Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration

Clemente, Ana Paula Grotti; Santos, Carla Danusa da Luz; Martins, Vinicius J.B.; Albuquerque, Maria Paula; Fachim, Mariana B.; Sawaya, Ana Lydia

doi:10.1016/j.jped.2014.01.015

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Original Articles • J. Pediatr. (Rio J.) 90 (05) • Sep-Oct 2014 • https://doi.org/10.1016/j.jped.2014.01.015 copy

Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration^☆ ☆ Please cite this article as: Clemente AP, Santos CD, Martins VJ, Albuquerque MP, Fachim MB, Sawaya AL. Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration. J Pediatr (Rio J). 2014;90:479-85.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether bio-chemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil.

Methods:

The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (−1 > HAZ ≥ −2) and non-stunted (HAZ ≥ −1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75^thpercentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations.

Results:

WC cut-off points of 58.25 cm and 67.2 cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively).

Conclusion:

The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts.

Waist circumference; Height; Insulin

Characteristics and prevalences		Females			Males
Characteristics and prevalences		Stunted^a a Height-for-age z-score < −1 and ≥ −2. (n = 35)	Non-stunted^b b Height-for-age z-score ≥ −1. (n = 67)	p value	Stunted^a a Height-for-age z-score < −1 and ≥ −2. (n = 36)	Non-stunted^b b Height-for-age z-score ≥ −1. (n = 68)	p value
Pubertal stage ^c c Significant differences between the groups were determined using the χ2 test (p < 0.05).
	Pre-pubertal	26	50	0.83	27	51	0.23
	Pubertal	9	17		9	17
Anthropometrical parameters (mean±standard deviation) ^d d Significant differences between groups were determined using Student's t-test (p < 0.05).
	Age (years)	11.09 ± 2.19	10.49 ± 2.55	0.154	11.21 ± 2.45	10.26 ± 2.50	0.017
	Weight (kg)	36.63 ± 11.46	45.85 ± 17.56	0.001	33.45 ± 10.81	41.42 ± 16.65	0.001
	Height (cm)	137.13 ± 11.07	145.75 ± 12.00	< 0.001	138.25 ± 12.83	144.52 ± 14.95	0.006
	Height-for-age z-score	−1.50 ± 0.25	0.33 ± 0.72	< 0.001	−1.49 ± 0.28	0.18 ± 0.80	< 0.001
	Body mass index (BMI; kg•m⁻²)	19.02 ± 3.65	20.94 ± 5.36	0.020	17.08 ± 2.88	19.22 ± 4.54	0.001
	BMI-for-age percentile	55.34 ± 30.06	67.98 ± 30.06	0.016	36.07 ± 30.26	61.24 ± 32.49	< 0.001
	Waist circumference (WC; cm)	61.82 ± 10.66	66.75 ± 12.69	0.045	61.27 ± 9.71	64.53 ± 9.16	0.081
	WC/height ratio	0.45 ± 0.06	0.46 ± 0.07	0.750	0.43 ± 0.04	0.45 ± 0.07	0.242
	WC/BMI ratio	3.32 ± 0.27	3.35 ± 0.32	0.653	3.53 ± 0.28	3.48 ± 0.30	0.404
Biochemical and hemodynamic parameters (mean ± standard error)^e e Significant differences between groups were determined using analysis of covariance adjusted for age and weight (p < 0.05).
	Glucose (mg•L⁻¹)	85.36 ± 0.98	86.38 ± 0.74	0.435	89.32 ± 0.92	89.16 ± 0.67	0.895
	Insulin (pmol•L⁻¹)	10.70 ± 0.97	7.62 ± 0.73	0.018	7.68 ± 0.62	5.42 ± 0.45	0.006
	Total cholesterol (mg•dL⁻¹)	163.18 ± 4.98	157.47 ± 3.73	0.387	159.01 ± 4.25	154.67 ± 3.10	0.440
	HDL-C (mg•dL⁻¹)	57.67 ± 2.00	54.10 ± 1.50	0.180	54.82 ± 1.65	54.04 ± 1.20	0.719
	LDL-C (mg•dL⁻¹)	91.92 ± 3.84	89.12 ± 2.88	0.582	91.54 ± 3.31	88.45 ± 2.41	0.480
	Triglycérides (mg•dL⁻¹)	75.85 ± 4.84	74.77 ± 3.63	0.866	68.95 ± 4.11	64.35 ± 2.99	0.397
	SAP (mmHg)	105.23 ± 2.19	109.72 ± 1.68	0.126	106.85 ± 1.86	106.04 ± 1.42	0.746
	DAP (mmHg)	64.37 ± 1.19	63.83 ± 0.82	0.794	64.33 ± 1.51	63.30 ± 1.16	0.617
Prevalence of metabolic alterations (%) ^f f Elevated concentrations are those above the 75th percentile (shown in parenthesis for each variable). Significant differences between the groups were determined using the χ2 test (p < 0.05).
	Elevated glucose (> 91 mmol•L⁻¹)	3.5	14.6	0.028	7.2	18.1	0.124
	Elevated insulin (> 8 U•mL⁻¹)	11.1	14.6	0.463	6.0	10.8	0.735
	Elevated total cholesterol (> 176.75 mmol•L⁻¹)	10.4	63.2	0.416	7.8	12.0	0.912
	Elevated HDL-C (> 61 mmol•L⁻¹)	11.1	16.7	0.782	9.0	8.4	0.109
	Elevated LDL-C (> 104 mmol•L⁻¹)	9.7	14.6	0.801	7.2	12.0	0.892
	Elevated triglycérides (> 81.75 mmol•L⁻¹)	8.3	19.4	0.209	5.4	11.4	0.445
	Elevated SAP (> 117 mmHg)	9.0	18.8	0.383	7.2	15.7	0.314
	Elevated DAP (> 70 mmHg)	9.0	20.1	0.251	9.6	19.9	0.312

