Visceral fat and cardiometabolic future in children and adolescents: a critical update

Validation of the 2024 European Association for the Study of Obesity diagnostic criteria: A comprehensive assessment of obesity-related mortality risks

AIMS

Obesity is a global public health challenge, and the traditional WHO-proposed diagnostic criteria based on body mass index (BMI) often fail to fully assess related health risks. The European Association for the Study of Obesity (EASO) has proposed new criteria that combine BMI, waist-to-height ratio (WtHR) and complications to more accurately evaluate obesity-related health risks.

MATERIALS AND METHODS

This study utilized data from the National Health and Nutrition Examination Survey database, covering the years 1999-2018. The study validated the new EASO criteria for diagnosing obesity, defined as BMI ≥25 kg/m2, WtHR ≥0.5 and the presence of 12 obesity-related complications. The associations between obesity and mortality were assessed using Kaplan-Meier survival curves and Cox proportional hazards regression analyses. Mediation analysis was conducted to explore potential mechanisms by which obesity impacts patient prognosis.

RESULTS

A total of 39 066 participants were included, with a mean age of 43.6 years; 51.3% were male. Over a median follow-up period of 141 months, 3708 deaths were recorded. The prevalence of obesity was 63.04% according to the new EASO criteria. The obesity rate based on BMI ≥30 is only 35.55%. The EASO criteria achieved a C-index of 0.5549, which surpasses the predictive accuracy of the traditional BMI ≥30 kg/m2 criterion, with a C-index of 0.5265. Cox regression analysis indicated that when using the traditional BMI ≥30 criterion to diagnose obesity, it was associated with all-cause mortality and cardiovascular disease (CVD)-related mortality, but it did not predict cancer-related mortality. Obesity diagnosed by EASO criteria was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR] and 95% confidence interval [CI]: 1.13 [1.02, 1.24]), CVD mortality (HR and 95% CI: 1.48 [1.20, 1.83]) and cancer mortality (HR and 95% CI: 1.26 [1.03, 1.54]). When using simplified BMI ≥25 kg/m2, WtHR ≥0.5 and any of the top five complications (diabetes mellitus, hypertension, CVD, metabolic syndrome and ageing) as diagnostic criteria, which had the highest C-index (0.612), obesity remained an independent prognostic factor for poor overall survival (HR and 95% CI for all-cause mortality: 1.41 [1.26, 1.58], HR for CVD mortality: 2.08 [1.61, 2.68] and HR for cancer mortality: 1.32 [1.06, 1.65]).

CONCLUSIONS

This study confirms the prognostic value of the new obesity diagnostic criteria proposed by EASO, suggesting that these criteria offer a more accurate assessment of obesity-related health risks.

Exploring Visceral Fat as a Screening Marker for Cardiometabolic Risk in Children and Adolescents

Objective: To establish and validate age- and sex-specific visceral fat area (VFA) cutoff values for the effective identification of cardiometabolic risk (CMR) in children and adolescents. Methods: A cross-sectional study involving 8133 participants was conducted to derive age- and sex-specific VFA cutoffs, which were validated in a longitudinal cohort comprising 10,805 individuals. The predictive performance of the derived VFA cutoffs for CMR was evaluated using the area under the receiver operating characteristic curve (AUC). Additionally, logistic regression models were utilized to calculate the relative risk (RR) of CMR associated with elevated VFA levels. Results: The 75th percentile of the VFA was identified as the optimal cutoff for screening for hypertension, hyperglycemia, dyslipidemia, and CMR clustering in boys. In girls, the 75th percentile was optimal for screening hypertension, dyslipidemia, and CMR clustering, while the 80th percentile proved best for hyperglycemia. No significant difference in predicative performance was observed between the optimal and simplified VFA cutoffs. Longitudinal validation demonstrated that individuals exceeding the VFA cutoff had a significantly higher risk for CMR, with RRs ranging from 1.33 to 3.89 (all p < 0.001) for boys and from 1.63 to 3.16 (all p < 0.001) for girls. Notably, normal-weight boys with VFA above the cutoff had a significantly higher CMR risk compared to their peers in other weight status categories. Conclusions: Both the optimal and simplified VFA cutoffs are robust tools for screening CMR in Chinese children and adolescents, with significant implications for early intervention strategies.

Exclusive or partial breastfeeding and estimated protein intake in infancy: Associations with childhood growth and body composition at 7 years of age in the Odense Child Cohort

BACKGROUND

Protein intake in infancy influences infant growth, body composition, and possibly metabolic programming later in life. Our objectives were to investigate whether macronutrient content in mother's own milk (MOM) differed between exclusive (EBF) or partial breastfeeding (PBF), including an estimation of protein intake (ePI) during the first 6 months of life. Second, to investigate associations of feeding type and ePI with childhood growth and body composition at 7 years.

METHODS

In a subset of 150 participants from the Odense Child Cohort, MOM was analysed for macronutrient content using midinfrared transmission spectroscopy. Information on breastfeeding duration was collected through weekly SMS questionnaires and used to calculate ePI. Outcomes were weight-for-age z-scores (WAZ) and height-for-age z-scores (HAZ) from birth to 7 years, and body composition in terms of dual X-ray absorptiometry fat mass, fat-free mass and calculated indexes at 7 years.

