Reaching the Tipping Point: Identification of Thresholds at which Visceral Adipose Tissue May Steeply Increase in Youth

Abstract

Objective This study aimed to determine whether children and adolescents demonstrate, similarly to adults, a threshold of total percent body fat (%BF) above which the slope of visceral adipose tissue (VAT) rises. Methods This cross‐sectional study included 557 youth, aged 8 to 18 years, with a wide range of BMI values. Dual‐energy x‐ray absorptiometry was used to determine body composition (including VAT), and fasting blood was collected for measurement of lipids, glucose, insulin, and biomarkers. Segmented linear regression analysis identified the threshold for %BF unadjusted and adjusted for Tanner stage. Linear regression with robust variance estimation compared associations of risk factors and thresholds. Results Thresholds of %BF were identified by sex (males = 33%, females = 38%), age (< 12 years = 34%; ≥ 12 years = 30%), and race (White/non‐Hispanic = 31%; all other races/Hispanic = 38%) above which the slope of VAT was significantly steeper (all P < 0 .001). The percentage of total body fat stored as VAT was higher above versus below these thresholds (all P < 0.001). Above threshold, but not below it, VAT was associated with triglycerides/high‐density lipoprotein ratio, insulin, adiponectin, and blood pressure. Conclusions The thresholds should be confirmed in longitudinal studies, and they may be useful in identifying youth at increased cardiometabolic risk in need of close clinical monitoring and/or intensive intervention to reduce excess adiposity.

The Association between Sarcopenic Obesity and DXA-Derived Visceral Adipose Tissue (VAT) in Adults

“…More specifically, VAT secretes several adipokines and cytokines that determine a local and systematic, chronic, low-grade inflammation that induces lipolysis, hyperlipidemia and, following that, fat redistribution with an ex novo accumulation in the form of visceral fat, determining a further increase in the VAT mass itself [ 36 ]. However, at a certain extent the VAT mass starts to “spillover” fat to other organs of the body such as the skeletal muscle known as ectopic fat infiltration (intermuscular adipose tissue, IMAT) [ 37 ]. Both phenomena mentioned above—namely, the (i) chronic low-grade systematic inflammation and (ii) muscle ectopic fat infiltration that demonstrated VAT mass had a central role—can potentially determine a mitochondrial dysfunction contributing to the SO physiopathology [ 38 ].…”

Sex steroids and adiposity in a prospective observational cohort of youth

“…Visceral adiposity predicts adverse cardiovascular risk factor profiles in children 1 , 2 as well as adults. 3 Therefore, understanding the determinants of visceral adipose tissue (VAT) in youth is important to improving metabolic health.…”