A Mini-Review of Pediatric Anthropometrics as Predictors of Future Insulin Resistance

Abstract

The impact of rising rates of childhood obesity is far reaching. Metabolic syndrome in children is increasing, yet for most children the consequences of excess adiposity will manifest in adulthood. Excess early fat accrual is a risk factor for future insulin resistance. However, certain types of fat and patterns of fat distribution are more relevant than others to metabolic risk. Therefore, adiposity measures are important. The link between childhood obesity and future insulin resistance was initially established with body mass index (BMI), but BMI is an in imperfect measure of adiposity. It is worthwhile to evaluate other anthropometrics as they may more accurately capture metabolic risk. While measures such as waist to height ratio are established as superior screening measures in adulthood - the findings are not as robust in pediatrics. Emerging evidence suggests that alternative anthropometrics may be slightly superior to BMI in identifying those youth most at risk of developing insulin resistance, but the clinical significance of that superiority appears limited. Increasing study is needed in longitudinal and varied cohorts to identify which pediatric anthropometric best predicts adult insulin resistance. We review alternative anthropometrics as predictors of future insulin resistance and identify current gaps in knowledge and potential future directions of inquiry.

Children With Short Stature Display Reduced ACE2 Expression in Peripheral Blood Mononuclear Cells

“…This study shows for the first time that children with short stature, being idiopathic or linked to growth hormone deficiency, had lower ACE2 expression in PBMC with subsequent increase of the ratio ACE/ACE2. ACE2 expression was associated with the risk of being a children with short stature, regardless of age, sex, and BMI, which suggests that ACE2 should not being related to adiposity, being BMI the most common anthropometric index to estimate adiposity (26). In addition, ACE2 expression had a moderate accuracy to predict short stature, and the cutoff of 0.45 fold induction was the value of ACE2 expression best predicting being a child with short stature with specificity of 88% and sensitivity of 54%, allowing to classify correctly 70% of the children.…”

A performance review of novel adiposity indices for assessing insulin resistance in a pediatric Latino population

“…The change in relative performance between the indices in our sample compared to those using adult populations may be partially attributable to pubertal development, since height and weights vary during this time ( 40 ). For instance, WC alone better assesses T2DM risk in adults, but this is not as clear in pediatric populations ( 41 ). However, the performance of these indices varies across different population demographics.…”

Anti-racist strategies for clinical and translational research: Design, implementation, and lessons learned from a new course

“…Ten were published by a student with a faculty appointment [34][35][36][37][38][39][40][41][42][43]. Overall, there were 3 case reports [34,44,45], one case series [46], 2 editorials [41,43], 2 letters [37,47], 2 review articles [48,49], 7 systematic reviews [35,36,[38][39][40]42,50], 2 retrospective cohort studies [51,52], an evaluation of mobile health applications [53], and a medical education report. [54] One case report noted the subject's race, without further comment [44].…”

“…One letter was a secondary analysis of a prospective cohort study that collected race/ethnicity data as "white" and "non-white"; it noted overrepresentation of high-income families as a limitation to generalizability [47]. One review article noted the lack of participant diversity in studies reviewed [49]. All retrospective cohort studies used race as a demographic variable, but there was variability in whether methods of collection were described and what categories were used.…”