REVISTA PAULISTA DE PEDIATRIA

Transcription

1 Rev Pul Peitr. 2015;33(1):63 71 REVISTA PAULISTA DE PEDIATRIA ORIGINAL ARTICLE Mesurements of oy ft istriution: ssessment of ollinerity with oy mss, iposity n height in femle olesents Ptríi Feliino Pereir*, Hir Miguel Stniol Serrno, Gisele Queiroz Crvlho, Sôni Mho Roh Rieiro, Mri o Crmo Gouvei Peluzio, Sylvi o Crmo Cstro Frneshini, Silvi Eloiz Priore Universie Feerl e Viços (UFV), Viços, MG, Brzil Reeive 15 April 2014; epte 10 July 2014 KEYWORDS Oesity; Aolesents; Boy ft istriution; Anthropometry Astrt Ojetive: To verify the orreltion etween oy ft lotion mesurements with the oy mss inex (BMI), oy ft perentge (BF%) n height, oring to the nutritionl sttus in femle olesents. Methos: A ontrolle ross-setionl stuy ws rrie out with 113 olesents (G1: 38 with norml weight, ut with high oy ft level, G2: 40 with norml weight n G3: 35 overweight) from puli shools in Viços-MG, Brzil. The following mesures were ssesse: weight, height, wist irumferene (WC), umilil irumferene (UC), hip irumferene (HC), thigh irumferene, wist-to-hip rtio (WHR), wist-to-height rtio (WHtR), wist-to-thigh rtio (WTR), oniity inex (CI), sgittl ominl imeter (SAD), oronl imeter (CD), entrl (CS) n peripherl skinfols (PS). The BF% ws ssesse y tetrpolr eletri ioimpene. Results: The inrese in entrl ft, represente y WC, UC, WHtR, SAD, CD n CS, n the inrese in peripherl ft inite y HC n thigh irumferene were proportionl to the inrese in BMI n BF%. WC n espeilly the UC showe the strongest orreltions with iposity. Wek orreltion etween WHR, WTR, CI n CS/PS with iposity were oserve. The height showe orreltion with lmost ll the ft lotion mesures, eing fir or wek with wist mesurements. Conlusions: The results inite olinerity etween oy mss n totl iposity with entrl n peripherl ipose tissue. We reommen the use of UC for ssessing nu- *Corresponing uthor. E-mil: pfeliinopereir@gmil.om (P.F. Pereir). DOI of refers to rtile: / 2014 Soiee e Peitri e São Pulo. Pulishe y Elsevier Eitor Lt. All rights reserve.

2 64 Feliino Pereir P et l tritionl sttus of olesents, s it showe the highest pity to preit iposity in eh group, n lso showe fir or wek orreltion with height Soiee e Peitri e São Pulo. Pulishe y Elsevier Eitor Lt. All rights reserve. PALAVRAS-CHAVE Oesie; Aolesentes; Distriuição e gorur orporl; Antropometri Meis e lolizção gorur orporl: um vlição olinerie om mss orporl, iposie e esttur em olesentes o sexo feminino Resumo Ojetivo: Verifir orrelção entre meis e lolizção gorur orporl om ínie e mss orporl (IMC), perentul e gorur orporl (%GC) e esttur, e oro om o esto nutriionl em olesentes o sexo feminino. Métoos: Relizou-se estuo trnsversl ontrolo, om 113 olesentes (G1: 38 eutrófis ms om gorur orporl elev; G2: 40 eutrófis e G3: 35 om exesso e peso), e nos, e esols púlis e Viços-MG. Aferiu-se peso, esttur, irunferêni intur (CC), irunferêni umilil (CUm), irunferêni o quril (CQ), irunferêni ox, relção intur/quril (RCQ), relção intur/esttur (RCE), relção intur/ox (RCC), ínie e oniie (IC), iâmetro ominl sgitl (DAS), iâmetro oronl (DC), pregs utânes entris (PCC) e periféris (PCP). Avliou-se o %GC por ioimpeâni elétri tetrpolr. Resultos: O umento gorur entrl, represent pel CC, CUm, RCE, DAS, DC e PCC, e o umento gorur periféri inio pel CQ e ox form proporionis o umento o IMC e %GC. A CC e priniplmente CUm presentrm s orrelções mis fortes om iposie, enqunto RCQ, RCC, IC e PCC/PCP s mis frs. A esttur presentou orrelção om prtimente tos s meis e lolizção e gorur, seno e fr regulr om s meis intur. Conlusões: Os resultos inim olinerie entre mss orporl e iposie totl om teio iposo entrl e perifério. Reomen-se o emprego CUm n vlição o esto nutriionl e olesentes, pois el presentou mior pie pr preizer iposie em grupo, lém e orrelção fr regulr om esttur Soiee e Peitri e São Pulo. Pulio por Elsevier Eitor Lt. Toos os ireitos reservos. Introution Aolesene strts with the oily hnges of puerty, eing perio of mjor psyhosoil n physil hnges. Among these, it is worth mentioning the intense growth tht interferes with the umultion n istriution of oy ft. 1,2 Clinil n epiemiologil stuies hve estlishe tht oy ft istriution is relte to riovsulr risk ftors in ults 3,4 n lso in hilren n olesents. 