Mayo Clinic Proceedings Home

Regional Adipose Compartments Confer Different Cardiometabolic Risk in Children and Adolescents:

The China Child and Adolescent Cardiovascular Health Study



      To investigate the associations of fat mass in specific regions with cardiometabolic risk factors in Chinese children and adolescents.

      Patients and Methods

      This cross-sectional study consisted of 8460 children and adolescents aged 6 to 18 years from Chinese urban areas who underwent dual-energy x-ray absorptiometry for regional fat masses and had cardiometabolic risk factors measured between January 1, 2013, and December 31, 2015.


      In the multivariate model containing arm fat mass, leg fat mass, and trunk fat mass, after adjustment for region, family income, age, puberty development, physical activity, and smoking, higher trunk fat mass was independently associated with greater odds of clustered cardiometabolic risk (odds ratio [OR], 2.21; 95% CI, 1.80-2.72), higher leg fat mass was associated with lower odds of clustered risk (OR, 0.72; 95% CI, 0.59-0.87), and arm fat mass was not significantly associated with clustered risk (OR, 1.22; 95% CI, 0.97-1.55). In the multivariate model including android fat mass, gynoid fat mass, and other covariates, higher android fat mass was positively associated with clustered risk (OR, 2.23; 95% CI, 1.88-2.64), but gynoid fat mass was not associated with clustered risk (OR, 0.86; 95% CI, 0.72-1.03). Analyses for individual risk factors demonstrated similar results.


      Fat stored in different regions has differential influences on cardiometabolic risk in youth. Prospective studies are warranted to evaluate the long-term impacts of regional fat masses in childhood on cardiovascular risk in adulthood.

      Abbreviations and Acronyms:

