Body composition estimation using skinfolds in children with and without health conditions affecting growth and body composition

Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region.

Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia

HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference -1·49, 95 % CI (-2·01, -0·97)) and impedance index Z-scores (-0·13, 95 % CI (-0·24, -0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (-1·47, 95 % CI (-1·97, -0·97)) and impedance index Z-scores (-0·23, 95 % CI (-0·36, -0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.

Assessment of body composition in pediatric intestinal failure: A comparison study

BACKGROUND

The objective of the study was to compare bioelectrical impedance analysis (BIA) and skinfolds with dual energy x-ray absorptiometry (DXA) in the assessment of body composition of children with intestinal failure. DXA is the reference method for body composition assessment in clinical settings.

METHODS

Children aged 1-18 years with intestinal failure whohave DXA as part of routine clinical monitoring were eligible. BIA measured total body water on the same day as DXA. Skinfold measurements were taken at four sites: triceps, biceps, subscapular, and suprailiac. Percentage of fat mass (%FM) and fat-free mass (%FFM) were derived from resistance and reactance measured by BIA by using age-specific equations. Percentage of FM was calculated from skinfold measures by using age-specific equations. Data on patient characteristics, intestinal failure-related factors, and feeding method were collected. Paired t test examined differences in %FM and %FFM and Bland-Altman analysis determined the agreement between BIA, skinfolds, and DXA. Marginal linear model assessed the effect of age, sex, and feeding method on the difference in body composition obtained between DXA and BIA and between DXA and skinfolds.

RESULTS

Sixty-eight children with intestinal failure, mean age 8.9 ± 4.2 years, were studied. There was no difference between %FFM and %FM obtained by DXA and BIA (P = 0.26), with a mean bias (95% CI) of -0.69 (-1.9 to 0.5) for %FFM. Sex and age were individually and jointly associated with the bias observed between DXA and BIA (P < 0.05). Skinfold and DXA measurements were significantly different (P < 0.05).

CONCLUSIONS

BIA is an acceptable clinical tool for assessing body composition in pediatric intestinal failure.

Equations based on anthropometric measurements for adipose tissue, body fat, or body density prediction in children and adolescents: a scoping review

PURPOSE

Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds.

METHODS

A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework ( https://osf.io/35uhc/ ).

RESULTS

We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations.

CONCLUSION

Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias.

LEVEL IV

Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence).

[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.

Validity and accuracy of body fat prediction equations using anthropometric measurements in children 7 – 10 years old

abstract Children with a deficit of growth because of perinatal malnutrition present specificities in the percentage of body fat (%BF) that could not be detected by previous fat mass-based equations. This study developed and validated predictive equations of the %BF derived from anthropometric variables in children aged 7 to 10 living in Northeast Brazil, using dual-energy x-ray absorptiometry (DXA) as a reference. Body composition data from 58 children were utilized. DXA was used as a reference. A stepwise (forward) multiple regression statistical model was used to develop the new equations. The Bland-Altman analysis (CI: 95%), paired Student's t-test, and the intraclass correlation coefficient (ICC) was used to validate and compare the developed equations. Two new equations were developed for either gender: boys: %BF: 13.642 + (1.527*BMI) + (-0.345*Height) + (0.875*Triceps) + (0.290* Waist Circumference) and girls: %BF: -13.445 + (2.061*Tight). The Bland-Altman analysis showed good agreement, with limits ranging from -1.33 to 1.24% for boys and -3.35 to 4.08% for girls. The paired Student’s t-test showed no difference between %BF-DXA and the two new equations (p> 0.05), and the ICC was 0.948 and 0.915, respectively. DXA-based anthropometric equations provide an accurate and noninvasive method to measure changes in the %BF in children.