5,6 The use of vli mesures when ssessing oy omposition n the ft istriution pttern is require in popultion stuies n linil prtie to ttin n erly ientifition of iniviuls t risk of eveloping iseses, n to help in the prevention/tretment of oesity. 7 Boy ft istriution n e ssesse y ifferent methos, suh s ompute tomogrphy (CT) n mgneti resonne imging (MRI), equipment whih re more preise n iretly mesure the mount of viserl ft; however, they re high-ost methos tht require extensive trining of evlutors, n itionlly, CT involves rition exposure. 7 Dul-energy X-ry sorptiometry (DXA) s well s nthropometry n ioeletril impene nlysis (BIA) oes not ifferentite etween suutneous n viserl ft. BIA, lthough not the most urte metho for ssessing oy omposition, is fst n onvenient metho for use in fiel stuies. 8,9 Anthropometri mesurements inlue oy irumferenes, skinfol thikness n some imeters, whih hve the vntge of eing reltively simple, inexpensive n non-invsive, n hve goo performne in the preition of viserl ft n riovsulr risk. 10,11 Severl nthropometri mesurements of oy ft hve een use in hilren n olesents, lthough the est mesure for the peitri popultion is yet to e efine. 2,5,6,12 It is unler whether the inrese in iposity in hilren n olesents is relte to the inrese in intr-ominl ft. 13 Thus, the present stuy ime to investigte the orreltion etween peripherl n entrl ft mesurements propose in the literture with BMI, oy ft perentge n height, oring to the nutritionl sttus of olesent girls. Methos We performe ross-setionl stuy with 113 femle olesents, ge 14 to 19 yers, from puli shools in the ity of Viços MG. A sreening ws rrie out in shools to selet the prtiipnts, using the mesures of height n weight to etermine BMI, s well s mesures of oy ft

3 Mesurements of oy ft istriution 65 perentge (BF %) y BIA (Tnit, Moel 2220, Illinois, USA). The olesents were lso ske whether they h h menrhe, n its te of ourrene. Mesurements were otine iniviully in room or re estlishe for tht purpose insie the shools. Aolesents tht met the riteri were invite for seon evlution rrie out y the Setion of Nutrition of the Division of Helth of Universie Feerl e Viços (UFV), where nthropometri n oy omposition mesures were ollete. The finl smple onsiste of 38 norml weight olesents (BMI perentile etween 5 n 85) 14 ut with high oy ft perentge (>28%) (G1-Stuy group), 40 olesents with norml weight oring to BMI n norml ft perentge (20-25%) (G2-ontrol group), n 35 with overweight risk/overweight lssifie oring to the Center for Disese Control n Prevention (CDC) urves (BMI perentile 85) 14 n high oy ft perentge (>28 %) (G3-ontrol group). The teengers inlue in the stuy reporte the ourrene of menrhe for t lest 1 yer, whih orrespons to greter hne of hving overome the most intense perio of physil trnsformtions inherent to puerty. 15 Smple size lultion ws rrie out with Epi Info 6.04 (CDC, Epi Info 6, Atlnt, USA) for ross-setionl stuies, onsiering popultion of the muniiplity of 4,507 iniviuls 16 in the ge rnge n gener of the stuy, prevlene of exess oy ft estimte t 25%, 15 10% vriility n 95% onfiene intervl, resulting in minimum smple size of 35 sujets for eh group. This stuy ws pprove y the Reserh Ethis Committee for Humn Sujets t UFV. Prtiiption ws voluntry fter verl explntion, n fter the free n informe onsent form ws signe y the olesents n their prents n/or gurins. Weight ws mesure in n eletroni igitl sle with pity of 150 kg n preision of 50g. Height ws mesure using stiometer with length of 2.00m, ivie into entimeters n suivie in millimeters. All mesurements followe the tehniques propose y Cllwy. 17 The BMI ws lulte s the rtio etween totl oy weight (kg) n height (m 2 ). The perentge of oy ft ws ssesse y tetrpolr eletril ioimpene nlysis (Bioynmis, moel 310, version 7.1, Wshington, USA). The ssessment ws rrie out etween 7:00 m n 8:30 m, fter 12-hour fsting n following the speifi protool for this type of evlution. 