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Assessment of Child Anthropometry in a Large Epidemiologic Study

Assessment of Child Anthropometry in a Large Epidemiologic Study

Published on: February 2, 2017

Central Adiposity, Rather Than in Utero Exposure to Maternal Obesity or Gestational Diabetes, Predicts Metabolic

Daniel O Mensah¹, Alysha B Everett¹, Amelia E Fouts¹

¹Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Pediatric Obesity

|December 10, 2025

Insights

Central adiposity in children, measured by waist circumference or waist-to-height ratio, is the main driver of cardiometabolic risk. This risk is independent of maternal obesity or gestational diabetes mellitus (GDM) exposure in utero.

Area of Science:

Pediatric endocrinology
Cardiovascular health
Metabolic disorders

Background:

Children of mothers with obesity or gestational diabetes mellitus (GDM) have increased risks of central adiposity and cardiometabolic issues.
The relative contributions of in utero exposure versus current adiposity to these risks are not fully understood.

Purpose of the Study:

To investigate the association between central adiposity (waist circumference [WC], waist-to-height ratio [WHtR]) and continuous metabolic syndrome (cMetS) scores in children.
To determine if maternal obesity or GDM exposure modifies these associations.
To examine the relationship between cMetS and cardiometabolic biomarkers.

Main Methods:

Children were categorized based on maternal pre-pregnancy weight status and GDM diagnosis.
WC and WHtR were measured and classified using standard percentiles/thresholds.
cMetS scores were calculated with and without WC; statistical analyses included ANCOVA and correlation.

Main Results:

WC and WHtR were significant predictors of cMetS, irrespective of maternal risk factors.
Children with higher WC or WHtR exhibited significantly elevated cMetS scores (p < 0.0001).
cMetS correlated with key biomarkers of insulin resistance and inflammation (e.g., leptin, adiponectin, HOMA-IR, CRP, IL-6).

Conclusions:

Central adiposity, not in utero exposure, is the primary determinant of cardiometabolic risk in children.
Insulin resistance and adipose tissue dysfunction are central mechanisms linking cMetS to cardiometabolic risk.

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Abstract

Background:

Children born to mothers with obesity or gestational diabetes mellitus (GDM) face elevated risks of central adiposity and adverse cardiometabolic outcomes, including metabolic syndrome (MetS) and systemic inflammation. However, it remains unclear whether these risks are primarily driven by current adiposity or by in utero exposure. This study investigated associations between waist circumference (WC), waist-to-height ratio (WHtR), and continuous MetS (cMetS) scores in children, and evaluated whether in utero exposure to maternal obesity or GDM moderated these relationships. Associations between cMetS and cardiometabolic biomarkers were also examined.

Methods:

Children were grouped by maternal early-pregnancy weight status and GDM diagnosis: (1) normal weight without GDM, (2) overweight/obesity without GDM, and (3) overweight/obesity with GDM. WC was classified as < 85th or ≥ 85th percentile; WHtR as < 0.5 or ≥ 0.5. cMetS scores were computed with and without the WC component. Group differences and associations were assessed using ANCOVA and correlation analyses.

Results:

WC and WHtR were strong predictors of cMetS, independent of in utero exposure group. Children with WC ≥ 85th percentile or WHtR ≥ 0.5 had significantly higher cMetS scores (p < 0.0001), even when WC was excluded from the cMetS calculation. cMetS was inversely correlated with adiponectin and positively correlated with leptin, the leptin-to-adiponectin ratio, HOMA-IR, CRP, and IL-6 (all p < 0.01).

Conclusions:

Central adiposity-indexed by WC or WHtR-rather than in utero exposure, is the primary driver of cardiometabolic risk. Associations between cMetS and cardiometabolic biomarkers underscore insulin resistance and adipose tissue dysfunction as key mechanisms underlying MetS in children.

Keywords:

cardiometabolic biomarkers central adiposity childhood metabolic risk in utero exposure insulin resistance

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