Childhood studies of the fat-bone relationship are conflicting, possibly reflecting the influence of metabolic abnormalities in some but not all obese children. Bone mass was compared between prepubertal overweight children with (n=41) and without (n=99) pre-diabetes. Associations of bone mass with measures of total and central adiposity, glucose intolerance, insulin sensitivity, lipid profile, systemic inflammation, and osteocalcin were also determined. In 140 overweight children aged 7–11 y, an oral glucose tolerance test was used to identify those with pre-diabetes and for determination of glucose, 2-h glucose, glucose AUC, insulin, 2-hr insulin, and insulin AUC. Blood samples were also assessed for lipids, C-reactive protein, and osteocalcin. Total body bone mineral content (BMC), fat-free soft tissue mass (FFST), and fat mass (FM) were measured by DXA. Visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) were assessed using MRI. Total body BMC was 4% lower in overweight children with pre-diabetes than those without pre-diabetes, after controlling for sex, race, height, and weight (P=0.03). In the total sample, FM was positively related with BMC (β=0.16, P=0.01), after adjusting for sex, race, height, and FFST. However, VAT (β=−0.13, P=0.03) and SAAT (β=−0.34, P=0.02) were inversely associated with BMC, after controlling for sex, race, height, FFST, FM, and SAAT or VAT. No significant associations were found between BMC and the biochemical measurements. Prepubertal overweight children with pre-diabetes may be at risk for poor skeletal development. In addition, it appears that greater levels of central, rather than total, adiposity may be deleterious for developing bone.

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These data suggest that the lower uncarboxylated osteocalcin concentrations found in children with prediabetes may be associated with β-cell dysfunction. In addition, our findings between carboxylated osteocalcin and insulin sensitivity suggest that carboxylated osteocalcin plays a role in human glucose homeostasis.

There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.