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Obesity, Physical Activity, Diet · Journal article
Metabolites · August 11, 2026
Encouraging direction, but not yet definitive.
This retrospective cross-sectional study of 147 prepubertal children with obesity demonstrates independent associations between central adiposity (waist circumference SDS), fat-to-muscle ratio, and body composition measures with insulin resistance (HOMA-IR ≥2.5) after adjustment for age and sex. The findings suggest that measures of central adiposity and body composition balance may refine metabolic risk assessment beyond BMI alone in this age group, but the use of a surrogate endpoint and lack of prospective follow-up limit claims of clinical impact.
Retrospective cross-sectional study. Prepubertal children with obesity; n=147 (61 males, 86 females). Specific eligibility criteria, inclusion/exclusion, and recruitment setting not stated.. Intervention: Body composition assessment via bioelectrical impedance analysis; anthropometric measurements including waist circumference, waist-to-height ratio, BMI.. Compared with: Insulin resistance status (HOMA-IR ≥2.5 vs <2.5). n = 147.
Waist circumference SDS independently associated with insulin resistance (OR = 6.04; 95% CI: 2.47–14.75; p < 0.001) after age and sex adjustment Fat-to-muscle ratio independently associated with insulin resistance (OR = 4.41; 95% CI: 1.16–16.78; p = 0.030) HOMA-IR showed significant positive correlations with WC_SDS (ρ = 0.39) and FMR (ρ = 0.22)
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These results suggest that clinicians may consider measuring waist circumference and body composition (fat-to-muscle ratio) in addition to BMI when assessing metabolic risk in obese children. However, given the reliance on HOMA-IR as a surrogate and the cross-sectional design, these associations should be validated prospectively before integrating them into routine clinical screening.
A sound cross-sectional study in a focused population identifying independent associations between body composition measures and insulin resistance using rigorous statistical adjustment, but limited by retrospective design, single-centre recruitment, and surrogate endpoint (HOMA-IR), requiring prospective validation.
As stated by the source record.
Quoted from the source exactly as published.
These results suggest that clinicians may consider measuring waist circumference and body composition (fat-to-muscle ratio) in addition to BMI when assessing metabolic risk in obese children. However, given the reliance on HOMA-IR as a surrogate and the cross-sectional design, these associations should be validated prospectively before integrating them into routine clinical screening.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Body mass index (BMI) is widely used to assess pediatric obesity but has limitations in distinguishing between fat and muscle mass. This study aimed to investigate the association between various body composition parameters and insulin resistance (IR) and to evaluate their clinical utility in prepubertal children with obesity. Methods: This retrospective cross-sectional study evaluated prepubertal children with obesity. Anthropometric measures and body composition, including percent body fat (PBF) and fat-to-muscle ratio (FMR), were assessed using bioelectrical impedance analysis. IR was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5. Spearman rank correlation, linear regression, and multivariate logistic regression analysis were performed to identify independent associated factors for IR. Results: A total of 147 prepubertal children (61 males, 86 females) were analyzed. The IR group exhibited significantly higher waist circumference SDS (WC_SDS), waist circumference-to-height ratio SDS (WHtR_SDS), and FMR compared to the non-IR group (all p < 0.05). In correlation analysis, HOMA-IR showed significant positive associations with WC_SDS (ρ = 0.39) and FMR (ρ = 0.22). After adjusting for age and sex, WC SDS (odds ratio (OR) = 6.04; 95% CI: 2.47–14.75; p < 0.001), FMR (OR = 4.41; 95% CI: 1.16–16.78; p = 0.030), BMI SDS (OR = 2.31; 95% CI: 1.30–4.10; p = 0.004), and PBF (OR = 1.12; 95% CI: 1.04–1.20; p = 0.004) remained independent risk factors for IR. Conclusions: In prepubertal children with obesity, WC SDS, FMR, BMI SDS and PBF were each significantly associated with IR after adjusting for age and sex. These findings suggest that measures of central adiposity and fat-to-muscle balance, in addition to conventional weight-based indices, are relevant to metabolic risk assessment in this age group.
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