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Muntis FR, Crandell JL, Evenson KR, Maahs DM, Seid M, Shaikh SR, Smith-Ryan AE, Mayer-Davis E. Pre-exercise protein intake is associated with reduced time in hypoglycaemia among adolescents with type 1 diabetes. Diabetes Obes Metab 2024; 26:1366-1375. [PMID: 38221862 PMCID: PMC10922329 DOI: 10.1111/dom.15438] [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: 09/12/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
AIM Secondary analyses were conducted from a randomized trial of an adaptive behavioural intervention to assess the relationship between protein intake (g and g/kg) consumed within 4 h before moderate-to-vigorous physical activity (MVPA) bouts and glycaemia during and following MVPA bouts among adolescents with type 1 diabetes (T1D). MATERIALS AND METHODS Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age and 36.6% overweight/obese, provided measures of glycaemia using continuous glucose monitoring [percentage of time above range (>180 mg/dl), time in range (70-180 mg/dl), time below range (TBR; <70 mg/dl)], self-reported physical activity (previous day physical activity recalls), and 24 h dietary recall data at baseline and 6 months post-intervention. Mixed effects regression models adjusted for design (randomization assignment, study site), demographic, clinical, anthropometric, dietary, physical activity and timing covariates estimated the association between pre-exercise protein intake on percentage of time above range, time in range and TBR during and following MVPA. RESULTS Pre-exercise protein intakes of 10-19.9 g and >20 g were associated with an absolute reduction of -4.41% (p = .04) and -4.83% (p = .02) TBR during physical activity compared with those who did not consume protein before MVPA. Similarly, relative protein intakes of 0.125-0.249 g/kg and ≥0.25 g/kg were associated with -5.38% (p = .01) and -4.32% (p = .03) absolute reductions in TBR during physical activity. We did not observe a significant association between protein intake and measures of glycaemia following bouts of MVPA. CONCLUSIONS Among adolescents with T1D, a dose of ≥10 g or ≥0.125 g/kg of protein within 4 h before MVPA may promote reduced time in hypoglycaemia during, but not following, physical activity.
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Affiliation(s)
- Franklin R Muntis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie L Crandell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Michael Seid
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Tran T, Igudesman D, Burger K, Crandell J, Maahs DM, Seid M, Mayer-Davis EJ. Eating behaviors and estimated body fat percentage among adolescents with type 1 diabetes. Diabetes Res Clin Pract 2024; 207:111070. [PMID: 38142747 PMCID: PMC10922665 DOI: 10.1016/j.diabres.2023.111070] [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: 07/13/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
AIMS Estimate associations between select eating behaviors and estimated body fat percentage (eBFP) and explore effect modification by sex among adolescents with type 1 diabetes (T1D). METHODS This analysis included 257 adolescents (mean age 14.9 ± 1.14 years; 49.8 % female) with baseline hemoglobin A1c (HbA1c) between 8 and 13 % (64 mmol/mol-119 mmol/mol) from a randomized trial designed to improve glycemia. Eating behaviors and eBFP were determined from surveys and validated equations respectively. Linear mixed models were used to estimate associations. Effect modification was assessed via stratified plots, stratified associations, and interaction terms. RESULTS Disordered eating, dietary restraint, and eBFP were significantly higher among females while external eating was higher among males. Disordered eating (β: 0.49, 95 %CI: 0.24, 0.73, p = 0.0001) and restraint (β: 1.11, 95 %CI: 0.29, 1.92, p = 0.0081) were positively associated with eBFP while external eating was not (β: -0.19, 95 %CI: -0.470, 0.096, p = 0.20). Interactions with sex were not significant (p-value range: 0.28-0.64). CONCLUSION Disordered eating and dietary restraint were positively associated with eBFP, highlighting the potential salience of these eating behaviors to cardiometabolic risk for both female and male adolescents. Prospective studies should investigate whether these eating behaviors predict eBFP longitudinally to inform obesity prevention strategies in T1D.
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Affiliation(s)
- Thanh Tran
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daria Igudesman
- Translational Research Institute, AdventHealth, Orlando, FL, USA.
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jamie Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA.
