Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents

Utility of wrist circumference in recognition of metabolic syndrome in overweight and obese South Indian children and adolescents

OBJECTIVE

To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children.

METHODS

A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5-17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner's stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting.

RESULTS

We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p<0.05). We observed a fair positive correlation between wrist circumference z score and BMI z score, (r=0.5; p<0.05). On receiver operating characteristic curve analysis, 97th percentile of wrist circumference predicted metabolic syndrome among overweight and obese children with a sensitivity of 86.7% and specificity of 37.5% (AUC=0.675).

CONCLUSIONS

Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents.

Association of Trunk/Leg Fat Mass Ratio with Low-Density Lipoproteins-Cholesterol and Triglycerides Concentration in Children and Adolescents: A Cross-Sectional, Retrospective Study

Background: Increased central (or abdominal) fat mass has been associated with cardiometabolic risk factors such as high low-density lipoproteins (LDL)-cholesterol or triglycerides (TG) concentration in children. Objectives: To generate pediatric reference centiles for trunk/leg fat mass ratio (T2L) (assessed by dual-energy X-ray absorptiometry [DXA]) and to evaluate the association of LDL-cholesterol and TG concentrations with T2L in children and adolescents. Methods: Data of the National Health and Nutrition Examination Survey (1999-2004) were used to determine total and regional fat mass by DXA of the participants (aged 8-19 years) who had also an examination of LDL-cholesterol and TG concentrations. Fat mass was assessed by DXA-determined fat mass index (FMI). Central fat mass was quantified by T2L. Results: The DXA results of 6538 children and adolescents (2629 females) were used to generate reference centiles for T2L. In girls, T2L was significantly associated with high LDL-cholesterol and TG concentration (odds ratio [OR] adjusted to FMI 1.69), (95% confidence interval [CI] 1.20-2.40), and 1.45 (95% CI 1.11-1.91, p = 0.003 and p = 0.008). In boys, T2L was significantly associated only with high TG concentration (OR adjusted to FMI 1.81 [95% CI 1.52-2.19, p < 0.001]). Conclusions: A central fat distribution seemed to be an independent risk factor for high TG concentrations in children and for high LDL-cholesterol only in girls. The first ethnicity-specific, pediatric reference centiles for T2L were presented.

Metabolic syndrome, biochemical markers, and body composition in youth living with perinatal HIV infection on antiretroviral treatment

People living with HIV who are on antiretroviral treatment are at increased risk of developing premature cardiovascular disease. Children with perinatal HIV infection (PHIV) have survived through their adolescence and are entering adulthood. We determined the prevalence of metabolic syndrome, abnormal biochemical markers, and characterized body composition parameters in youth living with perinatal HIV infection. This cross-sectional study was conducted at the Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand from December 2017 to February 2018. PHIV-youths between 15 <25 years of age who were receiving ART were enrolled. Data collection included ART-related history, blood pressure, and anthropometric measurements. Body composition including android, gynoid fat mass, and total body fat were measured by dual-energy X-ray absorptiometry. Fasting blood was drawn to test for lipid profile, glucose, and high sensitivity c-reactive protein (hsCRP). One hundred and twenty PHIV-youths (48% female) were enrolled. Their mean age and the median duration on ART were 20.3 (SD2.6) and 14.1 (IQR 10.4–14.9) years, respectively; 76 (63%) were on first-line non-nucleoside reverse transcriptase inhibitors-based regimens. Thirty-three (28%), 74 (62%), and 13 (11%) of PHIV-youths were underweight (BMI < 18.5 kg/m²), normal (BMI 18.5–24.9 kg/m²), and overweight (BMI ≥ 25.0 kg/m²), respectively. The prevalence of metabolic syndrome was 10.6% (95%CI 5.0–16.0). Seventy-six of 113 (67.3%) of PHIV-youths had lipid alteration; the most prevalent types being low HDL (46.9%) and increased triglycerides (27.4%). Overall 43 (35.9%) had increased hsCRP (16.7% with immediate and 19.2% with high risk for CVD). Females had significantly higher percentage of android and gynoid fat, but lower Android to gynoid ratio (AGR) compared to males. There were 77%, 31%, and 21% of PHIV-youths in the overweight, normal weight, and underweight group with AGR in tertile 3, respectively. In conclusion, we documented presence of metabolic syndrome in 10.6% of PHIV-youths on ART. Increase AGR representing abdominal obesity was detected even in youths with normal BMI or underweight.

