Key result
Every 0.1 increase in the android-to-gynoid-fat ratio was associated with a 13% to 29% reduction in insulin sensitivity across pubertal stages and sexes in children and adolescents with obesity.
Why the study?
The role of adipose tissue distribution in cardiometabolic risk, particularly insulin sensitivity, was evaluated in children and adolescents with obesity.
Cross-Sectional (n=479)
No
Effect estimate: -29% (95% CI -36 to -20)
p-value: p=<0.0001
Android-to-gynoid fat ratio is a stronger independent predictor of cardiometabolic risk factors, particularly glucose metabolism, than total body fat percentage in children and adolescents with obesity.
May refine insulin resistance risk stratification in obese youth; hypothesis-generating, needs prospective validation before practice change.
Objective: We aimed to assess the role of adipose tissue distribution in cardiometabolic risk (in particular insulin sensitivity) in a population of children and adolescents with obesity. Methods: In this cross-sectional study, participants were 479 children and adolescents with obesity (322 boys and 157 girls) aged 3 to 18 years attending the Children’s Hospital at Zhejiang University School of Medicine (Hangzhou, China). Clinical assessments included anthropometry, body composition (DXA scans), carotid artery ultrasounds, and OGTT. Insulin sensitivity was assessed using the Matsuda index. Participants were stratified into groups by sex and pubertal stage. Key predictors were DXA-derived android-to-gynoid-fat ratio (A/G) and total body fat percentage (TBF%). Results: Irrespective of sex and pubertal stage, there was a strong association between increasing A/G (i.e. greater abdominal adiposity) and lower insulin sensitivity. In multivariable models, every 0.1 increase in A/G was associated with a reduction in insulin sensitivity in prepubertal boys [-29% (95% CI -20%, -36%); p<0.0001], pubertal boys [-13% (95% CI -6%, 21%); p=0.001], and pubertal girls [-16% (95% CI -6%, 24%); p=0.002]. In contrast, TBF% was not associated with insulin sensitivity when A/G was adjusted for, irrespective of pubertal stage or sex. In addition, every 0.1 increase in A/G was associated with increased likelihood of dyslipidaemia in prepubertal boys [adjusted odds ratio (aOR) 1.62 (95% CI 1.05, 2.49)], impaired glucose tolerance in pubertal boys [aOR 1.64 (95% CI 1.07, 2.51)] and pubertal girls [aOR 1.81 (95% CI 1.10, 2.98)], and odds of NAFLD in both prepubertal [aOR 2.57 (95% CI 1.56, 4.21)] and pubertal [aOR 1.69 (95% CI 1.18, 2.40)] boys. In contrast, higher TBF% was only associated with higher fasting insulin and ALT in pubertal boys, being also predictive of NAFLD in this group [aOR 1.15 per percentage point (95% CI 1.06, 1.26)], but was not associated with the likelihood of other cardiometabolic outcomes assessed in any group. Conclusions: A/G is a much stronger independent predictor of cardiometabolic risk factors in children and adolescents with obesity in China, particularly glucose metabolism.
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Jin et al. (2020) conducted a cross-sectional in Obesity (n=479). Android-to-gynoid-fat ratio (A/G) vs. Lower A/G was evaluated on Reduction in insulin sensitivity (Matsuda index) per 0.1 increase in A/G in prepubertal boys (-29%, 95% CI -36 to -20, p=<0.0001). Every 0.1 increase in the android-to-gynoid-fat ratio was associated with a 13% to 29% reduction in insulin sensitivity across pubertal stages and sexes in children and adolescents with obesity.
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