Abdominal Adiposity and Total Body Fat as Predictors of Cardiometabolic Health in Children and Adolescents With Obesity

Abstract

Objective: We aimed to assess the role of adipose tissue distribution in cardiometabolic risk (in particular insulin sensitivity) in a population of children and adolescents with obesity. Methods: In this cross-sectional study, participants were 479 children and adolescents with obesity (322 boys and 157 girls) aged 3 to 18 years attending the Children's Hospital at Zhejiang University School of Medicine (Hangzhou, China). Clinical assessments included anthropometry, body composition (DXA scans), carotid artery ultrasounds, and OGTT. Insulin sensitivity was assessed using the Matsuda index. Participants were stratified into groups by sex and pubertal stage. Key predictors were DXA-derived android-to-gynoid-fat ratio (A/G) and total body fat percentage (TBF%). Results: Irrespective of sex and pubertal stage, there was a strong association between increasing A/G (i.e., greater abdominal adiposity) and lower insulin sensitivity. In multivariable models, every 0.1 increase in A/G was associated with a reduction in insulin sensitivity in prepubertal boys [−29% (95% CI −36%, −20%); p < 0.0001], pubertal boys [−13% (95% CI −21%, −6%); p = 0.001], and pubertal girls [−16% (95% CI −24%, −6%); p = 0.002]. In contrast, TBF% was not associated with insulin sensitivity when A/G was adjusted for, irrespective of pubertal stage or sex. In addition, every 0.1 increase in A/G was associated with increased likelihood of dyslipidemia in prepubertal boys [adjusted odds ratio (aOR) 1.62 (95% CI 1.05, 2.49)], impaired glucose tolerance in pubertal boys [aOR 1.64 (95% CI 1.07, 2.51)] and pubertal girls [aOR 1.81 (95% CI 1.10, 2.98)], and odds of NAFLD in both prepubertal [aOR 2.57 (95% CI 1.56, 4.21)] and pubertal [aOR 1.69 (95% CI 1.18, 2.40)] boys. In contrast, higher TBF% was only associated with higher fasting insulin and ALT in pubertal boys, being also predictive of NAFLD in this group Jin et al. A/G and Body Fat% as Cardiometabolic Predictors [aOR 1.15 per percentage point (95% CI 1.06, 1.26)], but was not associated with the likelihood of other cardiometabolic outcomes assessed in any group. Conclusions: A/G is a much stronger independent predictor of cardiometabolic risk factors in children and adolescents with obesity in China, particularly glucose metabolism.

Associations of muscular fitness and body composition in children

“…Contrary to these findings, positive associations have been found between muscle strength and adiposity, when muscle strength has been assessed with the handgrip test (Ortega et al, 2008;Smith et al, 2014;Thivel et al, 2016). Adiposity and especially increased abdominal adiposity (measured by DXA) have been shown to be independently associated with increased cardiometabolic health risk in obese children and adolescents (Jin et al, 2020). Conversely, there is accumulating evidence that health-related fitness, especially CRF, is associated with adiposity and may counteract the negative consequences of obesity in childhood (Ortega et al, 2018;Schmidt et al, 2016).…”

“…Height was measured to the nearest 0.1 cm and weight was determined using a high-precision electronic scale (F 150S-D2, Sartorius AG, Goettingen, Germany) to the nearest 0.1 kg, and the measurements were used to calculate BMI (kg/m2). The participants were classified as healthy weight, overweight or obese, according to the BMI cut-offs of the International Obesity Task Force (IOTF) for age and sex (Rolland-Cachera, 2011), as recommended by the European Childhood Obesity Group (Jin et al, 2020).…”

Effects of Fecal Microbiome Transfer in Adolescents With Obesity

“…A greater A/G ratio has been associated with insulin resistance, adverse lipid profiles, 25 and predictive of cardiometabolic health. 26 While the long-term significance of this reduction remains to be determined, the observed impact of the FMT raises promising new avenues to investigate the complex relationships between lipid partitioning and metabolic health.…”

Sex differences in the associations between adiposity distribution and cardiometabolic risk factors in overweight or obese individuals: a cross-sectional study

“…Among the studies explored the associations between DXA-measured fat distribution and cardiometabolic indicators in Chinese population [ 33 – 40 ], participants were children in two studies [ 34 , 40 ], women only in two studies [ 37 , 39 ], and middle-aged women and men with a mean age over 46 years in four studies [ 33 , 35 , 36 , 38 ]. While body composition or fat distribution varies substantially with age [ 41 ], limited studies had examined the associations of adiposity distribution and cardiometabolic risk among Chinese young adults.…”