Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Liggins Institute, University of Auckland, Auckland, New Zealand.
Front Endocrinol (Lausanne). 2020 Sep 4;11:579. doi: 10.3389/fendo.2020.00579. eCollection 2020.
We aimed to assess the role of adipose tissue distribution in cardiometabolic risk (in particular insulin sensitivity) in a population of children and adolescents with obesity. In this cross-sectional study, participants were 479 children and adolescents with obesity (322 boys and 157 girls) aged 3 to 18 years attending the Children's Hospital at Zhejiang University School of Medicine (Hangzhou, China). Clinical assessments included anthropometry, body composition (DXA scans), carotid artery ultrasounds, and OGTT. Insulin sensitivity was assessed using the Matsuda index. Participants were stratified into groups by sex and pubertal stage. Key predictors were DXA-derived android-to-gynoid-fat ratio (A/G) and total body fat percentage (TBF%). Irrespective of sex and pubertal stage, there was a strong association between increasing A/G (i.e., greater abdominal adiposity) and lower insulin sensitivity. In multivariable models, every 0.1 increase in A/G was associated with a reduction in insulin sensitivity in prepubertal boys [-29% (95% CI -36%, -20%); < 0.0001], pubertal boys [-13% (95% CI -21%, -6%); = 0.001], and pubertal girls [-16% (95% CI -24%, -6%); = 0.002]. In contrast, TBF% was not associated with insulin sensitivity when A/G was adjusted for, irrespective of pubertal stage or sex. In addition, every 0.1 increase in A/G was associated with increased likelihood of dyslipidemia in prepubertal boys [adjusted odds ratio (aOR) 1.62 (95% CI 1.05, 2.49)], impaired glucose tolerance in pubertal boys [aOR 1.64 (95% CI 1.07, 2.51)] and pubertal girls [aOR 1.81 (95% CI 1.10, 2.98)], and odds of NAFLD in both prepubertal [aOR 2.57 (95% CI 1.56, 4.21)] and pubertal [aOR 1.69 (95% CI 1.18, 2.40)] boys. In contrast, higher TBF% was only associated with higher fasting insulin and ALT in pubertal boys, being also predictive of NAFLD in this group [aOR 1.15 per percentage point (95% CI 1.06, 1.26)], but was not associated with the likelihood of other cardiometabolic outcomes assessed in any group. A/G is a much stronger independent predictor of cardiometabolic risk factors in children and adolescents with obesity in China, particularly glucose metabolism.
我们旨在评估脂肪组织分布在肥胖儿童和青少年的心脏代谢风险（特别是胰岛素敏感性）中的作用。在这项横断面研究中，参与者为浙江大学医学院附属儿童医院的 479 名肥胖儿童和青少年（322 名男孩和 157 名女孩），年龄在 3 至 18 岁之间。临床评估包括人体测量学、身体成分（DXA 扫描）、颈动脉超声和 OGTT。使用 Matsuda 指数评估胰岛素敏感性。根据性别和青春期阶段将参与者分层为不同组别。主要预测因素是 DXA 衍生的安卓到女性脂肪比（A/G）和全身脂肪百分比（TBF%）。无论性别和青春期阶段如何，A/G 的增加（即腹部脂肪增加）与胰岛素敏感性降低之间存在很强的关联。在多变量模型中，A/G 每增加 0.1，青春期前男孩的胰岛素敏感性就会降低[-29%（95%置信区间-36%，-20%）；<0.0001]，青春期男孩[-13%（95%置信区间-21%，-6%）；=0.001]，青春期女孩[-16%（95%置信区间-24%，-6%）；=0.002]。相比之下，当调整 A/G 时，TBF%与胰岛素敏感性无关，无论青春期阶段或性别如何。此外，A/G 每增加 0.1，青春期前男孩的血脂异常可能性就会增加[校正优势比（aOR）1.62（95%置信区间 1.05，2.49）]，青春期男孩的糖耐量受损[aOR 1.64（95%置信区间 1.07，2.51）]和青春期女孩[aOR 1.81（95%置信区间 1.10，2.98）]，以及青春期前男孩的非酒精性脂肪肝的可能性增加[aOR 2.57（95%置信区间 1.56，4.21）]和青春期男孩[aOR 1.69（95%置信区间 1.18，2.40）]。相比之下，较高的 TBF%仅与青春期男孩的空腹胰岛素和丙氨酸氨基转移酶（ALT）升高相关，并且也是该组中非酒精性脂肪肝的预测因素[aOR 每百分点增加 1.15（95%置信区间 1.06，1.26）]，但与任何组中评估的其他心脏代谢结果的可能性无关。A/G 是中国肥胖儿童和青少年心脏代谢危险因素的更强大的独立预测因素，尤其是葡萄糖代谢。
