PEDIATRICOBESITY SHORTCOMMUNICATION
Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents R. Jahagirdar1, K. P. Hemchand2, S. A. Chiplonkar3, V. V. Khadilkar4 and A. V. Khadilkar4 1
Bharati Vidyapeeth University Medical College, Pune, India; 2Department of Pediatric Endocrinology, Bharati Vidyapeeth University Medical College, Pune, India; 3Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India; 4 Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India Received 15 July 2011; revised 26 January 2012; accepted 13 February 2012
What is already known about this subject?
What this study adds?
• Incidence of paediatric obesity is increasing in developing countries. • Obese children have associated cardiometabolic risk factors. • Central obesity is an important predictor of metabolic risk.
• There are normal weight children with cardiometabolic risks. • There is a positive correlation between BMI, Body fat and cholesterol, TGL, LDL, insulin and HOMA. • There is an increase in the occurrence of cardiometabolic risk factors with increasing android fat.
Summary Background: Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce.
Objective: To assess the occurrence of cardiometabolic risk factors in Indian children and adolescents in relation to BMI and body fat and to study their association with body fat distribution. Methods: 286 children and adolescents (mean age 11.2 ⫾ 2.6 years, 139 boys) were recruited from routine health checks and schools. Anthropometry and blood pressure were recorded, total body fat (BF) and fat distribution (android and gynoid) were measured by Dual Energy X-ray Absorptiometry. Fasting plasma glucose, lipid profile and insulin were also measured. Results: When the study cohort was divided as per their BMI and biochemical cardiometabolic risk factors, 8% children had normal BMI with abnormal biochemical parameters while 40% children had abnormal BMI but normal biochemical parameters. Conclusion: There are normal weight children with cardiometabolic risks. There was an increase in the occurrence of cardiometabolic risk factors with increased android distribution of fat (p-value < 0.05). Keywords: Android, cardiometabolic, children, gynoid, Indian, obesity. The incidence of paediatric obesity is increasing in developing countries (1). Obese children and adolescents are exposed to the risk of high blood pressure (2), insulin resistance and cardiovas-
cular disease (3). The body mass index (BMI) is used to screen for obesity in children. However, associations between BMI and percentage distribution of body fat (BF) differ across populations (4).
Address for correspondence: Dr A Khadilkar, Senior Research Officer, Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune 411 001, India. E-mail:
[email protected] © 2012 The Authors Pediatric Obesity © 2012 International Association for the Study of Obesity. Pediatric Obesity ••, ••–•• Address of the Institution where the study was carried out Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune 411 001, India.
SHORTCOMMUNICATION
doi:10.1111/j.2047-6310.2012.00056.x
SHORTCOMMUNICATION
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R. Jahagirdar et al.
Studies reveal that Asian children have a higher percentage of BF at a lower BMI compared with Caucasians and African–Americans (5). Children having higher BF percentage are found to be at increased risk of the metabolic syndrome (6). Yet, studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Asian children are scarce. Central obesity is an important predictor for CM complications (7,8). However, literature on the distribution of BF in Asian children and CM risk factors is also scarce. Hence, we conducted a study on the occurrence of CM risk factors in Indian children in relation to BMI and BF and also the relationship of CM risk factors with BF distribution. In a cross-sectional study, 286 children and adolescents (6–18 years) were recruited from routine health checks at a tertiary level care hospital in Pune (India) and from schools on voluntary basis during 2008–2009. After written informed consent and ethics approval, subjects were examined and relevant investigations were carried out to rule out endocrine disease. However, subjects were not screened for inherited dyslipidemias. Height, weight, waist and hip circumference and blood pressure (ⱖ90th percentile for age, gender and height considered abnormal) (9) were measured as per standard protocols and BMI was computed. Total BF and distribution of BF were measured by dual energy X-ray absorptiometry (Lunar DPX-PRO total body pencil beam densitometer [GE Healthcare, Madison, WI, USA]) medium mode scan (software encore 2005 version 9.30.044, precision of repeat measurements of BF% in adolescents = 1.1%). Using standard software, percentage of BF was measured in the android (from the top of the ilium superiorly 20% of the distance from the ilium to the body of the mandible) and gynoid region (from the top of the ilium inferiorly 1.5 times the height of the android region) (10). Venous sample (8 mL) was collected at 8:00 am after an overnight fast (12 h) using vacutainers (BD, Franklin Lakes, NJ, USA). Total cholesterol (TC), triglycerides (TGL), low-density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL-C) were estimated (Siemens analyzer, Date Dimension RXL Max., Siemens Healthcare Diagnostics, Deerfield, IL, USA). Fasting plasma glucose (FPG) was analyzed enzymatically and serum insulin was estimated using a microparticle enzyme immunoassay kit (AxSYM Insulin assay, Abbott, Chicago, IL, USA) (coefficient of variation
