Comparing BMI with skinfolds to estimate age at adiposity rebound and its associations with cardio-metabolic risk markers in adolescence

Chiara Di Gravio,K Kumaran,Murali Krishna,S R Veena,S C Karat,R Somashekara,Caroline H D Fall,G V Krishnaveni

doi:10.1038/s41366-018-0144-8

Abstract

BackgroundBody mass index (BMI) reaches a nadir in mid-childhood, known as the adiposity rebound (AR). Earlier AR is associated with a higher risk of cardio-vascular diseases in later life. Skinfolds, which are a more direct measure of adiposity, may give better insight into the relationship between childhood adiposity and later obesity and cardio-metabolic risk.ObjectiveWe aimed to assess whether AR corresponds to a rebound in skinfolds, and compare associations of BMI-derived AR and skinfold-derived AR with cardio-metabolic risk markers in adolescence.MethodsWe used penalised splines with random coefficients to estimate BMI and skinfold trajectories of 604 children from the Mysore Parthenon Birth Cohort. Age at AR was identified using differentiation of the BMI and skinfold growth curves between 2 and 10 years of age. At 13.5 years, we measured blood pressure, and glucose, insulin and lipid concentrations.ResultsBMI and skinfolds had different growth patterns. Boys reached BMI-derived AR earlier than skinfold-derived AR (estimated difference: 0.41 years; 95% CI:[0.23, 0.56]), whereas the opposite was observed in girls (estimated difference: −0.71 years; 95% CI:[−0.90, −0.54]). At 13.5 years, children with earlier BMI-derived AR had higher BMI (−0.58 SD per SD increase of AR; 95%CI:[−0.65, −0.52]), fat mass (−0.44; 95%CI:[−0.50, −0.37]), insulin resistance (HOMA-IR: −0.20; 95%CI:[−0.28, −0.12]) and systolic blood pressure (−0.20; 95%CI:[−0.28, −0.11]), and lower HDL-cholesterol (0.12; 95%CI:[0.04, 0.21]). The associations were independent of BMI at time of rebound, but were fully explained by fat mass at 13.5 years. Similar associations were found for skinfold-derived AR.ConclusionBMI-derived adiposity rebound predicts later cardio-metabolic risk markers similarly to that derived from skinfolds, a direct measure of adiposity.

Highlights

Cardiovascular disease (CVD) is the primary cause of death in Indian adults, with age-standardised death rate of 348.9 per 100,000 men and 246.6 per 100,000 women [1]
While Body mass index (BMI) started to decrease at 2 years, and reached its second minimum after 5 years of age, skinfolds remained somewhat constant between 2 and 6 years and started increasing only after 6 years, with a steeper increase in girls
The different trends of BMI and skinfolds were reflected in the number of children who did not experience a rebound between 2 and 10 years of age

Summary

Introduction

Cardiovascular disease (CVD) is the primary cause of death in Indian adults, with age-standardised death rate of 348.9 per 100,000 men and 246.6 per 100,000 women [1]. The age corresponding to the lowest BMI value recorded before the onset of its second rise is called the adiposity rebound (AR) [8]. Earlier AR is associated with higher BMI in later childhood [9] and adulthood [7, 10], and a higher risk of Type 2 diabetes [11]. Body mass index (BMI) reaches a nadir in mid-childhood, known as the adiposity rebound (AR). Earlier AR is associated with a higher risk of cardio-vascular diseases in later life. Skinfolds, which are a more direct measure of adiposity, may give better insight into the relationship between childhood adiposity and later obesity and cardio-metabolic risk

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Conclusion