Correlations	Females				Males
	Stunted^a a Height-for age z score < −1 and ≥ −2. (n = 35)		Non-stunted^b b Height-for age z score ≥ −1. (n = 67)		Stunted^a a Height-for age z score < −1 and ≥ −2. (n = 36)		Non-stunted^b b Height-for age z score ≥ −1. (n = 68)
	Spearman test (r)	p-value	Spearman test (r)	p-value	Spearman test (r)	p-value	Spearman test (r)	p-value
Insulin^c c Insulin (pmol • L−1). x WC	0.507	0.002	0.684	< 0.001	0.565	< 0.001	0.602	< 0.001
Glucose^d d Glucose (mg • L−1). x WC	0.375	0.027	0.262	0.032	0.270	0.111	0.289	0.017
Total cholesterol x WC	0.024	0.890	0.133	0.282	0.154	0.371	0.057	0.647
HDL-C^e e HDL-C, high-density lipoprotein cholesterol (mg • dL−1). x WC	0.045	0.797	0.266	0.030	0.388	0.019	0.155	0.208
LDL-C^f f LDL-C, low-density lipoprotein cholesterol (mg • dL−1). x WC	0.014	0.935	0.028	0.824	0.084	0.624	0.122	0.322
Triglycerides^g g Triglycerides (mg • dL−1). x WC	0.060	0.733	0.401	0.001	0.401	0.015	0.169	0.167
SAP^h h SAP, systolic arterial pressure (mmHg). x WC	0.212	0.207	0.101	0.390	0.418	0.008	0.231	0.049
DAPⁱ i DAP, diastolic arterial pressure (mmHg). x WC	0.388	0.018	0.287	0.013	0.532	< 0.001	0.450	< 0.001

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[1] * Corresponding author. E-mail: anagrotticlemente@gmail.com (A.P.G. Clemente).