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Context Hepatic steatosis is associated with decreased bone mineral density (BMD). Bone marrow fat fraction (BMFF) could play a role in this relationship in children with obesity. Objective The objectives of this work were (i) to examine the relationship between the lumbar spine (LS) BMFF and BMD, and (ii) to explore the mediating role of LS-BMFF on the relationship between percentage hepatic fat with LS-BMD in preadolescent children with overweight/obesity. Methods Hepatic fat and LS-BMFF (magnetic resonance imaging) and areal LS-BMD (LS-aBMD, dual-energy x-ray absorptiometry) were measured in 106 children (aged 10.6 ± 1.1 years, 53.8% girls) with overweight/obesity. Results LS-BMFF was inversely associated with LS-aBMD (r = −0.313; P =.001) and directly related with percentage hepatic fat (r = 0.276; P =.005). LS-BMFF was significantly greater in children with than without hepatic steatosis (P =.003; Cohen's d : 0.61; 95% CI, −0.21 to 1.0), while no significant difference was seen between children with overweight and those with obesity (P =.604; Cohen's d : 0.16; 95% CI, −0.21-0.55). Mediating analysis indicated that LS-BMFF is an important mediator (50%) in the association of hepatic fat with lower LS-aBMD (indirect effect: β = −.076; 95% CI, −0.143 to −0.015). Conclusion These findings suggest that hepatic steatosis, rather than overall excess adiposity, is associated with greater bone marrow adipose tissue in preadolescent children with overweight/obesity, which in turn, is related to lower BMD. Hepatic steatosis could be a potential biomarker of osteoporosis risk, and a therapeutic target for interventions that aim to reduce not only hepatic steatosis, but for those designed to improve bone health in such children. [ABSTRACT FROM AUTHOR]

Objectives: Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under‐studied. Therefore, the aims of this study were: (i) to examine the differences between metabolically healthy (MHO) and unhealthy (MUO) overweight/obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity. Methods: A total of 114 children with overweight/obesity (10.6 ± 1.1 years, 62 girls) were included. Children were classified as MHO (n = 68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test. Results: MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference = 12.4%–25.8%, all p < 0.035). MUO‐unfit had more VAT and ASAT content than those MUO‐fit and MHO‐fit (difference = 34.8%–45.3%, all p < 0.044). MUO‐unfit shows also greater IMAAT fat fraction than those MUO‐fit and MHO‐fit peers (difference = 16.4%–13.9% respectively, all p ≤ 0.001). In addition, MHO‐unfit presented higher IMAAT fat fraction than MHO‐fit (difference = 13.4%, p < 0.001). MUO‐unfit presented higher psoas fat fraction than MHO‐fit (difference = 29.1%, p = 0.008). Conclusions: VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity. [ABSTRACT FROM AUTHOR]

Summary: Background: The early detection and management of children with metabolic associated fatty liver disease (MAFLD) is challenging. Objective: To develop a non‐invasive and accurate prediction protocol for the identification of MAFLD among children with overweight/obesity candidates to confirmatory diagnosis. Methods: A total of 115 children aged 8–12 years with overweight/obesity, recruited at a primary care, were enrolled in this cross‐sectional study. The external validation was performed using a cohort of children with overweight/obesity (N = 46) aged 8.5–14.0 years. MAFLD (≥5.5% hepatic fat) was diagnosed by magnetic resonance imaging (MRI). Fasting blood biochemical parameters were measured, and 25 candidates' single nucleotide polymorphisms (SNPs) were determined. Variables potentially associated with the presence of MAFLD were included in a multivariate logistic regression. Results: Children with MAFLD (36%) showed higher plasma triglycerides (TG), insulin, homeostasis model assessment of insulin resistance (HOMA‐IR), alanine aminotransferase (ALT), aspartate transaminase (AST), glutamyl‐transferase (GGT) and ferritin (p < 0.05). The distribution of the risk‐alleles of PPARGrs13081389, PPARGrs1801282, HFErs1800562 and PNLPLA3rs4823173 was significantly different between children with and without MAFLD (p < 0.05). Three biochemical‐ and/or SNPs‐based predictive models were developed, showing strong discriminatory capacity (AUC‐ROC: 0.708–0.888) but limited diagnostic performance (sensitivity 67%–82% and specificity 63%–69%). A prediction protocol with elevated sensitivity (72%) and specificity (84%) based on two consecutive steps was developed. The external validation showed similar results: sensitivity of 70% and specificity of 85%. Conclusions: The HEPAKID prediction protocol is an accurate, easy to implant, minimally invasive and low economic cost tool useful for the early identification and management of paediatric MAFLD in primary care. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between physical fitness and physical activity (PA) with specific abdominal fat depots and their potential implications for cardiometabolic risk and insulin resistance (IR) in children with overweight/obesity. Materials and Methods: A total of 116 children with overweight/obesity (10.7 ± 1.1 year, 54% girls) participated in the study. Abdominal visceral (VAT), subcutaneous (ASAT), and intermuscular abdominal adipose tissue (IMAAT) were assessed by magnetic resonance imaging. The cardiometabolic risk (MetS) score and the insulin resistance homeostasis model assessment (HOMA‐IR) were calculated. Health‐related physical fitness components (treadmill test, and 20 m shuttle run, handgrip, standing broad jump and 4 × 10 m tests) were evaluated, and PA was measured (accelerometry). Children were categorized as fit or unfit for each specific fitness test, and as active or inactive. Results: Higher VAT, ASAT, and IMAAT were associated with higher MetS score and HOMA‐IR (all p < 0.02). A better performance in all fitness tests and total and vigorous PA were strongly associated with lower VAT (all p < 0.04), ASAT (all p < 0.005), and IMAAT (all p < 0.005). Fit or active children had lower VAT, ASAT, and IMAAT (all p < 0.03) than their unfit or inactive counterparts. Conclusion: These results reinforce the importance of having adequate fitness and PA levels to reduce abdominal fat accumulation in children. Given that VAT, ASAT, and IMAAT are associated with higher risk of developing cardiovascular diseases and type 2 diabetes, the improvement of physical fitness by the promotion of PA should be goals of lifestyle interventions for improving health in children with overweight/obesity. [ABSTRACT FROM AUTHOR]