18 Wist irumferene ws mesure t two lotions: smllest ominl irumferene (wist irumferene) n t the umilius (umilil irumferene), uner the lothes n t the en of norml expirtion, using flexile n inelsti mesuring tpe. 17 The hip ws mesure t the gretest irumferene of the glutel region, 17 over light lothing. Thigh irumferene ws mesure 3 m ove the ptell on the left sie of the oy in iniviuls whose right hn ws ominnt, n on the right sie of the oy in those whose left hn ws ominnt. 19 Mesurements were tken twie, n the men vlue ws use in the nlysis. Wist-to-hip rtio (WHR) ws lulte using the wist irumferene n hip irumferene mesures; wist-tothigh rtio (WTR) y iviing the umilil irumferene y thigh irumferene, n wist-to-height rtio (WHtR) through the rtio etween wist irumferene n height. The oniity inex (CI) ws lulte through the following formul: 12 C Inex = Wist irumferene (m) oy weight (kg) height (m) The istne etween the k n the omen (sgittl ominl imeter, SAD), n the istne etween the ili rests (oronl imeter, CD) were mesure with the olesents in the supine position, knees ent on flt, firm surfe, uner the lothes n fter norml expirtion. The mipoint etween the ili rests ws ientifie n then the reing ws performe t the level of the right ili rest, tking re not to ompress the tissues, using metl liper with n extension of 50m, ivie into entimeters n suivie into millimeters (Cesorf, Rio Grne o Sul, Brzil). 11,20 Suspulr, suprili, trieps n ieps skinfols were ssesse on the right sie of the oy, n ll mesurements were tken y single evlutor. Eh mesurement ws verifie three times, non-onseutively (using the men vlue), with Lnge Skinfol Cliper. 21 The mesurement ws repete in se of ivergene >10% etween the three vlues. Peripherl skinfol (PSF) onsiste of the sum of trieps n ieps fols, n entrl skinfol (CSF), of the sum of the suspulr n suprili fols, from whih we lulte the CSF/PSF rtio. 22 For the sttistil nlysis, the istriution of vriles ws verifie through the Kolmogorov-Smirnov test. Explortory nlysis of t ws rrie out y mesures of entrl teneny n ispersion. Susequently, the Mnn- Whitney test n/or Stuent s t test were use to ientify sttistil ifferenes in stuy vriles etween the three groups of nutritionl sttus, oring to vrile istriution. Person s n Spermn s orreltion ws performe etween nthropometri vriles n oy omposition with mesures of ft istriution, oring to the normlity of the vriles. The qulittive ssessment of the egree of orreltion etween the vriles followe the Cllegri-Jques riteri 23 (null orreltion: r=0; wek: 0-0.3; fir: , strong: , very strong: 0.9-1). Anlyses were performe using Sigm-sttisti 2.0 n STATA softwre, version 11.0 (SttCorp LP, Texs, USA). The sttistil signifine ws set t p<0.05. Results The hrteristis of the stuy popultion re shown in Tle 1. Men ge n height i not iffer etween the groups, refleting homogeneity etween them. The vriles weight, BMI, BF%, wist irumferene (WC), umilil irumferene (UC), hip, thigh, WHtR, SAD, CD, WTR n PSF in group G1 were signifintly higher thn in G2, n lower thn in G3 (p<0.001). WHR n WTR i not iffer etween G1 n G2. No sttistilly signifint ifferenes were oserve etween G1 n G3 regring WTR, CI, n CSF/PSF rtio. Tle 2 shows the orreltion oeffiient etween the nthropometri n oy omposition vriles in the totl

