Original article
Large Waist but Low Body Mass Index: The Metabolic Syndrome in Australian Aboriginal Children

https://doi.org/10.1016/j.jpeds.2008.02.006Get rights and content

Objective

To describe the prevalence and clinical characteristics of the metabolic syndrome (MetS) in a cohort of Australian Aboriginal children.

Study design

Body mass index (BMI), waist circumference, skin fold thickness, body fat percentage, insulin resistance, and the prevalence of MetS were evaluated in 486 children age 9 to 14 years from the Darwin Health Region, Northern Territory, Australia.

Results

Using an age- and sex- specific definition, 14% of the children in the cohort had MetS, 6.4% were overweight, 4.9% were obese, and 26.2% had an elevated waist circumference. The mean percentage of body fat was 30.2%. The children with MetS had higher BMI and waist z-scores, percent body fat, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score, and skin fold thickness compared with those without MetS (P < .001); however, >50% of those with MetS were neither overweight nor obese. Waist circumference was significantly associated with insulin resistance as measured by the HOMA-IR (P < .001).

Conclusions

MetS is common in our cohort despite low rates of overweight and obesity. A tendency for central adiposity is already evident in these young children. Measurement of waist circumference may help identify Aboriginal children at high risk for MetS.

Section snippets

Methods

The recruitment and follow-up of this Aboriginal Birth Cohort has been described in detail presviously.15 In brief, 686 of 1238 Aboriginal children born at the Royal Darwin Hospital between January 1987 and March 1990 were recruited into the cohort. There were no significant differences in the mean birth weight, birth weight frequencies, or sex ratio between those recruited and not recruited.15 The Royal Darwin Hospital is the designated hospital for routine newborn deliveries within the Darwin

Results

A total of 489 of the original cohort of 570 from the Darwin Health Region (86%) were seen in follow-up examination. The remaining children were either not traced or not available for reexamination at the time of follow-up. Demographic, clinical, and metabolic characteristics of the cohort participants are given in Table I. The cohort's mean age was 11.5 years (range, 8.8 to 13.8 years), and it was 52% male. Fasting lipid profile and insulin and glucose levels were available for 258

Discussion

We found a high rate of MetS (14%) in our cohort of Australian Aboriginal children. This finding is unexpected in view of the relative underweight nature of this cohort, as indicated by a mean BMI z-score <0. The prevalence of overweight (6.4%) and obesity (4.9%) also was low in this cohort. This contrasts with an estimated prevalence of 4% for MetS and 15% for obesity in US adolescents using the same definitions as we used in the present study.12

Some 70% of the cohort participants had at least

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    Supported by the National Health and Medical Research Council of Australia, the Colonial Foundation Trust and the Channel 7 Research Foundation of SA Inc.

    The authors have no conflicts of interest to declare.

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