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Kelly AS, Bahlke M, Baker JL, de Beaufort C, Belin RM, Fonseca H, Hale PM, Holm JC, Hsia DS, Jastreboff AM, Juliusson PB, Murphy M, Pak J, Paul E, Rudolph B, Srivastava G, Tornøe CW, Weghuber D, Fox CK. Considerations for the design and conduct of pediatric obesity pharmacotherapy clinical trials: Proceedings of expert roundtable meetings. Pediatr Obes 2024; 19:e13161. [PMID: 39289849 DOI: 10.1111/ijpo.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 09/19/2024]
Abstract
Anti-obesity medications (AOMs) have emerged as one element of comprehensive obesity clinical care intended to improve long-term health outcomes for children and adolescents. The number of pediatric AOM clinical trials has burgeoned in recent years as new pharmacotherapeutics have been developed. Factors related to growth and development in children and adolescents can present unique challenges in terms of designing and conducting clinical trials investigating the safety and efficacy of AOMs. These barriers can delay the AOM development and evaluation process, increase the cost of performing trials, create challenges in the interpretation of results, influence the generalizability of the findings and present ethical dilemmas. In an effort to address these issues and provide guidance to streamline the process of designing and conducting pediatric AOM clinical trials, relevant key stakeholders convened a series of roundtable meetings to discuss, debate and achieve harmonization on design features. Stakeholder participants included a multidisciplinary group of international pediatric obesity experts, patient (parent) representatives and representatives from academic medicine, key regulatory agencies and industry. Topics of discussion included primary efficacy end-points, secondary end-points, eligibility criteria, trial run-in and follow-up phases, use of active comparators and guidelines for down-titration and/or stopping rules for excessive weight reduction. Consensus recommendations were agreed upon. Regarding end-points, emphasis was placed on moving away from BMI z-score as a primary outcome, incorporating multiple alternative BMI-related outcomes and measuring adiposity/body fat as a prominent secondary end-point. Trial eligibility criteria were carefully considered to maximize generalizability while maintaining safety. The limited value of trial run-in phases was discussed. It was also underscored that designing trials with extended follow-up periods after AOM withdrawal should be avoided owing to ethical issues (including possible psychological harm) related to weight regain without providing the opportunity to access other treatments. The panel emphasized the value of the randomized, placebo-controlled trial but recommended the thoughtful consideration of the use of active comparators in addition to, or instead of, placebo to achieve clinical equipoise when appropriate. Finally, the panel recommended that clinical trial protocols should include clear guidance regarding AOM down-titration to avoid excessive weight reduction when applicable.
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Affiliation(s)
- Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- The Obesity Society, Rockville, Maryland, USA
| | - Melanie Bahlke
- European Coalition for People Living with Obesity, Dublin, Ireland
- Global Patient Alliance
- Adipositaschirurgie Selbsthilfe Deutschland e.V. (Obesity Surgery Patient Organisation), Germany
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Frederiksberg, Denmark
- European Association for the Study of Obesity, Teddington, England
| | - Carine de Beaufort
- Pediatric Clinic/Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
- Department of Science, Technology, and Medicine, University of Luxembourg, Luxembourg City, Luxembourg
| | - Ruth M Belin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Helena Fonseca
- Pediatric Obesity Clinic, Department of Pediatrics, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Jens-Christian Holm
- European Association for the Study of Obesity, Teddington, England
- Department of Paediatrics, The Children's Obesity Clinic, European Center of Management, Holbaek, Denmark
| | - Daniel S Hsia
- The Obesity Society, Rockville, Maryland, USA
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Ania M Jastreboff
- The Obesity Society, Rockville, Maryland, USA
- Department of Medicine (Endocrinology) and Pediatrics (Pediatric Endocrinology), Yale Obesity Research Center (Y-Weight), New Haven, Connecticut, USA
| | - Petur B Juliusson
- Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Jonathan Pak
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
- Boehringer Ingelheim Pharmaceuticals, Inc., Ingelheim, Germany
| | | | - Bryan Rudolph
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
- Boehringer Ingelheim Pharmaceuticals, Inc., Ingelheim, Germany
| | - Gitanjali Srivastava
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
- The European Childhood Obesity Group, Brussels, Belgium
| | - Claudia K Fox
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Loenneke JP, Abe A, Yamasaki S, Tahara R, Abe T. Sex Differences in Strength During Development: Implications for Inclusivity and Fairness in Sport. Am J Hum Biol 2024; 36:e24152. [PMID: 39275866 DOI: 10.1002/ajhb.24152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/16/2024] Open
