Magnetic resonance imaging of abdominal adiposity in a large cohort of British children

Quantitative computed tomography analysis of body composition changes in paediatric patients with acute lymphoblastic leukaemia

Children with acute lymphoblastic leukaemia (ALL) are at risk for obesity and cardiometabolic diseases. To gain insight into body composition changes among children with ALL, we assessed quantitative computed tomography (QCT) data for specific body compartments (subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT], total adipose tissue [TAT], lean tissue [LT], LT/TAT and VAT/SAT at lumbar vertebrae L1 and L2) at diagnosis and at off-therapy for 189 children with ALL and evaluated associations between body mass index (BMI) Z-score and clinical characteristics. BMI Z-score correlated positively with SAT, VAT and TAT and negatively with LT/TAT and VAT/SAT. At off-therapy, BMI Z-score, SAT, VAT and TAT values were higher than at diagnosis, but LT, LT/TAT and VAT/SAT were lower. Patients aged ≥10 years at diagnosis had higher SAT, VAT and TAT and lower LT and LT/TAT than patients aged 2.0-9.9 years. Female patients had lower LT and LT/TAT than male patients. Black patients had less VAT than White patients. QCT analysis showed increases in adipose tissue and decreases in LT during ALL therapy when BMI Z-scores increased. Early dietary and physical therapy interventions should be considered, particularly for patients at risk for obesity.

Pediatric body composition based on automatic segmentation of computed tomography scans: a pilot study

BACKGROUND

Body composition during childhood may predispose to negative health outcomes later in life. Automatic segmentation may assist in quantifying pediatric body composition in children.

OBJECTIVE

To evaluate automatic segmentation for body composition on pediatric computed tomography (CT) scans and to provide normative data on muscle and fat areas throughout childhood using automatic segmentation.

MATERIALS AND METHODS

In this pilot study, 537 children (ages 1-17 years) who underwent abdominal CT after high-energy trauma at a Dutch tertiary center (2002-2019) were retrospectively identified. Of these, the CT images of 493 children (66% boys) were used to establish normative data. Muscle (psoas, paraspinal and abdominal wall) and fat (subcutaneous and visceral) areas were measured at the third lumbar vertebral (L3) level by automatic segmentation. A representative subset of 52 scans was also manually segmented to evaluate the performance of automatic segmentation.

RESULTS

For manually-segmented versus automatically-segmented areas (52 scans), mean Dice coefficients were high for muscle (0.87-0.90) and subcutaneous fat (0.88), but lower for visceral fat (0.60). In the control group, muscle area was comparable for both sexes until the age of 13 years, whereafter, boys developed relatively more muscle. From a young age, boys were more prone to visceral fat storage than girls. Overall, boys had significantly higher visceral-to-subcutaneous fat ratios (median 1.1 vs. 0.6, P<0.01) and girls higher fat-to-muscle ratios (median 1.0 vs. 0.7, P<0.01).

CONCLUSION

Automatic segmentation of L3-level muscle and fat areas allows for accurate quantification of pediatric body composition. Using automatic segmentation, the development in muscle and fat distribution during childhood (in otherwise healthy) Dutch children was demonstrated.

Anthropometric Equations to Predict Visceral Adipose Tissue in European and American Youth

OBJECTIVE

To investigate whether prediction equations including a limited but selected number of anthropometrics that consider differences in subcutaneous abdominal adipose tissue may improve prediction of the visceral adipose tissue (VAT) in youth.

STUDY DESIGN

Anthropometrics and abdominal adipose tissue by MRI were available in 7-18 years old youth with overweight or obesity: 181 White Europeans and 186 White and Black Americans. Multivariable regressions were performed to develop and validate the VAT anthropometric predictive equations in a cross-sectional study.

RESULTS

A model with both waist circumference (WaistC) and hip circumference (HipC) (VAT = [1.594 × WaistC] - [0.681 × HipC] + [1.74 × Age] - 48.95) more strongly predicted VAT in girls of White European ethnicity (R² = 50.8%; standard error of the estimate [SEE] = 13.47 cm²), White American ethnicity (R² = 41.9%; SEE, 15.63 cm²), and Black American ethnicity (R² = 25.1%; SEE, 16.34 cm²) (P < .001), than WaistC or BMI. In boys, WaistC was the strongest predictor of VAT; HipC did not significantly improve VAT prediction.

CONCLUSIONS

A model including both WaistC and HipC that considers differences in subcutaneous abdominal adipose tissue more accurately predicts VAT in girls and is superior to commonly measured anthropometrics used individually. In boys, other anthropometric measures did not significantly contribute to the prediction of VAT beyond WaistC alone. This demonstrates that selected anthropometric predictive equations for VAT can be an accessible, cost-effective alternative to imaging methods that can be used in both clinics and research.

Effectiveness of a body shape index in predicting pediatric high blood pressure

BACKGROUND

A body shape index (ABSI) is an emerging anthropometric indicator, challenging two traditional parameters: body mass index (BMI) and waist circumference (WC). We aimed to systematically compare and validate the capability of anthropometric indicators for determining pediatric high blood pressure (HBP).

METHODS

A total of 3150 participants aged 7-17 years were enrolled from Suzhou, China. Areas under the receiver operating characteristic curve (AUC) were obtained to evaluate the performance of anthropometric indicators in detecting HBP. DeLong's test was used to examine whether the AUCs of anthropometric indicators in contrast to BMI or original ABSI were statistically different. Furthermore, a meta-analysis was performed to combine results from this study and five similar articles from databases.

RESULTS

In Suzhou population, BMI exhibited the largest AUC (AUC = 0.705), followed by WC (AUC = 0.669) and original ABSI (AUC = 0.514). Modified ABSI (AUC: 0.537-0.681), although had slightly better performance than original ABSI, was still less valuable than BMI (P &lt; 0.05), either in the total sample or in boys. The meta-analysis with 21108 children and adolescents subsequently confirms the results derived from Suzhou population.

CONCLUSIONS

In predicting pediatric HBP, original ABSI and modified ABSI underperform BMI and WC.

IMPACT

The current study is the first to evaluate whether original ABSI or modified ABSI is comparable to BMI and WC for screening HBP in children and adolescents. In predicting pediatric HBP, original ABSI and modified ABSI do not perform as well as traditional anthropometric indicators, such as BMI and WC. BMI remains the optimal indicator in pediatric HBP screening. This study provides a theoretical basis for the early identification of HBP in children and adolescents by adopting effective predictors.

Visceral adiposity is related to insulin sensitivity and inflammation in adolescents with obesity and mild sleep disordered breathing

OBJECTIVES

To evaluate the relationships between adipose tissue distribution, insulin secretion and sensitivity, sleep-disordered breathing, and inflammation in obese adolescents.

METHODS

Cross-sectional study of 56 obese adolescents who underwent anthropometric measures, dual-energy X-ray absorptiometry, overnight polysomnography, oral glucose tolerance test (OGTT) and frequently sampled intravenous glucose tolerance test. Correlation and regression analyses were used to assess relationships between adiposity, insulin secretion and sensitivity, measures of sleep-disordered breathing (oxyhemoglobin nadir, SpO₂; apnea hypopnea index, AHI; arousal index, AI; maximum end-tidal CO₂; non-REM sleep duration), and inflammation (high-sensitivity C-reactive protein, hsCRP).

RESULTS

Subjects (55% female) were mean (SD) 14.4 (2.1) years, with BMI Z-score of 2.3 (0.4). AHI was >5 in 10 (18%) subjects and 1< AHI ≤5 in 22 (39%). Visceral adipose tissue area (VAT) was positively correlated with OGTT 1 and 2 h insulin and 1 h glucose, and hsCRP (r=0.3-0.5, p≤0.007 for each). VAT was negatively correlated with sensitivity to insulin (r=-0.4, p=0.005) and SpO₂ nadir (r=-0.3, p=0.04) but not with other sleep measures. After adjustment for BMI-Z, sex, population ancestry, age, and sleep measures, VAT remained independently associated with insulin measures and 1 h glucose, but no other measures of glycemia. SAT was not associated with measures of glycemia or insulin resistance.

CONCLUSIONS

Among adolescents with obesity, visceral adiposity was associated with insulin resistance, SpO₂ nadir, and inflammation. The independent association of visceral adiposity with insulin resistance highlights the potential role of VAT in obesity-related chronic disease.

