Best single-slice location to measure visceral adipose tissue on paediatric CT scans and the relationship between anthropometric measurements, gender and VAT volume in children

Abstract

Objective: Visceral adipose tissue (VAT) is a significant risk factor for obesity-related metabolic diseases. This study investigates (1) the best single CT slice location for predicting total abdominal VAT volume in paediatrics and (2) the relationship between waist circumference (WC), sagittal diameter (SD), gender and VAT volume. Methods: A random sample of 130 paediatric abdomen CT scans, stratified according to age and gender, was collected. Three readers measured VAT area at each intervertebral level between T12 and S1 using ImageJ analysis (National Institute of Health, Bethesda, MD) software by thresholding 2190 to 230 HU and manually segmenting VAT. Single-slice VAT measurements were correlated with total VAT volume to identify the most representative slice. WC and SD were measured at L3-L4 and L4-L5 slices, respectively. Regression analysis was used to evaluate WC, SD and gender as VAT volume predictors. Results: Interviewer and intraviewer reliability were excellent (intraclass correlation coefficient 5 0.99). Although VAT measured at multiple slices correlated strongly with abdominal VAT, only one slice in females at L2-L3 and two slices in males at L1-L2 and L5-S1 were strongly correlated across all age groups. Linear regression analysis showed that WC was strongly correlated with VAT volume (beta 5 0.970, p , 0.001). Conclusion: Single-slice VAT measurements are highly reproducible. Measurements performed at L2-L3 in females and L1-L2 or L5-S1 in males were most representative of VAT. WC is indicative of VAT. Advances in knowledge: VAT should be measured at L2-L3 in female children and at either L1-L2 or L5-S1 in males. WC is a strong indicator of VAT in children. INTRODUCTIONThe prevalence of obesity has increased dramatically over the past 30 years and was recently described by the World Health Organization as a "global epidemic".1 In 1980, 7% of children aged 6-11 years were obese compared with nearly 18% in 2012. Similarly, the percentage of adolescents aged 12-19 years who were obese increased from 5% to almost 21% over the same period.2 The Centers for Disease Control (CDC) and Prevention classifies overweight children as those with a body mass index (BMI) over the 85th percentile and obese children as those with BMI over the 95th percentile relative to a child's age and sex. Currently, more than one-third of children and adolescents are overweight or obese, related to the sex-specific CDC BMI-for-age growth charts from 2000.

Performance of obesity indices for screening elevated blood pressure in pediatric population

“…WC and WHtR were also strongly correlated with VAT assessed by magnetic resonance imaging and computed tomography. [37,38] However, our study indicates that WC and WHtR were no better than BMI to identify the risk of elevated BP in children.…”

Estimation of visceral fat in 9‐ to 13‐year‐old girls using dual‐energy X‐ray absorptiometry (DXA) and anthropometry

“… had shown only low to moderate correlation; however, a study by O'Connor et al . showed a strong correlation with VF. Body weight, on the other hand, was not as well correlated with MRI VF as WC and BMI.…”

“…From the literature, it is evident that 'best site' often depends on numerous factors (18)(19)(20)(21)(22)(23)(24)(25)(26). For MRI VF, segmentation was performed on four intervertebral slices, between L1 and L2 (L1-L2), L2 and L3 (L2-L3), L3 and L4 (L3-L4) and L4 and L5 (L4-L5), in order to observe the association with DXA measures of adiposity and subsequently select the slices best correlated with MRI VF.…”

Added values of DXA-derived visceral adipose tissue to discriminate cardiometabolic risks in pre-pubertal children

“…In adults, the single-slice VAT area showed high to very high correlation with total VAT volume, with the highest correlation in slices taken at 5-10 cm above L4-L5 in healthy adults (r = 0.97-0.99) [29][30][31][32]. The correlations between single-slice VAT area and total VAT volume was also high to very high in school-aged children (r � 0.874), but the best single-slice location to represent total VAT volume varied between studies [33][34][35]. It is not clear why the best single-slice location for VAT differs between children and adults.…”