Abstract
OBJECTIVES Males, on average, are bigger and stronger than females. Hormonal differences during puberty are one reason given for this performance advantage. However, not all evidence supports that thesis. Our aim was to further this discussion by measuring early life changes between sexes (when hormones would be similar) in components of muscle function. METHODS Fifty-one children (29 boys, 22 girls) completed this study. Forearm muscle size and strength were assessed three times with each time point being separated by approximately a year (2021-2023). RESULTS There was no sex*time interaction for handgrip strength (p = 0.637). There was, however, a time (p < 0.001) and sex (p < 0.001) effect. Strength increased each year and boys were stronger than girls (difference of 1.5 [95% 0.7, 2.3] kg). There was no sex*time interaction for ulnar muscle thickness (p = 0.714) but there was a time (p < 0.001) effect. Muscle size increased each year but there was no evidence of a sex effect (p = 0.12; difference of 0.81 [95% -0.21, 1.8] mm). A strong positive within-participant correlation between muscle size and strength (r = 0.803 95% CI: [0.72, 0.86], p < 0.0001) was found across time. CONCLUSION Muscle size and strength increased together but this increase did not differ based on sex and boys were stronger than girls. Future work is needed to determine the reason for this difference in maximal strength. Any effect was seemingly present at the initial measurement (at the age of 4 years), since muscle size and strength did not change differently between boys and girls over time.
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Affiliation(s)
- Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, Oxford, Mississippi, USA
| | - Akemi Abe
- Division of Children's Health and Exercise Research, Institute of Trainology, Fukuoka, Japan
| | - Sakiya Yamasaki
- Department of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Ryoji Tahara
- Department of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Takashi Abe
- Division of Children's Health and Exercise Research, Institute of Trainology, Fukuoka, Japan
- Graduate School of Health and Sports Science, Institute of Health and Sports Science & Medicine, Juntendo University, Chiba, Japan
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Wang X, Gao L, Xiong J, Cheng H, Liu L, Dong H, Huang Y, Fan H, Wang X, Shan X, Xiao P, Liu J, Yan Y, Mi J. The life-course changes in muscle mass using dual-energy X-ray absorptiometry: The China BCL study and the US NHANES study. J Cachexia Sarcopenia Muscle 2024; 15:1687-1695. [PMID: 38952048 PMCID: PMC11446696 DOI: 10.1002/jcsm.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/13/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Sarcopenia is an important indicator of ill health and is linked to increased mortality and a reduced quality of life. Age-associated muscle mass indices provide a critical tool to help understand the development of sarcopenia. This study aimed to develop sex- and age-specific percentiles for muscle mass indices in a Chinese population and to compare those indices with those from other ethnicities using the National Health and Nutrition Examination Survey (NHANES) data. METHODS Whole-body and regional muscle mass was measured by dual-energy X-ray absorptiometry (DXA) in participants of the China Body Composition Life-course (BCL) study (17 203 healthy Chinese aged 3-60 years, male 48.9%) and NHANES (12 663 healthy Americans aged 8-59 years, male 50.4%). Age- and sex-specific percentile curves were generated for whole-body muscle mass and appendicular skeletal muscle mass using the Generalized Additive Model for Location Scale and Shape statistical method. RESULTS Values of upper and lower muscle mass across ages had three periods: an increase from age 3 to a peak at age 25 in males (with the 5th and 95th values of 41.5 and 66.4 kg, respectively) and age 23 in females (with the 5th and 95th values of 28.4 and 45.1 kg, respectively), a plateau through midlife (30s-50s) and then a decline after their early 50s. The age at which muscle mass began to decline was 52 years in men with the 5th and 95th percentile values of 43.5 and 64.6 kg, and 51 years in women with the 5th and 95th percentile values of 31.6 and 46.9 kg. Appendicular skeletal muscle mass decreased earlier than whole body muscle mass, especially leg skeletal muscle mass, which decreased slightly after age 49 years in both sexes. In comparison with their US counterparts in the NHANES, the Chinese participants had lower muscle mass indices (all P < 0.001) and reached a muscle mass peak earlier with a lower muscle mass, with the exception of similar values compared with adult Mexican and White participants. The muscle mass growth rate of Chinese children decreased faster than that of other races after the age of 13. CONCLUSIONS We present the sex- and age-specific percentiles for muscle mass and appendicular skeletal muscle mass by DXA in participants aged 3-60 from China and compare them with those of different ethnic groups in NHANES. The rich data characterize the trajectories of key muscle mass indices that may facilitate the clinical appraisal of muscle mass and improve the early diagnosis of sarcopenia in the Chinese population.