[Development of anthropometric equations for predicting total body fat percentage in Chilean children and adolescents]

INTRODUCTION

studying the percentage of body fat (%BF) in children and adolescents is very relevant, since a high level of body fat in childhood and adolescence represents overweight and obesity.

OBJECTIVE

to identify the anthropometric indicators related to %BF and to validate regression equations to predict %BF in children and adolescents using dual-energy X-ray absorptiometry (DXA) as a reference method.

METHODS

a descriptive study (cross-sectional) was designed in 1126 schoolchildren (588 males and 538 females) from the Maule region (Chile). The age range ranged from 6.0 to 17.9 years. Weight, height, two skinfolds (tricipital and subscapular and waist circumference (WC) were evaluated. Body mass index (BMI), triponderal mass index (TMI), waist height index (WHtR) were calculated. Body fat percentage (%BF) was assessed by DXA scanning.

RESULTS

the relationships between Σ (Tricipital + Subscapular), TMI and WHtR with %BF (DXA) ranged from R2 = 52 % to 54 % in men, and from R2 = 41 % to 49 % in women. The equations generated for men were: %BF = 9.775 + [(0.415 * (Tr + SE)] + (35.084 * WHtR) - (0.828 * age), R2 = 70 %, and %BF = 20.720 + [(0.492 * (Tr + SE)] + (0.354 * TMI) - (0.923 * age), R2 = 68 %], and for women: %BF = 8.608 + [(0.291 * (Tr + SE)] + (38.893 * WHtR) - (0.176 * age), R2 = 60 %, and %BF = 16.087 + [(0.306 * (Tr + SE)] + (0.818 * TMI) - (0.300 * age), R2 = 59 %.

CONCLUSION

this study showed that the sum of tricipital and subscapular skinfolds, IP and WHtR are adequate predictors of %BF. These indicators allowed the development of two regression equations acceptable in terms of precision and accuracy to predict %BF in children and adolescents of both sexes.

Comparison of child adiposity indices in prediction of hypertension in early adulthood

We aimed to compare child body mass index (BMI) in prediction of hypertension in early adulthood with 4 other adiposity indices (waist circumference [WC], waist circumference-to-height ratio [WHtR], waist-to-hip ratio [WHR], and triceps skinfold [TSF]). The cohort from the China Health and Nutrition Survey 1993-2011 consisted of 1444 adults aged 18-36 years who were examined in childhood and early adulthood. Child adiposity indices and adult blood pressure (BP) were transformed into age-, sex-, and survey year-specific Z-scores. Adult hypertension was defined as BP ≥130/80 mm Hg as per the 2017 American College of Cardiology/American Heart Association guidelines. Adult hypertension prevalence was 32.9% during a mean follow-up of 10.1 years. Childhood BMI showed stronger correlation with adult BP than WHR and TSF (PS for difference <.05). Child BMI showed the better prediction of adult hypertension compared with WHtR, WHR, and TSF using area under the receiver operating characteristic curves (PS for difference <.05). Per SD change in the predictor, child BMI (relative risk [95% confidence interval], 1.11 [1.04-1.18]) and WC (1.12 [1.05-1.20]) were significantly associated with adult hypertension using covariate-adjusted Poisson models with robust standard errors. Child BMI performed equally or better compared with 4 other adiposity indices in predicting adult hypertension.

Metabolic Risk Factors Associated with Visceral and Subcutaneous Adipose Tissue in a Sex-Specific Manner in Seven-Year-Olds

OBJECTIVE

This study aimed to investigate how visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes were associated with metabolic risk factors in 7-year-old children.

METHODS

A total of 81 children (52% girls) from a Swedish birth cohort were studied. At 6 years of age, anthropometric data, fasting insulin, glucose, cholesterol, and blood pressure were collected on 53 children with normal weight and 28 children with overweight or obesity, and insulin resistance was estimated. At 7 years of age, magnetic resonance imaging quantified VAT and SAT. Sex and regression analyses were conducted.

RESULTS

SAT was more strongly associated with metabolic risk factors than VAT. The associations between VAT and metabolic risk factors were stronger in girls (P < 0.05). When VAT was adjusted for birth weight and maternal BMI and education, it accounted for 51% of insulin variance (β = 11.72; P = 0.001) but only in girls. The key finding of this study was that adjusted SAT accounted for 63% of the fasting insulin variance in girls (β = 2.76; P < 0.001). Waist circumference was the best anthropometric marker for insulin resistance.

CONCLUSIONS

Insulin resistance was associated with abdominal adipose tissue and its associated metabolic risk factors in children as young as 7 years old.

Intrauterine metformin exposure and offspring cardiometabolic risk factors (PedMet study): a 5-10 year follow-up of the PregMet randomised controlled trial

BACKGROUND

Metformin is increasingly used to treat gestational diabetes and type 2 diabetes in pregnancy, and in attempts to improve pregnancy outcomes in polycystic ovary syndrome and obesity. It passes across the placenta with possible long-term consequences for the offspring. We previously explored the effect of metformin, given to women with polycystic ovary syndrome during pregnancy, on children's growth up to 4 years of age. In this 5-10 year follow-up, we examined the cardiometabolic risk factors in these children.

METHODS

This is a follow-up of children from the PregMet study, a double-blind, randomised controlled trial comparing metformin with placebo in polycystic ovary syndrome pregnancies. In the PregMet study, between Feb 4, 2005, and Jan 27, 2009, 257 pregnant women aged 18-45 years with polycystic ovary syndrome according to the Rotterdam criteria were included with 274 singleton pregnancies at 5-12 weeks of gestation at 11 study centres in Norway. 17 women participated twice. Pregnant women were randomised to metformin (2000 mg/day) or placebo from inclusion in the first trimester to birth. Randomisation was stratified according to metformin use at conception. In this follow-up, the primary endpoint was body-mass index (BMI) in the offspring at 5-10 years of age assessed by the standard deviation score (Z score). The primary endpoint was analysed with independent sample t tests. ClinicalTrials.gov number NCT00159536.

FINDINGS

Of the 255 invited children from the PregMet study, 141 (55%) consented to participate and were included between April 29, 2014, and July 12, 2016. Maternal baseline characteristics in the first trimester were similar between groups. Children in the metformin group had a higher BMI Z score than those in the placebo group (difference in means=0·41, 95% CI 0·03-0·78, p=0·03).

INTERPRETATION

The increased BMI in metformin-exposed children might indicate a potential risk of inferior cardiometabolic health. Implications for adult health cannot be excluded.

FUNDING

The Research Council of Norway, Novo Nordisk Foundation, St Olavs University Hospital, and the Norwegian University of Science and Technology.

Effect of High-Intensity Interval Training on Fitness, Fat Mass and Cardiometabolic Biomarkers in Children with Obesity: A Randomised Controlled Trial

BACKGROUND

Paediatric obesity significantly increases the risk of developing cardiometabolic diseases across the lifespan. Increasing cardiorespiratory fitness (CRF) could mitigate this risk. High-intensity interval training (HIIT) improves CRF in clinical adult populations but the evidence in paediatric obesity is inconsistent.

OBJECTIVES

The objectives of this study were to determine the efficacy of a 12-week, HIIT intervention for increasing CRF and reducing adiposity in children with obesity.

METHODS

Children with obesity (n = 99, 7-16 years old) were randomised into a 12-week intervention as follows: (1) HIIT [n = 33, 4 × 4-min bouts at 85-95% maximum heart rate (HR_max), interspersed with 3 min of active recovery at 50-70% HR_max, 3 times/week] and nutrition advice; (2) moderate-intensity continuous training (MICT) [n = 32, 44 min at 60-70% HR_max, 3 times/week] and nutrition advice; and (3) nutrition advice only (nutrition) [n = 34]. CRF was quantified through a maximal exercise test ([Formula: see text]) while adiposity was assessed using magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry (DXA) and air-displacement plethysmography.

RESULTS

HIIT stimulated significant increases in relative [Formula: see text] compared with MICT (+3.6 mL/kg/min, 95% CI 1.1-6.0, P = 0.004) and the nutrition intervention (+5.4 mL/kg/min, 95% CI 2.9-7.9, P = 0.001). However, the intervention had no significant effect on visceral and subcutaneous adipose tissue, whole body composition or cardiometabolic biomarkers (P > 0.05).

CONCLUSION

A 12-week, HIIT intervention was highly effective in increasing cardiorespiratory fitness when compared with MICT and nutrition interventions. While there were no concomitant reductions in adiposity or blood biomarkers, the cardiometabolic health benefit conferred through increased CRF should be noted.

