Gender Differences in Morbid Obese Children: Clinical Significance of Two Diagnostic Obesity Notation Model Assessment Indices
Childhood obesity is an ever increasing global health problem, affecting both developed and developing countries. Accurate evaluation of obesity in children requires difficult and detailed investigation. In our study, obesity in children was evaluated using new body fat ratios and indices. Assessment of anthropometric measurements, as well as some ratios, is important because of the evaluation of gender differences particularly during the late periods of obesity. A total of 239 children; 168 morbid obese (MO) (81 girls and 87 boys) and 71 normal weight (NW) (40 girls and 31 boys) children, participated in the study. Informed consent forms signed by the parents were obtained. Ethics Committee approved the study protocol. Mean ages (years)±SD calculated for MO group were 10.8±2.9 years in girls and 10.1±2.4 years in boys. The corresponding values for NW group were 9.0±2.0 years in girls and 9.2±2.1 years in boys. Mean body mass index (BMI)±SD values for MO group were 29.1±5.4 kg/m2 and 27.2±3.9 kg/m2 in girls and boys, respectively. These values for NW group were calculated as 15.5±1.0 kg/m2 in girls and 15.9±1.1 kg/m2 in boys. Groups were constituted based upon BMI percentiles for age-and-sex values recommended by WHO. Children with percentiles >99 were grouped as MO and children with percentiles between 85 and 15 were considered NW. The anthropometric measurements were recorded and evaluated along with the new ratios such as trunk-to-appendicular fat ratio, as well as indices such as Index-I and Index-II. The body fat percent values were obtained by bio-electrical impedance analysis. Data were entered into a database for analysis using SPSS/PASW 18 Statistics for Windows statistical software. Increased waist-to-hip circumference (C) ratios, decreased head-to-neck C, height ‘to’ ‘two’-‘to’-waist C and height ‘to’ ‘two’-‘to’-hip C ratios were observed in parallel with the development of obesity (p≤0.001). Reference value for height ‘to’ ‘two’-‘to’-hip ratio was detected as approximately 1.0. Index-II, based upon total body fat mass, showed much more significant differences between the groups than Index-I based upon weight. There was not any difference between trunk-to-appendicular fat ratios of NW girls and NW boys (p≥0.05). However, significantly increased values for MO girls in comparison with MO boys were observed (p≤0.05). This parameter showed no difference between NW and MO states in boys (p≥0.05). However, statistically significant increase was noted in MO girls compared to their NW states (p≤0.001). Trunk-to-appendicular fat ratio was the only fat-based parameter, which showed gender difference between NW and MO groups. This study has revealed that body ratios and formula based upon body fat tissue are more valuable parameters than those based on weight and height values for the evaluation of morbid obesity in children.
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 www.cdc.gov/healthyschools/obesity/facts.htm (August 27, 2015)
 www.who.int/dietphysicalactivity/childhood/en (who 2016)
 B. M. Kaess, A. Pedley, J. M. Massaro, J. Murabito, U. Hoffmann, C. S. Fox, “The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk,” Diabetologia,, vol. 55, no. 10, pp. 2622–2630, Oct. 2012.
 S. Alpsoy, A. Akyuz, D. C. Akkoyun, B. Nalbantoglu, B. Topcu, F. Tulubas, M. Demirkol, M. M. Donma, “Is overweight a risk of early atherosclerosis in childhood?”, Angiology, Feb.2013 (to be published).
 S. Alpsoy, A. Akyuz, D. C.Akkoyun, B. Nalbantoglu, B. Topcu. M. M. Donma,, “Effect of obesity on endothelial function and subclinical atherosclerosis in children.”, Eur. J. Gen. Med., vol. 11, no. 3, pp. 141-147, 2014.
 M. M. Donma, “Macrosomia, top of the iceberg: The charm of underlying factors.”, Pediatr. Int., vol. 53, no: 1, pp. 78–84, Feb. 2011.
 M. J. Muller, M. Lagerpusch, J. Enderle, B. Schautz, M. Heller, A. Bosy-Westphal, “Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome.”, Obes. Rev., vol. 13, no.suppl.2, pp. 6-13, Dec. 2012.
 M. J. A. Cordero, E. G. Jimenez, C. J. G. Garcia, P. G. Lopez, J. A. Ferre, C. A. P. Lopez, N. M. Villar, “Comparative study of the effectiveness of body mass index and the body-fat percentage as methods for the diagnosis of overweight and obesity in children.”, Nutr. Hosp., vol. 27, no. 1, pp. 185-191, Jan-Feb 2012.
 C. Scheffler, J. Obermuller, “Development of fat distribution patterns in children and its association with the type of body shape assessed by the metric-index.”, Anthropol. Anz., vol. 69, no. 1, pp.45-55, 2012.
 V. S. Janeva, A. Ghos, C. Scheffler, “Comparison of BMI and percentage of body fat of Indian and German children and adolescents.”, Anthropol. Anz., vol. 69, no. 2, pp. 175-187, 2012.
 B. Srdic, B. Obradovic, G. Dimitric, E. Stokic, S. S. Babovic, “Relationship between body mass index and body fat in children-age and gender differences.”, Obes. Res. Clin. Pract., vol. 6, no. 2, pp. e91-e174, Apr-Jun 2012.
 W. Y. So, B. Swearingin, T. K. Dail, D. Melton, “Body fat measurement in African-American students at a historically black college and university and its correlation with estimations based on body mass index, waist circumference, and bioelectrical impedance analysis, compared to air displacement plethysmography.”, Health Med., vol. 6, no. 4, pp. 1092-1096, 2012.
