High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat

Abstract

OBJECTIVE:The objectives were to study the relationships of insulin resistance with generalized and abdominal obesity, and body fat patterning in urban postpubertal Asian Indian children. DESIGN: Cross-sectional, population-based epidemiological study. SUBJECTS: In all, 250 (155 males and 95 females) healthy urban postpubertal children. MEASUREMENTS: Anthropometric profile, percentage of body fat (%BF), fasting serum insulin, and lipoprotein profile. RESULTS: Fasting insulin correlated significantly with body mass index (BMI), %BF, waist circumference (WC), central and peripheral skinfold thicknesses and sum of four skinfold thicknesses ( P 4SF) in both sexes, and with systolic blood pressure and waist-to hip circumference ratio (W-HR) in males only. Consistent increase in fasting insulin was noted with increasing values of central skinfold thickness at each tertile of peripheral skinfold thickness, WC, and %BF. Central skinfold thickness correlated with fasting insulin even after adjusting for WC, W-HR, and %BF. The odds ratios (OR) (95% CI) of hyperinsulinemia (fasting insulin concentrations in the highest quartile) were 4.7 (2.4-9.4) in overweight subjects, 8 (4.1-15.5) with high %BF, 6.4 (3.2-12.9) with high WC, 3.7 (1.9-7.3) with high W-HR, 6.8 (3.3-13.9) with high triceps skinfold thickness, 8 (4.1-15.7) with high subscapular skinfold thickness, and 10.1 (5-20.5) with high P 4SF. In step-wise multiple logistic regression analysis, %BF [OR (95% CI): 3.2 (1.4-7.8)] and ?4SF [OR (95% CI): 4.5 (1.8-11.3)] were independent predictors of hyperinsulinemia, similar to insulin resistance assessed by HOMA (homeostatic model of assessment) in the study. CONCLUSION: A high prevalence of insulin resistance in postpubertal urban Asian Indian children was associated with excess body fat, abdominal adiposity, and excess truncal subcutaneous fat. Primary prevention strategies for coronary heart disease and diabetes mellitus in Asian Indians should focus on the abnormal body composition profile in childhood.

The impact of fat distribution on the severity of nonalcoholic fatty liver disease and metabolic syndrome

“…38,39 WC also correlated significantly with hypertension and best correlated with hypertriglyceridemia. These data confirm the contribution of abdominal obesity to the metabolic and other clinical abnormalities associated with the metabolic syndrome.…”

Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity

“…13,16,17 Total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-c) were measured according to the methods described earlier 13,16,17 Low-density lipoprotein cholesterol (LDL-c) levels were calculated using the Friedewald's formula. 18 Definitions Value of BMI X23 kg/m 2 was used to define overweight and X25 kg/m 2 was used to define obese.…”

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

“…[10][11][12] Two 10,12 of the three common definitions include measures of insulin resistance, reflecting the proposed causal or mediating role insulin action plays in the development of MS. 13,14 In the paediatric literature there is no single definition of MS. [15][16][17] Barriers to a consistent, accepted definition for children and adolescents include use of adult cut points or a single set of cut points for all ages of childhood, the fact that disturbances seen in the metabolic indicators in most children are quantitatively moderate, lack of a normal range for insulin concentration across childhood, the insulin resistance of puberty, and lack of central obesity (waist) cut points linked to obesity morbidity or MS for children. If hyperinsulinaemia alone is used as a marker of MS in children, 18 it ignores the clustering of several metabolic indicators which is potentially of greater clinical significance.…”