CLINICAL TRIALS REGISTRATION NUMBER

Clinicaltrials.gov; NCT01991106.

Association of prenatal exposure to gestational diabetes with offspring body composition and regional body fat distribution

The aim of this cohort study was to compare body composition and regional body fat distribution between children exposed (GDM+) or unexposed (GDM-) in utero to gestational diabetes mellitus (GDM) and to investigate the association with the glycaemic and the insulin profile. Data from 56 GDM+ and 30 GDM- were analysed. Height, weight and waist circumference were measured. Total and regional body composition was measured by dual-energy X-ray absorptiometry. Insulin, glucose and HbA_1c were obtained from a fasting plasma sample, and the HOMA-IR index was calculated. anova was performed to compare adiposity measures between GDM+ and GDM-. Associations between the glycaemic and insulin profile and adiposity measures were studied using partial Pearson correlations. Mean age was 6.6 ± 2.3 years. Waist circumference, fat mass percentage, android fat mass, android fat mass percentage and android-to-gynoid fat mass ratio were higher among GDM+, and lean mass percentage was lower (P < 0.05). Among GDM+ children, body mass index (BMI) z score, waist circumference, fat mass percentage, android fat mass percentage and android-to-gynoid fat mass ratio were all positively correlated with HbA_1C (r = 0.32-0.43, P < 0.05). Prenatal exposure to GDM is associated with increased total and abdominal adiposity. This increased adiposity observed among GDM+ children is associated with an altered glycaemic profile. This study is registered in the Clinical Trials.gov registry (NCT01340924).

Dehydroepiandrosterone impacts working memory by shaping cortico-hippocampal structural covariance during development

Existing studies suggest that dehydroepiandrosterone (DHEA) may be important for human brain development and cognition. For example, molecular studies have hinted at the critical role of DHEA in enhancing brain plasticity. Studies of human brain development also support the notion that DHEA is involved in preserving cortical plasticity. Further, some, though not all, studies show that DHEA administration may lead to improvements in working memory in adults. Yet these findings remain limited by an incomplete understanding of the specific neuroanatomical mechanisms through which DHEA may impact the CNS during development. Here we examined associations between DHEA, cortico-hippocampal structural covariance, and working memory (216 participants [female=123], age range 6-22 years old, mean age: 13.6 +/-3.6 years, each followed for a maximum of 3 visits over the course of 4 years). In addition to administering performance-based, spatial working memory tests to these children, we also collected ecological, parent ratings of working memory in everyday situations. We found that increasingly higher DHEA levels were associated with a shift toward positive insular-hippocampal and occipito-hippocampal structural covariance. In turn, DHEA-related insular-hippocampal covariance was associated with lower spatial working memory but higher overall working memory as measured by the ecological parent ratings. Taken together with previous research, these results support the hypothesis that DHEA may optimize cortical functions related to general attentional and working memory processes, but impair the development of bottom-up, hippocampal-to-cortical connections, resulting in impaired encoding of spatial cues.

The genetic underpinnings of body fat distribution

Obesity, defined as a body mass index (BMI) ≥ 30 kg/m², has reached epidemic proportions; people who are overweight (BMI > 25 kg/m²) or obese now comprise more than 25% of the world's population. Obese individuals have a higher risk of comorbidity development including type 2 diabetes, cardiovascular disease, cancer, and fertility complications. Areas covered: The study of monogenic and syndromic forms of obesity have revealed a small number of genes key to metabolic perturbations. Further, obesity and body shape in the general population are highly heritable phenotypes. Study of obesity at the population level, through genome-wide association studies of BMI and waist-to-hip ratio (WHR), have revealed > 150 genomic loci that associate with these traits, and highlight the role of adipose tissue and the central nervous system in obesity-related traits. Studies in animal models and cell lines have helped further elucidate the potential biological mechanisms underlying obesity. In particular, these studies implicate adipogenesis and expansion of adipose tissue as key biological pathways in obesity and weight gain. Expert commentary: Further work, including a focus on integrating genetic and additional genomic data types, as well as modeling obesity-like features in vitro, will be crucial in translating genome-wide association signals to the causal mechanisms driving disease.

Anthropometry, DXA, and leptin reflect subcutaneous but not visceral abdominal adipose tissue on MRI in 197 healthy adolescents

BackgroundAbdominal fat distribution is associated with the development of cardio-metabolic disease independently of body mass index (BMI). We assessed anthropometry, serum adipokines, and DXA as markers of abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) using magnetic resonance imaging (MRI).MethodsWe performed a cross-sectional study that included 197 healthy adolescents (114 boys) aged 10-15 years nested within a longitudinal population-based cohort. Clinical examination, blood sampling, DXA, and abdominal MRI were performed. SAT% and VAT% were adjusted to total abdominal volume.ResultsGirls had a higher SAT% than did boys in early and late puberty (16 vs. 13%, P<0.01 and 20 vs. 15%, P=0.001, respectively), whereas VAT% was comparable (7% in both genders, independently of puberty). DXA android fat% (standard deviation score (SDS)), suprailiac skinfold thickness (SDS), leptin, BMI (SDS), waist-to-height ratio (WHtR), and waist circumference (SDS) correlated strongly with SAT% (descending order: r=0.90-0.55, all P<0.001) but weakly with VAT% (r=0.49-0.06). Suprailiac skinfold was the best anthropometric marker of SAT% (girls: R²=48.6%, boys: R²=65%, P<0.001) and VAT% in boys (R²=16.4%, P<0.001). WHtR was the best marker of VAT% in girls (R²=7.6%, P=0.007).ConclusionsHealthy girls have a higher SAT% than do boys, whereas VAT% is comparable, independently of puberty. Anthropometry and circulating leptin are valid markers of SAT%, but not of VAT%.

Subtraction of subcutaneous fat to improve the prediction of visceral adiposity: exploring a new anthropometric track in overweight and obese youth

BACKGROUND

The efficiency of traditional anthropometric measurements such as body mass index (BMI) or waist circumference (Waist C) used to replace biomedical imaging for assessing visceral adipose tissue (VAT) is still highly controversial in youth.

HYPOTHESIS AND OBJECTIVES

We evaluated the most accurate model predicting VAT in overweight/obese youth, using various anthropometric measurements and their correlation with different body fat compartments, especially by testing, for the first time in youth, the hypothesis that subtracting the anthropometric measurement the most highly correlated with subcutaneous abdominal adipose tissue (SAAT) and less correlated possible with VAT from an anthropometric abdominal measurement highly correlated with visceral and total abdominal adipose tissue (TAAT), predicts VAT with higher accuracy.

SUBJECTS AND METHODS

VAT and SAAT data resulted from magnetic resonance imaging (MRI) analysis performed on 181 boys and girls (7-17 y) from Diabetes & Endocrinology Care Paediatrics Clinic in Luxembourg. Height, weight, abdominal diameters, waist, hip, and thigh circumferences were measured with a view to developing the anthropometric VAT predictive algorithms.

RESULTS

In girls, subtracting proximal thigh circumference (Proximal Thigh C), the most closely correlated anthropometric measurement with SAAT, from Waist C, the most closely correlated anthropometric measurement with VAT was instrumental in improving VAT prediction, in comparison with the most accurate single VAT anthropometric surrogate. [Formula: see text] Residual analysis showed a negligible estimation error (5 cm² ). In boys, Waist C was the best VAT predictor.

CONCLUSIONS

Subtraction of abdominal subcutaneous fat is important to predict VAT in overweight/obese girls.

Association between individual fat depots and cardio-metabolic traits in normal- and overweight children, adolescents and adults

OBJECTIVES

To determine age-related associations between fat mass (FM), regional fat depots and cardiometabolic traits in normal- and overweight children, adolescents and adults.

METHODS

Detailed body composition (regional subcutaneous and visceral adipose tissue; SAT, VAT) by whole-body magnetic resonance imaging (MRI), FM and fat-free mass by air-displacement plethysmography, systolic and diastolic blood pressure (SBP, DBP), triglycerides (TG), high-density lipoprotein cholesterol (HDL), plasma glucose and plasma insulin were measured in 433 subjects (BMI: 23.6 (21.0-27.7); 151 children and adolescents, aged 6-18 years, 150 young adults, aged 18-30 years and 132 adults, aged 30-60 years). Data were derived from pooled data of the 'Reference Center for Body Composition' in Kiel, Germany. Insulin resistance was determined by the homeostatic model assessment of insulin resistance (HOMA-IR). Partial correlations and multivariate linear regression analyses were used to evaluate the associations between body composition and cardiometabolic traits. A descriptive approach was used to demonstrate age-dependent differences in associations between body fat depots and insulin resistance, independent of BMI.