Serum Fibroblast Growth Factor 21 Levels in Children and Adolescents with Hashimoto’s Thyroiditis before and after l-Thyroxin Medication: A Prospective Study

Backgrounds and Objectives: Fibroblast growth factor 21 (FGF-21) is a complex hormone, sharing common sites of action with thyroid hormones. We investigated the association among FGF-21 levels, resting metabolic rate (RMR), and l-thyroxin (LT4) treatment in children and adolescents with Hashimoto’s thyroiditis. Materials and Methods: A total of 60 youngsters with chronic autoimmune thyroiditis (AIT) (30 with subclinical hypothyroidism, 30 with euthyroidism) and 30 age and sex-matched healthy participants (5–18 years old) were enrolled in the study. Anthropometric, biochemical parameters, and RMR levels were assessed in all participants; serum FGF-21 levels were measured in the control group and the group with subclinical hypothyroidism before and six months after medication with LT4. Results: FGF-21 levels were lower in the treatment group compared with the healthy ones, but this difference was not statistically significant (p > 0.05); despite the increase in FGF-21 levels after six months of LT4 treatment, this difference was not statistically significant (p > 0.05). Free thyroxin (FT4) levels correlated well with FGF-21 levels (r = 0.399, p < 0.01), but further analysis revealed no interaction between these two variables. Both patient groups presented elevated triglyceride (TG) levels compared to controls (p < 0.05). LT4 treatment had no impact on RMR and lipid or liver or glycaemic parameters. An increase in fat mass and fat-free mass were reported, independently of FGF-21 levels. Conclusions: In youngsters with subclinical hypothyroidism due to Hashimoto’s thyroiditis, the serum FGF-21 levels are not significantly lower than in healthy individuals and increase after treatment with LT4 without a statistical significance. Further studies with a large number of young patients and severe hypothyroidism are recommended to confirm our results.

The anthropometric assessment of body composition and nutritional status in children aged 2-15 years: A cross-sectional study from three districts in Bangladesh

Background

Early life nutrition plays a critical role in the development of better health and nutrition in adulthood. However, assessing the nutritional status of Bangladeshi children and adolescents through measurement of body composition using skinfold thickness is barely studied. The current study aims to determine children’s body composition and nutritional status, and contributing factors among children aged 2 to 15 years in the northern part of Bangladesh.

Methods

This is a descriptive cross-sectional study done in Bangladesh. Anthropometric methods, including multiple skinfold thickness and basic anthropometric and socio-demographic characteristics, were used. Body composition was calculated from multiple skinfold thicknesses using the standard regression equation. Nutritional status was measured using Z score according to WHO 2007 reference standard. A total of 330 children from Naogaon, Bogra and Kurigram districts in Bangladesh were examined from April 2019 to September 2019.

Results

The Nutritional status of 2–15 years old child is exceedingly poor in the northern part of Bangladesh. Fat mass and fat-free mass were higher among children from Kurigram district than from Bogra and Naogaon district. Body fat percentages and arm fat area were greater among female children than males. The overall prevalence of stunting, underweight and wasting was around 25%, 32% and 29%, respectively, and the rate was higher among girls and children aged 2–5 years. The average SD score for weight-for-age, height-for-age, and BMI-for-age was -1.295, -0.937 and -1.009. The median weight-for-age and height-for-age Z scores of boys and girls were below the WHO reference percentile rank. Girls were twice (OR:1.951, CI:1.150–3.331) as likely to suffer from being underweight than boys. Children who don’t practice handwashing are three times (OR:3.531, CI:1.657–7.525) more likely to be underweight. Children become underweight and stunted when their family income is not sufficient to maintain their nutritional requirements.

Conclusions

The children of the three northern districts had a poor nutritional status, and family income was the potential contributing factor. Therefore, interventions like the promotion of income-generating activities and integrated approaches to ensuring food diversification could be an option to address the nutritional problem of children of the three northern districts of Bangladesh.

