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Julien Aucouturier, MSc; Martine Meyer, MD; David Thivel, MSc; Michel Taillardat, MD; Pascale Duché, PhD

Arch Pediatr Adolesc Med. 2009;163(9):826-831.

Background  Upper body fat distribution is associated with the early development of insulin resistance in obese children and adolescents.

Objective:  To determine if an android to gynoid fat ratio is associated with the severity of insulin resistance in obese children and adolescents, whereas peripheral subcutaneous fat may have a protective effect against insulin resistance.

Setting  The pediatric department of University Hospital, Clermont-Ferrand, France.

Design  A retrospective analysis using data from medical consultations between January 2005 and January 2007.

Participants  Data from 66 obese children and adolescents coming to the hospital for medical consultation were used in this study.

Main Outcome Measures  Subjects were stratified into tertiles of android to gynoid fat ratio determined by dual-energy x-ray absorptiometry. Insulin resistance was assessed by the homeostasis model of insulin resistance (HOMA-IR) index.

Results  There were no differences in weight, body mass index, and body fat percentage between tertiles. Values of HOMA-IR were significantly increased in the 2 higher tertiles (mean [SD], tertile 2, 2.73 [1.41]; tertile 3, 2.89 [1.28]) compared with the lower tertile (tertile 1, 1.67 [1.24]) of android to gynoid fat ratio (P < .001). The HOMA-IR value was significantly associated with android to gynoid fat ratio (r = 0.35; P < .01).

Conclusions  Android fat distribution is associated with an increased insulin resistance in obese children and adolescents. An android to gynoid fat ratio based on dual-energy x-ray absorptiometry measurements is a useful and simple technique to assess distribution of body fat associated with an increased risk of insulin resistance.

Author Affiliations: Laboratory of Exercise Biology (BAPS), Blaise Pascal University, Aubière (Drs Aucouturier, Thivel, and Duché), Department of Pediatrics, Hotel Dieu, University Hospital, Clermont-Ferrand (Dr Meyer), and Children's Medical Center, Romagnat (Dr Taillardat), France.

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