RESULTS

FM, SAT, and VAT increased from childhood to adulthood with low VAT in children and adolescents. When compared to children, TG was higher in adults. HDL and DBP did not differ between age groups. Insulin resistance was highest in male adolescents and female young adults. Associations between body fat depots and cardiometabolic traits were seen after puberty with no associations in pre- and intrapubertal children. When compared to FM, SAT and VAT had the strongest association with insulin resistance in adults. This association was independent of BMI.

CONCLUSIONS

Associations between individual body fat depots and most cardiometabolic traits became evident after puberty only. The strongest associations were observed between insulin resistance and abdominal fat in adults. The impact of VAT was independent of BMI.

Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity

STUDY OBJECTIVES

Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA.

METHODS

Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] > 99th percentile [BMI z-score 2.35] or > 95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) > 5 and OSA as obstructive AHI (OAHI) > 1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated.

RESULTS

Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores > 2.35. Ten had AHI > 5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35.

CONCLUSIONS

NAF % ratio was associated with OSA severity in males and youth with BMI > 99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth.

Quantification of Abdominal Fat in Obese and Healthy Adolescents Using 3 Tesla Magnetic Resonance Imaging and Free Software for Image Analysis

Background and Aims

Computed tomography, which uses ionizing radiation and expensive software packages for analysis of scans, can be used to quantify abdominal fat. The objective of this study is to measure abdominal fat with 3T MRI using free software for image analysis and to correlate these findings with anthropometric and laboratory parameters in adolescents.

Methods

This prospective observational study included 24 overweight/obese and 33 healthy adolescents (mean age 16.55 years). All participants underwent abdominal MRI exams. Visceral and subcutaneous fat area and percentage were correlated with anthropometric parameters, lipid profile, glucose metabolism, and insulin resistance. Student’s t test and Mann-Whitney’s test was applied. Pearson’s chi-square test was used to compare proportions. To determine associations Pearson’s linear correlation or Spearman’s correlation were used.

Results

In both groups, waist circumference (WC) was associated with visceral fat area (P = 0.001 and P = 0.01 respectively), and triglycerides were associated with fat percentage (P = 0.046 and P = 0.071 respectively). In obese individuals, total cholesterol/HDL ratio was associated with visceral fat area (P = 0.03) and percentage (P = 0.09), and insulin and HOMA-IR were associated with visceral fat area (P = 0.001) and percentage (P = 0.005).

Conclusions

3T MRI can provide reliable and good quality images for quantification of visceral and subcutaneous fat by using a free software package. The results demonstrate that WC is a good predictor of visceral fat in obese adolescents and visceral fat area is associated with total cholesterol/HDL ratio, insulin and HOMA-IR.

Dexa Body Composition Assessment in 10-11 Year Healthy Children

Introduction

Obesity is a growing health problem associated with metabolic derangements and cardiovascular disease. Accumulating evidence links the accumulation of visceral adipose tissue (VAT) to these obesity related health risks in adults. Childhood obesity is associated with a lifetime risk of cardiovascular disease and poses a serious challenge to future health care. In children, there is much less data on the prevalence and gender differences of visceral obesity than in adults. This study aims to provide reference values for VAT in children 10–11 years of age.

Methods

In a cross-sectional study performed in the north western part of theNetherlands, healthy children of 10–11 years of age, were recruited from primary schools. Anthropometric data consisting of height, weight, waist circumference (WC) and BMI were measured. Body composition was measured using DXA, providing measures for bone mineral content, total fat mass (TFM), lean body mass (LBM) and VAT.

Results

217 children were eligible for this study. Girls appeared to have a greater TFM (31.4% vs 27.5% of total body weight (TBW); P < .01) but lower VAT (0.3% vs 0.5% of TBW;P < .01) than boys, whereas boys had higher LBM (65.4% vs 69.3% TBW;P < .01). Median VAT area (cm²) was 41.1 for boys and 22.4 for girls (P < .01). Moderate to strong correlations were found for WC and BMI with VAT (boys: r = .664 and r = .630; Girls r = .699 and r = .546 respectively all P < .001).

Discussion

This study shows gender specific differences in VAT percentiles in healthy non-obese 10–11 year old children as measured by DXA that may serve as reference values in children. Independent of BMI and WC, girls tend to have more TFM but less VAT and LBM than boys.

Association of early protein intake and pre-peritoneal fat at five years of age: Follow-up of a randomized clinical trial

BACKGROUND AND AIMS

The double-blind randomized European Childhood Obesity Project (CHOP) demonstrated that reduced protein content in infant formula leads to a lower body mass index (BMI) up to six years of age. Here we aimed at assessing pre-peritoneal fat, a marker of visceral fat, in children participating in the CHOP trial.

METHODS AND RESULTS

Healthy term formula-fed infants in five European countries were randomized either to higher (n = 550) or lower (n = 540) protein formulas in the first year of life. Infants who were exclusively breastfed for at least three months (n = 588) were enrolled as an observational (non randomized) group. At age 5 years, subcutaneous fat (SC) and pre-peritoneal fat (PP) were measured by ultrasound in a subgroup of 275 children. The PP fat layer was thicker in the higher compared to the lower protein group (adjusted estimated difference: 0.058 cm, 95%CI 0.002; 0.115; p = 0.043), while SC fat was not different. Girls showed a thicker SC fat layer than boys.

CONCLUSIONS

Higher protein intake in formula-fed infants appears to enhance pre-peritoneal fat tissue accumulation at the age of 5 years, but not of subcutaneous fat, which may trigger adverse metabolic and health consequences.

Role of waist measures in addition to body mass index to assess the hypertension risk in children

AIM

This study aimed to evaluate whether waist measures, including waist circumference (WC) and waist-to-height ratio (WHtR), can improve the ability of body mass index (BMI) to assess the hypertension risk when used as continuous variables.

METHODS

In this cross-sectional study, 82 432 Chinese children aged 9-17 years were included. Elevated BP was defined using age-sex-and-height-specific references. Logistic regression model and area under the receiver operating characteristic curve (AUC) were performed after BMI and waist measures were converted into age-and-sex-based z-scores.

RESULTS

WHtR, but not WC, was associated with elevated BP after adjusting for BMI, with the odds ratios ranging between 1.14 (95% confidence interval: 1.04, 1.25) and 1.30 (1.21, 1.39) for one unit increase in WHtR z-score. Combined use of BMI and WHtR z-scores showed a significantly larger AUC than BMI alone (p < 0.05), while joint use of BMI and WC was not better than BMI alone.

CONCLUSION

WHtR, rather than WC, provided further information on hypertension risk beyond that provided by BMI alone when used as a continuous variable. This study suggests WHtR, in addition to BMI, should be included for the assessment of childhood adiposity in routine paediatric practice.

Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention

The aim of this study was to analyze changes in adipose tissue (AT) distribution, intrahepatic lipids (IHL), and insulin resistance (IR) among a group of obese adolescents undergoing a 7-months low-level lifestyle intervention. Thirty-nine obese Caucasian adolescents (mean age 13.9 years, body mass index standard deviation score (BMI-SDSLMS) 2.14) were included. AT and IHL were determined by T1-weighted magnetic resonance (MR) imaging and single-voxel MR spectroscopy; IR was estimated using the homeostatic model assessment (HOMA-IR). The lifestyle intervention led to a reduction of both BMI-SDSLMS (boys 2.27 to 2.17; girls 2.00 to 1.82) and HOMA-IR (boys 6.1 to 4.4 (p = 0.008); girls 6.2 to 4.7 (p = 0.030)). IHL dropped in both genders (boys 7.5 to 4.3 %; girls 4.6 to 3.4 %) positively correlating with HOMA-IR (boys r = 0.52; girls r = 0.68), while in contrast visceral AT did not change significantly.

CONCLUSIONS

Although the lifestyle intervention only slightly reduced BMI-SDSLMS, insulin sensitivity improved in both genders and came along with a marked reduction of IHL. This suggests that IHL might play the dominant role regarding insulin resistance in the youth, especially if compared to other AT compartments such as visceral AT.

WHAT IS KNOWN

• MR imaging/spectroscopy can be used to evaluate body fat distribution and intrahepatic lipids in the youth. • The strength of associations between body fat compartments and insulin resistance is under scientific debate.