Development of population-specific prediction equations for bioelectrical impedance analyses in Vietnamese children

There is a need for accurate, inexpensive and field-friendly methods to assess body composition in children. Bioelectrical impedance analysis (BIA) is a promising approach; however, there have been limited validation and use among young children in resource-poor settings. We aim to develop and validate population-specific prediction equations for estimating total fat mass (FM), fat free-mass (FFM) and percentage body fat (PBF) in Vietnamese children (4-7 years) using reactance and resistance from BIA, anthropometric variables and demographic information. We conducted a cross-sectional survey of 120 children. Body composition was measured using dual-energy X-ray absorptiometry (DXA), BIA and anthropometry. To develop prediction equations, we split all data into development (70 %) and validation datasets (30 %). The model performance was evaluated using predicted residual error sum of squares, root mean squared error (RMSE), mean absolute error (MAE) and R2. We identified a top performing model with the least number of parameters (age, sex, weight and resistance index or resistance and height), low RMSE (FM 0·70, FFM 0·74, PBF 3·10), low MAE (FM 0·55, FFM 0·62, PBF 2·49), high R2 (FM 0·95, FFM 0·92, PBF 0·82) and the least difference between predicted values and actual values from DXA (FM 0·03 kg or 0·01 sd, FFM 0·06 kg or 0·02 sd, PBF 0·27 % or 0·04 sd). In conclusion, we developed the first valid and highly predictive equations to estimate FM, FFM and PBF in Vietnamese children using BIA. These findings have important implications for future research on the double burden of disease and risks associated with overweight and obesity in young children.

Evaluation of the body adiposity index against dual-energy X-ray absorptiometry for assessing body composition in children and adolescents

BACKGROUND

It is important to clarify the association of lean and fat mass between children and adolescents considering the rising prevalence of overweight and obesity in this age group. The aim of this study was to verify the association between the body adiposity index (BAI) and dual-energy X-ray absorptiometry (DXA) methods for analyzing body composition, as well as analyzing the validity of BAI to verify the percentage of fat in children and adolescents.

METHODS

The sample was composed of 106 children and adolescents, 44 females (age: 11.5 ± 1.8 years) and 62 evils (13.6 ± 2.6 years). The body fat (%F) was measured using DXA and the doubly indirect BAI body fat estimation technique.

RESULTS

The BAI and DXA estimates of %F were strongly correlated (boys: r = .71, P < .0001; girls: r = .72, P < .0001). The linear regression analyses showed that BAI is significant to estimate the %F in total sample (P < .0001). For boys, the %F analyzes performed by BAI and DXA did not show any differences when compared (P = .2). In addition, BAI pointed out a significant proportion bias for both sexes (P < .0001), which suggests its inefficiency in the analysis of %F.

CONCLUSIONS

BAI and DXA correlate; however, there is low reliability and a high proportion bias for the analysis of %F by BAI.

[Body phenotypes in adolescence: is it necessary to adjust body mass index according to sexual maturation stages?]

This study aimed to analyze the effect of sexual maturation on body phenotypes, based on multivariate analysis of adolescents' nutritional status. This was a cross-sectional study with a sample of 833 adolescent schoolchildren 10 to 15 years of age, selected by complex sampling in Piracicaba, São Paulo State, Brazil. Body phenotypes were defined by principal components analysis (PCA), based on age, anthropometric data (body mass, height, skinfolds, and waist circumference), body composition (phase angle measured by bioelectrical impedance), and biochemical parameters (triglycerides, glucose, total cholesterol/LDL ratio, hemoglobin). Body phenotypes were classified as: P1adiposity characterized as positive association with skinfolds, body mass, and waist circumference; P2growth characterized as positive association between height and age; P3biochemical characterized as positive association with total cholesterol/LDL ratio, triglycerides, and glucose; and P4metabolic characterized as positive association with phase angle and hemoglobin and negative association with glucose. The phenotypes were later considered outcomes in the mixed effects analysis, incorporating sex at the first level and sexual maturation, age, sex, and socioeconomic score at the second level. This analysis allowed measuring the effect of sexual maturation on body phenotypes. Our results indicate that sexual maturation only a displayed relevant explanation of body phenotype that represents linear growth (height and age). Thus, it is not necessary to adjust anthropometric measures by sexual maturation.