 O. Androutsos, E. Grammatikaki, G. Moschonis, E. Roma-Giannikou, G. P. Chrousos, Y. Manios, C. Kanaka-Gantenbein, “Neck circumference: a useful screeening tool of cardiovascular risk in children.”, Pediatr. Obes., vol. 7, no. 33, pp. 187-195, Jun 2012.
 T. L. Phan, M. M. Maresca, J. Hossain, G. A. Datto, “Does body mass index accurately reflect body fat ? A comparison of anthropometric measures in the longitudinal assessment of fat mass.”, Clin. Pediatr. (Phila), vol. 51, no. 7, p. 671-677, Jul. 2012.
 C. O. Lyra, S. C. Lima, K. C. Lima, R. F. Arrais, L. F. Pedrosa, “Prediction equations for fat and fat-free body mass in adolescents, based on body circumferences.”, Ann. Hum. Biol., vol. 39, no. 4, pp. 275-280, Jul. 2012.
 M. Maligie, T. Crume, A. Scherzinger, “Adiposity, fat patterning and metabolic syndrome among diverse youth: The EPOCH study.”, J. Pediatr., vol. 161, no. 5, pp. 875-880, Nov. 2012.
 M. M. Donma, O. Donma, “Obesity, children, youth and media.” in 2006 2nd International Children and Communication Cong., Istanbul
 M. Efrat, S. Tepper, R. Z. Birk, “From fat cell biology to public health preventive strategies-pinpointing the critical period for obesity prevention.”, J. Pediatr. Endocrinol. Metab., vol.26, no. 3-4, pp. 197-209, 2013.
 M. J. Müller, “Fat chemistry: the science behind obesity.” Edited by CS Allardyce., Eur. J. Clin. Nutr., vol. 67, pp.125, 2013.
 A. Tchernof, J. P. Després, “Pathophysiology of human visceral obesity: an update.”, Physiol. Rev., vol. 93, no. 1, pp. 359-404, Jan. 2013.
 M. M. Donma, O. Donma, “Infant feeding and growth : A study on Turkish infants from birth to six months.”, Pediatr. Int., vol. 41, no. 5, pp. 542–548, Oct. 1999.
 M. M. Donma, O. Donma, “Phytonutrients and children: The other side of the medallion.”, Food. Res. Int., vol. 38, no. 6, pp.81-92, 2005.
 M. M. Donma, O. Donma, “Trace elements and obesity.”, in 5th National Conference on Obesity and Health., Birmingham, 2009.
 O. Donma, M. M. Donma, “Cadmium, lead and phytochemicals.”, Med. Hypotheses, vol. 65, no.4, pp. 699-702, 2005.
 M. M. Donma, O. Donma, “Arsenic and Nickel : Unavoidable constituents of our everyday diet.”, Med. Hypotheses, vol. 66, no. 3, pp. 681, 2006.
 M. M. Donma, O. Donma, “Potential links between metals from parental smoking and childhood obesity.”, Int. J. Ped. Obesity, 2008; vol. 2, pp. 39.
 M. M. Donma, “Strategies to Prevent Obesity”., in 5th National Conference on Obesity and Health, Birmingham, 2009.
 M. M. Donma, O. Donma, “Counteracting obesity: Healthy nutrition for children and adolescents.”, in 2nd International Congress on Food and Nutrition, Istanbul, 2007.
 T. Moffat, “The childhood obesity epidemic: Health crisis or social construction? Med. Anthropol. Q., vol. 24, no. 1, pp. 1-21, Mar. 2010.
 K. K. Lee, H. S. Park, K. S. Yum, “Cut-off values of visceral fat area and waist-to-height ratio: Diagnostic criteria for obesity-related disorders in Korean children and adolescents.” Yonsei Med. J., vol. 53, no. 1, pp. 99-105, Jan. 2012.
 M. M. Mazicioglu, S. Kurtoglu, A. Ozturk, N. Hatipoglu, B. Cicek, H. B. Ustunbas, “Percentiles and mean values for neck circumference in Turkish children aged 6-18 years.”, Acta Pediatr., vol. 99, no. 12, pp. 1847-1853, Dec. 2010.
 S. Kurtoglu, N. Hatipoglu, M. M. Mazicioglu, M. Kondolot, “Neck circumference as a novel parameter to determine metabolic risk factors in obese children.”, Eur. J. Clin. Invest., vol. 42, no. 6, pp. 623-630, Jun. 2012.
 N. Yabanci, S. Kilic, I. Simsek, “The relationship between height and arm span, mid-upper arm and waist circumferences in children.”, Ann. Hum. Biol., vol. 37, no. 1, pp. 70-75, Jan.-Feb. 2010.
 M. M. Mazicioglu, N. Hatipoglu, A. Ozturk, I. Gun, H. B. Ustunbas, S. Kurtoglu, “Age references for the arm span and stature of Turkish children and adolescents.”, Ann. Hum. Biol., vol. 36, no. 3, pp. 308-319, May-Jun. 2009.
 B. Cicek, A. Ozturk, M. M. Mazicioglu, F. Elmali, N. Turp, S. Kurtoglu, “The risk analysis of arm fat area in Turkish children and adolescents.”, Ann. Hum. Biol., vol. 36, no. 1, pp. 28-37, Jan-Feb. 2009.
 K. Kouda, H. Nakamura, Y. Fujita, K. Ohara, M. Iki, “Increased ratio of trunk to appendicular fat and increased blood pressure: study of a general population of Hamamatsu children.”, Circ. J., vol. 76, no. 12, pp. 2848-2854, 2012.
 V. P. Wickramasinghe, “Hattori chart based evaluation of body composition and its relation to body mass index in a group of Sri Lankan children.”, Indian J. Pediatr., vol. 79, no. 5, pp. 632-639, May 2012.