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Muntis FR, Smith-Ryan AE, Crandell J, Evenson KR, Maahs DM, Seid M, Shaikh SR, Mayer-Davis EJ. A High Protein Diet Is Associated with Improved Glycemic Control Following Exercise among Adolescents with Type 1 Diabetes. Nutrients 2023; 15:nu15081981. [PMID: 37111199 PMCID: PMC10143215 DOI: 10.3390/nu15081981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Nutritional strategies are needed to aid people with type 1 diabetes (T1D) in managing glycemia following exercise. Secondary analyses were conducted from a randomized trial of an adaptive behavioral intervention to assess the relationship between post-exercise and daily protein (g/kg) intake on glycemia following moderate-to-vigorous physical activity (MVPA) among adolescents with T1D. Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age, and 36.6% overweight or obese, provided measures of glycemia using continuous glucose monitoring (percent time above range [TAR, >180 mg/dL], time-in-range [TIR, 70-180 mg/dL], time-below-range [TBR, <70 mg/dL]), self-reported physical activity (previous day physical activity recalls), and 24 h dietary recall data at baseline and 6 months post-intervention. Mixed effects regression models adjusted for design (randomization assignment, study site), demographic, clinical, anthropometric, dietary, physical activity, and timing covariates estimated the association between post-exercise and daily protein intake on TAR, TIR, and TBR from the cessation of MVPA bouts until the following morning. Daily protein intakes of ≥1.2 g/kg/day were associated with 6.9% (p = 0.03) greater TIR and -8.0% (p = 0.02) less TAR following exercise, however, no association was observed between post-exercise protein intake and post-exercise glycemia. Following current sports nutrition guidelines for daily protein intake may promote improved glycemia following exercise among adolescents with T1D.
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Affiliation(s)
- Franklin R Muntis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Abbie E Smith-Ryan
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
- Department of Exercise & Sports Science, University of North Carolina, Chapel Hill, NC 27519, USA
| | - Jamie Crandell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Diabetes Research Center, Stanford, CA 94304, USA
| | - Michael Seid
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA
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Sarteau AC, Kahkoska AR, Crandell J, Igudesman D, Corbin KD, Kichler JC, Maahs DM, Muntis F, Pratley R, Seid M, Zaharieva D, Mayer-Davis E. More hypoglycemia not associated with increasing estimated adiposity in youth with type 1 diabetes. Pediatr Res 2023; 93:708-714. [PMID: 35729217 PMCID: PMC10958738 DOI: 10.1038/s41390-022-02129-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/08/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the widespread clinical perception that hypoglycemia may drive weight gain in youth with type 1 diabetes (T1D), there is an absence of published evidence supporting this hypothesis. METHODS We estimated the body fat percentage (eBFP) of 211 youth (HbA1c 8.0-13.0%, age 13-16) at baseline, 6, and 18 months of the Flexible Lifestyles Empowering Change trial using validated equations. Group-based trajectory modeling assigned adolescents to sex-specific eBFP groups. Using baseline 7-day blinded continuous glucose monitoring data, "more" vs. "less" percent time spent in hypoglycemia was defined by cut-points using sample median split and clinical guidelines. Adjusted logistic regression estimated the odds of membership in an increasing eBFP group comparing youth with more vs. less baseline hypoglycemia. RESULTS More time spent in clinical hypoglycemia (defined by median split) was associated with 0.29 the odds of increasing eBFP in females (95% CI: 0.12, 0.69; p = 0.005), and 0.33 the odds of stable/increasing eBFP in males (95% CI: 0.14, 0.78; p = 0.01). CONCLUSIONS Hypoglycemia may not be a major driver of weight gain in US youth with T1D and HbA1c ≥8.0. Further studies in different sub-groups are needed to clarify for whom hypoglycemia may drive weight gain and focus future etiological studies and interventions. IMPACT We contribute epidemiological evidence that hypoglycemia may not be a major driver of weight gain in US youth with type 1 diabetes and HbA1c ≥8.0% and highlight the need for studies to prospectively test this hypothesis rooted in clinical perception. Future research should examine the relationship between hypoglycemia and adiposity together with psychosocial, behavioral, and other clinical factors among sub-groups of youth with type 1 diabetes (i.e., who meet glycemic targets or experience a frequency/severity of hypoglycemia above a threshold) to further clarify for whom hypoglycemia may drive weight gain and progress etiological understanding of and interventions for healthy weight maintenance.
