Predictors of Metabolic Complications in Obese Indian Children and Adolescents
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ORIGINAL ARTICLE
Predictors of Metabolic Complications in Obese Indian Children and Adolescents C. Dave 1,2 & N. Agarwal 1,2 & R. Patel 1,2 & R. Shukla 1 & Anurag Bajpai 1,2 Received: 12 June 2020 / Accepted: 25 September 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objective To identify predictors of metabolic complications in obese Indian children and adolescents. Methods This cross-sectional study included 282 obese children and adolescents [188 boys, mean (SD) age of 11.7 (3.1) y, body mass index standard deviation score (BMI SDS) 2.4 (0.6)] who underwent metabolic work-up (oral glucose tolerance test, SGPT, lipid profile) and adiposity assessment (waist circumference and Dual energy X-ray absorptiometry). Results One hundred and fifteen subjects (40.8%) had no metabolic complication (metabolic healthy obesity) with similar prevalence across BMI SDS categories (38.8% for BMI SDS below 2, 42.1% for 2–3 and 40.4% for those above 3). Normal birth weight (odds ratio 3.2, 95% confidence interval 1.0–10.1, p = 0.04), negative family history of type 2 diabetes (odds ratio 1.81, 95% confidence interval 1.0–3.3, p = 0.04) and younger age [11.3 (3.1) y as against 12.1 (3.1) y, p = 0.03] were associated with metabolically healthy obesity. No difference in BMI SDS [2.4 (0.6) as against 2.4 (0.6), p = 0.7], waist circumference SDS [2.0 (0.7) as against 2.2 (0.9), p = 0.07], waist to height ratio [0.6 (0.05) as against 0.6 (0.05), p = 0.1], DXA derived fat percentage [48.6 (5.4)% as against 47.8% (5.2), p = 0.2], android to gynoid ratio [1.05 (0.1) as against 1.06 (0.1), p = 0.08] and fat mass index [13.8 (3.5) as against 13.8 (3.3), p = 0.9] was observed in the two groups. Conclusions A substantial proportion of obese children and adolescents do not develop metabolic complications. Birth weight and family history of type 2 diabetes are the only predictors of complications. Further exploration is needed to identify interventional targets. Keywords Childhood obesity . Body composition . Metabolically healthy obesity
Dramatic increase in childhood obesity has resulted in metabolic complications at a young age [1–6]. Many obese children however do not develop complications despite high levels of obesity [7]. Identification of these children without complications is desirable to target preventive and therapeutic interventions. Body mass index (BMI) is the most commonly used tool to identify childhood obesity [8]. It, however, includes both lean and fat mass while metabolic complications are more closely associated with fat mass [9]. Studies have suggested role of adiposity markers like waist circumference, wrist circumference and waist-to-height ratio in predicting
metabolic complications of obesity [10–12]. Body composition assessed by dual energy enhanced X-ray absorptiometry (DXA) is the gold standard for adiposity assessment and could identify obese children at risk for metabolic complications [13]. There is a paucity of data regarding predictive value of DXA derived adiposity measures in children and adolescents fo
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