{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T01:59:56Z","timestamp":1768528796481,"version":"3.49.0"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T00:00:00Z","timestamp":1548374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K01\u2010DK102851"],"award-info":[{"award-number":["K01\u2010DK102851"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["T32\u2010DK007734"],"award-info":[{"award-number":["T32\u2010DK007734"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21\u2010HD089056"],"award-info":[{"award-number":["R21\u2010HD089056"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Obesity"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This study aims to describe patterns of truncal versus peripheral fat deposition measured by truncal\u2010to\u2010leg fat ratio (TLR) in adolescents and examine associations of TLR with cardiometabolic (CMD) risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were from 3810 adolescents (12\u201019\u00a0years old) in the National Health and Examination Survey (NHANES) 2003\u20102006. Body fat was assessed by dual\u2010energy X\u2010ray absorptiometry, and CMD risk factors were determined by blood samples and physical examination. Linear and logistic regressions adjusted for BMI z\u2010score and other covariates were used to examine associations of TLR with CMD risk factors as continuous and dichotomized outcomes, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Adolescents who were Mexican American, who have lower income, and with obesity had the highest mean TLR (all <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). In linear regression, increasing TLR was associated positively with homeostasis model assessment of insulin resistance (HOMA\u2010IR), triglycerides, total cholesterol, systolic blood pressure (BP), c\u2010reactive protein, and alanine aminotransferase (ALT), and negatively with high\u2010density lipoprotein (HDL) cholesterol in both sexes (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). TLR was also associated with diastolic BP in boys and low\u2010density lipoprotein cholesterol in girls (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). A similar pattern of findings resulted from logistic regression. When further stratified by race\/ethnicity, TLR was positively associated with high triglycerides, total cholesterol, and ALT for White and\/or Mexican American (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05), but not Black adolescents, while associations with HOMA\u2010IR and HDL were significant for all race\/ethnicities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this cohort of adolescents, TLR was associated with several risk factors independent of BMI z\u2010score, although some findings were sex or race\/ethnicity specific. Body fat distribution may be an important determinant of future CMD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijpo.12509","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T22:36:52Z","timestamp":1548455812000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Truncal\u2010to\u2010leg fat ratio and cardiometabolic disease risk factors in US adolescents: NHANES 2003\u20102006"],"prefix":"10.1111","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8402-0118","authenticated-orcid":false,"given":"Catherine E.","family":"Cioffi","sequence":"first","affiliation":[{"name":"Department of Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica A.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta GA, USA"},{"name":"Department of Medicine, Division of Endocrinology, Diabetes and Lipids Emory University School of Medicine  Atlanta GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-5524","authenticated-orcid":false,"given":"Jean A.","family":"Welsh","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta GA, USA"},{"name":"Department of Pediatrics Emory University School of Medicine  Atlanta GA, USA"},{"name":"Department of Gastroenterology, Hepatology, and Nutrition Children's Healthcare of Atlanta  Atlanta GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam B.","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta GA, USA"},{"name":"Department of Pediatrics Emory University School of Medicine  Atlanta GA, USA"},{"name":"Department of Gastroenterology, Hepatology, and Nutrition Children's Healthcare of Atlanta  Atlanta GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,1,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.3216"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/met.2014.0055"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031049"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-1697"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/edrv.21.6.0415"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2012.00994.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.12.051"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2009.286"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2001.57"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.10.064"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12292"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.4.541"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2009.148"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/846578"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.150672"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0068716"},{"key":"e_1_2_8_18_1","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics. 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