Methods for Measuring Central Adiposity in Children and Adolescents and Their Cardiometabolic Implications: A Systematic Review

Childhood adiposity is a major driver of cardiometabolic risk, yet the relative contributions of overall, regional, and ectopic fat remain unclear. This systematic review, conducted between July 2025 and January 2026, aimed to assess methods for measuring adiposity in children and adolescents, as well as their cardiometabolic implications. It included 26 English-language articles reporting on the measurement of adiposity and its cardiometabolic implications in children and adolescents aged ≤19 years, published between 2012 and 2025. The common methods used to measure adiposity reported were anthropometry, dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), ultrasonography, echocardiography, and computed tomography (CT). Anthropometric indices such as waist-to-height ratio (WHtR), waist circumference (WC), and composite adiposity indices (visceral adiposity index) were reported to outperform body mass index (BMI) in predicting cardiovascular disease (CVD). Strong correlations were observed between simple anthropometric measurements and advanced imaging techniques (e.g., DXA). Visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) showed stronger associations with cardiometabolic risk than subcutaneous adipose tissue (SAT). Cardiometabolic conditions reported were hypertension (11.4–28.3%), dyslipidaemia (up to 46.7%), and insulin resistance (39.5%). The prevalence of non-alcoholic fatty liver disease (NAFLD) increased with adiposity (1.0% at normal weight to 25.0% at obese) and was strongly associated with cardiometabolic risk clustering (66.7% vs. 12.0%; OR: 24.43). Cardiometabolic risk in children was reported to be more strongly associated with central adiposity than with overall body mass. Simple measures such as WHtR and WC were reported to be effective and low-cost screening tools for CVD. Early identification and lifestyle interventions are recommended to help monitor long-term cardiovascular risk.