Waist Circumference Can Predict Insulin Resistance Syndrome in Children

In children age six to 13 years, the strongest predictors of insulin resistance are WC and systolic BP.

The investigators suggest that measuring children’s WC should be incorporated into routine clinical practice.

"In adults, measurement of WC as an indicator of intra-abdominal fat mass more directly correlates with cardiovascular disease (CVD) risk and atherogenic lipoprotein profile than does overall obesity as determined by body mass index (BMI)," write Valeria Hirschler, MD, from the Durand Hospital of Buenos Aires and School of Pharmacy and Biochemistry, University of Buenos Aires in Argentina, and colleagues. "The health risks associated with an excessive abdominal fat distribution in children, however, are unclear."

The study objective was to determine the relationship between WC and insulin resistance determined by homeostasis assessment model of insulin resistance (HOMA-IR) and proinsulinemia and components of the metabolic syndrome, such as lipid profile and blood pressure (BP).

Of 84 students age six to 13 years who were enrolled in this study, 40 were boys; 40 were obese (body mass index [BMI] >/= 95th percentile), 28 were overweight (BMI, 85th – 94th percentile), and 16 were nonobese (BMI < 85th percentile). The three groups were matched for sex and age, and all children underwent anthropometric measurements, oral glucose tolerance test, lipid profile, insulin and proinsulin assays, and measurement of BMI, WC, BP, and Tanner stage.

WC was directly associated with height, BMI, Tanner stage, age, systolic BP, diastolic BP, high-density lipoprotein cholesterol (HDL) level, triglyceride level, proinsulin level, and HOMA-IR. When HOMA-IR was used as the dependent variable in multiple linear regression analysis, significant independent predictors for insulin resistance adjusted for diastolic BP, height, BMI, acanthosis nigricans, and HDL level were WC and systolic BP.

"Waist circumference is a predictor of insulin resistance syndrome in children and adolescents and could be included in clinical practice as a simple tool to help identify children at risk," the authors write. "The present study showed that children with abdominal obesity, as determined by WC, have increased metabolic risk factors for CVD and T2DM [type 2 diabetes mellitus]."

Arch Pediatr Adolesc Med. 2005;159:740-744

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