To evaluate the relationship between wrist circumference, markers of adipose dysfunction, and cardiovascular risk in youths with obesity.
In this cross-sectional study, we measured body mass composition by dual-energy X-ray absorptiometry, wrist circumference, waist-to-height ratio, fasting blood insulin, glucose, lipid profile, adiponectin, and leptin in 280 children with overweight/obesity and without diabetes (age: 7–18 years). Cardiovascular risk was estimated by “metabolic syndrome score” (MetS score).
Study participants had median [25th–75th percentile] wrist circumference of 17.5 [16.7–18.5] cm and waist-to-height ratio of 0.62 [0.59–0.67]. Lower adiponectin–leptin ratio was found among subjects in the upper 50th percentiles of wrist circumference [0.17 (0.09–0.36) vs. 0.38 (0.16–0.79); p < 0.001]. Wrist circumference was independently associated with MetS score (r = 0.5 p < 0.001). Among MetS score components, an independent association between wrist circumference HDLc, triglycerides, and systolic blood pressure was found (r = − 0.253 p < 0.001; r =+ 0.204 p < 0.001; r = + 0.403 p = < 0.001, respectively). The coefficient of determination for MetS score was nominally higher when considering wrist circumference as independent variable (Adj-R2 = 0.30) then when considering body mass index SD (Adj-R2 = 0.28), waist-to-height ratio (Adj-R2 = 0.26) or truncal fat percentage (Adj-R2 = 0.01). The addition of wrist circumference in age and gender adjusted models, accounting to any other anthropometric parameters, resulted in a significant improvement of the Adj-R2 (p < 0.001 for all).
Our study shows that wrist circumference independently relates to adiponectin–leptin ratio and to the prediction of cardiovascular risk, suggesting it as an efficient and adjunctive anthropometric marker of cardiometabolic risk in children with obesity.
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Weihrauch-Blüher S, Wiegand S (2018) Risk factors and implications of childhood obesity. Curr Obes Rep 7:254–259. https://doi.org/10.1007/s13679-018-0320-0
Steinbeck KS, Lister NB, Gow ML, Baur LA (2018) Treatment of adolescent obesity. Nat Rev Endocrinol 14:331–344. https://doi.org/10.1038/s41574-018-0002-8
Valerio G, Maffeis C, Saggese G et al (2018) Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 44:88. https://doi.org/10.1186/s13052-018-0525-6
Ho HCH, Maddaloni E, Buzzetti R (2019) Risk factors and predicitve biomarkers of early cardiovascular disease in obese youth. Diabetes Metab Res Rev. https://doi.org/10.1002/dmrr.3134
Yanovski JA (2015) Pediatric obesity: an introduction. Appetite 93:3–12. https://doi.org/10.1016/j.appet.2015.03.028
Namazi N, Djalalinia S, Mahdavi-Gorabi A et al (2018) Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0534-x
Maddaloni E, Cavallari I, De Pascalis M et al (2016) Relation of body circumferences to cardiometabolic disease in overweight-obese subjects. Am J Cardiol. https://doi.org/10.1016/j.amjcard.2016.06.044
Jayawardene WP, Lohrmann D, Dickinson S et al (2017) Clinical measures of obesity and cumulative cardiometabolic risk in adolescents. Clin Obes 7:11–21. https://doi.org/10.1111/cob.12171
de Quadros TMB, Gordia AP, Silva LR (2017) Anthropometry and clustered cardiometabolic risk factors in young people: a systematic review. Rev Paul Pediatr 35:340–350. https://doi.org/10.1590/1984-0462/;2017;35;3;00013
Capizzi M, Leto G, Petrone A et al (2011) Wrist circumference is a clinical marker of insulin resistance in overweight and obese children and adolescents. Circulation 123:1757–1762. https://doi.org/10.1161/CIRCULATIONAHA.110.012898
Cameron N (1978) The methods of auxological anthropometry. Hum Growth. Springer, Boston, pp 35–90
Freedman DS, Thornton JC, Pi-Sunyer FX et al (2012) The body adiposity index (hip circumference ÷ height 1.5) is not a more accurate measure of adiposity than is bmi, waist circumference, or hip circumference. Obesity 20:2438–2444. https://doi.org/10.1038/oby.2012.81
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243. https://doi.org/10.1136/bmj.320.7244.1240
Bacopoulou F, Efthymiou V, Landis G et al (2015) Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatr 15:50. https://doi.org/10.1186/s12887-015-0366-z