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Affiliation(s)
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen D Corbin
- Translational Research Institute, AdventHealth Orlando, Orlando, FL, USA
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, USA
| | - Frank Muntis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard Pratley
- Translational Research Institute, AdventHealth Orlando, Orlando, FL, USA
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Dessi Zaharieva
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Equations based on anthropometric measurements for adipose tissue, body fat, or body density prediction in children and adolescents: a scoping review. Eat Weight Disord 2022; 27:2321-2338. [PMID: 35699918 DOI: 10.1007/s40519-022-01405-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds. METHODS A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework ( https://osf.io/35uhc/ ). RESULTS We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations. CONCLUSION Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias. LEVEL IV Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Hudda MT, Wells JCK, Adair LS, Alvero-Cruz JRA, Ashby-Thompson MN, Ballesteros-Vásquez MN, Barrera-Exposito J, Caballero B, Carnero EA, Cleghorn GJ, Davies PSW, Desmond M, Devakumar D, Gallagher D, Guerrero-Alcocer EV, Haschke F, Horlick M, Ben Jemaa H, Khan AI, Mankai A, Monyeki MA, Nashandi HL, Ortiz-Hernandez L, Plasqui G, Reichert FF, Robles-Sardin AE, Rush E, Shypailo RJ, Sobiecki JG, Ten Hoor GA, Valdés J, Wickramasinghe VP, Wong WW, Riley RD, Owen CG, Whincup PH, Nightingale CM. External validation of a prediction model for estimating fat mass in children and adolescents in 19 countries: individual participant data meta-analysis. BMJ 2022; 378:e071185. [PMID: 36130780 PMCID: PMC9490487 DOI: 10.1136/bmj-2022-071185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the performance of a UK based prediction model for estimating fat-free mass (and indirectly fat mass) in children and adolescents in non-UK settings. DESIGN Individual participant data meta-analysis. SETTING 19 countries. PARTICIPANTS 5693 children and adolescents (49.7% boys) aged 4 to 15 years with complete data on the predictors included in the UK based model (weight, height, age, sex, and ethnicity) and on the independently assessed outcome measure (fat-free mass determined by deuterium dilution assessment). MAIN OUTCOME MEASURES The outcome of the UK based prediction model was natural log transformed fat-free mass (lnFFM). Predictive performance statistics of R2, calibration slope, calibration-in-the-large, and root mean square error were assessed in each of the 19 countries and then pooled through random effects meta-analysis. Calibration plots were also derived for each country, including flexible calibration curves. RESULTS The model showed good predictive ability in non-UK populations of children and adolescents, providing R2 values of >75% in all countries and >90% in 11 of the 19 countries, and with good calibration (ie, agreement) of observed and predicted values. Root mean square error values (on fat-free mass scale) were <4 kg in 17 of the 19 settings. Pooled values (95% confidence intervals) of R2, calibration slope, and calibration-in-the-large were 88.7% (85.9% to 91.4%), 0.98 (0.97 to 1.00), and 0.01 (-0.02 to 0.04), respectively. Heterogeneity was evident in the R2 and calibration-in-the-large values across settings, but not in the calibration slope. Model performance did not vary markedly between boys and girls, age, ethnicity, and national income groups. To further improve the accuracy of the predictions, the model equation was recalibrated for the intercept in each setting so that country specific equations are available for future use. CONCLUSION The UK based prediction model, which is based on readily available measures, provides predictions of childhood fat-free mass, and hence fat mass, in a range of non-UK settings that explain a large proportion of the variability in observed fat-free mass, and exhibit good calibration performance, especially after recalibration of the intercept for each population. The model demonstrates good generalisability in both low-middle income and high income populations of healthy children and adolescents aged 4-15 years.
