Percent body fat, but not body mass index, is associated with cardiometabolic risk factors in children and adolescents

Abstract Background The epidemic of overweight and obesity has become a worldwide public health problem. Cardiometabolic diseases may originate in childhood. We investigated the association between percent body fat (PBF) measured by the bioelectrical impedance assay and cardiometabolic risk (CMR) in pediatrics. Methods This cross‐sectional study involved 3819 subjects (6–17 years old) in Shanghai. We assessed the association between PBF and body mass index (BMI) with multiple CMR factors. We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age‐ and sex‐specific PBF Z‐scores and BMI Z‐scores, respectively. Results PBF, but not BMI, was positively associated with multiple CMR factors in males and females except for total cholesterol in females (all p < 0.05). Compared with the non‐overweight group based on PBF, overweight and obese subjects had increasingly higher odds ratio of dyslipidemia (2.90 (1.99–4.23), 4.59 (2.88–7.32) for males and 1.82 (1.20–2.75), 2.46 (1.47–4.11) for females) and elevated blood pressure (BP) (3.26 (2.35–4.51), 4.55 (2.92–7.09) for males and 1.59 (1.07–2.34), 3.98 (2.27–6.17) for females). Obesity females showed a higher likelihood for hyperglycemia (2.19 (1.24–3.84)) than non‐overweight females. In both sexes, the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children. For hyperglycemia, the predictive effect of PBF was better in male adolescents and female children. There was no risk difference for cardiometabolic abnormalities attributable to BMI‐based obesity categories. Conclusions PBF but not BMI was associated with CMR. Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.