# Interaction of intrauterine Zika virus exposure on the relationship between body adiposity and dyslipidemia in school-aged children

## TL;DR

Children exposed to Zika virus in the womb show altered relationships between body fat and cholesterol levels, suggesting potential long-term metabolic risks.

## Contribution

This study reveals how intrauterine Zika virus exposure modifies the link between body adiposity and dyslipidemia in children.

## Key findings

- Zika-exposed children had higher rates of low HDL-c compared to unexposed peers.
- BMI and waist circumference showed stronger associations with lipid abnormalities in Zika-exposed children.
- Neck circumference was more strongly linked to elevated cholesterol and triglycerides in Zika-exposed children.

## Abstract

Intrauterine exposure to the Zika virus (ZIKV) has been primarily associated with neurological outcomes, while its potential metabolic and nutritional consequences remain poorly understood. This study aimed to evaluate the association between anthropometric indicators body mass index (BMI)-for-age, waist circumference, and neck circumference and lipid profile alterations in school-aged children born during the ZIKV epidemic.

This retrospective cohort included 93 children aged 5–9 years (mean 6.5 ± 0.7 years; 58.1% boys) from the Belo Horizonte Region, Brazil. Participants were classified as exposed (59.1%) or unexposed to ZIKV in utero. Anthropometric measurements followed standardized protocols and included BMI-for-age, waist circumference, and neck circumference. Lipid profile assessment included total cholesterol, HDL-c, LDL-c, and triglycerides. Cardiovascular risk was estimated using Castelli indices I and II. Behavioral and sociodemographic factors, including screen time, caregiver education, and family income, were also recorded. Associations between anthropometric indicators and lipid outcomes were analyzed using Poisson regression models with robust variance, including interaction terms to assess the modifying effect of ZIKV exposure.

Lipid abnormalities were common: low HDL-c (44.1%), high total cholesterol (33.3%), high LDL-c (26.9%), and high triglycerides (44.1%). Children exposed to ZIKV had a higher prevalence of low HDL-c compared with unexposed peers (54.6% vs. 29.0%; p = 0.015). BMI-for-age was inversely associated with low HDL-c (PR 0.87; 95% CI 0.78–0.97) and showed significant interactions with ZIKV exposure for total cholesterol (p interaction = 0.005) and triglycerides (p interaction = 0.008). Waist circumference interacted with ZIKV exposure regarding total cholesterol (p = 0.029; PR 1.09; 95% CI 1.03–1.16). Neck circumference was positively associated with total cholesterol, LDL-c, and triglycerides, with stronger associations among ZIKV-exposed children. Castelli Index I was higher in the exposed group (p = 0.0389), while Castelli Index II did not differ significantly (p = 0.1087).

Intrauterine ZIKV exposure influences the relationship between adiposity and lipid profile in children. Central adiposity measures including waist circumference, neck circumference, and BMI—provide complementary information for early metabolic risk assessment. These findings highlight the importance of longitudinal monitoring of children exposed to ZIKV in utero to detect early metabolic alterations and guide preventive interventions.