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Affiliation(s)
- Xi Wang
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liwang Gao
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- School of Public Health, Capital Medical University, Beijing, China
| | - Jingfan Xiong
- Child and Adolescent Chronic Diseases Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Hong Cheng
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Li Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongbo Dong
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yiwen Huang
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongmin Fan
- North China University of Science and Technology, Tangshan, China
| | - Xia Wang
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinying Shan
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Pei Xiao
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junting Liu
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Yinkun Yan
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Mi
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Alkhatib A, Obita G. Childhood Obesity and Its Comorbidities in High-Risk Minority Populations: Prevalence, Prevention and Lifestyle Intervention Guidelines. Nutrients 2024; 16:1730. [PMID: 38892662 PMCID: PMC11175158 DOI: 10.3390/nu16111730] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The prevalence of childhood obesity and its associated comorbidities is a growing global health problem that disproportionately affects populations in low- and middle-income countries (LMICs) and minority ethnicities in high-income countries (HICs). The increased childhood obesity disparities among populations reflect two concerns: one is HICs' ineffective intervention approaches in terms of lifestyle, nutrition and physical activity in minority populations, and the second is the virtually non-existent lifestyle obesity interventions in LMICs. This article provides guidelines on childhood obesity and its comorbidities in high-risk minority populations based on understanding the prevalence and effectiveness of preventative lifestyle interventions. First, we highlight how inadequate obesity screening by body mass index (BMI) can be resolved by using objective adiposity fat percentage measurements alongside anthropometric and physiological components, including lean tissue and bone density. National healthcare childhood obesity prevention initiatives should embed obesity cut-off points for minority ethnicities, especially Asian and South Asian ethnicities within UK and USA populations, whose obesity-related metabolic risks are often underestimated. Secondly, lifestyle interventions are underutilised in children and adolescents with obesity and its comorbidities, especially in minority ethnicity population groups. The overwhelming evidence on lifestyle interventions involving children with obesity comorbidities from ethnic minority populations shows that personalised physical activity and nutrition interventions are successful in reversing obesity and its secondary cardiometabolic disease risks, including those related to cardiorespiratory capacity, blood pressure and glucose/insulin levels. Interventions combining cultural contextualisation and better engagement with families are the most effective in high-risk paediatric minority populations but are non-uniform amongst different minority communities. A sustained preventative health impact can be achieved through the involvement of the community, with stakeholders comprising healthcare professionals, nutritionists, exercise science specialists and policy makers. Our guidelines for obesity assessment and primary and secondary prevention of childhood obesity and associated comorbidities in minority populations are fundamental to reducing global and local health disparities and improving quality of life.