WHAT IS NEW

• The study emphasizes that even a low-level lifestyle intervention has a beneficial effect. • The study suggests that intrahepatic lipids are an important factor in the development of insulin resistance.

Sonographic assessment of abdominal fat distribution during the first year of infancy

BACKGROUND

Longitudinal data regarding the fat distribution in the early postnatal period is sparse.

METHODS

We performed ultrasonography (US) as a noninvasive approach to investigate the development of abdominal subcutaneous (SC) and preperitoneal (PP) fat depots in infants ≤1 y and compared longitudinal US data with skinfold thickness (SFT) measurements and anthropometry in 162 healthy children at 6 wk, 4 mo, and 1 y postpartum.

RESULTS

US was found to be a reproducible method for the quantification of abdominal SC and PP adipose tissue (AT) in this age group. Thickness of SC fat layers significantly increased from 6 wk to 4 mo and decreased at 1 y postpartum, whereas PP fat layers continuously increased. Girls had a significantly higher SC fat mass compared to boys, while there was no sex-specific difference in PP fat thickness. SC fat layer was strongly correlated with SFT measurements, while PP fat tissue was only weakly correlated with anthropometric measures.

CONCLUSION

US is a feasible and reproducible method for the quantification of abdominal fat mass in infants ≤1 y of age. PP and SC fat depots develop differentially during the first year of life.

Ultrasonography is not more reliable than anthropometry for assessing visceral fat in obese children

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Visceral fat accumulation is a risk factor for obesity-related complications. Waist circumference is used in clinical practice to assess visceral adiposity.

WHAT THIS STUDY ADDS

Ultrasound is not superior to waist circumference for assessing visceral obesity in obese children. The optimal site for measuring waist circumference in obese children is at the smallest body circumference between xiphisternum and umbilicus.

OBJECTIVE

Visceral fat accumulation is a well-established risk factor for obesity-related complications. In children, it has not been determined whether ultrasonography is superior to waist measurement for assessing visceral fat. Moreover, the optimal site for waist measurement has not been determined.

DESIGN

In a prospective cohort of 92 severely obese children and adolescents (age 13.9 ± 2.2 years, body mass index z-score 3.29 ± 0.33), we evaluated the performance of ultrasonography and two different methods of waist circumference measurement, using magnetic resonance imaging as the reference standard.

RESULTS

Waist circumference, defined as the smallest body circumference between xiphisternum and umbilicus had the strongest correlation with visceral fat quantity (r = 0.69 all, r = 0.68 girls, r = 0.64 boys). It was not outperformed by ultrasonography (r = 0.60 all, r = 0.62 girls, r = 0.50 boys) and correlated significantly better than the World Health Organization standard for waist measurement, midway between lower margin of the last rib and the crest of the ilium, (r = 0.51 all, r = 0.39 girls, r = 0.46 boys).

CONCLUSIONS

Waist circumference measurement, defined as the smallest body circumference between xiphisternum and umbilicus, is the preferred non-invasive technique for daily clinical practice to assess visceral fat accumulation in severely obese children and adolescents. There is no place for ultrasonography for the quantification of visceral fat in this group.

Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders

Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R²) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R² attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. R² for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20) than for WHtR (0.17–0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.

Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults

AIMS/HYPOTHESIS

We validated the metabolic syndrome (MetS) score by confirmatory factor analysis (CFA) in children, middle-aged men, and older women and men and by investigating the relationships of the MetS score to incident type 2 diabetes, myocardial infarction, and cardiovascular and overall death in middle-aged men.

METHODS

We assessed the core features of MetS, calculated the MetS score using z scores for waist circumference, insulin, glucose, triacylglycerols, HDL-cholesterol and blood pressure, and carried out CFA to investigate whether MetS represents a single entity in population samples of 491 children, 1,900 middle-aged men, 614 older women and 555 older men from Finland. We also followed-up incident type 2 diabetes for 11 years and other outcomes for 17-18 years in middle-aged men.

RESULTS

We carried out second-order CFAs in which the MetS was represented by a second-order latent variable underlying four latent variables characterised by abdominal obesity, insulin resistance, dyslipidaemia and raised blood pressure in different age groups. These second-order factors and factors derived from first-order CFA using previously proposed models were strongly associated with a composite MetS score in all age groups (r = 0.84-0.94) and similarly predicted type 2 diabetes, cardiovascular outcomes and mortality in middle-aged men. The risk of type 2 diabetes, myocardial infarction, cardiovascular death and overall death increased 3.67-, 1.38-, 1.56- and 1.44-fold, respectively, for a 1 SD increase in the MetS score.

CONCLUSIONS

The MetS can be described as a single entity in all age groups. The MetS score is a valid tool for research evaluating cardiometabolic risk in different age groups. Further research is needed to define cut-off points for risk estimation in clinical practice.

Relationship of anthropometric indices to abdominal and total body fat in youth: sex and race differences

OBJECTIVE

To determine the influence of sex and race on relationships between anthropometry (body mass index [BMI], waist circumference [WC], waist-to-height ratio [W/Ht]) and adiposity (fat mass [FM], abdominal subcutaneous [SAT] and visceral adipose tissue [VAT]) in African American and white youth.

METHODS

The sample included 382 youth 5-18 years of age. FM and abdominal adiposity were assessed using dual energy X-ray absorptiometry and magnetic resonance imaging. Regression was used to examine sex and race effects in the relationship between independent (BMI, WC, and W/Ht) and dependent (FM, SAT and VAT) variables.

RESULTS

BMI and WC were highly related to adiposity while W/Ht was moderately related. The association of BMI with FM and SAT was independent of sex and race, while the relationships of WC and W/Ht with FM and SAT were influenced by both sex and race. In contrast, the association between BMI and VAT was influenced by sex and race, while the relationships of WC and W/Ht with VAT were not.

CONCLUSIONS

WC and W/Ht have similar relationships with adiposity; however, WC presented stronger relationships. BMI is a predictor of overall adiposity but sex and race play a role in its relationship with VAT.

Routine clinical measures of adiposity as predictors of visceral fat in adolescence: a population-based magnetic resonance imaging study

Objective

Visceral fat (VF) increases cardiometabolic risk more than fat stored subcutaneously. Here, we investigated how well routine clinical measures of adiposity, namely body mass index (BMI) and waist circumference (waist), predict VF and subcutaneous fat (SF) in a large population-based sample of adolescents. As body-fat distribution differs between males and females, we performed these analyses separately in each sex.

Design and Methods

VF and SF were measured by magnetic resonance imaging in 1,002 adolescents (482 males, age 12–18 years). Relationships of BMI and waist with VF and SF were tested in multivariable analyses, which adjusted for potentially confounding effects of age and height.

Results

In both males and females, BMI and waist were highly correlated with VF and SF, and explained 55–76% of their total variance. When VF was adjusted for SF, however, BMI and waist explained, respectively, only 0% and 4% of VF variance in males, and 4% and 11% of VF variance in females. In contrast, when SF was adjusted for VF, BMI and waist explained, respectively, 36% and 21% of SF variance in males, and 48% and 23% of SF variance in females. These relationships were similar during early and late puberty.

Conclusions and Relevance

During adolescence, routine clinical measures of adiposity predict well SF but not VF. This holds for both sexes and throughout puberty. Further longitudinal studies are required to assess how well these measures predict changes of VF and SF over time. Given the clinical importance of VF, development of cost-effective imaging techniques and/or robust biomarkers of VF accumulation that would be suitable in everyday clinical practice is warranted.

Relationships between direct and indirect measures of central and total adiposity in children: what are we measuring?

OBJECTIVE

The relationship between central and total fat measured by anthropometry, dual energy X-ray absorptiometry, and magnetic resonance imaging (MRI) with each other and systolic blood pressure (SBP) was examined.

DESIGN AND METHODS

Participants of the Avon Longitudinal Study of Parents and Children were examined at ages 9, 11, 13, and 15 years (n = 3,796-6,567). MRI was available on a subset of children at 11 (n = 156) and 13 (n = 95).

RESULTS

Body mass index (BMI) and waist circumference (WC) were highly correlated (r = 0.84-0.91, across ages), and total body fat mass (TBFM) and trunk fat mass (TFM) were very strongly correlated (r ≥ 0.98). Among boys, BMI vs. WC explained a similar degree of variation in TBFM and TFM (41-71% vs. 43-76%, across age and overweight groups); in girls, BMI accounted for 62-73% variance and WC 47-69%. Adiposity measures were generally similarly correlated with SBP within age groups. Further, the relationship between intra-abdominal adipose tissue (IAAT) volume and adiposity measures did not vary greatly at 11 (0.65-0.67) and 13 (0.64-0.67).

