High LDL-cholesterol in children and adolescents with type 1 diabetes: the impact of body adiposity and sex

Background and aims: To investigate the association between LDL cholesterol (LDL-C) and body adiposity in children and adolescents with type 1 diabetes (T1D), evaluating the influence of sex, glycemic control, and insulin treatment modalities. Methods and results: This cross-sectional study included children and adolescents aged 6-18 years with T1D. Adiposity indices [BMI, BMI Z-score, and waist-to-height ratio (WHtR)] and body composition [fat mass (FM), fat mass index (FMI)] were obtained by anthropometry and bioelectrical impedance analysis. Biochemical parameters included LDL-C, total cholesterol, triglycerides, and HbA1c. Glycemic metrics, including time in range (TIR) and time above range (TAR), were also evaluated. Logistic regression models were applied to identify predictors of LDL-C >100 mg/dL. LDL-C was significantly associated with FMI and WHtR (boys: p < 0.01; girls: p < 0.05). In boys, elevated LDL-C was significantly predicted by FMI [OR 1.23 (95% CI 1.02-1.48), p = 0.03] and WHtR × 100 [OR 1.09 (1.02-1.18), p = 0.013], independent of glycemic control and treatment modality. WHtR remained significant across models, including HbA1c, TIR, and TAR (p ≤ 0.05). In girls, HbA1c was the strongest predictor of LDL-C >100 mg/dL [OR 2.40 (1.44-3.86), p < 0.001] independent of FMI and WHtR; lower TIR also predicted higher LDL-C [OR 0.97 (0.93-0.99), p = 0.007]. Conclusion: In boys with T1D, body adiposity and abdominal fat independently predict elevated LDL-C. In girls, who have higher adiposity than boys, glycemic control is the stronger predictor of LDL-C. These findings emphasize the need for sex-specific strategies combining optimized glucose management and body composition to reduce early cardiovascular risk in pediatric T1D.