Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio–Metabolic Risk in Children and Adolescents

Abstract

Monitoring of children at heightened risk of cardio–metabolic diseases raises the need for accurate assessment of obesity. A standardized approach for measuring subcutaneous adipose tissue (SAT) by bright-mode ultrasound was evaluated in relation to body indices and anthropometry in a cross-sectional sample of 76 South African children (7–10 years) and 86 adolescents (13–17 years) to assess cardio–metabolic risk. SAT was higher in girls as compared to boys (children: 50.0 ± 21.7 mm > 34.42 ± 15.8 mm, adolescents: 140.9 ± 59.4 mm > 79.5 ± 75.6 mm, p < 0.001) and up to four times higher in adolescents than in children. In children, measures of relative body weight showed only a poor correlation to SAT (BMI: r = 0.607, p < 0.001), while in adolescents, BMI correlated high with SAT (r = 0.906, p < 0.001) based on high rates of overweight and obesity (41.8%). Children with identical BMIs may have large differences (>2–3-fold) in their amount of SAT. The moderate association to systolic (r = 0.534, r = 0.550, p < 0.001) and diastolic blood pressure (r = 0.402, r = 0.262, p < 0.001) further substantiates that SAT measured by ultrasound provides an accurate, safe and easy applicable approach for monitoring in children and adolescents at cardio–metabolic risk.

Ultrasound‐based measurement of central adiposity: Key considerations and guidelines

“…For example, BMI measurements among children-a population of great interest in the context of body composition given concerning rates of childhood obesity 81 -have been poorly correlated with ultrasoundderived SFT, underscoring that individuals with identical BMI's can have large differences in their quantity and distribution of adipose tissue (in children, > 2-3 fold). 82 In terms of overt CMD risk prediction, compared to anthropometric indices that reflect but do not measure body composition, ultrasound-based measures of IAT and SFT are more strongly related to components of metabolic syndrome including systolic blood pressure, total cholesterol, and lowdensity lipoprotein in obese diabetics and non-obese non-diabetics. 83…”

“…It is also important to note that the robust methodological detail provided in this paper offers a preliminary framework that health‐care practitioners may eventually implement to make superior clinical decisions using ultrasound as compared to BMI, the most common, yet intrinsically flawed marker of obesity status because of its inability to differentiate adiposity versus lean mass. For example, BMI measurements among children—a population of great interest in the context of body composition given concerning rates of childhood obesity 81 —have been poorly correlated with ultrasound‐derived SFT, underscoring that individuals with identical BMI's can have large differences in their quantity and distribution of adipose tissue (in children, > 2–3 fold) 82 . In terms of overt CMD risk prediction, compared to anthropometric indices that reflect but do not measure body composition, ultrasound‐based measures of IAT and SFT are more strongly related to components of metabolic syndrome including systolic blood pressure, total cholesterol, and low‐density lipoprotein in obese diabetics and non‐obese non‐diabetics 83 .…”

Centile reference curves of the ultrasound-based characteristics of the rectus femoris muscle composition in children at 4–11 years old

“…With regard to subcutaneous adipose tissue (SAT) Point. Chmid-Zalaudek et al ( 20 ) studied SAT measured via US in children and adolescents demonstrated that those with excess adiposity, as determined by DXA (%body fat), had significantly higher levels of cardio-metabolic risk factors. In this context, quantitative musculoskeletal diagnostic US has been proposed as a viable method for characterizing muscle structure ( 21 ).…”