CONCLUSIONS

BMI and WC contain a large amount of overlapping information as evidenced by their high correlation and similarly sized associations with fat mass, SBP, and IAAT. This suggests that WC may be an inadequate marker of central adiposity during childhood.

The association of anthropometric indices in adolescence with the occurrence of the metabolic syndrome in early adulthood: Tehran Lipid and Glucose Study (TLGS)

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome (MetS). There are controversies about the predictive power of body mass index (BMI) vs. waist circumference (WC) for prediction of MetS in late adolescence; some of the studies did not support the need to measure WC in mid-adolescence, in addition to BMI; on the other hand, some other studies proposed either similar predictability or superiority of WC to identify MetS in late adolescence.

WHAT THIS STUDY ADDS

This is the first study to evaluate the adolescent anthropometric indices in relation to early adulthood MetS incidence one decade later in the Middle East region. There is an important sex difference regarding the incidence of MetS in Tehranian adolescents. It is interesting to know that all anthropometric indices in the pubertal age group (11-14 years) had better predictive ability compared to late-pubertal (15-18 years) adolescents. In addition, adolescent abdominal obesity surrogates, including WC and waist-to-height ratio, predicted adulthood MetS better than BMI in boys. It seems that WC had an independent role beyond BMI in identification of adulthood MetS in Tehranian boys (11-18 years old).

BACKGROUND

Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome (MetS).

OBJECTIVE

Our purpose was to explore incidence of MetS and the optimal anthropometric indicator to predict early adulthood MetS in Tehranian adolescents.

METHODS

Using data from the population-based, prospective, Tehran Lipid and Glucose Study, the utility of four anthropometric indices of adolescents in predicting early adulthood MetS (2009 Joint Scientific Statement definition) was examined among 1100 participants, aged 11-18 years, who were free of MetS at baseline, during a mean of 10.2 years of follow-up.

RESULTS

The cumulative incidence of MetS was 25.5% (95% confidence interval [CI]: 21.8-29.2%) for young men and 1.8% (95% CI: 0.6-3%) for young women. In boys, waist circumference (WC) had the highest odds ratio (OR) for the MetS risk, followed by waist-to-height ratio (WHtR). Adjusting body mass index (BMI) in addition to WC did not change the results in the 11-14-year age group (OR for WC: 2.28 [1.64-3.16] without BMI adjustment vs. 1.98 [1.05-3.73] with BMI adjustment), suggesting that WC may predict MetS risk beyond BMI. None of the anthropometric indices were found to have significant associations with subsequent MetS risk in girls.

CONCLUSIONS

Measures of abdominal obesity including WHtR and WC predicted early adulthood MetS better than BMI in Tehranian male adolescents (11-18 years old).

Waist circumference measurement site does not affect relationships with visceral adiposity and cardiometabolic risk factors in children

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

A number of anatomic sites are used for the measurement of waist circumference. A number of studies have documented differences in the absolute values of waist circumference measurements across these common sites in adults. It is unclear whether waist circumference measurement site alters the relationship with abdominal adiposity and cardiometabolic risk factors in children.

WHAT THIS STUDY ADDS

The absolute values of waist circumference at four anatomic locations (minimal, midway, iliac, umbilicus) differed and this affected prevalence of high (≥90th percentile) waist circumference. The relationships between waist circumference values at four anatomic locations and both depot-specific adiposity and cardiometabolic risk factors were similar across race and sex groups.

BACKGROUND

Different waist circumference (WC) measurement sites are used in clinical and epidemiological settings.

OBJECTIVES

To examine differences in WC measurement at four anatomic sites and how each WC measurement relates to visceral adipose tissue (VAT) and cardiometabolic risk factors in children.

METHODS

A total of 371 white and African-American children aged 5 to 18 years had WC measured at four sites: minimal waist, midpoint between the iliac crest and the lowest rib, superior border of the iliac crest and the umbilicus. Abdominal VAT was measured using magnetic resonance imaging and cardiometabolic risk factors were defined using National Heart, Lung and Blood Institute guidelines. Relationships between WC sites and VAT and risk factors were explored in each race-by-sex group.

RESULTS

All WC sites were highly correlated (r = 0.97 to 0.99). Differences in absolute mean WC values existed in all race-by-sex groups, and this affected the prevalence of high WC (≥90th percentile). Values were lowest for minimal waist and highest for umbilicus. Age-controlled partial correlations between WC and logVAT VAT were 0.81-0.89 (all P < 0.001) and between WC and cardiometabolic risk factors were -0.24 to -0.41 and 0.19 to 0.52 (all P < 0.05).

CONCLUSIONS

  While the absolute values of WC at four anatomic locations differed, the relationships between WC values and both VAT and cardiometabolic risk factors were similar within all race-by-sex groups.

Measurements of total and regional body composition in preschool children: A comparison of MRI, DXA, and anthropometric data

OBJECTIVE

There are clear sex differences in the distribution of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in adults, with males having more VAT and less SAT than females. This study assessed whether these differences between the sexes were already present in preschool children. It also evaluated which measures of body composition were most appropriate for assessing abdominal obesity in this age group.

DESIGN AND METHODS

One-hundred and five children (57 boys and 48 girls) participated in the study. Body composition was measured using dual-energy X-ray absorptiometry (DXA). Weight, height, and waist circumference (WC) were also recorded. Magnetic resonance imaging (MRI) of the entire abdomen using sixteen 10-mm-thick T1 -weighted slices was performed in a subgroup of 48 children (30 boys and 18 girls); SAT and VAT volumes were measured using semiautomated segmentation.

RESULTS

Boys had significantly more VAT than girls (0.17 versus 0.10 l, P < 0.001). Results showed that VAT correlated significantly with all measurements of anthropometry (P < 0.01) after adjusting for SAT and for total fat mass measured with DXA. The mean limits of agreement between DXA and MRI regarding truncal FM were calculated to be -11.4 (range -17.8 to -3.6), using a Bland-Altman plot.

CONCLUSION

Sex differences in adipose tissue distribution are apparent at an early age. MRI is the best method with which to study abdominal fat distribution in young children.

Maturity-associated variation in total and depot-specific body fat in children and adolescents

OBJECTIVES

This study considered the association between sexual maturation and adiposity in children and adolescents, and examined the contribution of sexual maturation to ethnic differences in total and depot-specific body fat.

METHODS

The sample included 382 White and African American 5-18-year-olds. Body mass index (BMI), waist circumference (WC) and sexual maturity status (breast/genital and pubic hair stage) were assessed in a clinical setting. Total body fat (TBF) was measured by dual-energy X-ray absorptiometry and abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) were measured by magnetic resonance imaging. Analysis of covariance adjusted for age was used to examine the association between sexual maturity status and adiposity, and linear regression adjusted for age was used to examine the influence of sexual maturation on ethnic differences in adiposity. Analysis of VAT also controlled for TBF. Significance was accepted at P < 0.05.

RESULTS

Breast/genital stage was significantly associated with BMI, WC, TBF, and SAT in girls of both ethnic groups and in White boys. Breast stage was associated with VAT. Stage of pubic hair was significantly associated with TBF and VAT in White girls only. In girls, sexual maturation attenuated the ethnic effects on BMI and WC, but the ethnic effect in VAT persisted. In boys, sexual maturation did not attenuate ethnic differences on VAT and did not predict WC or SAT. Sexual maturity status independently explained variance in adiposity in girls only.

CONCLUSIONS

Sexual maturity status is an important determinant of pediatric adiposity and attenuates ethnic differences in girls' adiposity.

BMI percentiles for the identification of abdominal obesity and metabolic risk in children and adolescents: evidence in support of the CDC 95th percentile

OBJECTIVES

Body mass index (BMI) percentiles have been routinely and historically used to identify elevated adiposity. The aim of this study was to investigate the optimal Centers for Disease Control and Prevention (CDC) BMI percentile that predicts elevated visceral adipose tissue (VAT), fat mass and cardiometabolic risk in a biracial sample of children and adolescents.