4 66 Feliino Pereir P et l Tle 1 Age, nthropometry n oy omposition of the olesents. Group 1 (n=38) Group 2 (n=40) Group 3 (n=35) Men ± SD Mein (rnge) Men ± SD Mein (rnge) Men ± SD Mein (rnge) Age (yers) 15.9 (1.3) 15.6 ( ) 15.9 (1.3) 15.8 (14-18) 15.7 (1.1) 15.4 ( ) Weight (kg) 57.7 (6.3) 57. ( ) 51.2 (6.0) ( ) 70. (12.7) 67.5 ( ). Height (m) 1.62 (0.06) 1.62 ( ) 1.61 (0.07) 1.61 ( ) 1.6 (0.06) 1.59 ( ) BMI (kg/m 2 ) 21.9 (1.75) 21.7 ( ) 19.7 (1.5) 19.4 ( ) (4.03) 25.9 ( ). BF% 30.6 (1.8) 30.2 ( ) 22.7 (1.3) 22.9 ( ) (3.3) 32.6 ( ). WC (m) 70.9 (7.9) 69.6 ( ) 65.2 (3.1) 64.7 ( ) (7.8) 76.8 ( ). UmC (m) 79.1 (5.5) 78.9 ( ) 72.3 (4.3) 72.3 ( ) (9.4) 88.0 ( ). HC (m) 97.8 (5.3) 97.2 ( ) 91.8 (4.8). 91. ( ) (8.0) ( ) Thigh (m) 40.4 (2.7) 40.7 ( ) 37.9 (2.3) ( ) 44.8 (4.1) 44.4 ( ). WHR 0.73 (0.09) 0.72 ( ) 0.71 (0.03) 0.71 ( ) 0.74 (0.05) 0.74 ( ). WHtR 0.44 (0.05) 0.43 ( ) 0.41 (0.02) 0.41 ( ) (0.05) 0.48 ( ). WTR 1.96 (0.13) 1.95 ( ) 1.91 (0.11) 1.91 ( ) 2.00 (0.13) 2.00 ( ) CI 1.07 (0.12) 1.06 ( ) 1.04 (0.03) ( ) 1.08 (0.04) 1.09 ( ) SAD 17.4 (0.9) 17.3 ( ) 15.9 (1.1) ( ) 20. (2.3) 19.7 ( ). CD 30. (1.7) 30.2 ( ) 27.7 (1.6) (25-31) 33.4 (2.7) ( ) CSF 56.5 (12.8) 53.5 ( ) 39.2 (7.6) 38.0 ( ) (13.5) ( ) PSF 38.5 (6.5) 38.5 ( ) 30.8 (5.4) 30.0 ( ) (9.9) ( ) CSF/PSF 1.47 (0.26) 1.43 ( ) 1.28 (0.19) ( ) 1.48 (0.21) 1.50 ( ) BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. Stuent s t Test n Mnn-Whitney Test. Differene etween G1 n G2. Differene etween G1 n G3. p<0.05. Tle 2 Coeffiient of orreltion etween mesures of ft istriution with totl oy mss, oy ft perentge n height in the totl popultion (n=113). Vriles Mesures of ft istriution WC UmC HC Thigh WHR WHtR WTR CI SAD CD CSF PSF CSF/PSF BMI BF% Height BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. Person s orreltion test. Spermn s orreltion test. p<0.01.

5 Mesurements of oy ft istriution 67 Tle 3 Coeffiient of orreltion etween mesures of ft istriution with totl oy mss, oy ft perentge n height in norml weight olesents with high oy ft (G1) (n=38). Vriles Mesures of ft istriution WC UmC HC Thigh WHR WHtR WTR CI SAD CD CSF PSF CSF/PSF BMI 0.69,e 0.63,e 0.78,e 0.78,e ,e , 0.59,e 0.51, 0.61,e 0.19 BF% Height , , BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. Person s orreltion test. Spermn s orreltion test. p<0.05. p<0.01. e Tle 4 Coeffiient of orreltion etween mesures of ft istriution with totl oy mss, oy ft perentge n height in olesents with norml weight (G2) (n = 40). Vriles Mesures of ft istriution WC UmC HC Thigh WHR WHtR WTR CI SAD CD CSF PSF CSF/PSF BMI BF% Height e BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. Person s orreltion test. Spermn s orreltion test. p<0.05. p<0.01. e Tle 5 Coeffiient of orreltion etween mesures of ft istriution with totl oy mss, oy ft perentge n height in olesents with exess weight (G3) (n = 35). Vriles Mesures of ft istriution WC UmC HC Thigh WHR WHtR WTR CI SAD CD CSF PSF CSF/PSF BMI 0.83.e 0.87.e 0.75.e 0.65.e e e 0.76.e 0.62.e BF% e 0.55.e e Height BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. Person s orreltion test. Spermn s orreltion test. p<0.05. p<0.01. e

6 68 Feliino Pereir P et l Tle 6 Multiple liner regression nlysis etween the mesurements of oy ft istriution n BF%, juste for ge n nutritionl sttus. Explntory vriles Coeffiients of the inepenent vriles () p R 2 WC UmC HC Thigh WHR WHtR WTR CI SAD CD CSF PSF CSF/PSF BMI, oy mss inex; BF%, oy ft perentge; WC, wist irumferene; UmC, umilil irumferene; HC, hip irumferene; WHR, wist/hip rtio; WHtR, wist/height rtio; WTR, wist/thigh rtio; CI, oniity inex; SAD, sgittl ominl imeter; CD, oronl imeter; CSF, entrl skinfols; PSF, peripherl skinfols; CSF/PSF, entrl/peripherl skin fols. popultion. BMI n BF% were strongly orrelte with mesures of istriution of oy ft, exept WHR, WTR, CI n CSF/PSF. For these, the orreltions were wek to fir. The strongest orreltions were foun etween BMI n WC (r = 0.90, p<0.001) n etween BF% n UC (r=0.76, p<0.001). Height showe positive sttistilly signifint orreltion (lthough wek) with HC n negtive one with WHtR. Tle 3 shows the orreltion oeffiient in the group of olesents with norml weight ut with exess oy ft. BMI showe signifint orreltion with WC, UC, HC, WHtR, SAD, CD, CSF n PSF. The BF% ws not orrelte with ny mesure of ft istriution, wheres height ws orrelte, ut t fir egree, with HC n WHtR. In olesents with norml weight n equte oy ft ontent, BMI showe sttistilly signifint fir to strong orreltion with virtully ll mesures of ft istriution, exept WHR, WTR, IC n PSF. The BF% showe fir