Utility of published skinfold thickness equations for prediction of body composition in very young New Zealand children

Measurement of body composition is increasingly important in research and clinical settings but is difficult in very young children. Bioelectrical impedance analysis (BIA) and air displacement plethysmography (ADP) are well-established but require specialist equipment so are not always feasible. Our aim was to determine if anthropometry and skinfold thickness measurements can be used as a substitute for BIA or ADP for assessing body composition in very young New Zealand children. We used three multi-ethnic cohorts: 217 children at a mean age of 24·2 months with skinfold and BIA measurements; seventy-nine infants at a mean age of 20·9 weeks and seventy-three infants at a mean age of 16·2 weeks, both with skinfold and ADP measurements. We used Bland-Altman plots to compare fat and fat-free mass calculated using all potentially relevant equations with measurements using BIA or ADP. We also calculated the proportion of children in the same tertile for measured fat or fat-free mass and tertiles (i) calculated using each equation, (ii) each absolute skinfold, and (iii) sum of skinfold thicknesses. We found that even for the best equation for each cohort, the 95 % limits of agreement with standard measures were wide (25-200 % of the mean) and the proportion of children whose standard measures fell in the same tertile as the skinfold estimates was ≤69 %. We conclude that none of the available published skinfold thickness equations provides good prediction of body composition in multi-ethnic cohorts of very young New Zealand children with different birth history and growth patterns.

Deficits in Muscle Strength and Physical Performance Influence Physical Activity in Sarcopenic Children After Liver Transplantation

Sarcopenia is a muscle disease characterized by reduced skeletal muscle mass (SMM), muscle strength, and physical performance. Reduced SMM has been identified in children after liver transplantation (LT), but no information related to muscle strength/physical performance or lifestyle factors contributing to sarcopenia is available. We hypothesized that sarcopenia, as determined by measures of SMM, muscle strength, and physical performance, is highly prevalent in children after LT and is related to poor diet quality (DQ) and physical inactivity. A cross-sectional study in post-LT children (n = 22) and age-matched healthy controls (n = 47) between the ages of 6 and 18 years examining body composition (dual energy X-ray absorptiometry and multiple skinfold), measures of muscle strength (handgrip, sit-to-stand, and push-ups), physical performance (6-minute walk test and stair climb test), diet (3-day food intake), and physical activity (accelerometer) was conducted. Low muscle strength/physical performance and SMM (SMM z scores ≤-1.5) were defined by values 2 standard deviations below the mean values for age- and sex-matched controls. Sarcopenia occurred in 36% of children who underwent LT, and they had significantly lower scores for muscle strength (sit-to-stand and push-up tests) and physical performance (stair climb test) than controls (P < 0.05). Deficits in physical performance in children with sarcopenia were predominantly revealed by longer stair climbing times (P = 0.03), with no differences in other muscle tests. Low SMM, muscle strength, and physical performance were associated with a lower amount of time spent in fairly and very active physical activity, but no associations with DQ were found. Sarcopenia is highly prevalent in children after LT and is related to lower moderate-to-vigorous physical activity. Development of effective rehabilitation strategies to treat sarcopenia are needed in post-LT children.

Association between Physical Activity and Adiposity in Adolescents with Down Syndrome

PURPOSE

Obesity is highly prevalent among adolescents with Down syndrome (DS); however, reported associations between body composition and moderate-to-vigorous physical activity (MVPA) have been small and nonsignificant. The purpose of this study was to compare group differences between adolescents with and without DS, including dual-energy x-ray absorptiometry (DXA) measured body composition and accelerometer-measured physical activity, and then examine associations within adolescents with DS.

METHODS

Thirty-nine adolescents (22 with DS and 17 typically developing controls) 12-18 yr of age participated in the study. Groups had similar distributions of age, sex, and Tanner pubertal stage. Body composition was assessed by DXA, body mass index (BMI), and BMI percentile. MVPA was measured with ActiGraph GT3X+ accelerometers.

RESULTS

Adolescents with DS had significantly higher BMI, BMI percentile, and DXA-derived percent body fat (%BF) as well as lower MVPA compared with controls (P < 0.05). Associations between MVPA and %BF in adolescents with DS were moderate (r = -0.39, P = 0.07) but substantially stronger than BMI (r = -0.19, P = 0.40). However, linear regression analyses identified Tanner stage (β = -0.77, P < 0.001) and MVPA (β = -0.34, P = 0.047) as significant predictors of %BF. No relevant associations between body composition and MVPA were observed in adolescents with typical development (P > 0.05).