RESULTS

The macronutrient content in MOM did not differ between EBF and PBF, but ePI was significantly higher in PBF infants than in EBF infants at 6 months. We found no difference in WAZ or HAZ until 7 years of age according to feeding type, but within the PBF group, ePI was positively associated with 7-year WAZ (β = 0.001; 95% CI 0.000-0.003; p = 0.03) and HAZ (β = 0.002; 0.001-0.003;p = 0.007). ePI was not associated with body composition at 7 years.

CONCLUSION

Milk macronutrient content and childhood growth did not differ between EBF and PBF during infancy. Estimated protein intake in partially breastfed infants was positively associated with childhood growth, but not body composition, at 7 years of age.

Cashew nut consumption reduces waist circumference and oxidative stress in adolescents with obesity: A randomized clinical trial

Previous evidence suggests that certain types of nuts, when included in a healthy diet pattern, may provide health benefits. Therefore, we hypothesize that the consumption of cashew nuts associated with a healthy diet may enhance antioxidant defenses and improve anthropometric and body composition parameters in individuals with obesity. We conducted a 12-week randomized clinical trial, divided into 4 sessions, involving adolescents randomly assigned to receive either 30 g of roasted cashew nuts together with nutrition education (cashew nut group-CNG) or only nutrition education (control group-CG). The total number of participants who started the study was 142, with 77 in the CNG and 65 in the CG. Data on anthropometry, body composition, and oxidative stress were collected at baseline (0-week) and endpoint (12-week). The main post-intervention findings in the CNG showed decreases in waist circumference (WC), thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) at 60 minutes in the CNG, while neck circumference (NC) increased. However, the CG showed an increase in TBARS and percentage of lean body mass (LBM), along with reduction in TAC at 60 minutes. After 12 weeks, the consumption of cashew nuts seemed to assist in WC reduction, even without a decrease in other anthropometric parameters, thereby decreasing the cardiometabolic risk. Furthermore, the consumption of cashew nuts demonstrated the ability to decrease overall oxidative damage as assessed by TBARS, a finding that reinforces the effects of this nut consumption against systemic oxidative stress associated with obesity.

Association between a body shape index and colorectal cancer in US population: a cross-sectional study based on NHANES

Background

Colorectal cancer (CRC) is linked to obesity, particularly visceral fat. A more accurate measure of visceral fat accumulation is offered by a body shape index (ABSI). Currently, the direct application of the ABSI to populations with varying ethnic backgrounds might be restricted. Moreover, there is less evidence about the correlation between ABSI and CRC among individuals from different ethnical backgrounds.

Methods

A total of 40,998 individuals who took part in the National Health and Nutrition Examination Survey (NHANES) spanning from 2003 to 2023 were subjected to analysis. Logistic regression was utilized to examine the associations between the ABSI and the risk of CRC. In addition, restricted cubic spline curves (RCS) were utilized, and subgroup analyses along with interaction tests were also carried out. The receiver operating characteristic curve (ROC) was employed to predict the risk of CRC relying on various anthropometric indicators.

Results

After adjusting for covariates, ABSI demonstrated a positive association with the incidence of CRC (OR = 1.03 [95% CI: 1.01-1.05], p = 0.018). Individuals in the upper quartile of ABSI exhibited a greater prevalence of CRC than those in the lower quartile (OR = 1.88 [95% CI: 1.19-2.96], p = 0.006). RCS analysis indicated a nonlinear correlation between ABSI and CRC (P for nonlinear = 0.030). Subgroup analysis indicated a notable interaction between age and BMI subgroups (interaction p < 0.05), and ROC curves indicated that the ABSI was effective in predicting CRC risk (AUC = 0.658), demonstrating good sensitivity, particularly in individuals under 60 years of age.

Conclusion

A positive correlation exists between ABSI levels and the increased incidence of CRC among U.S. adults. This is especially true for people under 60 years of age (40-60 years), with a BMI below 25 kg/m2, and those with a BMI of 30 kg/m2 or beyond. ABSI can be used as a simple anthropometric predictor of CRC.

Skeletal and Adipose Manifestations of Stress in a Contemporary Pediatric Sample

INTRODUCTION

Adverse experiences leading to physiological disruptions (stress) in early life produce cascade effects on various biological systems, including the endocrine and metabolic systems, which, in turn, shape the developing skeletal system. To evaluate the effects of stress on adipose and skeletal tissues, we examine the relationship between skeletal indicators of stress (porotic hyperostosis [PH] and cribra orbitalia [CO]), bone mineral density (BMD), vertebral neural canal (VNC) diameters, and adipose tissue distribution in a contemporary pediatric autopsy sample.

METHODS

Data is from 702 (409 males, 293 females) individuals from a pediatric (0.5-20.9 years) autopsy sample from New Mexico who died between 2011 and 2022. Data includes visceral adipose tissue (VAT) in the abdomen, heart, and liver, CO/PH, VNC size of the fifth lumbar vertebra, and BMD.

