The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents

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Abstract

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2–18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.

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A New Body Shape Index Predicts Mortality Hazard Independently of Body Mass Index

Nir Krakauer, Jesse C. Krakauer (2012)

Background Obesity, typically quantified in terms of Body Mass Index (BMI) exceeding threshold values, is considered a leading cause of premature death worldwide. For given body size (BMI), it is recognized that risk is also affected by body shape, particularly as a marker of abdominal fat deposits. Waist circumference (WC) is used as a risk indicator supplementary to BMI, but the high correlation of WC with BMI makes it hard to isolate the added value of WC. Methods and Findings We considered a USA population sample of 14,105 non-pregnant adults ( ) from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 with follow-up for mortality averaging 5 yr (828 deaths). We developed A Body Shape Index (ABSI) based on WC adjusted for height and weight: ABSI had little correlation with height, weight, or BMI. Death rates increased approximately exponentially with above average baseline ABSI (overall regression coefficient of per standard deviation of ABSI [95% confidence interval: – ]), whereas elevated death rates were found for both high and low values of BMI and WC. ( – ) of the population mortality hazard was attributable to high ABSI, compared to ( – ) for BMI and ( – ) for WC. The association of death rate with ABSI held even when adjusted for other known risk factors including smoking, diabetes, blood pressure, and serum cholesterol. ABSI correlation with mortality hazard held across the range of age, sex, and BMI, and for both white and black ethnicities (but not for Mexican ethnicity), and was not weakened by excluding deaths from the first 3 yr of follow-up. Conclusions Body shape, as measured by ABSI, appears to be a substantial risk factor for premature mortality in the general population derivable from basic clinical measurements. ABSI expresses the excess risk from high WC in a convenient form that is complementary to BMI and to other known risk factors.

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Adipocyte Turnover: Relevance to Human Adipose Tissue Morphology

Erik Arner, Pal O. Westermark, Kirsty Spalding … (2009)

OBJECTIVE Adipose tissue may contain few large adipocytes (hypertrophy) or many small adipocytes (hyperplasia). We investigated factors of putative importance for adipose tissue morphology. RESEARCH DESIGN AND METHODS Subcutaneous adipocyte size and total fat mass were compared in 764 subjects with BMI 18–60 kg/m2. A morphology value was defined as the difference between the measured adipocyte volume and the expected volume given by a curved-line fit for a given body fat mass and was related to insulin values. In 35 subjects, in vivo adipocyte turnover was measured by exploiting incorporation of atmospheric 14C into DNA. RESULTS Occurrence of hyperplasia (negative morphology value) or hypertrophy (positive morphology value) was independent of sex and body weight but correlated with fasting plasma insulin levels and insulin sensitivity, independent of adipocyte volume (β-coefficient = 0.3, P < 0.0001). Total adipocyte number and morphology were negatively related (r = −0.66); i.e., the total adipocyte number was greatest in pronounced hyperplasia and smallest in pronounced hypertrophy. The absolute number of new adipocytes generated each year was 70% lower (P < 0.001) in hypertrophy than in hyperplasia, and individual values for adipocyte generation and morphology were strongly related (r = 0.7, P < 0.001). The relative death rate (∼10% per year) or mean age of adipocytes (∼10 years) was not correlated with morphology. CONCLUSIONS Adipose tissue morphology correlates with insulin measures and is linked to the total adipocyte number independently of sex and body fat level. Low generation rates of adipocytes associate with adipose tissue hypertrophy, whereas high generation rates associate with adipose hyperplasia.

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Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.

Claudio Maffeis, Claudia Banzato, Giorgio Talamini (2008)

To determine whether using a combination of body mass index (BMI) and waist circumference (WC) or waist-to-height ratio (W/Hr) is clinically helpful in identifying children with high metabolic and cardiovascular risks. Caucasian children (M/F: 740/739; n = 1479; ages 5 to 15 years) were studied. Anthropometry, blood pressure, and venous fasting blood samples tested for triacylglycerol, HDL cholesterol, and glucose were measured. Overweight children with a large waist (>90(th) percentile) or high W/Hr (>0.5) but not obese or normal-weight children had significantly greater chances of being at high metabolic and cardiovascular risk than normal-weight children (OR: 7; 95% CI: 3.63-13.48; P < .001, OR: 8.16; 95% CI: 3.87-17.23; P < .001, respectively) with a low waist measurement (

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Author and article information

Contributors

Chiara Mameli:

ORCID: http://orcid.org/0000-0002-6768-3411

Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Writing – original draft

Nir Y. Krakauer: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: Writing – original draft

Jesse C. Krakauer: Role: ConceptualizationRole: Data curationRole: MethodologyRole: ResourcesRole: Writing – original draft

Alessandra Bosetti: Role: Resources

Chiara Matilde Ferrari: Role: Investigation

Norma Moiana: Role: Investigation

Laura Schneider: Role: Data curationRole: Investigation

Barbara Borsani: Role: Investigation

Teresa Genoni: Role: InvestigationRole: Writing – original draft

Gianvincenzo Zuccotti: Role: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Yvonne Böttcher: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 3 January 2018

Publication date Collection: 2018

Volume: 13

Issue: 1

Electronic Location Identifier: e0190426

Affiliations

[1 ] Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy

[2 ] Department of Civil Engineering, The City College of New York, New York, NY, United States of America

[3 ] Metro Detroit Diabetes and Endocrinology, Southfield, MI, United States of America

University of Oslo, NORWAY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: chiara.mameli@ 123456unimi.it

Author information

Chiara Mameli http://orcid.org/0000-0002-6768-3411

Article

Publisher ID: PONE-D-17-30625

DOI: 10.1371/journal.pone.0190426

PMC ID: 5752028

PubMed ID: 29298340

SO-VID: a0ec7b3e-7cb3-440b-91d2-047eb30f461d

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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 19 August 2017

Date accepted : 14 December 2017

Page count

Figures: 0, Tables: 5, Pages: 12

Funding

The authors received no specific funding for this work.

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The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents

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Most cited references 24

A New Body Shape Index Predicts Mortality Hazard Independently of Body Mass Index

Adipocyte Turnover: Relevance to Human Adipose Tissue Morphology

Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.

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