Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile

Oliosa, Polyana Romano; Zaniqueli, Divanei; Alvim, Rafael de Oliveira; Barbosa, Miriam Carmo Rodrigues; Mill, José Geraldo

doi:10.1016/j.jped.2017.11.003

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Original articles • J. Pediatr. (Rio J.) 95 (1) • Jan-Feb 2019 • https://doi.org/10.1016/j.jped.2017.11.003 copy

Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile^☆ ☆ Please cite this article as: Oliosa PR, Zaniqueli D, Alvim RO, Barbosa MC, Mill JG. Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile. J Pediatr (Rio J). 2019;95:112–8.

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Abstract

Objective:

To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile.

Methods:

This was a cross-sectional study involving 840 children and adolescents (6–18 years). The same individuals were classified as non-obese (<P⁹⁵) or obese (≥P⁹⁵) according to body fat percentage and indicators of weight status, body mass index, and waist-to-height ratio. Body fat percentage was obtained by multi-frequency bioelectrical impedance. Linear association between obesity and increased lipid fractions was tested by ANCOVA. Normal distribution curves of non-HDL cholesterol were designed for obese and non-obese. To provide the proportion of obese individuals with elevated non-HDL-c across all indicators, Z-score was calculated.

Results:

Obese boys presented higher non-HDL cholesterol when compared with those non-obese, classified by body mass index (107 ± 28 vs. 94 ± 25 mg/dL, p = 0.001), waist-to-height ratio (115 ± 29 vs. 94 ± 25 mg/dL, p < 0.001) and body fat percentage (119 ± 33 vs. 94 ± 24 mg/dL, p < 0.001). Differently, obese girls presented with higher non-HDL cholesterol when compared with those non-obese only according to the body fat percentage classification (118 ± 24 vs. 96 ± 26 mg/dL, p = 0.001). A large shift to the right in the distribution curve of non-HDL cholesterol among obese girls compared with non-obese was observed only when body fat percentage was used to discriminate between obese and non-obese.

Conclusion:

Body fat percentage was better than the indicators of weight status to identify children and adolescents with unfavorable lipid profile, mainly among girls.

KEYWORDS
Blood lipids; Obesity; Children and adolescents; Indicators of weight status; Body fat percentage

	All	Male	Female	p-value
n	840	471	369	-
Age (years)	11.8 ± 2.7	11.3 ± 2.6	11.4 ± 2.8	0.642
Height (cm)	149.5 ± 15.4	150.4 ± 16.4	148.3 ± 14.1	0.049
Weight (kg)	44.1 ± 15.1	44.1 ± 15.5	44.2 ± 14.7	0.957
BMI (kg/m²)	19.2 ± 3.9	18.9 ± 3.8	19.5 ± 4.0	0.016
WC (cm)	64.7 ± 9.6	64.9 ± 9.9	64.4 ± 9.2	0.395
WHtR	0.43 ± 0.05	0.43 ± 0.05	0.43 ± 0.05	0.525
BFP	22.8 ± 9.3	20.1 ± 9.29	26.2 ± 8.21	<0.001
SBP (mmHg)	104 ± 9	105 ± 10	103 ± 8	<0.001
DBP (mmHg)	62 ± 6	62 ± 7	63 ± 6	0.027
HR (bpm)	74 ± 11	71 ± 11	77 ± 11	<0.001
Chol (mg/dL)	143.8 ± 27.9	143 ± 28	145 ± 28	0.285
LDL-c (mg/dL)	78.4 ± 24.6	78 ± 24	79 ± 25	0.431
HDL-c (mg/dL)	47.5 ± 9.5	47 ± 9	48 ± 10	0.819
non-HDL-c (mg/dL)	96 ± 26	95 ± 25	97 ± 26	0.269
TG (mg/dL)	69.7 ± 29.6	68 ± 29	72 ± 30	0.113