orreltion with WC, UC, HC, thigh n SAD. As for the mesures of ft istriution n height, they showe fir orreltion with WC, UC, HC, SAD, CD n WHtR. The orreltion with WHtR ws negtive one (r= 0.44) (Tle 4). Tle 5 shows the orreltion oeffiients mong olesents t risk for overweight/overweight. BMI orrelte with ll mesures of ft istriution, exept WTR n CSF/ PSF. The BF%, in turn, orrelte with ll mesures of ft istriution, exept WHR, CI, SAD, CD n CSF/PSF. Height showe positive orreltion with UC, HC, thigh n SAD. Consiering the totl smple n the nlysis per group, the WC n UC showe the strongest orreltions with BMI n BF%, in ition to showing wek to fir ssoition with height in the totl smple n in eh group. In multiple liner regression nlysis etween eh mesure of ft istriution n BF% (epenent vrile), fter justment for ge n nutritionl sttus, it ws oserve tht WC, UC, HC, thigh, SAD n CSF showe signifint preitive pity (p<0.05) of BF% (Tle 6). When the moel inlue ll mesures of oy ft, just UC remine s signifint preitor (p=0.038); however, the finl moel inite multiollinerity (VIF: 11.18; if VIF < 4 there is no multiollinerity) (t not shown in tle). Disussion The present stuy investigte the orreltion etween BMI, BF% n height, with mesures of oy ft ontent in femle olesents with ifferent levels of iposity. The results showe tht the inrese in entrl ft, represente y WC, UC, WHtR, SAD, CD n CSF, n in peripherl ft, inite y HC, thigh n PSF ws proportionl to the inrese in BMI n oy ft. Vieir et l. 24 foun signifintly higher men vlues of WC, HC n WHR in norml olesents with high perentge of oy ft when ompre to those with norml ft perentge. Similr to the ovementione stuy, the results inite tht olesents with norml weight n exess oy ft (G1) h higher proportion of entrl ft, represente y the ifferent mesures of ft istriution, ompre to norml weight ones with equte oy ft (G2); i.e., even though the olesents were onsiere s hving norml weight oring to the BMI, they h exess totl oy ft n this ws reflete in the inrese in entrl ft. These results onfirm the limittion of BMI to report on iposity, prtiulrly on n outptient sis, n reinfore the importne of routine evlution of oy ft omposition n istriution in olesents. In the orreltion nlysis, it ws oserve tht the WC, UC, WHtR, SAD, CD, CSF, HC, thigh n PSF mesures were the ones most ssoite with BMI n BF%, n WC n UC h the est performne ompre to the others. In the group nlysis, the lrgest numer of orreltions etween mesures of ft istriution with BMI n BF% ws foun in the group with exess weight n oy ft. A greter proportion of trunk ft with inrese BMI hs een previously emonstrte in hilren n olesents. 12 Regring WC, it hs een previously shown tht it is highly orrelte with BMI (r=0.89, p=0.001) in femle olesents. 25 Jnssen et l. 26 lso foun similr orreltion etween BMI n WC (r=0.92 to 0.94) in stuy with 2,597 hilren n olesents ge 5-18 yers. Consiering the strong orreltion etween the two, it my e inferre tht suh prmeters re virtully ientil, hving no inepenent effet. However, when evluting the linil usefulness of their omine use in tegorize mnner, it ws oserve tht the ovrine etween them is reue, n thus the omine use of BMI n WC woul e etter preitor of helth risk for hilren n olesents. Regring BF%, similr stuy oserve higher orreltion etween WC n BF% (r=0.85, p<0.001) in overweight olesents (12-18 yers) thn the present stuy, when ssesse y ipolr eletril ioimpene, whih my hve ourre ue to possile ifferenes etween ipolr