Effects of curcumin on cardiovascular risk factors in obese and overweight adolescent girls: a randomized clinical trial

BACKGROUND

Obese adolescents are at higher risk of development of cardiovascular risk factors and obesity in later life. Dietary intake of antioxidants, particularly curcumin, as an active ingredient of turmeric extract, may have noticeable effects on obesity and its important complications such as cardiovascular risk factors. Therefore, the aim of this study was to assess the effects of curcumin supplementation on cardiovascular risk factors among overweight and obese female adolescents.

DESIGN AND SETTING

Randomized placebo-controlled clinical trial; Pediatric Cardiovascular Research Center, Isfahan, Iran.

METHODS

60 adolescent girls (aged 13-18 years) were randomly assigned to receive either placebo or intervention. The adolescents were asked to consume one 500 mg tablet per day, containing either standardized 95% turmeric extract or placebo, and to undergo a weight maintenance or a mild weight loss diet for 10 weeks. Anthropometric and biochemical indices were assessed at the baseline and the end of the intervention.

RESULTS

Curcumin supplementation had beneficial effects on body mass index (P = 0.019), waist circumference (P = 0.008), hip circumference (P = 0.030), high-density lipoprotein levels (P = 0.042) and triglyceride/high-density lipoprotein ratio (P = 0.021). However, in univariate analysis of covariance, no significant differences were found between the intervention and placebo groups after 10 weeks of supplementation (P > 0.05).

CONCLUSIONS

Prescription of curcumin supplementation along with use of a slight weight loss diet might have beneficial effects on some cardiovascular risk factors among overweight and obese female adolescents. Larger clinical trials with higher curcumin doses and longer duration are needed to confirm the results from the current study.

CLINICAL TRIAL REGISTRATION

IRCT20171107037302N1.

Longitudinal associations of android and gynoid fat mass on cardiovascular disease risk factors in normal weight and overweight boys during puberty

OBJECTIVES

The aim of this longitudinal study was to assess associations between android and gynoid fat distribution and different cardiovascular disease risk factors in normal weight as well as overweight/obese boys during the pubertal period.

METHODS

In total, 146 boys (baseline age 11.9 ±0.6 years) were recruited for a 2-year longitudinal study. Total body fat percentage and android-gynoid fat distribution were measured using DXA. In addition, waist and hip circumference was measured and body mass index (BMI) was calculated. Total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, insulin and glucose were measured, and homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. Tanner stage and physical activity were assessed as covariates.

RESULTS

Overweight subjects had worse values for most of the measured blood parameters (P <0.05). Higher android, gynoid fat mass (FM), and android/gynoid FM ratio were longitudinally associated with higher insulin and HOMA-IR values in both normal weight and overweight boys (P <0.05). In addition, higher android FM and gynoid FM were associated with worse values in HDL cholesterol, LDL cholesterol, and triglycerides in overweight boys (P <0.05).

CONCLUSIONS

Our results suggest that higher android as well as gynoid fat have a strong impact on cardiovascular disease risk factors in both normal weight and overweight boys during the pubertal period. It can be suggested that measurement of fat distribution as android and gynoid fat is important for the assessment of the development or burden of metabolic diseases in boys with different weight statuses.

Indian girls have higher bone mineral content per unit of lean body than boys through puberty

Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p < 0.05)]. In girls, adjusted BMC/LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p < 0.05). Boys had significantly higher adjusted BMC/LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p < 0.05). Indian boys and girls showed higher total and regional body, and age- and fat percentage-adjusted BMC/LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.

