Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome

Unraveling Metabolic Syndrome in Youth: The Obesity Epidemic's Hidden Complication

BACKGROUND/OBJECTIVES

One of the metabolic complications of obesity is known as Metabolic Syndrome (MetS). This narrative review aims to synthesize current research on MetS in young populations, identify knowledge gaps, and guide future studies and funding priorities. It provides evidence-based insights into screening, diagnosis, and treatment, offering practical guidance for healthcare professionals.

METHODS

A comprehensive search of the literature was conducted to identify relevant studies on obesity in MetS in PubMed and Google Academic electronic database. The search was performed using a combination of "obesity", "complications", "metabolic syndrome", "children", and "adolescents" keywords. Studies were selected based on predefined inclusion and exclusion criteria to ensure relevance and methodological rigor.

RESULTS

The lack of universally accepted diagnostic criteria for MetS in children has led to inconsistencies in its definition across medical literature. Irrespective of the chosen diagnostic approach, the prevalence of MetS in children and adolescents has exhibited a concurrent rise with the increasing rates of obesity in this age group. The pathophysiology of MetS remains incompletely understood, with ongoing discussions on the interplay of genetic, epigenetic, environmental, dietary, and lifestyle factors. Screening for MetS is recommended for overweight and obese children.

CONCLUSIONS

Establishing global, consensus-driven criteria that account for ethnicity, gender, and age would enhance diagnostic accuracy and treatment approaches. The prevention of excessive weight among children and adolescents stands as a paramount objective within modern society's healthcare system. Considering the complexity of the disease and the treatment, the team must be multidisciplinary.

Predictive Accuracy of Biochemical and Anthropometric Indices for Metabolic Syndrome in Children with Obesity: A Comparative Study

Children with obesity, regardless of gender, are a high-risk population that requires ongoing monitoring not only for present obesity and metabolic syndrome (MetS) but also future risks of metabolic, cardiac, musculoskeletal, and psychiatric complications. Data from a cohort of 185 obese children who underwent a second follow-up in 2019 were used for this retrospective study. The study cohort consisted of 94 boys and 91 girls who were elementary school students with a mean age of 10.2 ± 0.5 years. Following anthropometric and biochemical assessments, the cardio metabolic index (CMI), visceral adiposity index (VAI), triglyceride-glucose index (TyGI), and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. The overall prevalence of MetS was 19.5% (12.8% in boys and 26.4% in girls). According to the receiver operating characteristic curve analysis, CMI, VAI, and TyGI performed significantly better than HOMA-IR in identifying MetS. CMI was the most accurate predictor of MetS, as indicated by the highest area under the curve value, in both genders. In conclusion, our findings suggest that the CMI can serve as a practical, efficient, and affordable screening tool for the ongoing monitoring of childhood obesity in both daily endocrine clinical practice and primary care settings.

Body Roundness Index Is Better Correlated with Insulin Sensitivity than Body Shape Index in Young and Middle-Aged Japanese Persons

Aims: The present study aimed to clarify the relationships between novel and traditional anthropometric indices and insulin sensitivity (SI) in young and middle-aged Japanese persons with normal glucose tolerance (NGT), and middle-aged Japanese persons with NGT and glucose intolerance. Methods: Plasma glucose and insulin levels were measured in 1270 young (age <40 years) and 2153 middle-aged persons with NGT (n = 1531) and glucose intolerance (n = 622) during a 75-g oral glucose tolerance test. Height (Ht), weight, and waist circumference (WC) were measured. The body mass index (BMI), WC, and the WC/Ht ratio were used as traditional anthropometric indices. A body shape index (ABSI) and the body roundness index (BRI) were calculated as novel indices. Indices of SI (Matsuda index and 1/homeostasis model assessment of insulin resistance) were calculated and compared with anthropometric indices. Results: The ABSI showed a weak correlation with SI indices in all groups. The BRI showed almost the same correlation with SI indices as the BMI, WC, and WC/Ht in all groups. The inverse correlation between each of the anthropometric indices other than ABSI and SI indices was weak in young persons, at 0.16-0.27 (Spearman's ρ values), but strong in middle-aged persons, at 0.38-1.00. On receiver-operating characteristic (ROC) curve analysis for detection of insulin resistance, the ABSI had a lower area under the ROC curve (AUC) than the other anthropometric indices, and the BRI and the WC/Ht ratio showed similar AUCs. The AUCs for the BRI and WC/Ht ratio were the highest in middle-aged men with NGT and glucose intolerance. Conclusions: The BRI, not the ABSI, was better correlated with SI in young and middle-aged Japanese persons. The BRI and WC/Ht ratio were comparable in their correlations with SI and the detection of insulin resistance in the participants of the present study.