CONCLUSIONS

Our findings suggest that MVPA is associated with adiposity when measured with DXA among adolescents with DS.

Body Composition in Children with Chronic Illness: Accuracy of Bedside Assessment Techniques

OBJECTIVE

To evaluate the accuracy of estimated fat mass and fat-free mass from bedside methods compared with reference methods in children with chronic illnesses.

STUDY DESIGN

Fat mass and fat-free mass values were obtained by skinfold, bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), and deuterium dilution method in children with spinal muscular atrophy, intestinal failure, and post hematopoietic stem cell transplantation (HSCT). Spearman's correlation and agreement analyses were performed between (1) fat mass values estimated by skinfold equations and by DXA and (2) fat-free mass values estimated by BIA equations and by DXA and deuterium dilution methods. Limits of agreement between estimating and reference methods within ±20% were deemed clinically acceptable.

RESULTS

Fat mass and fat-free mass values from 90 measurements in 56 patients, 55% male, and median age of 11.6 years were analyzed. Correlation coefficients between the skinfold-estimated fat mass values and DXA were 0.93-0.94 and between BIA-estimated fat-free mass values and DXA were 0.92-0.97. Limits of agreement between estimated and DXA values of fat mass and fat-free mass were greater than ±20% for all equations. Correlation coefficients between estimated fat-free mass values and deuterium dilution method in 35 encounters were 0.87-0.91, and limits of agreement were greater than ±20%.

CONCLUSION

Estimated body composition values derived from skinfold and BIA may not be reliable in children with chronic illnesses. An accurate noninvasive method to estimate body composition in this cohort is desirable.

Concentrations of leptin, adiponectin and other metabolic parameters in non-obese children with Down syndrome

BACKGROUND

Recent data indicates that adults with Down syndrome (DS) are at increased risk for cardiovascular disease (CVD) that significantly contributes to their morbidity and mortality. Although identification of cardiometabolic risk factors during childhood is desirable to design preventive interventions, the data on such risk factors in children with DS is scarce. The aim of this study was to study the cardiometabolic risk factors such as insulin resistance (IR), leptin and adiponectin concentrations, lipid abnormalities and leptin resistance in non-obese children with DS.

METHODS

This cross-sectional case control study included karyotype confirmed trisomy-21 DS children aged 2-12 years and their matched healthy controls. After detailed anthropometry, weight, height and body mass index (BMI) standard deviation scores (SDSs) were calculated with reference data. Laboratory evaluation included determination of fasting lipid parameters, insulin, glucose, leptin and adiponectin concentrations. The homeostasis model assessment method (HOMA-IR) was used to assess IR and the ratio of leptin to BMI was used as an index of leptin resistance.

RESULTS

Seventy-seven children (39 with DS and 38 controls) comprised the study cohort. The anthropometric parameters were similar in the two groups. Children with DS showed significantly higher mean leptin concentrations (2.098±1.68 ng/mL vs. 1.44±0.52 ng/mL, p-value: 0.00) and higher indices of leptin resistance (0.127±0.085 vs. 0.09±0.03, p-value: 0.001) as compared to controls. Fasting adiponectin concentrations were lower (20.64±19.87 ng/mL vs. 32.58±34.25 ng/mL, p-value: 0.21) and fasting glucose higher (89.25±8.12 mg/dL vs. 85.71±5.52 mg/dL, p-value: 0.06) in the DS group as compared to the controls but the differences did not reach statistical significance. The concentrations of insulin, various lipid parameters and calculated HOMA-IR values were similar in the two groups. In the DS group, five children were identified to have high (>75th centile) leptin levels and four as impaired fasting glucose as compared to none in the controls.

CONCLUSIONS

Alterations of several cardiometabolic risk factors, in particular, leptin concentrations and leptin resistance are present in children with DS. The presence of hyperleptinemia without hyperinsulinemia suggests a probable inherent genetic basis for increased leptin resistance in patients with DS. There is a need for larger studies to further understand increased leptin resistance in DS that may contribute to increased CVD related morbidity and mortality in these patients.