Validation of Bioelectric Impedance Analysis against Dual-energy X-Ray Absorptiometry for Assessment of Body Composition in Indian Children Aged 5 to 18 Years

OBJECTIVE

To validate body composition measurements by Bioelectric Impedance Analysis (BIA) against Dual-Energy X-ray Absorptiometry (DXA) as the reference method in healthy children and adolescents.

DESIGN

Cross-sectional.

SETTING

Schools in and around Pune city, India.

PARTICIPANTS

A random sample of 210 (114 boys, 96 girls) apparently healthy Indian children and adolescents (5-18 y).

METHODS

Weight, height, Tanner stage (TS) were recorded. Body composition measures: fat-free mass (FFM), fat mass (FM), lean mass (LM), bone mineral content (BMC) and body fat percentage (%BF) were assessed by BIA and DXA on a single day. Agreement between the methods was estimated by Pearson's correlation, and Bland and Altman analysis.

MAIN OUTCOME MEASURES

%BF, FM, FFM, LM, BMC.

RESULTS

BIA underestimated %BF by 6.7 (3.7)% as compared to DXA. Mean FFM, BMC and LM by BIA were significantly higher than by DXA (P<0.001). These differences remained similar after adjusting for age, BMI and TS. Mean differences between FFM (-2.32 (1.39) kg), BMC (-0.18 (0.15) kg), and LM (-2.15 (1.34) kg) by DXA and BIA were significant (P<0.01). Correlations between BIA and DXA were 0.92 for %BF, 0.96 for LM and 0.98 for FFM and BMC. Both the methods were similar in identifying normal and overfat children as per their respective cut-offs.

CONCLUSION

BIA and DXA techniques are not interchangeable for assessment of body composition. However, BIA may be used in the field/clinical setting preferably with ethnicity specific references.

Cardiometabolic risk: leg fat is protective during childhood

BACKGROUND

Childhood obesity is associated with early cardiometabolic risk (CMR), increased risk of adulthood obesity, and worse health outcomes. Leg fat mass (LFM) is protective beyond total fat mass (TFM) in adults. However, the limited evidence in children remains controversial.

OBJECTIVE

We investigated the relationship between LFM and CMR factors in youth.

SUBJECTS

A total of 203 overweight/obese children, 7-17-yr-old, followed in the Pediatric Clinic, Luxembourg.

METHODS

TFM and LFM by dual energy x-ray absorptiometry and a detailed set of CMR markers were analyzed.

RESULTS

After TFM, age, sex, body mass index (BMI) Z-score, sexual maturity status, and physical activity adjustments, negative significant partial correlations were shown between LFM and homeostasis model assessment of insulin resistance (HOMA) (variance explained: 6.05% by LFM*; 7.18% by TFM**), fasting insulin (variance explained: 5.71% by LFM*; 6.97% by TFM**), triglycerides (variance explained: 3.96% by LFM*; 2.76% by TFM*), systolic blood pressure (variance explained: 2.68% by LFM*; 4.33% by TFM*), C-reactive protein (variance explained: 2.31% by LFM*; 4.28% by TFM*), and resistin (variance explained: 2.16% by LFM*; 3.57% by TFM*). Significant positive partial correlations were observed between LFM and high-density lipoprotein (HDL) cholesterol (variance explained: 4.16% by LFM*) and adiponectin (variance explained: 3.09% by LFM*) (*p-value < 0.05 and **p-value < 0.001). In order to adjust for multiple testing, Benjamini-Hochberg method was applied and the adjusted significance level was determined for each analysis. LFM remained significant in the aforementioned models predicting HOMA, fasting insulin, triglycerides, and HDL cholesterol (Benjamini and Hochberg corrected p-value < 0.01).

CONCLUSIONS

LFM is protective against CMR in children, at least in terms of insulin resistance and adverse blood lipid profiles.

Relationship between body composition parameters and metabolic syndrome in young Thai adults

OBJECTIVE

The aim of this study was to evaluate the relationship between body composition parameters, i.e. waist circumference, android fat mass (AFM), gynoid fat mass (GFM), android to gynoid fat mass ratio (AG ratio) and metabolic syndrome (MS) risk components in young Thai adults.