Obesity- and lipid-related indices as a predictor of obesity metabolic syndrome in a national cohort study

Objective

Metabolic syndrome is a common condition among middle-aged and elderly people. Recent studies have reported the association between obesity- and lipid-related indices and metabolic syndrome, but whether those conditions could predict metabolic syndrome is still inconsistent in a few longitudinal studies. In our study, we aimed to predict metabolic syndrome by obesity- and lipid-related indices in middle-aged and elderly Chinese adults.

Method

A national cohort study that consisted of 3,640 adults (≥45 years) was conducted. A total of 13 obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), and triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-WC, and TyG-WHtR), were recorded. Metabolic syndrome (MetS) was defined based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III (2005). Participants were categorized into two groups according to the different sex. Binary logistic regression analyses were used to evaluate the associations between the 13 obesity- and lipid-related indices and MetS. Receiver operating characteristic (ROC) curve studies were used to identify the best predictor of MetS.

Results

A total of 13 obesity- and lipid-related indices were independently associated with MetS risk, even after adjustment for age, sex, educational status, marital status, current residence, history of drinking, history of smoking, taking activities, having regular exercises, and chronic diseases. The ROC analysis revealed that the 12 obesity- and lipid-related indices included in the study were able to discriminate MetS [area under the ROC curves (AUC > 0.6, P < 0.05)] and ABSI was not able to discriminate MetS [area under the ROC curves (AUC < 0.6, P > 0.05)]. The AUC of TyG-BMI was the highest in men, and that of CVAI was the highest in women. The cutoff values for men and women were 187.919 and 86.785, respectively. The AUCs of TyG-BMI, CVAI, TyG-WC, LAP, TyG-WHtR, BMI, WC, WHtR, BRI, VAI, TyG index, CI, and ABSI were 0.755, 0.752, 0.749, 0.745, 0.735, 0.732, 0.730, 0.710, 0.710, 0.674, 0.646, 0.622, and 0.537 for men, respectively. The AUCs of CVAI, LAP, TyG-WC, TyG-WHtR, TyG-BMI, WC, WHtR, BRI, BMI, VAI, TyG-index, CI, and ABSI were 0.687, 0.674, 0.674, 0.663, 0.656, 0.654, 0.645, 0.645, 0.638, 0.632, 0.607, 0.596, and 0.543 for women, respectively. The AUC value for WHtR was equal to that for BRI in predicting MetS. The AUC value for LAP was equal to that for TyG-WC in predicting MetS for women.

Conclusion

Among middle-aged and older adults, all obesity- and lipid-related indices, except ABSI, were able to predict MetS. In addition, in men, TyG-BMI is the best indicator to indicate MetS, and in women, CVAI is considered the best hand to indicate MetS. At the same time, TyG-BMI, TyG-WC, and TyG-WHtR performed better than BMI, WC, and WHtR in predicting MetS in both men and women. Therefore, the lipid-related index outperforms the obesity-related index in predicting MetS. In addition to CVAI, LAP showed a good predictive correlation, even more closely than lipid-related factors in predicting MetS in women. It is worth noting that ABSI performed poorly, was not statistically significant in either men or women, and was not predictive of MetS.

Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

Introduction

Waist circumference-to-height ratio (WHtR) is a simple anthropometric index with good screening power and fast interpretation for early detection of childhood abdominal obesity. This systematic review and meta-analysis aims to determine the best cut-off value of WHtR to use in clinical setting.

Methods

Comprehensive searches were conducted in PubMed, Scopus, and Web of Science by the end of March 2021. Observational studies investigated the best WHtR cut-off to detect abdominal obesity in children and adolescents were included. Thirteen articles (n = 180,119) were included in this systematic review and eight documents were included in the meta-analysis.

Results

The overall optimal cut-off was 0.49 with pooled sensitivity, specificity and diagnostic odds ratio (DOR) of 0.93 (95% confidence interval (CI): 0.93-0.96), 0.88 (95% CI: 0.85-0.91) and 102.6 (95% CI: 50.7-207.5), respectively. The optimal WHtR cut-off to predict abdominal obesity in girls and boys were both 0.49.

Discussion

The current study shows that we could use this cut-off as a simple index for predicting abdominal obesity in children and adolescents without the need for any charts in practice.