7 Mesurements of oy ft istriution 69 n tetrpolr moels, in ition to the younger ge rnge evlute in the forementione stuy, whih must hve inlue olesents whose menrhe ourre reently or who h not yet h it, n the ssoitions etween ominl ft n totl oy ft, whih re ltere uring the sexul mturtion proess. 25 Although the WC is roly use mesure, there is vriety of lotions use for its mesurement, 27 n there re no methoologil stnrs, thus mking it iffiult to ompre stuies. This stuy evlute n ompre WC n UC, with lose orreltions of these mesurements eing oserve with BMI n BF%, exept in the group with exess weight, in whih ssoitions with UC were stronger. This my reflet preferentil umultion of ft in the umilil region rther thn in the nturl wist, with the inrese weight n oy ft in olesents. As it is importnt to monitor the growth n evelopment of olesents over time, it is visle to e onsistent n use single ntomil point for mesuring the wist. Consiering tht the multiple liner regression nlysis inite tht the UC ws the min preitor of BF%, even fter justing for ge, nutritionl sttus n y other mesures of ft istriution, we reommen the use of this stnrize ntomil point for wist mesurement. WHR my reflet ifferent spets of oy omposition (ft tissue, musle mss n skeletl struture), n for given vlue, there n e lrge vritions in the level of totl oy ft n viserl ipose tissue. 28 In the present stuy, WHR showe lower orreltion thn the WC to estimte BF%, ut the HC showe similr orreltion to the two ntomil points of wist mesurement. Thus, it n e stte tht in ses where the WC mesurement is extremely iffiult to e otine ue to n exessive umultion of ominl ft, HC oul e goo hoie regring iposity. Oliveir et l 25 foun in femles tht WHR showe weker orreltions with BMI (r=0.51, p=0.03) n BF% (r=0.50, p=0.001) thn WC, emonstrting tht this mrker is less epenent on totl oy ft. Inepenent effets of wist n hip n e onfoune in WHR, initing tht this inex hs low sensitivity to ientify oy hnges in puerty. 27 The thigh irumferene, similr to HC, lso omprises peripherl mesure of ft ontent. The nlyses inite lose orreltions etween the two mesures for oth BMI n BF% in eutrophi olesents n those with exess oy ft. As n vntge, unlike HC, the thigh irumferene is not ffete y vritions in the pelvi rhiteture. 13 The wek orreltions foun for WTR, n inex selom use in olesents, my e ue to the reson mentione for WHR, i.e., the isolte effet of the mesures seems to e ilute when using the rtio etween them. Apprently, the use of UC n thigh irumferene mesures seprtely, when ompre to the use of WTR, hs etter performne in preiting iposity. Reently, it hs een propose the use of the thigh irumferene n HC s lterntives to evlute hnges relte to growth in oy omposition n proportions, in ples where no imging methos re ville. 28 One question tht hs een isusse is whether the use of wist omine with height woul e superior to wist irumferene lone in preiting riovsulr risk. 29 Although the preise effet of height on WC is quntittively unknown, it is known tht it influenes the mgnitue of WC throughout growth n lso in ult life. 4 In this stuy, it ws oserve tht the WC n the WHtR showe lose orreltions with BMI n BF%, exept in G2, in whih the WHtR, unlike the WC, showe no ssoition with BF%. In generl, the CI ws not goo initor of oy mss n totl oy ft. In stuy with hilren n olesents, this inex ws not goo initor of ft ontent in the trunk, proly euse the ssoitions etween the mesures re not goo initors of oesity. 12 Moreover, the SAD hs een reporte s similr or even superior to WC s preitor of metoli risk in ults. 4,5 This stuy i not ssess metoli prmeters, ut we oserve similr orreltion etween these mesures with BMI n BF% in the generl popultion. CD h not yet een evlute in olesents, n this is the first stuy out it. In ult women, there ws strong orreltion (r=0.91, p<0.001) etween this imeter n totl ipose tissue evlute y MRI. 20 In the present stuy, the CD showe similr ehvior to the SAD, emonstrting reltive epenene etween height n the ominl with. Regring the skinfols, in generl, the CSF showe stronger orreltion with BMI n BF% thn PSF, n oth h higher ssoition thn the CSF/PSF rtio. This is proly ue to the smll vrition in rtio vlues. In the se of overweight olesents with high oy ft, it is prtiulrly importnt to onsier the frgility of the skin fols in preiting oy ft, s the thikness of the fols often exees the reommene limit (>40 mm) to otin goo qulity mesurements. 