The Effect of Different Adiposity Factors on Insulin Resistance in Obese Children and Adolescents

Yang Niu; Xuelin Zhao; Huijun He; Xiaomeng Mao; Jinye Sheng; Jing Zou; Qingya Tang; Wei Cai


Clin Endocrinol. 2021;94(6):949-955. 

In This Article

Abstract and Introduction


Context: Insulin resistance (IR) has been common in obese children, but the effect of different adiposity factors on IR is still unclear.

Objective: To evaluate the associations between IR with body mass index (BMI), waist circumference (WC), body fat mass (BFM), and body fat percentage (BFP) in obese children and adolescents.

Methods: A total of 224 simple obese children were included in this study, including 150 boys and 74 girls, aged 3–18 who were seen in the clinical nutrition outpatient of Xinhua Hospital from September 2012 to December 2019. Basic information, body composition and laboratory tests were collected.

Results: Compared with girls, boys had higher height, weight, BMI, WC, and BFM (P < 0.05), but on the contrary, boys' FINS and HOMA- IR were lower than girls' (P > 0.05). With the age increasing, height, weight, BMI, BFM, WC, HC, WHtR, FINS and HOMA-IR increased accordingly (P < 0.05). The results from univariate analysis and multiple linear regression analysis showed that the impact of BMI on IR was slightly lower than BFM, WC and HC, but higher than BFP, with adjusting for the effects of age, sex and lipid metabolism (P < 0.01).

Conclusion: Overall adipose tissue, especially abdominal adipose tissue, is a powerful marker in inducing IR in obese children and adolescents. In addition, more attention should be paid to WC and BFM than BMI in obese people with IR.


Nearly one-third of the world's population is currently classified as overweight or obese, which has doubled the prevalence of overweight or obesity worldwide in 1980.[1] It is not optimistic that a total of 107.7 million children were classified as obese, making the global prevalence of childhood overweight and obesity as high as 23% in 2015.[2–4] Whether in developed or developing countries, childhood and adolescent obesity has been considered as a global problem endangering human health and aggravating medical economic burden.[5,6] Childhood obesity not only increases the incidence of chronic diseases such as fatty liver, hypertension, metabolic syndrome,[7] but is also associated with a significantly higher risk of developing type 2 diabetes in later life.[8]

Obesity and insulin resistance are previously regarded as the problems of the elderly, and now it has become a serious problem that harms children's health. As early as 1995, Stern attributed the pathophysiological basis of the metabolic syndrome to insulin resistance (IR) in the common soil theory.[9] IR was reported to be associated with obesity, a core component of metabolic syndrome.[10] There was an increase in the values of IR as the mean body mass index (BMI) increased,[10] which was an important cause of diabetes in obesity children and adolescents.[11]

In the current study of children, the evaluation method of obesity is often limited to BMI, which cannot differentiate whether an excess of body weight reflects increasing of fat mass or fat-free mass, thus cannot comprehensively assess the location and type of obesity. However, with the children and adolescent development, weight is not proportional to height squared, which could undercut the validity of BMI in adolescents, thus leading to the question whether the BMI can accurately measure childhood obesity.[12] Moreover, the effects of other adiposity factors such as waist circumference (WC), body fat mass (BFM) and body fat percentage (BFP) on IR have not been examined in obese children and adolescents. Therefore, this study aims to explore the relationship between different adiposity factors (BMI, WC, BFM and BFP) and IR, as well as the magnitude of their effects on IR in obese children and adolescents.