PARTICIPANTS AND METHODS

This cross-sectional analysis included 369 white and African-American children (5-18 years). BMI was calculated using height and weight and converted to BMI percentiles based on CDC growth charts. Receiver operating characteristic curve analysis identified the optimal (balance of sensitivity and specificity) BMI percentile to predict the upper quartile of age-adjusted VAT (measured by magnetic resonance imaging), age-adjusted fat mass (measured by dual-energy X-ray absorptiometry) and elevated cardiometabolic risk (≥ 2 of high glucose, triglycerides and blood pressure, and low high-density lipoprotein cholesterol) for each race-by-sex group.

RESULTS

The optimal CDC BMI percentile to predict those in the top quartile of age-adjusted VAT, age-adjusted fat mass and elevated cardiometabolic risk were the 96th, the 96th and the 94th percentiles, respectively, for the sample as a whole. Sensitivity and specificity was satisfactory (>0.70) for VAT and fat mass. Compared to VAT and fat mass, there was a lower overall accuracy of the optimal percentile in identifying those with elevated cardiometabolic risk.

CONCLUSIONS

The present findings support the utility of the 95th CDC BMI percentile as a useful threshold for the prediction of elevated levels of VAT, fat mass and cardiometabolic risk in children and adolescents.

Adiposity in children and adolescents: correlates and clinical consequences of fat stored in specific body depots

The 2011 Pennington Biomedical Research Center's Scientific Symposium focused on adiposity in children and adolescents. The symposium was attended by 15 speakers and other invited experts. The specific objectives of the symposium were to (i) integrate the latest published and unpublished findings on the laboratory and clinical assessment of depot-specific adiposity in children and adolescents, (ii) understand the variation in depot-specific adiposity and related health outcomes associated with age, sex, maturation, ethnicity and other factors and (iii) identify opportunities for incorporating new markers of abdominal obesity into clinical practice guidelines for obesity in children and adolescents. This symposium provided an overview of important new advances in the field and identified directions for future research. The long-term goal of the symposium is to aid in the early identification of children and adolescents who are at increased health risk because of obesity and obesity-related conditions.

Use of MRI and CT for fat imaging in children and youth: what have we learned about obesity, fat distribution and metabolic disease risk?

Childhood obesity is a matter of great concern for public health. Efforts have been made to understand its impact on health through advanced imaging techniques. An increasing number of studies focus on fat distribution and its associations with metabolic risk, in interaction with genetics, environment and ethnicity, in children. The present review is a qualitative synthesis of the existing literature on visceral and subcutaneous abdominal, intrahepatic and intramuscular fat. Our search revealed 80 original articles. Abdominal as well as ectopic fat depots are prevalent already in childhood and contribute to abnormal metabolic parameters, starting early in life. Visceral, hepatic and intramuscular fat seem to be interrelated but their patterns as well as their independent contribution on metabolic risk are not clear. Some ethnic-specific characteristics are also prevalent. These results encourage further research in childhood obesity by using imaging techniques such as magnetic resonance imaging and computed tomography. These imaging methods can provide a better understanding of fat distribution and its relationships with metabolic risk, compared to less detailed fat and obesity assessment. However, studies on bigger samples and with a prospective character are warranted.

Adrenarche and middle childhood

Middle childhood, the period from 6 to 12 years of age, is defined socially by increasing autonomy and emotional regulation, somatically by the development of anatomical structures for subsistence, and endocrinologically by adrenarche, the adrenal production of dehydroepiandrosterone (DHEA). Here I suggest that DHEA plays a key role in the coordinated development of the brain and body beginning with middle childhood, via energetic allocation. I argue that with adrenarche, increasing levels of circulating DHEA act to down-regulate the release of glucose into circulation and hence limit the supply of glucose which is needed by the brain for synaptogenesis. Furthermore, I suggest the antioxidant properties of DHEA may be important in maintaining synaptic plasticity throughout middle childhood within slow-developing areas of the cortex, including the insula, thamalus, and anterior cingulate cortex. In addition, DHEA may play a role in the development of body odor as a reliable social signal of behavioral changes associated with middle childhood.

Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents

Body fat and the specific depot where adipose tissue (AT) is stored can contribute to cardiometabolic health risks in children and adolescents. Imaging procedures including magnetic resonance imaging and computed tomography allow for the exploration of individual and group differences in pediatric adiposity. This review examines the variation in pediatric total body fat (TBF), visceral AT (VAT) and subcutaneous AT (SAT) due to age, sex, maturational status and ethnicity. TBF, VAT and SAT typically increase as a child ages, though different trends emerge. Girls tend to accumulate more TBF and SAT during and after puberty, depositing fat preferentially in the gynoid and extremity regions. In contrast, pubertal and postpubertal boys tend to deposit more fat in the abdominal region, particularly in the VAT depot. Sexual maturation significantly influences TBF, VAT and SAT. Ethnic differences in TBF are mixed. VAT tends to be higher in white and Hispanic youth, whereas SAT is typically higher in African American youth. Asian youth typically have less gynoid fat but more VAT than whites. Obesity per se may attenuate sex and ethnic differences. Particular health risks are associated with high amounts of TBF, VAT and SAT, including insulin resistance, hepatic steatosis, metabolic syndrome and hypertension. These risks are affected by genetic, biological and lifestyle factors including physical activity, nutrition and stress. Synthesizing evidence is difficult as there is no consistent methodology or definition to estimate and define depot-specific adiposity, and many analyses compare SAT and VAT without controlling for TBF. Future research should include longitudinal examinations of adiposity changes over time in representative samples of youth to make generalizations to the entire pediatric population and examine variation in organ-specific body fat.

Ability of different adiposity indicators to identify children with elevated blood pressure

OBJECTIVE

Body composition measured by dual-energy X-ray absorptiometry (DXA) is believed to be superior to crude measures such as BMI or waist circumference (WC) to assess health risks associated with adiposity in adults. We compared the ability of BMI, WC, waist-to-height ratio (WHtR), percentage body fat from skinfold thickness, and measures of total and central fat assessed by DXA to identify children with elevated blood pressure (BP).

STUDY DESIGN

The QUALITY Study follows 630 Caucasian families (father, mother, and child originally aged 8-10 years). BP, height, weight, WC, and skinfold thickness were measured according to standardized protocols. Elevated BP was defined as systolic or diastolic BP at least 90th age, sex, and height-specific percentile. Total and central fat were determined with DXA. The area under the receiver operating characteristic (ROC) curve (AUC) statistic was computed from logistic models that adjusted for age, sex, height, Tanner stage, and physical activity.

RESULTS

All adiposity indicators were highly correlated. WC and WHtR did not show superior ability over BMI to identify children with elevated SBP (P = 0.421 and 0.473). Measures of total and central fat from DXA did not show an improved ability over BMI or WC to identify children with elevated SBP (P = 0.325-0.662).

CONCLUSION

Results support the use of BMI in clinical and public health settings, at least in this age group. As all indicators had a limited ability to identify children with elevated BP, results also support measurement of BP in all children of this age independent of a weight status.

Glucose tolerance is affected by visceral adiposity and sex, but not birth weight, in Yucatan miniature pigs

Epidemiological studies have linked small birth weight and lack of breastfeeding to type 2 diabetes mellitus. This study aimed to determine if (i) small birth weight promotes and (ii) suckling prevents the development of adiposity and diabetes biomarkers in a Yucatan miniature pig model. At 3 days of age, the intrauterine growth-restricted (IUGR) piglet (n = 6) was paired with a normal weight (NW), same-sex littermate (n = 6) and fed milk replacer for 4 weeks. A sow-fed normal weight littermate (n = 6) was also compared with the NW littermate to assess the effects of suckling. All pigs were fed a standard diet ad libitum for 5 h·day–1 from week 4. At 9.5 months, pigs underwent intravenous glucose tolerance (IVGTT) and insulin sensitivity tests (IST). At 10 months, tissues were harvested for fat analysis and pancreas histology. IUGR pigs demonstrated compensatory growth before sexual maturity and had greater subcutaneous fat depth; birth weight also negatively correlated with visceral fat content. Visceral and subcutaneous adiposity were greater in females than males. IVGTT and IST outcomes were not different due to birth weight or suckling. However, visceral adiposity was associated with several glucose tolerance outcomes and females were more glucose intolerant due to their greater adiposity. Pancreas insulin content or histology outcomes were not different. This model did not develop markers of type 2 diabetes mellitus because of small birth weight or formula feeding. However, visceral adiposity and sex were associated with glucose intolerance, which is consistent with data in humans.