METHODS

This was a cross-sectional study conducted among 391 adolescents (174 male, 217 female). The body mass index (BMI), waist circumference, blood pressure, triglyceride, high-density lipoprotein (HDL) cholesterol and glucose levels were determined. AFM, GFM and AG ratio were assessed by dual-energy X-ray absorptiometry (DXA). Linear regression analysis was done to assess the relationship of waist circumference, AFM, GFM and AG ratio with MS risk components' score, separately.

RESULTS

Among 391 young adults aged 18.5-21.8 years, MS was found in 5.9%. Participants with MS (n=23) had a significantly higher weight, height and BMI than those without MS. There was no statistically significant difference in bone mineral density between the two groups. At univariable linear regression analysis, waist circumferences, AFM, GFM and AG ratio showed significant relationship with MS risk components' score. However, after adjusting for gender, birth weight and BMI, AG ratio demonstrated greater relationship with MS risk components' score (β 1.89, 95%CI 1.096-2.978) than waist circumference (β 0.046, 95%CI 0.033-0.058) and AFM (β 0.979, 95%CI 0.667-1.290). No significant association was observed between GFM and MS risk components' score (β 0.077, 95%CI -0.089-0.243).

CONCLUSION

The results from this study indicated that AG ratio is a stronger predictor of MS than waist circumference and AFM in young Thai adults. The role of AG ratio for the diagnosis of MS needs to be further investigated.

Gender-assortative waist circumference in mother-daughter and father-son pairs, and its implications. An 11-year longitudinal study in children (EarlyBird 59)

BACKGROUND/OBJECTIVES

Body mass index (BMI) is reportedly gender assortative (mother-daughter, father-son) in contemporary children. We investigated the corresponding transmission of waist circumference (WC) and its implications.

METHODS

We measured parental WC at baseline and WC, height, weight and para-umbilical skin-fold (USF) annually in their offspring from 5 to 15 years (n = 223 trios). Parents were deemed normal metabolic risk (NR) or high risk (HR) according to World Health Organization (WHO) cut-points for WC (mothers 80 cm, fathers 94 cm). The residual from WC adjusted for BMI (WC|BMI ) was used as a surrogate for excess intra-abdominal fat, and its association with insulin resistance (HOMA2-IR) was sought.

RESULTS

WC and USF were both gender assortative, while WC|BMI was not. WC was greater by 1.62 cm (P < 0.05, confidence interval [CI]: 0.09-3.16) and USF by 0.37 cm (P < 0.01, CI: 0.19-0.56) among the daughters (but not the sons) of HR compared with those of NR mothers, and by 1.32 cm (P < 0.05, CI: 0.09-2.55) and 0.18 cm (P < 0.05, CI: 0.04-0.32), respectively in the corresponding father-son (but not father-daughter) pairings. No such differences could be demonstrated for WC|BMI . A standard deviation score 1(SDS) change in WC|BMI , independent of BMI, was associated with a 7.14% change in IR in girls (P < 0.01, CI: 1.76-12.80) and 8.02% in boys (P < 0.001, CI: 2.93-13.36), but there was no relationship between IR and USF.

CONCLUSION

The relationship of offspring WC to metabolic health and to parental size is complex. Subcutaneous abdominal fat is gender assortative but harmless, while intra-abdominal fat (its surrogate in this analysis) is unrelated to parental waist circumference, but metabolically harmful.

Cardiometabolic risk factors and fat distribution in children and adolescents

OBJECTIVES

To determine if cardiometabolic risk factors have differential associations with the proportion of fat distributed in the trunk, leg, and arm, in White and African American children and adolescents.

STUDY DESIGN

The sample included 391 White and African American 5- to 18 year-olds. Total and regional (trunk, leg, and arm) fat were measured by dual energy X-ray absorptiometry. Resting blood pressure and fasting triglycerides, high density lipoprotein cholesterol (HDL-C), glucose, insulin, and C-reactive protein were measured in a clinical setting. Insulin resistance was determined with the homeostatic model of insulin resistance. Multivariable linear and logistic regression models were used to examine associations between each cardiometabolic risk factor and proportion of fat (trunk, leg, or arm fat divided by whole body fat), with whole body fat, age, sex, race, sexual maturity status, and self-reported physical activity as covariates.

