Abstract
The impact of rising rates of childhood obesity is far reaching. Metabolic syndrome in children is increasing, yet for most children the consequences of excess adiposity will manifest in adulthood. Excess early fat accrual is a risk factor for future insulin resistance. However, certain types of fat and patterns of fat distribution are more relevant than others to metabolic risk. Therefore, adiposity measures are important. The link between childhood obesity and future insulin resistance was initially established with body mass index (BMI), but BMI is an in imperfect measure of adiposity. It is worthwhile to evaluate other anthropometrics as they may more accurately capture metabolic risk. While measures such as waist to height ratio are established as superior screening measures in adulthood - the findings are not as robust in pediatrics. Emerging evidence suggests that alternative anthropometrics may be slightly superior to BMI in identifying those youth most at risk of developing insulin resistance, but the clinical significance of that superiority appears limited. Increasing study is needed in longitudinal and varied cohorts to identify which pediatric anthropometric best predicts adult insulin resistance. We review alternative anthropometrics as predictors of future insulin resistance and identify current gaps in knowledge and potential future directions of inquiry.
Highlights
Rising obesity rates have led to a commensurate unprecedented rise in associated comorbidities including insulin resistance
Multiple studies have indicated that waist circumference (WC) or waist to height ratio (WtHR) can better predict metabolic disease and insulin resistance than body mass index (BMI) alone in adults [9, 10]
Other anthropometric measurements include WC adjusted for height, weight adjusted for height, hip circumference, waist-hipratio, WtHR, conicity index, abdominal volume index, body adiposity index, and body shape index (Table 1)
Summary
Rising obesity rates have led to a commensurate unprecedented rise in associated comorbidities including insulin resistance. Excess fat is implicated in the development of insulin resistance. Insulin resistance is not just a potential precursor to diabetes mellitus, but is a critical component of metabolic syndrome. Insulin resistance is often both a contributor to and a harbinger of other disturbances of metabolism including fatty liver disease and dyslipidemia [1, 2]. Obesity is defined as an accumulation of excess body fat to the extent that it may have an adverse effect on health [3]. Obesity has become synonymous with definitions set by health organizations correlating with body mass index (BMI) thresholds. In pediatrics, the World Health Organization (WHO) defines obesity as greater than two standard deviations above the Growth
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