High LDL-cholesterol in children and adolescents with type 1 diabetes: the impact of body adiposity and sex.

• Girls with T1D have higher adiposity than boys, and glycemic control is the stronger predictor of LDL cholesterol • In boys with T1D, body adiposity and abdominal fat independently predict elevated LDL cholesterol • Sex-specific strategies are needed to reduce early cardiovascular risk in pediatric T1D • Treatment should combine optimizing glucose management and the control of body composition Girls with T1D have higher adiposity than boys, and glycemic control is the stronger predictor of LDL cholesterol In boys with T1D, body adiposity and abdominal fat independently predict elevated LDL cholesterol Sex-specific strategies are needed to reduce early cardiovascular risk in pediatric T1D Treatment should combine optimizing glucose management and the control of body composition To investigate the association between LDL cholesterol (LDL-C) and body adiposity in children and adolescents with type 1 diabetes (T1D), evaluating the influence of sex, glycemic control, and insulin treatment modalities. This cross-sectional study included children and adolescents aged 6–18 years with T1D. Adiposity indices [BMI, BMI Z-score, and waist-to-height ratio (WHtR)] and body composition [fat mass (FM), fat mass index (FMI)] were obtained by anthropometry and bioelectrical impedance analysis. Biochemical parameters included LDL-C, total cholesterol, triglycerides, and HbA1c. Glycemic metrics, including time in range (TIR) and time above range (TAR), were also evaluated. Logistic regression models were applied to identify predictors of LDL-C >100 mg/dL. LDL-C was significantly associated with FMI and WHtR (boys: p<0.01; girls: p<0.05). In boys, elevated LDL-C was significantly predicted by FMI [OR 1.23 (95% CI 1.02–1.48), p=0.03] and WHtR×100 [OR 1.09 (1.02–1.18), p=0.013], independent of glycemic control and treatment modality. WHtR remained significant across models, including HbA1c, TIR, and TAR (p≤0.05). In girls, HbA1c was the strongest predictor of LDL-C >100 mg/dL [OR 2.40 (1.44–3.86), p<0.001] independent of FMI and WHtR; lower TIR also predicted higher LDL-C [OR 0.97 (0.93–0.99), p=0.007]. In boys with T1D, body adiposity and abdominal fat independently predict elevated LDL-C. In girls, who have higher adiposity than boys, glycemic control is the stronger predictor of LDL-C. These findings emphasize the need for sex-specific strategies combining optimized glucose management and body composition to reduce early cardiovascular risk in pediatric T1D.