	BMI			WHtR			BFP
	<P⁹⁵	≥P⁹⁵	p-value	<P⁹⁵	≥P⁹⁵	p-value	<P⁹⁵	≥P⁹⁵	p-value
n	410	48	-	434	24	-	437	21	-
Age (years)	11.3 ± 2.7	10.6 ± 2.2	0.074	11.3 ± 2.7	10.4 ± 1.6	0.017	11.4 ± 2.7	10.7 ± 1.7	0.067
BMI (kg/m²2 Zhang Y, Wu NQ, Li S, Zhu CG, Guo YL, Qing P, et al. Non-HDL-C is a better predictor for the severity of coronary atherosclerosis compared with LDL-C. Heart Lung Circ. 2016;25:975-81.)	18.0 ± 2.7	26.5 ± 3.3	<0.001	18.4 ± 3.2	26.7 ± 3.5	<0.001	18.6 ± 3.4	26.3 ± 3.7	<0.001
WHtR	0.42 ± 0.04	0.54 ± 0.05	<0.001	0.42 ± 0.04	0.52 ± 0.03	<0.001	0.43 ± 0.04	0.56 ± 0.06	<0.001
BFP (%)	18.1 ± 7.2	37.9 ± 5.9	<0.001	18.9 ± 7.8	40.0 ± 7.8	<0.001	19.0 ± 7.8	44.6 ± 4.2	<0.001
Chol (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	142 ± 27	150 ± 30	0.058	142 ± 27	158 ± 30	0.005	142 ± 27	164 ± 35	<0.001
LDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	77 ± 24	88 ± 28	0.003	76 ± 24	96 ± 29	<0.001	76 ± 23	102 ± 32	<0.001
HDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	48 ± 9	43 ± 10	<0.001	48 ± 9	43 ± 10	0.022	48 ± 9	45 ± 9	0.167
non-HDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	94 ± 25	107 ± 28	0.001	94 ± 25	115 ± 29	<0.001	94 ± 24	119 ± 33	<0.001
TG (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	65 ± 25	96 ± 33	<0.001	66 ± 22	108 ± 39	<0.001	67 ± 27	99 ± 46	<0.001

	BMI			WHtR			BFP
	<P⁹⁵	≥P⁹⁵	p-value	<P⁹⁵	≥P⁹⁵	p-value	<P⁹⁵	≥P⁹⁵	p-value
n	323	30	-	334	19	-	334	19	-
Age (years)	11.4 ± 2.8	10.8 ± 2.9	0.217	11.4 ± 2.8	10.8 ± 2.8	0.439	11.5 ± 2.8	10.3 ± 2.8	0.061
BMI (kg/m²)	18.8 ± 3.1	26.8 ± 4.0	<0.001	19.1 ± 3.4	27.0 ± 4.7	<0.001	19.2 ± 3.7	25.4 ± 4.2	<0.001
WHtR	0.42 ± 0.04	0.53 ± 0.03	<0.001	0.43 ± 0.04	0.56 ± 0.03	<0.001	0.43 ± 0.05	0.52 ± 0.03	<0.001
BFP (%)	24.7 ± 7.0	40.2 ± 4.5	<0.001	25.5 ± 7.6	39.5 ± 8.4	<0.001	25.3 ± 7.3	42.5 ± 3.9	<0.001
Chol (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	145 ± 29	150 ± 27	0.328	145 ± 29	139 ± 25	0.393	144 ± 29	160 ± 26	<0.021
LDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	79 ± 25	87 ± 24	0.086	79 ± 25	78 ± 24	0.858	78 ± 25	96 ± 25	0.003
HDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	48 ± 10	44 ± 10	0.025	48 ± 10	43 ± 10	0.059	48 ± 10	42 ± 8	0.013
non-HDL-c (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	97 ± 26	106 ± 26	0.060	97 ± 27	96 ± 26	0.820	96 ± 26	118 ± 24	0.001
TG (mg/dL)^a a Difference of means was adjusted for age, SBP, and HR.	70 ± 29	88 ± 38	0.001	70 ± 29	84 ± 37	0.063	70 ± 29	92 ± 41	0.003

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[1] * Corresponding author. divozaniqueli@hotmail.com