{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:02:27Z","timestamp":1779951747402,"version":"3.53.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Visceral adiposity in pediatric obesity is conventionally assessed through aggregate measures that lack compartmental resolution. The\n                      <jats:italic>Eco-Obesity<\/jats:italic>\n                      ultrasound protocol enables simultaneous quantification of distinct abdominal fat layers. This study aims to evaluate the clinical and metabolic correlates of each compartment in a pediatric cohort with overweight or obesity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective cross-sectional study of consecutive pediatric patients evaluated at a multidisciplinary obesity unit. All underwent structured\n                      <jats:italic>Eco-Obesity<\/jats:italic>\n                      ultrasound, anthropometric assessment, bioelectrical impedance, and fasting biochemical profiling. Pearson correlations between fat layer thickness and cardiometabolic parameters were computed for the overall cohort and stratified by sex. ROC curve analysis was performed to identify optimal\n                      <jats:italic>omental<\/jats:italic>\n                      fat thickness cut-offs for the discrimination of metabolically unhealthy status, defined as the fulfilment of at least one criterion: HDL-cholesterol &amp;lt; 40\u2005mg\/dL, triglycerides &amp;gt; 150\u2005mg\/dL, fasting glucose &amp;gt; 100\u2005mg\/dL, blood pressure above the 90th percentile, HOMA-IR\u2009&amp;gt;\u20093.16, or hepatic steatosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 84 pediatric patients (62% female; mean age 14.0\u2009\u00b1\u20092.6 years; mean BMI SDS 2.8\u2009\u00b1\u20091.1), of whom 71.3% were classified as obese (class I\u2013III) and 28.7% as overweight with abdominal obesity; 28.3% presented ultrasound-diagnosed hepatic steatosis.\n                      <jats:italic>Omental<\/jats:italic>\n                      fat was the only compartment consistently associated with anthropometric obesity indices, insulin resistance, LDL cholesterol, and hepatic steatosis, and the only one to exhibit significant sexual dimorphism (40.5\u2005mm males vs. 27.3\u2005mm females;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009= &amp;lt;0.001). Associations were markedly stronger in males. ROC analysis to predict metabolic syndrome showed AUCs of 0.64 (males; cut-off 34.6\u2005mm) and 0.57 (females; cut-off 19.6\u2005mm).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Omental<\/jats:italic>\n                      fat appears to be the visceral compartment most consistently associated with metabolic risk markers in pediatric obesity, with sex-specific thresholds substantially lower than adult reference values, reinforcing the need for a dedicated pediatric cut-off.\n                    <\/jats:p>\n                  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