Yoo E-G (2016) Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean J Pediatr 59:425–431. https://doi.org/10.3345/kjp.2016.59.11.425
Nyland J, Fried A, Maitra R et al (2006) Wrist circumference is related to patellar tendon thickness in healthy men and women. Clin Imaging 30:335–338. https://doi.org/10.1016/j.clinimag.2006.02.004
Campagna G, Zampetti S, Gallozzi A et al (2016) Excellent intra and inter-observer reproducibility of wrist circumference measurements in obese children and adolescents. PLoS One 11:e0156646. https://doi.org/10.1371/journal.pone.0156646
Hazani R, Engineer NJ, Cooney D, Wilhelmi BJ (2008) Anatomic landmarks for the first dorsal compartment. Eplasty 8:e53
Srinivas Reddy R, Compson J (2005) (i) Examination of the wrist—surface anatomy of the carpal bones. Curr Orthop 19:171–179. https://doi.org/10.1016/j.cuor.2005.02.008
Strobel MJ (2002) Manual of arthroscopic surgery. Springer, Berlin Heidelberg
Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419
Matsuda M, DeFronzo RA (1999) Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 22:1462–1470. https://doi.org/10.2337/diacare.22.9.1462
Viitasalo A, Lakka TA, Laaksonen DE et al (2014) Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults. Diabetologia 57:940–949. https://doi.org/10.1007/s00125-014-3172-5
Bai Y, Sun Q (2015) Macrophage recruitment in obese adipose tissue. Obes Rev 16:127–136. https://doi.org/10.1111/obr.12242
Gruzdeva O, Borodkina D, Uchasova E et al (2019) Leptin resistance: underlying mechanisms and diagnosis. Diabetes Metab Syndr Obes 12:191–198. https://doi.org/10.2147/DMSO.S182406
Szewczyk-Golec K, Woźniak A, Reiter RJ (2015) Inter-relationships of the chronobiotic, melatonin, with leptin and adiponectin: implications for obesity. J Pineal Res 59:277–291. https://doi.org/10.1111/jpi.12257
Buzzetti R, Petrone A, Caiazzo AM et al (2005) PPAR-gamma2 Pro12Ala variant is associated with greater insulin sensitivity in childhood obesity. Pediatr Res 57:138–140. https://doi.org/10.1203/01.PDR.0000147728.62185.21
Petrone A, Zavarella S, Caiazzo A et al (2006) The promoter region of the adiponectin gene is a determinant in modulating insulin sensitivity in childhood obesity. Obesity (Silver Spring) 14:1498–1504. https://doi.org/10.1038/oby.2006.172
Frühbeck G, Catalán V, Rodríguez A et al (2019) Adiponectin–leptin ratio is a functional biomarker of adipose tissue inflammation. Nutrients. https://doi.org/10.3390/nu11020454
Bray GA, Heisel WE, Afshin A et al (2018) The science of obesity management: an endocrine society scientific statement. Endocr Rev 39:79–132. https://doi.org/10.1210/er.2017-00253
Zampetti S, Campagna G, Lucantoni F et al (2018) Wrist circumference is associated with increased systolic blood pressure in children with overweight/obesity. Hypertens Res 41:193–197. https://doi.org/10.1038/s41440-017-0006-0
Zampetti S, Campagna G, Leto G et al (2018) Relation between wrist circumference and left ventricular structure in overweight children. Am J Cardiol 121:1624–1628. https://doi.org/10.1016/j.amjcard.2018.02.057
Bussler S, Penke M, Flemming G et al (2017) Novel insights in the metabolic syndrome in childhood and adolescence. Horm Res Paediatr 88:181–193. https://doi.org/10.1159/000479510
Eisenmann JC (2008) On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol 7:17. https://doi.org/10.1186/1475-2840-7-17
Bosy-Westphal A, Booke C-A, Blöcker T et al (2010) Measurement site for waist circumference affects its accuracy as an index of visceral and abdominal subcutaneous fat in a Caucasian population. J Nutr 140:954–961. https://doi.org/10.3945/jn.109.118737
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Ethical Committee of Bambino Gesù Children’s Hospital in Rome.
Written informed consent was obtained from the parents or guardians of the children included in this study, in accordance with the principles of the Declaration of Helsinki.
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Luordi, C., Maddaloni, E., Bizzarri, C. et al. Wrist circumference is a biomarker of adipose tissue dysfunction and cardiovascular risk in children with obesity. J Endocrinol Invest 43, 101–107 (2020) doi:10.1007/s40618-019-01086-7
- Childhood obesity
- Wrist circumference
- Cardiovascular risk
- Insulin resistance