Background: Intra-abdominal fat (IAF) is a valuable predictor of cardiovascular morbidity. However, neither reference values nor determinants are known in children. Methods: IAF was assessed as sonographically measured intra-abdominal depth in 1,046 children [median age 7.6 years, interquartile range (IQR) 7.2–7.9; 54% boys] of the URMEL-ICE study. Results: The intraclass correlation coefficient for intraobserver agreement was 0.93. The median IAF showed a significant gender difference (boys: 54.6 mm, IQR 50.1–59.3, vs. girls: 51.7 mm, IQR 46.3–56.4; p < 0.001). Age- and gender-specific centiles were generated. IAF showed a positive correlation to systolic blood pressure [regression coefficient (β) = 0.24 mm Hg/mm; p < 0.001] and a negative correlation to HDL cholesterol (β = –0.01 mmol/l/mm; p < 0.001). IAF showed a positive association with increased paternal and maternal BMI (β = 0.28 mm/kg/m2 and 0.27 mm/kg/m2; p < 0.001), increased weight gain in the first 2 years of life (β = 3.04 mm; p < 0.001), and maternal smoking during pregnancy (β = 2.4 mm; p = 0.001). Increased parental education was negatively associated with IAF (maternal: β = –0.65 mm/degree; p = 0.004, and paternal: β = –0.61 mm/degree; p = 0.002). Conclusion: Sonography was a reliable tool to estimate IAF. Factors influencing IAF included rapid infant weight gain, smoking during pregnancy, and parental BMI and education. Since IAF showed an association with cardiovascular risk factors even in prepubertal children, it might become a valuable predictor of cardiovascular vulnerability.

Keywords:
Intra-abdominal fat, Reference values, Childhood, Developmental origins of disease, Ultrasonography
1.
Goran MI, Gower BA: Relation between visceral fat and disease risk in children and adolescents. Am J Clin Nutr 1999;70:149S–156S.
2.
Despres JP: Abdominal obesity as important component of insulin-resistance syndrome. Nutrition 1993;9:452–459.
3.
Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S: Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987;36:54–59.
4.
von Eyben FE, Mouritsen E, Holm J, Montvilas P, Dimcevski G, Suciu G, Helleberg I, Kristensen L, von Eyben R: Intra-abdominal obesity and metabolic risk factors: a study of young adults. Int J Obes Relat Metab Disord 2003;27:941–949.
5.
Kim SK, Kim HJ, Hur KY, Choi SH, Ahn CW, Lim SK, Kim KR, Lee HC, Huh KB, Cha BS: Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases. Am J Clin Nutr 2004;79:593–599.
6.
Lee S, Bacha F, Gungor N, Arslanian SA: Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006;148:188–194.
7.
Reinehr T, Wunsch R: Relationships between cardiovascular risk profile, ultrasonographic measurement of intra-abdominal adipose tissue, and waist circumference in obese children. Clin Nutr 29:24–30.
8.
Kim JA, Park HS: Association of abdominal fat distribution and cardiometabolic risk factors among obese Korean adolescents. Diabetes Metab 2008;34:126–130.
9.
Jung C, Fischer N, Fritzenwanger M, Pernow J, Brehm BR, Figulla HR: Association of waist circumference, traditional cardiovascular risk factors, and stromal-derived factor-1 in adolescents. Pediatr Diabetes 2009;10:329–335.
10.
Freedman DS, Serdula MK, Srinivasan SR, Berenson GS: Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69:308–317.
11.
Tamura A, Mori T, Hara Y, Komiyama A: Preperitoneal fat thickness in childhood obesity: association with serum insulin concentration. Pediatr Int 2000;42:155–159.
12.
Caprio S, Hyman LD, Limb C, McCarthy S, Lange R, Sherwin RS, Shulman G, Tamborlane WV: Central adiposity and its metabolic correlates in obese adolescent girls. Am J Physiol 1995;269:E118–E126.
13.
Gower BA, Nagy TR, Goran MI: Visceral fat, insulin sensitivity, and lipids in prepubertal children. Diabetes 1999;48:1515–1521.
14.
Owens S, Gutin B, Ferguson M, Allison J, Karp W, Le NA: Visceral adipose tissue and cardiovascular risk factors in obese children. J Pediatr 1998;133:41–45.
15.
Brambilla P, Manzoni P, Sironi S, Simone P, Del Maschio A, di Natale B, Chiumello G: Peripheral and abdominal adiposity in childhood obesity. Int J Obes Relat Metab Disord 1994;18:795–800.
16.
Fox K, Peters D, Armstrong N, Sharpe P, Bell M: Abdominal fat deposition in 11-year-old children. Int J Obes Relat Metab Disord 1993;17:11–16.
17.
Goran MI, Kaskoun M, Shuman WP: Intra-abdominal adipose tissue in young children. Int J Obes Relat Metab Disord 1995;19:279–283.
18.
de Ridder CM, Thijssen JH, Bruning PF, Van den Brande JL, Zonderland ML, Erich WB: Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls. J Clin Endocrinol Metab 1992;75:442–446.
19.
de Ridder CM, de Boer RW, Seidell JC, Nieuwenhoff CM, Jeneson JA, Bakker CJ, Zonderland ML, Erich WB: Body fat distribution in pubertal girls quantified by magnetic resonance imaging. Int J Obes Relat Metab Disord 1992;16:443–449.
20.
Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, Fox KR, Peters DM, Barbeau P, De Simone M, Pietrobelli A: Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes (Lond) 2006;30:23–30.
21.
Benfield LL, Fox KR, Peters DM, Blake H, Rogers I, Grant C, Ness A: Magnetic resonance imaging of abdominal adiposity in a large cohort of British children. Int J Obes (Lond) 2008;32:91–99.
22.
Goran MI, Gower BA, Treuth M, Nagy TR: Prediction of intra-abdominal and subcutaneous abdominal adipose tissue in healthy pre-pubertal children. Int J Obes Relat Metab Disord 1998;22:549–558.
23.
Armellini F, Zamboni M, Rigo L, Todesco T, Bergamo-Andreis IA, Procacci C, Bosello O: The contribution of sonography to the measurement of intra-abdominal fat. J Clin Ultrasound 1990;18:563–567.
24.
Ribeiro-Filho FF, Faria AN, Azjen S, Zanella MT, Ferreira SR: Methods of estimation of visceral fat: advantages of ultrasonography. Obes Res 2003;11:1488–1494.
25.
Stolk RP, Wink O, Zelissen PM, Meijer R, van Gils AP, Grobbee DE: Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue. Int J Obes Relat Metab Disord 2001;25:1346–1351.
26.
Tornaghi G, Raiteri R, Pozzato C, Rispoli A, Bramani M, Cipolat M, Craveri A: Anthropometric or ultrasonic measurements in assessment of visceral fat? A comparative study. Int J Obes Relat Metab Disord 1994;18:771–775.
27.
Ferrozzi F, Zuccoli G, Tognini G, Castriota-Scanderbeg A, Bacchini E, Bernasconi S, Campani R: An assessment of abdominal fatty tissue distribution in obese children. A comparison between echography and computed tomography (in Italian). Radiol Med 1999;98:490–494.
28.
Nishina M, Kikuchi T, Yamazaki H, Kameda K, Hiura M, Uchiyama M: Relationship among systolic blood pressure, serum insulin and leptin, and visceral fat accumulation in obese children. Hypertens Res 2003;26:281–288.
29.
Semiz S, Ozgoren E, Sabir N, Semiz E: Body fat distribution in childhood obesity: association with metabolic risk factors. Indian Pediatr 2008;45:457–462.
30.
Polat TB, Urganci N, Caliskan KC, Akyildiz B: Correlation of abdominal fat accumulation and stiffness of the abdominal aorta in obese children. J Pediatr Endocrinol Metab 2008;21:1031–1040.
31.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240–1243.
32.
Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, Bemben DA: Skinfold equations for estimation of body fatness in children and youth. Hum Biol 1988;60:709–723.
33.
Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB: Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 2000;320:967–971.
34.
Voigt M, Schneider KT, Jahrig K: Analysis of a 1992 birth sample in Germany. 1. New percentile values of the body weight of newborn infants (in German). Geburtshilfe Frauenheilkd 1996;56:550–558.
35.
Ravelli GP, Stein ZA, Susser MW: Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 1976;295:349–353.
36.
Ounsted M, Sleigh G: The infant’s self-regulation of food intake and weight gain: difference in metabolic balance after growth constraint or acceleration in utero. Lancet 1975;i:1393–1397.
37.
Monteiro PO, Victora CG: Rapid growth in infancy and childhood and obesity in later life – a systematic review. Obes Rev 2005;6:143–154.
38.
Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ, Biswas SK, Ramji S, Prabhakaran D, Reddy KS: Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med 2004;350:865–875.
39.
Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG: Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005;353:1802–1809.
40.
Kramer MS, Guo T, Platt RW, Vanilovich I, Sevkovskaya Z, Dzikovich I, Michaelsen KF, Dewey K: Feeding effects on growth during infancy. J Pediatr 2004;145:600–605.
41.
Bergmann KE, Bergmann RL, Von Kries R, Bohm O, Richter R, Dudenhausen JW, Wahn U: Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding. Int J Obes Relat Metab Disord 2003;27:162–172.
42.
Cruz ML, Bergman RN, Goran MI: Unique effect of visceral fat on insulin sensitivity in obese Hispanic children with a family history of type 2 diabetes. Diabetes Care 2002;25:1631–1636.
43.
Goran MI, Lane C, Toledo-Corral C, Weigensberg MJ: Persistence of pre-diabetes in overweight and obese Hispanic children: association with progressive insulin resistance, poor beta-cell function, and increasing visceral fat. Diabetes 2008;57:3007–3012.
44.
Ku CY, Gower BA, Nagy TR, Goran MI: Relationships between dietary fat, body fat, and serum lipid profile in prepubertal children. Obes Res 1998;6:400–407.
45.
Freedman DS, Srinivasan SR, Harsha DW, Webber LS, Berenson GS: Relation of body fat patterning to lipid and lipoprotein concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1989;50:930–939.
46.
Psarra G, Nassis GP, Sidossis LS: Short-term predictors of abdominal obesity in children. Eur J Public Health2006;16:520–525.
47.
Mueller WH, Dai S, Labarthe DR: Tracking body fat distribution during growth: using measurements at two occasions versus one. Int J Obes Relat Metab Disord 2001;25:1850–1855.
48.
Freedman DS, Srinivasan SR, Burke GL, Shear CL, Smoak CG, Harsha DW, Webber LS, Berenson GS: Relation of body fat distribution to hyperinsulinemia in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1987;46:403–410.
49.
Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiβ HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, et al: Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001;8:807–818.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.