Do Post‐menarcheal Anthropometric Measures of Body Fat Better Predict Late Adolescent Lipid Levels than Pre‐menarche Values?
Authors: Ferreira Sanae E. , Singer Martha R , Bradlee M. Loring , Daniels Stephen R , Moore Lynn L 
Published: November 2023

Identifying simple, early predictors of cardiometabolic risk is crucial to inform targeted strategies for chronic disease prevention. In adults, excess body fat stored around the waist is an important risk factor for dyslipidemia. The role of body composition on lipid levels during childhood and adolescence is less well understood. We sought to determine which anthropometric measures of body composition better predicted lipid levels in later adolescence, and whether measures taken after menarche would more strongly predict lipid levels than those taken before.

Previously collected data from the NHLBI's Growth and Health Study were used to evaluate the independent effects of early adolescent waist to hip ratio (WHR) and BMI on lipid levels at 17–20 years of age in this cohort of Caucasian (white) and African‐American (black) girls, initially 9–10 years of age. We included 830 girls (371 blacks, 459 whites) with WHR data measured 1–2 years before menarche (Pre‐M) and 1201 girls (655 blacks, 546 whites) with measurements taken 1–2 years after menarche (Post‐M); all were required to have complete data for LDL, HDL, triglycerides [TG], and TG/HDL ratio at 17–20 years of age. Analysis of covariance models were used to compare adjusted mean lipid levels in black and white girls across tertiles (T1,T2,T3) of Pre‐M and Post‐M WHR and BMI, while adjusting for potential confounding by activity, height, dietary, age at menarche, mother's BMI, and demographic variables.

As shown in previous studies, mean HDL levels were higher in blacks (54.8 vs. 52.2 mg/dL, p<.0001) while mean LDL levels were higher in whites than in blacks (98.8 vs. 98.0 mg/dL, p=0.6199). WHR, particularly in blacks, was inversely associated with HDL, whether measured before or after menarche. For LDL, Post‐M WHR was a stronger direct predictor of later LDL among whites while levels of TG increased across tertiles of WHR both before and after menarche. TG/HDL, which provides an estimate of LDL particle size, was associated with WHR both before and after menarche. Mean TG/HDL levels in the highest tertile of WHR for white girls was 2.2, which is above the standard cutoff (2.0) considered indicative of an atherogenic lipid profile and higher likelihood of insulin resistance. In the table below, the difference in lipid levels between the highest and lowest tertiles of WHR and BMI are shown. In general, these results suggest that BMI in both black and white girls is at least as strong a predictor of later adolescent lipid levels as WHR.

These results suggest that simple anthropometric measures of body fat (BMI and WHR) in early adolescence are strong predictors of subsequent dyslipidemic profiles. HDL, a marker of metabolic risk, is more strongly associated with WHR (than with BMI), regardless of race. In comparison, BMI, particularly following menarche, is a strong predictor of elevated LDL, HDL, and the TG/HDL in both black and white girls.

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T32HL007969

Comparison of Mean Differences in Later Lipid Levels Across Tertiles of Early‐Adolescent Pre‐and‐Post‐menarche WHR and BMI in White and Black Girls

LDL (mg/dL)
HDL (mg/dL)
TG/HDL
LDL (mg/dL)
HDL (mg/dL)
TG/HDL

White Girls
Pre‐menarche WHR (n=459)
Post‐menarche WHR (n=475)

Mean diff. (T3‐T1)
5.8
−4.8
.30
10.7
−5.1
.50

p‐trend
.1092
.0005
.0164
.0012
<.0001
<.0001

Black Girls
Pre‐menarche WHR (n=371)
Post‐menarche WHR (n=579)

Mean diff. (T3‐T1)
2.8
−7.0
.30
3.0
−3.8
.35

p‐trend
.4272
<.0001
.0006
.2744
.0008
<.0001

White Girls
Pre‐menarche BMI (n=459)
Post‐menarche BMI (n=475)

Mean diff. (T3‐T1)
7.3
−2.5
.34
14.6
−4.4
.64

p‐trend
.04
.08
.04
.0002
.0006
<.0001

Black Girls
Pre‐menarche BMI (n=371)
Post‐menarche BMI (n=579)

Mean diff. (T3‐T1)
7.6
−6.5
.47
12.1
−4.9
.39

p‐trend
.03
<.0001
<.0001
<.0001
<.0001
<.0001