30 This stuy lso ime to ssess the influene of height on mesures of ft istriution. Height ws positively orrelte with HC, n negtively with WHtR. In the ontrol groups, esies these two, WC, UC, thigh, SAD n CD showe signifint orreltion, emonstrting tht they seem to e influene y the olesents height. The strongest orreltion ws with HC, whih erives from the ft tht this mesure is influene y the skeletl struture. 13 Its ssoition with WHtR is proly ue to the ft tht it prtiiptes in the rtio, s well s the influene it woul hve on the WC, s previously isusse. Weker orreltions were oserve for WC n UC. It is importnt to mention tht low orreltion with height is esirle for ny initor of oesity. As height inreses with ge, the strong orreltion of n initor of ft istriution with height my isguise the true ssoition with iposity. 27 Severl nthropometri initors of ft istriution hve een propose in the literture s preitors of oy ft level n its istriution. 9,13,19,25,30 However, suh surveys re limite regring the numer of evlute nthropometri mesurements. Dissimilrly, this ontrolle ross-setionl stuy ws se on the mesurement of severl irumferenes, skinfol thiknesses n imeters; however, one limittion is the lk of t from the erly olesent yers, thus restriting the reommentions for the finl phse. Consiering tht nthropometri mesures in the ssessment of oy omposition in olesents hve goo ury, 30 n tht exess oy ft, minly ominl ft, is relte to yslipiemi, hypertension n insulin resistne s erly s in olesene, 2,6,13 the

8 70 Feliino Pereir P et l ssessment of oy ft istriution shoul e routine in peitri re. It n e onlue tht the inrese in entrl n peripherl ft ws proportionl to the inrese in BMI n oy ft, initing ollinerity etween the speifi ft eposits with totl ft. The wist n umilil irumferenes were the oy ft mesure lotions tht showe the strongest orreltions with BMI n BF%, in ition to showing wek to fir ssoition with height in the totl smple n in eh group. A wek orreltion etween nthropometri mesures n height is esirle, espeilly in perio of intense growth, to prevent height from oneling the rel ssoition with iposity. As for the ntomil lotion of the wist mesurement, the umilius lotion ws more relte to iposity thn the smllest wist point in the overweight group. As it is importnt to monitor the growth n evelopment of olesents over time, it is visle to stnrize the use of one mesure of oy ft lotion. Consiering tht ominl ft, more thn totl ft, hs een ssoite with riometoli risk, it is reommene the use of wist irumferene mesure t the umilius s mesure tht reflets the ipose tissue in this region, ssoite t lest with BMI, in the ssessment of the nutritionl sttus of olesents. Funing This stuy is prt of the projet Influene of oy ft on the risk ftors for riovsulr isese in femle olesents fune y Função e Ampro à Pesquis o Esto e Mins Geris (FAPEMIG), proess APQ Conflits of interest The uthors elre no onflits of interest. Aknowlegements To ll olesents n their prents/gurins who llowe their prtiiption, mking this work possile. To CAPES (Coorenção e Aperfeiçomento e Pessol e Nível Superior) for the grnt given to the Post-Grute Progrm in Nutrition Siene. Referenes 1. Mirn VP, e Fri FR, e Fri ER, Priore SE. Somti mturtion n oy omposition in femle helthy olesents with or without justment for oy ft. Rev Pul Peitr. 2014; 32: Bénéfie E, Grnier D, Simonon KB, Mlin RM. Reltionship etween stunting in infny n growth n ft istriution uring olesene in Seneglese girls. Eur J Clin Nutr. 2001; 55: Snijer MB, Zimmet PZ, Visser M, Dekker JM, Seiell JC, Shw JE. Inepenent n opposite ssoitions of wist n hip irumferenes with ietes, hypertension n yslipiemi: the AusDi Stuy. Int J Oes Relt Met Disor. 2004;28: Ashwell M, Gunn P, Gison S. Wist-to-height rtio is etter sreening tool thn wist irumferene n BMI for ult riometoli risk ftors: systemti review n metnlysis. Oes Rev. 2012;13: Pereir PF, Serrno HM, Crvlho GQ, Lmounier JA, Peluzio MC, Frneshini SC, et l. Wist n wist-to-height rtio: useful to ientify the metoli risk of femle olesents? Rev Pul Peitr. 2011;29: Stino AE, Gupt AK, Ktzmrzyk PT. Criometoli risk ftors n ft istriution in hilren n olesents. J Peitr. 