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Affiliation(s)
- Ahmad Alkhatib
- College of Life Sciences, Birmingham City University, City South Campus, Edgbaston, Birmingham B15 3TN, UK
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK;
| | - George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK;
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Trueba-Timmermans DJ, Grootjen LN, Juriaans AF, Kerkhof GF, Rings EH, Hokken-Koelega AC. Measured Resting Energy Expenditure by Indirect Calorimetry and Energy Intake in Long-Term Growth Hormone-Treated Children with PWS. Horm Res Paediatr 2024; 98:164-173. [PMID: 38368858 PMCID: PMC11965815 DOI: 10.1159/000536466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Severe obesity can develop in children with PWS when food intake is not controlled. Maintenance of body weight requires an energy balance, of which energy intake and energy expenditure are important components. Previous studies described a decreased resting energy expenditure (REE) in growth hormone (GH)-untreated children with PWS. In short-term studies, no difference in REE was found between GH-treated and untreated children with PWS. However, there are limited data on REE in children with PWS who were GH-treated for a long period. METHODS This study describes measured REE (mREE), energy intake, and body composition during long-term GH treatment in children with PWS. Patients were treated with 1.0 mg GH/m2/day (∼0.035 mg/kg/day). REE was determined by indirect calorimetry; dietary energy intake was calculated using a 3-day dietary record. Body composition by dual-energy X-ray absorptiometry (DXA) scans. RESULTS We included 52 GH-treated children with PWS with a mean (SD) age of 8.53 (4.35) years and a median (IQR) GH-treatment duration of 7 (4-11) years. mREE increased with age, but was not associated with GH-treatment duration. A higher LBM was associated with higher mREE. Mean energy intake was significantly lower compared to daily energy requirements (DER) for age- and sex-matched healthy children (p < 0.001), ranging from 23 to 36% less intake in children aged 3.5-12 years to 49% less intake in children aged 12-18 years. Fifty percent of children had a normal REE, 17.3% a decreased REE, and 32.7% an elevated REE, according to predicted REE based on measured REE in a large group of healthy children. CONCLUSION In children with PWS, mREE increases with age. GH-treatment duration is not associated, whereas LBM is an important determinant of mREE. Children with PWS have a low to very low energy intake compared to DER for age- and sex-matched children, with a declining intake when becoming older. INTRODUCTION Severe obesity can develop in children with PWS when food intake is not controlled. Maintenance of body weight requires an energy balance, of which energy intake and energy expenditure are important components. Previous studies described a decreased resting energy expenditure (REE) in growth hormone (GH)-untreated children with PWS. In short-term studies, no difference in REE was found between GH-treated and untreated children with PWS. However, there are limited data on REE in children with PWS who were GH-treated for a long period. METHODS This study describes measured REE (mREE), energy intake, and body composition during long-term GH treatment in children with PWS. Patients were treated with 1.0 mg GH/m2/day (∼0.035 mg/kg/day). REE was determined by indirect calorimetry; dietary energy intake was calculated using a 3-day dietary record. Body composition by dual-energy X-ray absorptiometry (DXA) scans. RESULTS We included 52 GH-treated children with PWS with a mean (SD) age of 8.53 (4.35) years and a median (IQR) GH-treatment duration of 7 (4-11) years. mREE increased with age, but was not associated with GH-treatment duration. A higher LBM was associated with higher mREE. Mean energy intake was significantly lower compared to daily energy requirements (DER) for age- and sex-matched healthy children (p < 0.001), ranging from 23 to 36% less intake in children aged 3.5-12 years to 49% less intake in children aged 12-18 years. Fifty percent of children had a normal REE, 17.3% a decreased REE, and 32.7% an elevated REE, according to predicted REE based on measured REE in a large group of healthy children. CONCLUSION In children with PWS, mREE increases with age. GH-treatment duration is not associated, whereas LBM is an important determinant of mREE. Children with PWS have a low to very low energy intake compared to DER for age- and sex-matched children, with a declining intake when becoming older.