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Affiliation(s)
- Mohammed T Hudda
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Jonathan C K Wells
- Population, Policy, and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Linda S Adair
- Department of Nutrition, University of North Carolina Schools of Public Health and Medicine, NC, USA
| | | | - Maxine N Ashby-Thompson
- Department of Pediatrics, New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, NY, USA
| | | | - Jesus Barrera-Exposito
- Biodynamic and Body Composition Laboratory, Faculty of Education Sciences, University of Málaga, Málaga, Spain
| | - Benjamin Caballero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elvis A Carnero
- Translational Research Institute, Adventhealth Orlando, Orlando, FL, USA
| | - Geoff J Cleghorn
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Peter S W Davies
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Malgorzata Desmond
- Population, Policy, and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Dympna Gallagher
- Department of Medicine and Institute Human Nutrition, Division of Endocrinology, New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, NY, USA
| | - Elvia V Guerrero-Alcocer
- Centro Universitario UAEM Amecameca, Universidad Autónoma del Estado de México, Amecameca de Juárez, Mexico
| | | | - Mary Horlick
- Body Composition Unit, St Luke's-Roosevelt Hospital, New York, NY, USA
| | - Houda Ben Jemaa
- Nutrition Department, Higher School of Health Sciences and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | - Ashraful I Khan
- International Centre for Diarrheal Disease Research, Dhaka 1212, Bangladesh
| | - Amani Mankai
- Nutrition Department, Higher School of Health Sciences and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | - Makama A Monyeki
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Hilde L Nashandi
- School of Nursing and Public Health, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia
| | - Luis Ortiz-Hernandez
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Mexico City, Mexico
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University, Maastricht, Netherlands
| | - Felipe F Reichert
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Alma E Robles-Sardin
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | - Elaine Rush
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Roman J Shypailo
- Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Jakub G Sobiecki
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Gill A Ten Hoor
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Jesús Valdés
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN, Mexico City, Mexico
| | | | - William W Wong
- Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
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Kahkoska AR, Sarteau AC, Igudesman D, Reboussin BA, Dabelea D, Dolan LM, Jensen E, Wadwa RP, Pihoker C, Mayer-Davis EJ. Association of Insulin Regimen and Estimated Body Fat Over Time among Youths and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. J Diabetes Res 2022; 2022:1054042. [PMID: 35127949 PMCID: PMC8816579 DOI: 10.1155/2022/1054042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS To explore how changes in insulin regimen are associated with estimated adiposity over time among youths and young adults with type 1 diabetes and whether any associations differ according to sex. MATERIALS AND METHODS Longitudinal data were analyzed from youths and young adults with type 1 diabetes in the SEARCH for Diabetes in Youth study. Participants were classified according to insulin regimen categorized as exclusive pump ("pump only"), exclusive injections ("injections only"), injection-pump transition ("injections-pump"), or pump-injection transition ("pump-injections") for each follow-up visit completed. Estimated body fat percentage (eBFP) was calculated using validated equations. Sex-specific, linear mixed effects models examined the relationship between the insulin regimen group and change in eBFP during follow-up, adjusted for baseline eBFP, baseline insulin regimen, time-varying insulin dose, sociodemographic factors, and baseline HbA1c (≥9.0% vs. <9.0%). RESULTS The final sample included 284 females and 304 males, of whom 80% were non-Hispanic white with mean diagnosis age of 12.7 ± 2.4 years. In fully adjusted models for females, exclusive pump use over the study duration was associated with significantly greater increases in eBFP compared to exclusive use of injections (difference in rate of change = 0.023% increase per month, 95%CI = 0.01, 0.04). Injection-to-pump transitions and pump-to-injection transitions were also associated with greater increases in eBFP compared to exclusive use of injections (difference in rate of change = 0.02%, 95%CI = 0.004, 0.03, and 0.02%; 95%CI = 0.0001, 0.04, respectively). There was no relationship between the insulin regimen and eBFP among males. CONCLUSIONS Among females with type 1 diabetes, exclusive and partial pump use may have the unintended consequence of increasing adiposity over time compared to exclusive use of injections, independent of insulin dose.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Lawrence M. Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R. Paul Wadwa
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Santos RMD, Nobre IG, Santos GCJ, Oliveira TLPSDA, Ribeiro IDC, Santos MAMD, Pirola L, Leandro CG. Validity and accuracy of body fat prediction equations using anthropometric measurements in children 7 – 10 years old. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2022. [DOI: 10.1590/1980-0037.2022v24e86719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
abstract Children with a deficit of growth because of perinatal malnutrition present specificities in the percentage of body fat (%BF) that could not be detected by previous fat mass-based equations. This study developed and validated predictive equations of the %BF derived from anthropometric variables in children aged 7 to 10 living in Northeast Brazil, using dual-energy x-ray absorptiometry (DXA) as a reference. Body composition data from 58 children were utilized. DXA was used as a reference. A stepwise (forward) multiple regression statistical model was used to develop the new equations. The Bland-Altman analysis (CI: 95%), paired Student's t-test, and the intraclass correlation coefficient (ICC) was used to validate and compare the developed equations. Two new equations were developed for either gender: boys: %BF: 13.642 + (1.527*BMI) + (-0.345*Height) + (0.875*Triceps) + (0.290* Waist Circumference) and girls: %BF: -13.445 + (2.061*Tight). The Bland-Altman analysis showed good agreement, with limits ranging from -1.33 to 1.24% for boys and -3.35 to 4.08% for girls. The paired Student’s t-test showed no difference between %BF-DXA and the two new equations (p> 0.05), and the ICC was 0.948 and 0.915, respectively. DXA-based anthropometric equations provide an accurate and noninvasive method to measure changes in the %BF in children.
