the percentage of body fat and cardiometabolic risk factors in children and adolescents in the city of Bucaramanga, Colombia.

MATERIAL AND METHODS

About 494 children and adolescents aged 10-20 years were studied. Laboratory tests were made for analyzing cardiovascular risk factors and anthropometric measurements. Percentage body fat was determined with Slaughter equation. Lineal regression analyses were conducted to evaluate the association between cardiometabolic risk factors and the percentage body fat.

RESULTS

Prevalence of percentage body fat (>26%) was 46.1%. Variables associated with percentage body fat were HOMA-IR - insulin resistance, HDL, LDL, triglycerides, and total cholesterol levels, and high blood pressure.

CONCLUSIONS

Increase in percentage body fat is significantly associated with cardiometabolic risk factors in children and adolescents in Bucaramanga. Early identification and intervention of this population at risk is fundamental.

Ultrasonographic evaluation of the common carotid intima-media complex in healthy and overweight/obese children

BACKGROUND

Obesity is a global epidemic, including among children. It is therefore necessary to identify cardiovascular changes in overweight/obese children as early as possible. Mode B ultrasonography of the common carotids can be used to precisely evaluate in real time early changes in the thickness of the intima-media complex (IMC), which can detect onset of the atherosclerosis process.

OBJECTIVES

This study compared IMC thickness between schoolchildren with and without overweight/obesity.

METHODS

A sample of 59 children of both sexes, aged 7 to 10 years, were recruited from health centers in São Paulo, Brazil. Children were classified by z scores for body mass index (BMI) into two groups, with or without overweight/obesity. These groups were then compared in terms of IMC thickness.

RESULTS

The groups were homogenous for age and sex. The mean IMC measurement in the group with overweight/obesity was 0.49 (± 0.07) mm, whereas in the group free from overweight/obesity it was 0.41 (± 0.05) mm (p < 0.01). These differences were maintained when groups with and without overweight/obesity were compared separately by sex and for right and left sides. The coefficient for the correlation between IMC measurement and BMI z score was 0.61 (95% confidence interval = 0.42-0.75). Within the same nutritional status group, there were no differences between sexes or between right and left sides.

CONCLUSIONS

Intima-media thickness was greater among children with overweight/obesity and was directly proportional to BMI z score, denoting increased cardiovascular risk in this group.

Body fat indicators perform better than body mass index in identifying abnormal lipid profiles in boys but not in girls

BACKGROUND

BMI as a body weight indicator, may inadequately represent the biological effect of body fat on lipid profiles. This study aims to assess whether body fat indicators were superior to BMI for recognizing children with dyslipidemia.

METHODS

A nationwide cross-sectional study involving 8944 pediatric participants aged 6-18 years. Measures of fat mass index (FMI), fat mass percentage (FMP), BMI, and four lipid profiles were obtained.

RESULTS

Among boys, the standard multi-linear regression coefficients of FMI for TC, LDL-C, and TG were higher than those of BMI (P < 0.01), but not for HDL-C. Also, the prevalence ratios and area under curves (AUCs) of excess fat classified by FMI for specific abnormal lipid profiles (except for HDL-C) were greater than overweight classified by BMI. The AUCs for detecting children with abnormal TC, LDL-C, and TG of FMI-based excess fat were 3.9%, 5.6%, and 2.8% higher than those of BMI-based overweight, respectively, all P < 0.01. Among girls, the associations of BMI with lipid profiles were substantially similar to FMI. All these results were almost identical when FMP was used instead of FMI.

CONCLUSIONS

DXA measured body fat performs better than BMI in identifying abnormal lipid profiles in boys but not in girls.

Metabolic Profiles in Obese Children and Adolescents with Insulin Resistance

BACKGROUND:

In the past several decades, the increasing frequency of overweight and obese children and adolescents in the world has become a public health problem. It has contributed significantly to the already high tide of diabetes, cardiovascular and cerebrovascular diseases.

AIM:

To investigate the frequency of insulin resistance and to evaluate the metabolic profile of insulin resistant and non-insulin resistant obese children and adolescents.

SUBJECTS AND METHODS:

The study included 96 (45 boys, 51 girls) obese children and adolescents aged 4-17 years old (10.50 ± 2.87 years). Only participants with Body Mass Index ≥ 95 percentile were included. We analysed sera for fasting insulin levels (FI), fasting serum triglycerides (TG), total serum cholesterol (TC), fasting plasma glucose (FPG) and plasma glucose 2 hours after the performance of the oral glucose tolerance test (2-h G). Homeostatic model assessment for insulin resistance (HOMA-IR) index was calculated as fasting insulin concentration (microunits per millilitre) x fasting glucose concentration (millimolar)/22.5. The value of HOMA-IR above 3.16 was used as a cut-off value for both genders.

RESULTS:

Insulin resistance was determined in 58.33% of study participants. Insulin resistant participants had significantly higher level of 2-h G (p = 0.02), FI level (p = 0.000) as well as TG levels (p = 0.01), compared to non-insulin resistant group. Strikingly, 70.73% of the pubertal adolescents were insulin resistant in comparison to 49.09% of the preadolescents (p = 0.03). Significantly higher percentage of insulin-resistant participants were girls (p = 0.009). Moreover, a higher percentage of the girls (70.59%) than boys (44.44%) had HOMA-IR above 3.16 and had elevated FI levels (70.59% vs 48.89%). The difference in the frequency of insulin resistance among obese versus severely obese children and adolescents was not significant (p = 0.73, p > 0.05). Our study results also showed positive, but weak, correlation of HOMA-IR with age, FPG, TG and BMI of the participants (p < 0.05).

CONCLUSION:

Higher percentage of insulin-resistant participants was of female gender and was adolescents. In general, insulin resistant obese children and adolescents tend to have a worse metabolic profile in comparison to individuals without insulin resistance. It is of note that the highest insulin resistance was also linked with the highest concentrations of triglycerides.