      BMI (body mass index), BP (blood pressure), DXA (dual-energy x-ray absorptiometry), HDL-C (high-density lipid cholesterol), LDL-C (low-density lipid cholesterol), OR (odds ratio), TC (total cholesterol), TG (triglycerides)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ng M.
        • Fleming T.
        • Robinson M.
        • et al.
        Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2014; 384: 766-781
        • Liang Y.J.
        • Xi B.
        • Song A.Q.
        • Liu J.X.
        • Mi J.
        Trends in general and abdominal obesity among Chinese children and adolescents 1993-2009.
        Pediatr Obes. 2012; 7: 355-364
        • Singhal V.
        • Schwenk W.F.
        • Kumar S.
        Evaluation and management of childhood and adolescent obesity.
        Mayo Clin Proc. 2007; 82: 1258-1264
        • Twig G.
        • Yaniv G.
        • Levine H.
        • et al.
        Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood.
        N Engl J Med. 2016; 374: 2430-2440
        • Llewellyn A.
        • Simmonds M.
        • Owen C.G.
        • Woolacott N.
        Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis.
        Obes Rev. 2016; 17: 56-67
        • Juonala M.
        • Magnussen C.G.
        • Berenson G.S.
        • et al.
        Childhood adiposity, adult adiposity, and cardiovascular risk factors.
        N Engl J Med. 2011; 365: 1876-1885
        • Grossman D.C.
        • Bibbins-Domingo K.
        • Curry S.J.
        • et al.
        • US Preventive Services Task Force
        Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2017; 317: 2417-2426
        • Kumar S.
        • Kelly A.S.
        Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment.
        Mayo Clin Proc. 2017; 92: 251-265
        • Wildman R.P.
        • Muntner P.
        • Reynolds K.
        • et al.
        The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004).
        Arch Intern Med. 2008; 168: 1617-1624
        • Katzmarzyk P.T.
        • Shen W.
        • Baxter-Jones A.
        • et al.
        Adiposity in children and adolescents: correlates and clinical consequences of fat stored in specific body depots.
        Pediatr Obes. 2012; 7: e42-e61
        • Maffeis C.
        • Pietrobelli A.
        • Grezzani A.
        • Provera S.
        • Tatò L.
        Waist circumference and cardiovascular risk factors in prepubertal children.
        Obes Res. 2001; 9: 179-187
        • Savva S.C.
        • Tornaritis M.
        • Savva M.E.
        • et al.
        Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index.
        Int J Obes Relat Metab Disord. 2000; 24: 1453-1458
        • Freedman D.S.
        • Serdula M.K.
        • Srinivasan S.R.
        • Berenson G.S.
        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
        • Furtado J.M.
        • Almeida S.M.
        • Mascarenhas P.
        • et al.
        Anthropometric features as predictors of atherogenic dyslipidemia and cardiovascular risk in a large population of school-aged children.
        PLoS One. 2018; 13: e0197922
        • Pritchard J.E.
        • Nowson C.A.
        • Strauss B.J.
        • Carlson J.S.
        • Kaymakci B.
        • Wark J.D.
        Evaluation of dual energy X-ray absorptiometry as a method of measurement of body fat.
        Eur J Clin Nutr. 1993; 47: 216-228
        • Daniels S.R.
        • Morrison J.A.
        • Sprecher D.L.
        • Khoury P.
        • Kimball T.R.
        Association of body fat distribution and cardiovascular risk factors in children and adolescents.
        Circulation. 1999; 99: 541-545
        • Teixeira P.J.
        • Sardinha L.B.
        • Going S.B.
        • Lohman T.G.
        Total and regional fat and serum cardiovascular disease risk factors in lean and obese children and adolescents.
        Obes Res. 2001; 9: 432-442
        • Staiano A.E.
        • Gupta A.K.
        • Katzmarzyk P.T.
        Cardiometabolic risk factors and fat distribution in children and adolescents.
        J Pediatr. 2014; 164: 560-565
        • Samsell L.
        • Regier M.
        • Walton C.
        • Cottrell L.
        Importance of android/gynoid fat ratio in predicting metabolic and cardiovascular disease risk in normal weight as well as overweight and obese children.
        J Obes. 2014; 2014: 846578
        • Samouda H.
        • De Beaufort C.
        • Stranges S.
        • et al.
        Cardiometabolic risk: leg fat is protective during childhood.
        Pediatr Diabetes. 2016; 17: 300-308
        • Hetherington-Rauth M.
        • Bea J.W.
        • Lee V.R.
        • et al.
        Relationship between fat distribution and cardiometabolic risk in Hispanic girls.
        Am J Hum Biol. 2018; 30: e23149
        • Yan Y.
        • Liu J.
        • Zhao H.
        • et al.
        • China Child and Adolescent Cardiovascular Health (CCACH) collaboration group
        Cardiovascular health in urban Chinese children and adolescents.
        Ann Med. 2019; 51: 88-96
        • Chen F.
        • Liu J.
        • Yan Y.
        • Mi J.
        • China Child and Adolescent Cardiovascular Health (CCACH) Study Group
        Abnormal metabolic phenotypes among urban Chinese children: epidemiology and the impact of DXA-measured body composition.
        Obesity (Silver Spring). 2019; 27: 837-844
        • Ji C.Y.
        • Working Group on Obesity in China
        Report on childhood obesity in China (1)–body mass index reference for screening overweight and obesity in Chinese school-age children.
        Biomed Environ Sci. 2005; 18: 390-400
      1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
        Pediatrics. 2004; 114: 555-576
        • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents
        National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        Pediatrics. 2011; 128: S213-S256
        • Fox C.S.
        • Massaro J.M.
        • Hoffmann U.
        • et al.
        Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study.
        Circulation. 2007; 116: 39-48
        • Abraham T.M.
        • Pedley A.
        • Massaro J.M.
        • Hoffmann U.
        • Fox C.S.
        Association between visceral and subcutaneous adipose depots and incident cardiovascular disease risk factors.
        Circulation. 2015; 132: 1639-1647
        • Pou K.M.
        • Massaro J.M.
        • Hoffmann U.
        • et al.
        Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study.
        Circulation. 2007; 116: 1234-1241
        • Sánchez-López M.
        • Ortega F.B.
        • Moya-Martínez P.
        • et al.
        Leg fat might be more protective than arm fat in relation to lipid profile.
        Eur J Nutr. 2013; 52: 489-495
        • Hu G.
        • Bouchard C.
        • Bray G.A.
        • et al.
        Trunk versus extremity adiposity and cardiometabolic risk factors in white and African American adults.
        Diabetes Care. 2011; 34: 1415-1418
        • Mittelman S.D.
        • Van Citters G.W.
        • Kirkman E.L.
        • Bergman R.N.
        Extreme insulin resistance of the central adipose depot in vivo.
        Diabetes. 2002; 51: 755-761
        • Tsigos C.
        • Kyrou I.
        • Chala E.
        • et al.
        Circulating tumor necrosis factor alpha concentrations are higher in abdominal versus peripheral obesity.
        Metabolism. 1999; 48: 1332-1335
        • Després J.P.
        • Lemieux I.
        Abdominal obesity and metabolic syndrome.
        Nature. 2006; 444: 881-887
        • Mauriège P.
        • Marette A.
        • Atgié C.
        • et al.
        Regional variation in adipose tissue metabolism of severely obese premenopausal women.
        J Lipid Res. 1995; 36: 672-684
        • Rebuffé-Scrive M.
        • Enk L.
        • Crona N.
        • et al.
        Fat cell metabolism in different regions in women. Effect of menstrual cycle, pregnancy, and lactation.
        J Clin Invest. 1985; 75: 1973-1976
        • Snijder M.B.
        • van Dam R.M.
        • Visser M.
        • Seidell J.C.
        What aspects of body fat are particularly hazardous and how do we measure them.
        Int J Epidemiol. 2006; 35: 83-92
        • Lemieux I.
        Energy partitioning in gluteal-femoral fat: does the metabolic fate of triglycerides affect coronary heart disease risk.
        Arterioscler Thromb Vasc Biol. 2004; 24: 795-797
        • Manolopoulos K.N.
        • Karpe F.
        • Frayn K.N.
        Gluteofemoral body fat as a determinant of metabolic health.
        Int J Obes (Lond). 2010; 34: 949-959

      Linked Article

      • Adiposity and Cardiovascular Risk in Children and Adolescents: Implications of the Amount of Fat Carried and Where
        Mayo Clinic ProceedingsVol. 94Issue 10
        • Preview
          Obesity has reached the pandemic level. It has dramatically increased over recent decades and is now one of the most important public health problems facing both urban and rural areas.1 Among youths, the worldwide prevalence of overweight and obesity has risen by 47.1% since 1980.2 Pediatric obesity is associated with comorbidities affecting the cardiovascular (CV), pulmonary, endocrine, gastrointestinal, and musculoskeletal systems,3 and it seems to be the predominant cause of conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, insulin resistance, inflammation, and steatohepatitis.
        • Full-Text
        • PDF