Weight-to-height ratio and body roundness index are superior indicators to assess cardio-metabolic risks in Chinese children and adolescents: compared with body mass index and a body shape index

OBJECTIVE

To assess the relationship between five anthropometric indicators, which includes body mass index (BMI), weight-to-height ratio (WHtR), a body shape index (ABSI), ABSI-adolescents, and body roundness index (BRI) in Chinese children and adolescents, and select which could better predict cardio-metabolic risk factors (CMRFs).

METHODS

Cross-sectional study with 1,587 participants aged 3 to 17 years. Five anthropometric indicators were calculated according to weight, height and waist circumference (WC). Anthropometric measurements and laboratory indicators were used to diagnose CMRFs, which included hypertension, dyslipidemia, impaired fasting glucose and abdominal obesity. Partial correlation analysis was used to evaluate the relationship among anthropometric indicators, area under the receiver operating characteristic curve (AUCs) were used to compare the predict ability of each anthropometric indicators, the cut-off value, sensitivity, specificity and Youden Index of each indicator were calculated.

RESULTS

In 3-6 years old children, ABSI-adolescent positively correlated with WC (r=0.727, P<0.001), BMI (r=0.218, P<0.001) and WHtR (r=0.752, P<0.001), and in 7-17 years old participants, the correlation coefficients increased to 0.842, 0.563 and 0.850 (P<0.001), respectively. BRI were strong correlated with BMI, WHtR and ABSI-adolescents in both age group (P<0.001). In 3-6 years group, the ROC analysis showed that BMI and ABSI were significantly better in identifying hypertension in both genders, WHtR and BRI were significantly better in identifying abdominal obesity in girls, but all of them were failed in identifying dyslipidemia and hyperglycemia. In 7-17 years group, WHtR and BRI were significantly better in identifying hypertension, dyslipidemia, abdominal obesity in both genders, BMI and ABSI performed better in identifying hyperglycemia in girls.

CONCLUSIONS

In Chinese children aged 3-6 years, there is no indicator performed best in all the CMRFs, in 7-17 years old teenagers, WHtR and BRI can be recommended to identify hypertension, dyslipidemia, abdominal obesity and clustered CMRFs in both genders. However, ABSI showed weak discriminative power.

Visceral adiposity index is positively associated with blood pressure: A systematic review

PURPOSE

This systematic review aimed to investigate the association between VAI and blood pressure.

METHODS

The study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases.

RESULTS

This review included 32 articles, with 60,482 individuals - children to elderly people between 7 and 102 years old - of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design.

CONCLUSION

Individuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965).

Association of obesity and non-alcoholic fatty liver disease with the fecal calprotectin level in children

BACKGROUND AND STUDY AIMS

As the prevalence of obesity increased, obesity-related comorbidities such as non-alcoholic fatty liver disease (NAFLD) also increased. The aim of this study is to investigate the presence of intestinal inflammation by evaluating the faecal calprotectin (FC) level in children with obesity and NAFLD and to determine the factors affecting the FC level.

PATIENTS AND METHODS

Between August 2018 and November 2018, the FC levels of obese patients (Group 1a = NAFLD (n = 30) and 1b = without NAFLD (n = 30)) were prospectively compared to that of healthy children (Group 2, n = 20). Patients with BMI > 2 z-score were considered obese. NAFLD was identified with liver contrast and brightness on ultrasound.

RESULTS

Of the patients included in this study, 50 were male (62.5%), with a mean age of 11.4 ± 3.1 years. The mean FC levels were 121.6 ± 24.8 μg/g (19.5-800) in Group 1 (Group 1a = 128.4 and Group 1b = 84.5) and 43.8 ± 25.4 μg/g (19.5-144) in Group 2. In comparison, the FC levels were higher in Group 1. This difference was more significant when compared with Group 1a than with Group 2 (p = 0.018 and p = 0.007, respectively). When the FC levels of Group 1 (above 50) were compared to lower levels, the weight, BMI, waist circumference and waist circumference/height values were significantly higher (p = 0.006, p = 0.028, p = 0.035 and p = 0.026, respectively).

CONCLUSION

The FC level increased as a sign of intestinal inflammation in obese and NAFLD patients. This is directly proportional to the weight, waist circumference and waist-to-height ratio. It is thought that FC, which is easily applicable and an inexpensive biomarker, can be used safely in demonstrating the presence of intestinal inflammation in obese children.