Childhood obesity has become a major health issue in the last decades. Moreover, identifying a simple, feasible, and valid screening tool to select subjects at higher risk for obesity-related comorbidities has become a challenge. Current guidelines reccommend to use BMI percentile for overweight and obesity diagnosis. However, waist-to-height ratio (WHR) has been associated with the risk of metabolic derangement in children and adolescents with overweight and obesity. In addition, recently, the tri-ponderal mass index (TMI) has been proposed as a better predictor of total adiposity compared to body mass index in children and adolescents. However, in youth, BMI has been shown to be a better predictor of long-term obesity-related comorbidities compared to TMI and subscapular skinfold thickness. In our study we sought to evaluate the association between these three anthropometric indexes and metabolic variables in children and adolescents with overweight or obesity. Therefore, we investigated the association between TMI, BMI-z score, and WHR and glucose and lipid homeostasis parameters in 1397 obese and overweight children and adolescents. All the children underwent an anthropometrical and biochemical evaluation. Glucose homeostatis and insulin sensitivity were assessed by a standard 2-h oral glucose tolerance test. Simple logistic regression analyses were performed to estimate the association between metabolic parameters and anthropometric measures. Generalized Linear Model analyses were conducted between each metabolic parameter and each anthropometric measure adjusting for age, sex, and pubertal stage as second model. Moreover, a third model was performed including all covariates and TMI, BMI-ZS, and WHR. We observed that in our cohort, overall, WHR was the best predictor for glucose and lipid metabolism parameters followed by TMI and then BMI-z score. Moreover, TMI explained a lower variance of the three models compared to WHR for all the metabolic outcomes. Therefore, in the effort of select a feasible screening tool for the clinician, WHR might represent a more valid measure compared to TMI and BMI-z score.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology