Трипондеральный индекс массы тела как предиктор избыточного веса и ожирения у подростков

ABSTRACTObjective: To investigate whether tri-ponderal mass index and body mass index Z scoresare equivalent for screening children and adolescents with insulinresistance.Methods: Cross-sectional study with 296 children and adolescents enrolled at publicschools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. Thetri-ponderal mass index was calculated as the ratio between weight andheight cubed. The body mass index was calculated as the ratio between weightand height squared. Insulin resistance was defined with the homeostaticmodel assessment (HOMA-IR).Results: The HOMA-IR was higher in the 4th quartile of body mass index Zscores and tri-ponderal mass index compared to 1st and2nd quartiles for both girls and boys. The areas under theage-adjusted receiver operating characteristic curves were similar betweenthe indices for girls (body mass index Z scores=0.756; tri-ponderal massindex=0.763) and boys (body mass index Z scores=0.831; tri-ponderal massindex=0.843). In addition, according to the simple linear regressionanalyses estimations, both body mass index Z scores and tri-ponderal massindex explained a significant fraction of the homeostatic model assessmentvariability for girls (body mass index Z scores: R2=0.269;tri-ponderal mass index: R2=0.289; p<0.001) and boys (bodymass index Z scores: R2=0.175; tri-ponderal mass index:R2=0.210; p<0.001).Conclusions: The tri-ponderal mass index and body mass index Z scores were similar todiscriminate children and adolescents with insulin resistance. It isnoteworthy that the use of tri-ponderal mass index is clearly advantageous,because it can be calculated with no concerns on adjustments for the age, afact that makes it very applicable in the clinical practice.

Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. Treatments of ALL predispose survivors to obesity, which increases the risk of cardiovascular disease and diabetes. The hallmark of obesity is excess fat mass, and adiposity is a superior predictor of cardiometabolic risk when compared to Body Mass Index (BMI), yet clinical measures of adiposity in children are lacking. The Tri-Ponderal Mass Index (TMI) (kg/m3) is a more accurate adiposity measure compared to BMI z-score in the general pediatric population. This cross-sectional study aimed to validate TMI as an adiposity measure against DEXA scan-derived adiposity, and to compare it to BMI z-score, in pediatric ALL survivors. This study was a retrospective chart review of pediatric ALL survivors diagnosed between 2004 and 2015 at McMaster Children’s Hospital, a tertiary pediatric center in Ontario, Canada. One hundred and thirteen patients (Female n = 55, 48.70%) were included, and adiposity was measured using DEXA scans. Exploratory partial correlations and linear regression analyses were adjusted for age, sex, ethnicity, and ALL risk status. Both TMI and BMI z-score correlated with the DEXA-measured fat mass percentage (FM%) (partial correlation TMI versus FM% r = 0.56; p value < 0.0001; BMI z-score versus FM% r = 0.55; p value < 0.0001). In regression analyses, the association of TMI was not inferior to BMI z-score in assessing adiposity (TMI versus FM% estimated unstandardized B 0.80, 95% CI 0.56, 1.02; p value < 0.0001; BMI z-score versus FM% (unstandardized B 0.37, 95% CI 0.26, 0.49; p value < 0.0001). The TMI is a useful clinical adiposity-specific measure in survivors of pediatric ALL.

Diagnostic accuracy of the tri-ponderal mass index in identifying the unhealthy metabolic obese phenotype in obese patients

BackgroundCurrent reference systems using body mass index (BMI) or BMI z-scores to estimate overweight and obesity risk in adolescents are complex to use. An easy and effective measure and cutoffs such as the tri-ponderal mass index (TMI) are in need for parents and grassroots health workers.ObjectiveThe aim of this study was to test whether cohort-derived TMI could be efficient for obesity prediction and to find out whether simplified TMI cutoffs could be used in the prediction.MethodsData were obtained from a 12-year retrospective growth cohort generated in Guangdong, China. A total of 17,815 children (53.9% were boys) with 151,879 follow-ups conducted annually between 2005 and 2016 were involved. Late adolescent overweight and obesity were defined based on the BMI z-score (WHO 2007 growth reference) of the last measurement, which happened at the mean age of 17.2 (SD: 0.7) for both sexes. Analysis of the area under the curve (AUC) of the receiver operating characteristic curves was used to find the most appropriate cutoff.ResultsIn total, 9,604 boys and 8,211 girls were included in the final analysis. TMI cutoffs performed better than WHO BMI cutoffs in the prediction of late adolescent overweight and obesity, with all corresponding AUCs <0.7. The simplified TMI cutoffs used to predict late adolescent overweight and obesity were 13.1 and 14.1 kg/m3 for children aged 7 to 15 years, respectively, with the corresponding AUCs ranging from 0.7315 (standard error, SE: 0.0132) to 0.9367 (SE: 0.0052). The cutoffs for predicting late adolescent overweight and obesity for children aged 16 to 18 years were 14.0 and 15.8 kg/m3, respectively, with the corresponding AUCs ranging from 0.9189 (SE: 0.0048) to 0.9841 (95% CI: 0.0027).ConclusionTri-ponderal mass index with the ease of administration in practice could be a promising alternative screening tool to BMI for the prediction of late adolescent overweight and obesity.

Precisión diagnóstica del índice de masa triponderal (kg/m3) para identificar el fenotipo de riesgo metabólico en pacientes obesos

Tri-Ponderal Mass Index vs body Mass Index in discriminating central obesity and hypertension in adolescents with overweight

High blood pressure (HBP) and obesity are major public health issues globally. The aim of the study was to evaluate the associations between tri-ponderal mass index (TMI) and body mass index (BMI) and HBP and to determine which anthropometric parameters may best predict HBP among Lithuanian children and adolescents aged 7–18 years. This cross-sectional study included 3710 Lithuanian children and adolescents aged 7–18 (52.7% boys and 47.3% girls). Each subject’s height, weight, and other anthropometric parameters, as well as blood pressure were measured according to standardized protocols; subsequently, TMI and BMI were calculated. The prevalence of HBP was 27% (the prevalence of elevated BP and hypertension was 13.7% and 13.3%, respectively), significantly higher for boys than for girls. The Pearson correlation coefficients between the BMI z-score and BP were higher than those between the TMI z-score and BP. In both sexes combined, the adjusted odds ratios (aOR) for HBP were increased significantly with increasing quartiles of TMI and BMI as compared to the first quartile (Q1) (Q2: aOR = 1.37 and aOR = 1.69; Q3: aOR = 2.10 and aOR = 2.27; Q4: aOR = 3.95 and aOR = 4.91, respectively). Significant associations also were observed between overweight and obesity (defined according to two methods: age- and sex-specific TMI percentiles and IOTF criteria) among boys and girls separately. BMI presented a higher area under the curve value than TMI for predicting HBP in children and adolescents. The findings of the study suggest that BMI and TMI are significantly associated with HBP. However, BMI is a better predictor for HBP than TMI among Lithuanian children and adolescents aged 7–18 years.

Triponderal mass index is as strong as body mass index in the determination of obesity and adiposity

Overweight and obese children have demonstrated reduced rapid eye movement (REM) sleep, affecting energy balance regulation and predisposition to weight gain. Obstructive sleep apnea (OSA) is a known cause of decreased REM sleep. The purpose of this study is to examine the association between the percentage of REM sleep, BMI z-score, and OSA severity in overweight and obese adolescents. We performed a cross-sectional study of 92 (43% female) overweight and obese adolescents (13-17years old) who underwent overnight polysomnography (PSG) at Children's Hospital Los Angeles between 2010 and 2017. The average Body Mass Index (BMI) z-score was 2.27 ± 0.47, with 71% having BMI z-score ≥ 2. REM% during PSG was 15.6 ± 6.8, and obstructive apnea-hypopnea index was 17.1 ± 24.3. The distribution across categories of OSA severity was 27% none (≤ 1.5events/h), 24% mild (> 1.5-5events/h), 8% moderate (> 5-10events/h), and 41% severe (> 10events/h). REM% was not associated with BMI z-score, either on univariate or multivariate regression with adjustment for age, gender, and apnea-hypopnea index (AHI). When subdivided into OSA categories, a 1-unit increase in BMI z-score was associated with a 5.96 (p = 0.03) increase in REM% in mild OSA and an 8.86 (p = 0.02) decrease in REM% in severe OSA. There was no association between BMI z-score and REM% in none and moderate OSA. Among overweight and obese adolescents, BMI z-score was associated with decreased REM% in severe OSA and unexpectedly increased REM% in mild OSA, but there was no association in none or moderate OSA.

Performance of triponderal mass index, body mass index z scores, and body mass index performance in the diagnosis of obesity in children and adolescents

This study aimed to evaluate the efficiency of tri-ponderal mass index (TMI) in determining obesity in Chinese children aged 6-9 years, using the criteria of percentage of body fat (PBF) and body mass index z-scores (BMI-Z). The cross-sectional study included 5365 children, aged 6-9 years, who participated in the project survey "Group prevention and treatment of obesity among students and school health promotion in Shanghai" from September 2007 to September 2009. Height, weight, waist circumference, body mass index (BMI), TMI, waist-to-height ratio (WHtR), and PBF were recorded. Statistical analyses including Kolmogorov-Smirnov test, chi-square test, receiver operating characteristics curve, and kappa chi-square test were performed. TMI for both sexes was relatively constant with increasing age, and statistically significant differences were not observed at some ages (P > 0.05 at 6, 7, 8, and 9 years). WHtR showed subtle changes, while BMI and PBF increased significantly with age in boys and girls (P < 0.01). Using BMI-Z criteria as the measure of general obesity, the results indicated that TMI cutoff values for 6-9 years were 14.60 kg/m3 for boys and 14.84 kg/m3 for girls (P < 0.001). Analysis of the agreement between TMI and BMI-Z showed that the kappa statistic was 0.826 in boys and 0.709 in girls (P < 0.001). TMI, as a constant tool, holds great potential as an alternative screening method for identifying children aged 6-9 years who may be at risk of obesity at an early stage.

Physical exercise and lifestyle modification are recognized as adjunct therapy for obstructive sleep apnea (OSA) in overweight adults. The objectives of this study were to investigate the effects of long-term physical exercise combined with a balanced diet on sleep architecture, sleep duration, and OSA in adolescents with severe obesity. This interventional study was conducted in a nursing institution. Participants were aged 14.6 ± 1.2 years with obesity (body mass index (BMI) = 40.2 ± 6.5 kg/m2). At admission and at 9 months, participants underwent ambulatory polysomnography and incremental maximal exercise testing to determine cardiorespiratory fitness. Twenty-four subjects completed the study. Analyses were performed on the whole population and on a subgroup of subjects with OSA (OSA-subgroup). OSA, defined as obstructive apnea-hypopnea index (OAHI) ≥ 2 events/h, was diagnosed in 58.3% of the population. OAHI was only associated with fat mass in males (r = .75, P < .05). At 9 months postintervention, weight loss (-11.1 kg, P < .0001) and improved cardiorespiratory fitness (VO2peak: +4.9 mL/min/kg, P < .001) were found in the whole population. Sleep duration was increased (+34 minutes, P < .05) and sleep architecture was changed with an increase of rapid eye movement sleep (+2.5%, P < .05) and a decrease of stage N3 sleep (-3.1%, P < .001). Similar results were found in the OSA subgroup. However, OAHI remained unchanged (P = .18). A combination of supervised aerobic exercise and a balanced diet led to weight loss, improved aerobic capacity, and modified sleep architecture without changes in OSA. A commentary on this article appears in this issue on page 907. Registry: ClinicalTrials.gov, Title: Exercise and Venous Compression on Upper Airway Resistance in Obese Teenagers With OSA (OBESOMAC), URL: https://clinicaltrials.gov/ct2/show/NCT02588469, Identifier: NCT02588469.

Childhood obesity and overweight have a wide impact on physical and mental health, and affect adulthood. In the last decade, scientists have been looking with concern at the increasingly frequent excess body weight in children and adolescents. Therefore, it is crucial to estimate the scale of the problem, and thus to correctly assess the level of adipose tissue. In assessing the nutritional status of the young, anthropometric measurements and indicators are used. Despite the widespread use of BMI (body mass index), this indicator is often criticized. BMI is frequently recognized as an imprecise tool and its use often results in misleading classification. Therefore, the aim of this study is to present selected, non-invasive anthropometric indicators related to overweight/obesity in children.Anthropometric indicators are relatively simple tools used in public health. However, the search for a simple and useful indicator is still ongoing, which will enable the assessment of the nutritional status both in clinical practice and in population studies. The paper presents the most frequently described anthropometric indicators in the literature: body mass index (BMI) and BMIz score, relative fat mass pediatric (RFMp), tri-ponderal mass index (TMI), pediatric body adiposity fat index (BAIp) and the mid-upper arm circumference (MUCA). The possibilities of application and their effectiveness for the estimation of adipose tissue content and the risk of coexisting diseases are presented.Although there is no consensus on the best tool, it is known that BMI will remain the main parameter in assessing nutritional status. Nevertheless, the authors suggest the usefulness of tools such as RFMp, TMI and MUAC as a good complement to the imperfections ascribed to BMI.

Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents.

Introduction. Childhood overweight and obesity are a public health problem. The onset of the COVID-19 pandemic may have contributed to this condition. The body mass index (BMI) Z-score has been accepted as an indicator for overweight and obesity diagnosis and follow-up. Objective. To assess whether the prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased during the pandemic. Population and methods. Retrospective, cohort study. Patients included were those seen at public health care facilities in the City of Buenos Aires (CABA), who were aged 2 to 5 years, had weight and height values recorded at 2 different visits, before and after the establishment of the preventive and mandatory social isolation policy. Patients' nutritional status (BMI Z-score) and the variation in this indicator between both visits were recorded. Results. A total of 3866 subjects were assessed; their average age was 3.4 ± 0.8 years; 48.1% were girls. The average interval between both visits was 14.3 ± 2.5 months. The prevalence of overweight/ obesity increased from 12.6% (95% CI: 11.6-13.6) to 20.9% (95% CI: 19.6-22.2), p < 0.001, and so did the BMI Z-score (0.4 ± 1.1 versus 0.8 ± 1.3, p < 0.001). Conclusion. The prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased significantly during the pandemic.