Sex differences in the contributions of visceral and total body fat to blood pressure in adolescence

Excess body fat deposited viscerally rather than elsewhere in the body is associated with higher risk for hypertension; this relationship is stronger in men than in women. Here we investigated whether similar sex dimorphism exists already in adolescence. A population-based sample of adolescent boys (n=237) and girls (n=262), age 12 to 18 years, was studied. Total body fat (TBF) was assessed with multifrequency bioelectrical impedance, and visceral fat (VF) was quantified with MRI. Blood pressure (BP) was measured beat by beat during an hour-long protocol, including supine, standing, sitting, mental stress, and poststress sections. Multivariate mixed-model analysis was used to assess the relative contributions of TBF and VF to BP during these sections. In boys, BP was strongly positively associated with VF (P<0.0001), whereas it was less strongly and negatively associated with TBF (P=0.004); these relationships did not substantially vary during the protocol. In contrast, in girls, BP was strongly positively associated with TBF (P=0.0006), whereas it was not associated with VF (P=0.08); the relationship with TBF varied during the protocol and was most apparent during mental stress (TBF*section interaction: P=0.002). Furthermore, when waist circumference was included in multivariate models instead of VF, it was not associated with BP in either sex; this indicates that waist circumference may not be an appropriate surrogate for VF. Thus, in adolescence, adiposity-related BP elevation is driven mainly by visceral fat in males and by fat deposited elsewhere in females. This dimorphism suggests sex-specific mechanisms of obesity-induced hypertension and the need for sex-specific criteria of its prevention.

Pressão arterial elevada e obesidade abdominal em adolescentes

OBJETIVO: Analisar a associação entre obesidade abdominal e pressão arterial elevada em adolescentes da rede pública de ensino da região metropolitana da cidade de Londrina (PR). MÉTODOS: Constituiu-se uma amostra de 656 adolescentes com idades entre dez e 13 anos. Foram realizadas análises antropométricas de massa corporal, estatura e circunferência de cintura, além da aferição da pressão arterial de repouso. Para análise e comparação dos dados, foram aplicados Mann-Whitney e o teste t de Student. Também foram analisadas as possíveis associações entre pressão arterial e circunferência de cintura por meio do teste do qui-quadrado. RESULTADOS: Foram identificadas associações entre obesidade abdominal e pressão arterial elevada em ambos os sexos (RP 2,7; IC95% 1,8-4,2). Além disso, verificou-se que, independentemente do grupo etário, a obesidade abdominal associa-se com valores mais elevados de pressão arterial. CONCLUSÕES: A obesidade abdominal está associada à ocorrência de aumento da pressão arterial em adolescentes.

Gender-specific differences in adipose distribution and adipocytokines influence adolescent nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a predominantly adult-diagnosed disorder. Knowledge regarding the epidemiology, phenotype, and metabolic risk factors, during adolescence is limited. We sought to determine the prevalence, phenotype, and predictors of NAFLD in 1170 community-based adolescents in the Western Australian Pregnancy Cohort (Raine) Study (the Raine Cohort) who underwent a cross-sectional assessment that included questionnaires, anthropometry, cardiovascular examinations, blood tests, and abdominal ultrasound examinations. Among the 1170 adolescents assessed, the prevalence of NAFLD was 12.8%. Females compared with males had a significantly higher prevalence of NAFLD (16.3% versus 10.1%, P = 0.004) and central obesity (33.2% versus 9.9%, P < 0.05). The severity of hepatic steatosis was associated with the body mass index, waist circumference, subcutaneous adipose tissue thickness (SAT), serum leptin level, homeostasis model assessment for insulin resistance score (P < 0.001 for all), and serum alanine aminotransferase level (P < 0.005) in both genders, but it was associated with increasing visceral adipose tissue thickness (VAT; P < 0.001) and decreasing serum adiponectin levels (P < 0.05) in males alone. Males and females with NAFLD had similar amounts of SAT (P > 0.05); however, in comparison with females with NAFLD, males with NAFLD had greater VAT, a more severe metabolic phenotype with higher glucose levels and systolic blood pressure and lower adiponectin and high-density lipoprotein cholesterol levels (P < 0.001 for all), and greater measures of liver injury (alanine aminotransferase and aspartate aminotransferase, P < 0.001 for all). Similarly, metabolic syndrome was more common in males than females with NAFLD (24% versus 8%, P = 0.01). Suprailiac skinfold thickness predicted NAFLD independently of the body mass index, insulin resistance, and VAT.

CONCLUSION

Gender differences in adolescent NAFLD are related to differences in adipose distribution and adipocytokines. The male phenotype of NAFLD is associated with more adverse metabolic features and greater visceral adiposity than the female phenotype despite the lower prevalence of NAFLD.

Childhood obesity: evidence of an association between plasminogen activator inhibitor-1 levels and visceral adiposity

BACKGROUND

Plasminogen activator inhibitor-1 (PAI-1) has been considered as a cardiovascular risk factor, mainly because of its strong association with insulin resistance.

METHODS

To detect independent predictors of circulating PAI-1 levels in obese pediatric patients, we evaluated 86 subjects (mean age 10.7 +/- 2.8 years), 42 of whom were male (49%). Subjects were divided in two groups according to body mass index (BMI): obese subjects (n=61) and healthy non-obese controls (n=25). They were also divided by pubertal status. Besides anthropometric data, levels of PAI-1, leptin and biochemical markers of metabolic syndrome were measured.

RESULTS

The obese group had higher levels of PAI-1, leptin and biochemical markers of metabolic syndrome than nonobese controls (p<0.05). However, multivariate regression analysis showed that only puberty progression (p=0.005) and abdominal circumference/height index (p=0.002) remained independent predictors of PAI-1 levels.

CONCLUSION

In pediatric obesity, fat mass accumulation, mainly of visceral fat, and puberty progression were related to high PAI-1 levels, which might in turn contribute to cardiovascular risk.

Accuracy of simple clinical and epidemiological definitions of childhood obesity: systematic review and evidence appraisal

The optimum means of defining obesity in children is unclear, creating variation in practice, and hindering obesity surveillance, prevention and treatment. This study aimed to review evidence on the use of body mass index (BMI) and waist circumference for diagnosis of high body fat content and adverse cardiometabolic risk factors in children and adolescents. A systematic literature review was carried out and evidence appraised using the Quality Assessment of Studies of Diagnostic Accuracy in Systematic Reviews method. Literature searching began following the last systematic review of this topic (end 2001) and collected evidence in MEDLINE and EMBASE in 0- to 18-year-olds that compared the accuracy of BMI vs. waist circumference and compared BMI interpreted relative to national reference data vs. BMI interpreted relative to Cole/International Obesity Task Force international reference data. Ten studies compared diagnostic accuracy of BMI vs. waist circumference: they reported no improved identification of adverse cardiometabolic risk profiles from waist circumference over that provided by high BMI. Eight studies compared BMI with national reference data vs. the international approach: 5/8 found significantly poorer accuracy (lower sensitivity) using BMI with the international approach; 3/8 found similar sensitivity; in 7/7 studies that compared specificity this was similar. In conclusion, the present review provides no compelling evidence for use of either high waist circumference or BMI interpreted using the International Obesity Task Force approach in preference to the use of national BMI percentiles for the identification of children and adolescents with excess fatness and adverse cardiometabolic risk profile.

Efficacy of increasing physical activity to reduce children's visceral fat: a pilot randomized controlled trial

OBJECTIVE

To examine whether differentially targeting physical activity within the context of pilot family-based pediatric weight control treatment results in differential change in abdominal fat, particularly visceral fat.

METHOD

Twenty-nine overweight children (>85(th) body mass index [BMI] percentile) and at least one participating parent were randomly assigned to one of two family-based behavioral weight management conditions that either targeted 1) primarily dietary change (STANDARD; n = 15) or 2) dietary plus physical activity change (ADDED; n = 14). Differences at post-treatment in overall child weight status (e.g., BMI), whole-body composition (measured by dual x-ray absorptiometry), and abdominal fat (measured by waist circumference and magnetic resonance imaging) were assessed using intent-to-treat analyses, as were post-treatment parent BMI and waist circumference. Child and parent physical activity and dietary behavior changes were also evaluated. Results. At post-treatment, overall child weight status, whole-body composition, and child dietary measures did not differ by condition. Children in the ADDED condition tended to have higher physical activity and lower visceral abdominal fat at post-treatment relative to children in the STANDARD condition.

CONCLUSIONS

Increasing physical activity may be important to optimize reductions in abdominal fat, especially visceral fat, among overweight children provided with family-based behavioral weight management treatment.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00359957.