Abdominal obesity in prepubertal children

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Excess fat in the abdominal region, which can be clinically demonstrated by increased waist circumference, has been associated with the metabolic syndrome and increased risk of cardiovascular disease and type 2 diabetes. However, overall adiposity is also associated with these abnormalities. It has not been completely clear, especially in children, whether the development of abdominal fat is associated with higher risk, what metabolic factors are associated with increased abdominal mass, and whether there are important developmental aspects to the increase in abdominal fat.

In this issue of The Journal, Barat et al report on a study of prepubertal French children. They found that after adjusting for total body fat mass, truncal fat was associated with fasting insulin levels. Truncal fat was also associated with morning plasma cortisol and, in girls, was negatively associated with the rise of cortisol after a standard meal. These cross-sectional results suggest that the hypothalamic-pituitary-adrenocortical axis may be involved in factors associated with the metabolic syndrome. This deserves future study with a longitudinal approach to better sort out the timing of these relationships and with the timing of puberty.