RESULTS

Higher odds of low HDL-C, high triglycerides, insulin resistance, and high C-reactive protein were associated with % trunk fat. Lower odds of low HDL-C, high triglycerides, and insulin resistance were associated with % leg fat. No cardiometabolic risk factor was associated with % arm fat.

CONCLUSIONS

Cardiometabolic risk factors in children and adolescents were attenuated when a larger proportion of fat was distributed in the leg. The clinical assessment of children's fat distribution may be useful in determining cardiometabolic risk.

SERPINE1, PAI-1 protein coding gene, methylation levels and epigenetic relationships with adiposity changes in obese subjects with metabolic syndrome features under dietary restriction

Plasminogen activator inhibitor 1 (PAI-1) has been associated with metabolic disorders, through different mechanisms, which could involve changes in DNA methylation. This work aimed to assess the potential relationships of the cytosine methylation levels within SERPINE1 gene transcriptional regulatory region, which codes for PAI-1, in peripheral white blood cells with anthropometrical, metabolic and inflammatory features. Forty-six obese subjects with metabolic syndrome features followed Control or Metabolic Syndrome Reduction in Navarra (RESMENA) energy-restricted (−30%E) diets for 8 weeks. SERPINE1 transcriptional regulatory region methylation at baseline was analyzed by a microarray technical. Both dietary strategies reduced anthropometric and biochemical parameters. The Control group significantly reduced plasma PAI-1 concentrations but not the RESMENA group. Participants from both nutritional interventions with higher SERPINE1 methylation levels at baseline showed significantly major reductions in body weight, total fat mass, android fat mass, total cholesterol and triglycerides, as compared with those with lower initial SERPINE1 methylation levels. In conclusion, the DNA methylation levels of SERPINE1 transcriptional regulatory region were associated with some metabolic and anthropometric changes in obese subjects with metabolic syndrome under energy restriction, suggesting a complex epigenetic network in the regulation of this recognized pro-inflammatory marker. (www.clinicaltrials.gov; NCT01087086)

Correlation of resistin with inflammatory and cardiometabolic markers in obese adolescents with and without metabolic syndrome

OBJECTIVE

The link between plasma resistin and obesity-related cardiometabolic disorders in children remains debatable. This study assessed the relationships of plasma resistin with cardiovascular risk factors, pro-inflammatory markers and insulin resistance index (HOMA-IR) in obese (Ob) adolescents and obese adolescents with metabolic syndrome (Ob-MS) compared to healthy controls (CO).

METHODS

114 obese adolescents (60 Ob, age 13.6 ± 0.9 years, BMI 28.0 ± 2.2 kg/m(2), and 54 Ob-MS, age 13.8 ± 1.0 years, BMI 32.5 ± 4.8 kg/m(2)) and 37 CO (age 13.7 ± 0.8 years, BMI 22.8 ± 0.8 kg/m(2)) were studied. Anthropometrics, cardiac variables as well as fasting plasma concentrations of lipids, glucose, insulin, and adipocytokines (resistin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)) were measured. HOMA-IR was calculated, and the presence of MS was assessed.

RESULTS

Plasma resistin was significantly higher in Ob-MS than in both Ob and CO and was correlated with anthropometric, cardiovascular, pro-inflammatory markers and several components of MS as was HOMA-IR in Ob and Ob-MS. With increasing the number of MS components, plasma resistin, pro-inflammatory markers, and HOMA-IR were also increased. Multiple regression models highlighted significant correlation between resistin and both HOMA-IR (r = 0.40, p < 0.05) and systolic blood pressure (r = 0.63, p < 0.01) in Ob-MS.

CONCLUSION

These results support the hypothesis that there is an association between circulating resistin and childhood obesity-related inflammatory and cardiometabolic events.