Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2018; 7(1): 43-48
Published online Feb 8, 2018. doi: 10.5409/wjcp.v7.i1.43
Abdominal obesity adversely affects bone mass in children
Sowmya Krishnan, Michael P Anderson, David A Fields, Madhusmita Misra
Sowmya Krishnan, David A Fields, Department of Pediatrics, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, Oklahoma City, OK 73104, United States
Michael P Anderson, College of Public Health, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, United States
Madhusmita Misra, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA 02114, United States
Author contributions: Krishnan S collected data; Anderson MP helped in statistical analysis; Fields DA and Misra M helped in writing the paper.
Supported by Novo-Nordisk, No. C7042301.
Institutional review board statement: The study has been approved by the University of Oklahoma Health sciences Center Institutional review board research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 declaration of Helsinki and its later amendments.
Informed consent statement: All study participants or their legal guardians provided informed consent prior to enrollment in the study.
Conflict-of-interest statement: David A Fields has received grant funding from Nestle and Mead Johnson.
Data sharing statement: Consent was not obtained from participants for sharing data but presented data is anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sowmya Krishnan, MD, Associate Professor, Department of Pediatrics, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, 1200, N Children’s Avenue, Suite 4500, Oklahoma City, OK 73104, United States.
Telephone: +1-405-2718000-43091 Fax: +1-405-2713093
Received: August 25, 2017
Peer-review started: September 17, 2017
First decision: October 23, 2017
Revised: November 8, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: February 8, 2018
Research background

Adult onset osteoporosis has its antecedent in childhood. With the rise in obesity epidemic, the effect of childhood obesity on bone health needs to be delineated. Historically in adults, higher body mass index (BMI) was believed to be bone protective with increased bone mineral density reported with higher BMI. Further studies have revealed this to be proportional to total lean mass rather than total fat mass. However, the relative distribution of fat in the body may also play a role, and visceral adiposity in particular has been demonstrated to have an adverse impact on bone. Visceral adiposity is directly associated with insulin resistance, and the link between obesity and bone health may be mediated by the underlying insulin resistance. Insulin is a bone anabolic hormone and higher insulin levels may result in increased bone formation. However, a state of insulin resistance may negate the beneficial effects of insulin on bone. This in fact has been suggested in recent studies in adults. However, data in children remain inconclusive.

Research motivation

The main motivation for this research study was to understand the effect of body composition and insulin resistance on bone health in children.

Research methods

The study showed that percent trunk fat was associated inversely with whole body bone mineral content (BMC), whereas homeostatic model of insulin resistance was associated positively with whole body BMC.

Research results

These results suggest that abdominal adiposity may have an adverse effect on whole body bone parameters and that this effect is not mediated by insulin resistance.

Research perspectives

Future research should look at other possible connection between adipose tissue and bone health.