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Affiliation(s)
- Demi J. Trueba-Timmermans
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Lionne N. Grootjen
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Alicia F. Juriaans
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Gerthe F. Kerkhof
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Edmond H.H.M. Rings
- Department of Pediatrics, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Anita C.S. Hokken-Koelega
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Zhao Y, Gong JX, Ji YT, Zhao XY, He L, Cai SZ, Yan XM. Cross-sectional study of characteristics of body composition of 24,845 children and adolescents aged 3-17 years in Suzhou. BMC Pediatr 2023; 23:358. [PMID: 37442965 PMCID: PMC10339479 DOI: 10.1186/s12887-023-04134-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We aimed to analyze the characteristics of the body composition of children and adolescents aged 3-17 in Suzhou, China. METHODS A cross-sectional study between January 2020 and June 2022 using bioelectrical impedance was conducted to determine the fat mass (FM), fat-free mass (FFM), skeletal muscle mass, and protein and mineral contents of 24,845 children aged 3-17 who attended the Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, China. Measurement data was presented in tables as mean ± SD, and groups were compared using the independent samples t-test. RESULTS FM and fat-free mass increased with age in both boys and girls. The fat-free mass of girls aged 14-15 decreased after reaching a peak, and that of boys in the same age group was higher than that of the girls (p < 0.05). There were no significant differences in FM between boys and girls younger than 9- and 10-years old. The percentage body fat (PBF) and FM index of girls increased rapidly between 11 and 15 years of age (p < 0.05), and those of boys aged 11-14 were significantly lower (p < 0.05), suggesting that the increase in body mass index (BMI) was mainly contributed by muscle mass (MM) in boys. CONCLUSIONS The body composition of children and adolescents varies according to their age and sex. A misdiagnosis of obesity made on the basis of BMI alone can be avoided if BMI is used in combination with FM index, percentage body fat, and other indexes.
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Affiliation(s)
- Yan Zhao
- Department of Pediatrics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Jin-Xin Gong
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China
| | - Yi-Ting Ji
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China
| | - Xiao-Yun Zhao
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China
| | - Lu He
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China
| | - Shi-Zhong Cai
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China.
| | - Xiang-Ming Yan
- Department of Urology, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China.
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van Beijsterveldt IALP, Dorrepaal DJ, de Fluiter KS, de Ridder MAJ, Hokken-Koelega ACS. Skinfold-based-equations to assess longitudinal body composition in children from birth to age 5 years. Clin Nutr 2023; 42:1213-1218. [PMID: 37225558 DOI: 10.1016/j.clnu.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND & AIMS In order to identify children at risk for excess adiposity, it is important to determine body composition longitudinally throughout childhood. However, most frequently used techniques in research are expensive and time-consuming and, therefore, not feasible for use in general clinical practice. Skinfold measurements can be used as proxy for adiposity, but current anthropometry-based-equations have random and systematic errors, especially when used longitudinally in pre-pubertal children. We developed and validated skinfold-based-equations to estimate total fat mass (FM) longitudinally in children aged 0-5 years. METHODS This study was embedded in the Sophia Pluto study, a prospective birth cohort. In 998 healthy term-born children, we longitudinally measured anthropometrics, including skinfolds and determined FM using Air Displacement Plethysmography (ADP) by PEA POD and Dual energy X-ray Absorptiometry (DXA) from birth to age 5 years. Of each child one random measurement was used in the determination cohort, others for validation. Linear regression was used to determine the best fitting FM-prediction model based on anthropometric measurements using ADP and DXA as reference methods. For validation, we used calibration plots to determine predictive value and agreement between measured and predicted FM. RESULTS Three skinfold-based-equations were developed for adjoined age ranges (0-6 months, 6-24 months and 2-5 years), based on FM-trajectories. Validation of these prediction equations showed significant correlations between measured and predicted FM (R: 0.921, 0.779 and 0.893, respectively) and good agreement with small mean prediction errors of 1, 24 and -96 g, respectively. CONCLUSIONS We developed and validated reliable skinfold-based-equations which may be used longitudinally from birth to age 5 years in general practice and large epidemiological studies.
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Affiliation(s)
- Inge A L P van Beijsterveldt
- Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands; Dutch Growth Research Foundation, Rotterdam, the Netherlands.