2014;164: Gorn MI, Gower BA. Reltion etween viserl ft n isese risk in hilren n olesents. Am J Clin Nutr. 1999;70:149S Newton RL, Alfonso A, White MA, York-Crowe E, Wlen H, Ryn D et l. Perent oy ft mesure y BIA n DEXA in oese, Afrin-Amerin olesent girls. Int J Oes (Lon). 2005; 29: Sun Q, vn Dm RM, Spiegelmn D, Heymsfiel SB, Willet WC, Hu FB. Comprison of ul-energy x-ry sorptiometri n nthropometri mesures of iposity in reltion to iposityrelte iologi ftors. Am J Epiemiol. 2010;172: Willimson DF, Khn HS, Worthmn CM, Burnette JC, Russell CM. Preision of reument nthropometry. AJHB. 1993;5: Grulet M, Hernánez-Mornte JJ, Tér FJ, Zmor S, Cnters M. Two-imensionl preitive eqution to lssify viserl oesity in linil prtie. Oesity (Silver Spring). 2006;14: Tylor RW, Jones IE, Willims SM, Gouling A. Evlution of wist irumferene, wist-to-hip rtio, n the oniity inex s sreening tools for high trunk ft mss, s mesure y ulenergy X-ry sorptiometry, in hilren ge 3-19 y. Am J Clin Nutr. 2000;72: Teixeir PJ, Srinh LB, Going SB, Lohmn TG. Totl n regionl ft n serum riovsulr isese risk ftors in len n oese hilren n olesents. Oes Res. 2001;9: Centers for Disese Control n Prevention; Ntionl Centers for Helth Sttistis. CDC/NCHS (2000), growth hrts for the Unite Sttes: methos n evelopment. Vitl Helth Stt. 2002;11: Vieir PC, Priore SE, Frneshini SC, Monteiro JB. Composição orporl e olesentes pós menr. Rev Min Eu Fis. 2002;10: Brsil Ministério o Plnejmento, Orçmento e Gestão; Instituto Brsileiro e Geogrfi e Esttísti. Censo emográfio 2000: rterístis geris populção. Rio e Jneiro: IBGE; Aville from: home/esttisti/populo/enso2000/populo/ enso2000_populo.pf 17. Cllwy CW, Chumle WC, Bouhr C, Himes JH, Lohmn TG, Mrtin AD. Cirumferenes. In: Lohmn TG, Rohe AF, Mrtorell R, eitors. Anthropometri stnriztion referene mnul. Chmpign: Humn Kinetis Books; p Bros KB. Métoos pr vlição o onsumo limentr e su relção om os mrores e riso pr sínrome metóli em olesentes o sexo feminino [tese e mestro]. Viços (MG): UFV; Asym K, Hyshi K, Kw Y, Nkne T, Uhi N, Hyshie H, et l. New ge-juste mesure of oy ft istriution in hilren n olesents: stnriztion of wist-hip rtio using multivrite nlysis. Int J Oes Relt Met Disor. 1997;21: Kullerg J, von Below C, Lönn L, Lin L, Ahlström H, Johnsson L. Prtil pproh for estimtion of suutneous n viserl ipose tissue. Clin Physiol Funt Imging. 2007;27:

9 Mesurements of oy ft istriution Frisnho AR. New norms of upper lim ft n musle res for ssessment of nutritionl sttus. Am J Clin Nutr. 1981;34: Wärnerg J, Nov E, Moreno LA, Romeo J, Mesn MI, Ruiz JR, et l. Inflmmtory proteins re relte to totl n ominl iposity in helthy olesent popultion: the AVENA Stuy. Am J Clin Nutr. 2006;84: Cllegri-Jques SM. Bioesttísti: prinípios e plições. 3 r e. Porto Alegre: Artme; Vieir PC, Fri ER, Fri FR, Spernio N, Gontijo CA, Ceon RS, et l. Ftores ssoios à iposie em olesentes o sexo feminino eutrófis om equo e elevo perentul e gorur orporl: elorção e um moelo e riso. ALAN. 2011;61: Oliveir CL, Veig GV, Sihieri R. Anthropometri mrkers for riovsulr isese risk ftors mong overweight olesents. Nutrition Reserh. 2001;21: Jnssen I, Ktzmrzyk PT, Srinivsn SR, Chen W, Mlin RM, Bouhr C, et l. Comine influene of oy mss inex n wist irumferene on oronry rtery isese risk ftors mong hilren n olesents. Peitris. 2005;115: Gorn MI, Gower BA, Treuth M, Ngy TR. Preition of introminl n suutneous ominl ipose tissue in helthy pre-puertl hilren. Int J Oes Relt Met Disor. 1998;22: Khn HS. The wist-to-hip rtio s n inex of entrl oesity. JAMA. 1996;275: MCrthy HD. Mesuring growth n oesity ross hilhoo n olesene. Conferene on Chilhoo nutrition n oesity: urrents sttus n future hllenges Symposium 2: Dt olletion. Proeeings of the Nutrition Soiety Irish Setion Meeting 2013 Jun 21. p Moreno LA, Joynes M, Mesn MI, González-Gross M, Gil CM, Srrí A, et l. Hrmoniztion of nthropometri mesurements for multienter nutrition survey in Spnish olesents. Nutrition. 2003;19:481-6.