RESULTS

We find that adipose tissue distribution and location are differentially associated with CO/PH, BMD, and VNC size; VNC size is smaller, and liver adiposity is higher in those with CO/PH. Further, increased VAT and small VNC size are associated with PH presence and low BMD. Body mass index categories do not correspond with porous cranial lesion presence.

CONCLUSIONS

This paper provides evidence for the complex relationship between skeletal markers of early-life stress (CO/PH, reduced VNC size, low BMD) and endocrine system function. VAT distribution and VNC size are partly shaped by stressors during gestation, likely through alterations of the HPA axis. It is possible that alterations of the HPA axis due to gestational stress also shape the expression of porous cranial lesions during exposure to childhood stressors.

Predictors of visceral and subcutaneous adipose tissue and muscle density: The ShapeUp! Kids study

BACKGROUND AND AIMS

Body fat distribution, i.e., visceral (VAT), subcutaneous adipose tissue (SAT) and intramuscular fat, is important for disease prevention, but sex and ethnic differences are not well understood. Our aim was to identify anthropometric, demographic, and lifestyle predictors for these outcomes.

METHODS AND RESULTS

The cross-sectional ShapeUp!Kids study was conducted among five ethnic groups aged 5-18 years. All participants completed questionnaires, anthropometric measurements, and abdominal MRI scans. VAT and SAT areas at four lumbar levels and muscle density were assessed manually. General linear models were applied to estimate coefficients of determination (R2) and to compare the fit of VAT and SAT prediction models. After exclusions, the study population had 133 male and 170 female participants. Girls had higher BMI-z scores, waist circumference (WC), and SAT than boys but lower VAT/SAT and muscle density. SAT, VAT, and VAT/SAT but not muscle density differed significantly by ethnicity. R2 values were higher for SAT than VAT across groups and improved slightly after adding WC. For SAT, R2 increased from 0.85 to 0.88 (girls) and 0.62 to 0.71 (boys) when WC was added while VAT models improved from 0.62 to 0.65 (girls) and 0.57 to 0.62 (boys). VAT values were significantly lower among Blacks than Whites with little difference for the other groups.

CONCLUSION

This analysis in a multiethnic population identified BMI-z scores and WC as the major predictors of MRI-derived SAT and VAT and highlights the important ethnic differences that need to be considered in diverse populations.

Associations Between Risk Factors of Cardiovascular Disease in Young Adults

Introduction

Cardiovascular disease (CVD) impacts 50% of U.S. adults although few studies evaluate young adults' cardiovascular disease risk. Early identification of cardiovascular disease risk may mitigate increased adulthood incidence. We analyzed (CVD) risk factors and their association with cardiovascular fitness (V ˙ o2max) to devise effective strategies to improve cardiovascular health across the lifespan.

Methods

A cross-sectional study evaluated the effect of a single bout of aerobic exercise on cardiovascular disease risk factors in adults aged 18 to 36 years. Glycemic control (HbA1C), cardiovascular fitness (V ˙ o2max), percent body fat, lean body mass, waist circumference, and body mass index (BMI) were analyzed using correlation analysis and multiple linear regression.

Results

Statistically significant relationships were observed between percent body fat (r = .83, P < .001) and BMI, and waist circumference (r = .83, P < .001) and BMI. Percent body fat (P < .001) and race (P = .018) predicted exercise time, with Asians exercising the longest. Percent fat (P < .001) and HbA1C (P = .039) were identified as predictors of cardiovascular fitness which was low in spite of primarily normal average HbA1C levels.

Conclusions

HbA1C and body fat negatively influence cardiovascular fitness (V ˙ o2max) in young adults increasing adulthood cardiovascular disease risk. Research investigating the effect of HbA1C on cardiovascular health especially in youth is warranted.

Emerging Perspectives on the Set of Conditions That Lead to the Emergence of Metabolic Syndrome

Metabolic syndrome, as a medical condition, presents multifactorial complexity that is characterized by the resulting damage from genetic, environmental, and lifestyle factors (presence or absence of physical activity, food choices). Thus, metabolic syndrome qualifies unequivocally as a medical condition in which there are, simultaneously, several independent metabolic risk factors, namely, abdominal obesity, high triglyceride level, low HDL cholesterol level, arterial hypertension, and high glycemic level. Although age, sex, socio-economic status, and the precise definition of metabolic syndrome all influence the prevalence and risk of developing the condition, clinical and epidemiological studies clearly show that central obesity, as measured by an increased abdominal circumference, is the main risk factor. Thus, due to the growing global incidence of obesity, there has been an increase in the incidence of metabolic syndrome. Starting with obesity, all other metabolic risk factors are influenced: for example, as a result of insulin resistance with hyperglycemia, diabetes is linked to an increased risk of cardiovascular disease due to increased abdominal circumference. Through this review, we aimed to highlight the latest research studies and dietary nutritional interventions useful in the prevention of this disease but also implementation strategies for primary prevention among the healthy population.