| | - Demi J Dorrepaal
- Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Maria A J de Ridder
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands; Dutch Growth Research Foundation, Rotterdam, the Netherlands
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Lewis JI, Friis H, Mupere E, Wells JC, Grenov B. Calibration of Bioelectrical Impedance Analysis Against Deuterium Dilution for Body Composition Assessment in Stunted Ugandan Children. J Nutr 2023; 153:426-434. [PMID: 36894235 DOI: 10.1016/j.tjnut.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND BIA represents an important tool in body composition (BC) assessment, especially in low-income settings in which simple and affordable options are preferred. There is a particular need to measure BC in stunted children, in which cases population-specific BIA estimating equations are lacking. OBJECTIVES We calibrated an equation to estimate body composition from BIA using deuterium dilution (2H) as the criterion method in stunted children. METHODS We measured BC with 2H and performed BIA in stunted Ugandan children (n = 50). Multiple linear regression models were constructed to predict 2H-derived FFM from BIA-derived whole-body impedance and other relevant predictors. Model performance was expressed as adjusted R2 and RMSE. Prediction errors were also calculated. RESULTS Participants were aged 16-59 mo, of whom 46% were girls, and their median (IQR) height-for-age z-score (HAZ) was -2.58 (-2.92 to -2.37) according to the WHO growth standards. Impedance index (height2/impedance measured at 50 kHz) alone explained 89.2% variation in FFM and had an RMSE of 583 g (precision error 6.5%). The final model contained age, sex, impedance index, and height-for-age z-score as predictors and explained 94.5% variation in FFM with an RMSE of 402 g (precision error 4.5%). CONCLUSIONS We present a BIA calibration equation for a group of stunted children with a relatively low prediction error. This may help evaluate the efficacy of nutritional supplementation in large-scale trials in the same population. J Nutr 20XX;xxx:xx.
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Affiliation(s)
- Jack I Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy, and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
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van Beijsterveldt IA, Myers PN, Snowden SG, Ong KK, Brix S, Hokken-Koelega AC, Koulman A. Distinct infant feeding type-specific plasma metabolites at age 3 months associate with body composition at 2 years. Clin Nutr 2022; 41:1290-1296. [DOI: 10.1016/j.clnu.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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10
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van Beijsterveldt IALP, Beunders VAA, Bijlsma A, Vermeulen MJ, Joosten KFM, Hokken-Koelega ACS. Body Composition Assessment by Air-Displacement Plethysmography Compared to Dual-Energy X-ray Absorptiometry in Full-Term and Preterm Aged Three to Five Years. J Clin Med 2022; 11:1604. [PMID: 35329930 PMCID: PMC8952802 DOI: 10.3390/jcm11061604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
It is important to monitor body composition longitudinally, especially in children with atypical body composition trajectories. Dual-energy X-ray absorptiometry (DXA) can be used and reference values are available. Air-displacement plethysmography (ADP) is a relatively new technique, but reference values are lacking. In addition, estimates of fat-free mass density (Dffm), needed in ADP calculations, are based on children aged >8 years and may not be valid for younger children. We, therefore, aimed to investigate whether DXA and ADP results were comparable in young children aged 3−5 years, either born full-term or preterm, and if Dffm estimates in the ADP algorithm could be improved. In 154 healthy children born full-term and 67 born < 30 weeks of the inverse pressure-volume gestation, aged 3−5 years, body composition was measured using ADP (BODPOD, with default Lohman Dffm estimates) and DXA (Lunar Prodigy). We compared fat mass (FM), fat mass percentage (FM%) and fat-free mass (FFM), between ADP and DXA using Bland−Altman analyses, in both groups. Using a 3-compartment model as reference method, we revised the Dffm estimates for ADP. In full-term-born children, Bland−Altman analyses showed considerable fixed and proportional bias for FM, FM%, and FFM. After revising the Dffm estimates, agreement between ADP and DXA improved, with mean differences (LoA) for FM, FM%, and FFM of −0.67 kg (−2.38; 1.04), −3.54% (−13.44; 6.36), and 0.5 kg (−1.30; 2.30), respectively, but a small fixed and proportional bias remained. The differences between ADP and DXA were larger in preterm-born children, even after revising Dffm estimates. So, despite revised and improved sex and age-specific Dffm estimates, results of ADP and DXA remained not comparable and should not be used interchangeably in the longitudinal assessment of body composition in children aged 3−5 years, and especially not in very preterm-born children of that age.
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Affiliation(s)
- Inge A. L. P. van Beijsterveldt
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Victoria A. A. Beunders
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands; (V.A.A.B.); (A.B.); (M.J.V.)
| | - Alja Bijlsma
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands; (V.A.A.B.); (A.B.); (M.J.V.)
| | - Marijn J. Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands; (V.A.A.B.); (A.B.); (M.J.V.)
| | - Koen F. M. Joosten
- Department of Pediatric Intensive Care, Sophia Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Anita C. S. Hokken-Koelega
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
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