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. 2025;81(1):12-21.
doi: 10.1159/000542029. Epub 2024 Oct 28.

Validation of Fat Mass Metrics in Pediatric Obesity

Julia Lischka  1   2 , Thomas Pixner  3   4 , Katharina Mörwald  5   3 , Wanda Lauth  6   7 , Dieter Furthner  3   4 , Daniel Weghuber  5   3 , Julian Gomahr  5   3 , David Thivel  8 , Herwig Brandtner  9 , Max Bergauer  5   3 , Lotte Forer  5   3 , Gabriel Torbahn  5   3   10 , Anders Forslund  11 , Iris Ciba  11 , Hannes Manell  11 , Joel Kullberg  12   13 , Christian-Heinz Anderwald  3   14   15 , Peter Bergsten  11   16
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Free article

Validation of Fat Mass Metrics in Pediatric Obesity

Julia Lischka et al. Ann Nutr Metab. 2025.
Free article

Abstract

Introduction: Hudda-Index is a prediction model for fat mass (FM) based on simple anthropometric measures. FM is a crucial factor in the development of comorbidities, i.e., type 2 diabetes. Hence, Hudda-Index is a promising tool to facilitate the identification of children at risk for metabolic comorbidities. It has been validated against deuterium dilution assessments; however, independent validation against the gold standard for body composition analysis, magnetic resonance imaging (MRI), is lacking. The aim of this study was to validate FM calculated by Hudda-Index against FM measured by MRI. The secondary aim was to compare Hudda-Index to other anthropometric measures including body mass index (BMI), BMI-standard deviation score (BMI-SDS), waist/hip-ratio, waist circumference (WC), and skinfold thickness.

Methods: The study cohort consists of 115 individuals between the age of 9 and 15 years, recruited at Paracelsus Medical University Hospital in Salzburg (Austria) and Uppsala University Children's Hospital (Sweden). Anthropometry, blood samples, and oral glucose tolerance tests followed standard procedures. MRI examinations were performed to determine visceral adipose tissue (VAT) and subcutaneous adipose tissue.

Results: BMI and WC showed slightly stronger associations with the reference standard VAT (r = 0.72 and 0.70, p < 0.01, respectively) than Hudda-Index (r = 0.67, p < 0.01). There is an almost perfect linear association between BMI and Hudda-Index. Accordingly, BMI and Hudda-Index both showed an acceptable association with cardiometabolic parameters. VAT was strongly associated with markers of liver status (LFF r = 0.59, p < 0.01) and insulin resistance (HOMA-IR r = 0.71, p < 0.01) and predicted metabolic dysfunction-associated steatotic liver disease.

Conclusion: BMI, although an imperfect measure, remains the most reliable tool and estimates cardiometabolic risk more reliably than other anthropometry-based measures.

Keywords: Adipose tissue; BMI; Body composition; Hudda-Index; Magnetic resonance imaging.

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