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Cichosz SL, Rasmussen NH, Vestergaard P, Hejlesen O. Precise Prediction of Total Body Lean and Fat Mass From Anthropometric and Demographic Data: Development and Validation of Neural Network Models. J Diabetes Sci Technol 2021; 15:1337-1343. [PMID: 33190515 PMCID: PMC8655297 DOI: 10.1177/1932296820971348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Estimating body composition is relevant in diabetes disease management, such as drug administration and risk assessment of morbidity/mortality. It is unclear how machine learning algorithms could improve easily obtainable body muscle and fat estimates. The objective was to develop and validate machine learning algorithms (neural networks) for precise prediction of body composition based on anthropometric and demographic data. METHODS Cross-sectional cohort study of 18 430 adults and children from the US population. Participants were examined with whole-body dual X-ray absorptiometry (DXA) scans, anthropometric assessment, and answered a demographic questionnaire. The primary outcomes were predicted total lean body mass (predLBM), total body fat mass (predFM), and trunk fat mass (predTFM) compared with reference values from DXA scans. RESULTS Participants were randomly partitioned into 70% training (12 901) data and 30% validation (5529) data. The prediction model for predLBM compared with lean body mass measured by DXA (DXALBM) had a Pearson's correlation coefficient of R = 0.99 with a standard error of estimate (SEE) = 1.88 kg (P < .001). The prediction model for predFM compared with fat mass measured by DXA (DXAFM) had a Pearson's coefficient of R = 0.98 with a SEE = 1.91 kg (P < .001). The prediction model for predTFM compared with DXA measured trunk fat mass (DXAFM) had a Pearson's coefficient of R = 0.98 with a SEE = 1.13 kg (P < .001). CONCLUSIONS In this study, neural network models based on anthropometric and demographic data could precisely predict body muscle and fat composition. Precise body estimations are relevant in a broad range of clinical diabetes applications, prevention, and epidemiological research.
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Affiliation(s)
- Simon Lebech Cichosz
- Department of Health Science and
Technology, Aalborg University, Denmark
- Simon Lebech Cichosz PhD, Department of
Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2,
Aalborg, DK-9220, Denmark.
| | | | - Peter Vestergaard
- Steno Diabetes Center North Denmark,
Aalborg University Hospital, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Aalborg University, Denmark
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10
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Non-linear association of anthropometric measurements and pulmonary function. Sci Rep 2021; 11:14596. [PMID: 34272443 PMCID: PMC8285490 DOI: 10.1038/s41598-021-93985-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/24/2021] [Indexed: 11/08/2022] Open
Abstract
This study examined the association of anthropometric measurements [body mass index (BMI), waist circumference (WC), percentage body fat (PBF), body roundness index (BRI) and A Body Shape Index (ABSI)] with pulmonary function using a United States national cohort. This cross-sectional study included 7346 participants. The association between anthropometric measurements and pulmonary function was assessed by multivariable linear regression. Where there was evidence of non-linearity, we applied a restricted cubic spline to explore the non-linear association. All analyses were weighted to represent the U.S. population and to account for the intricate survey design. After adjusting for age, race, education, smoking, and physical activity, both underweight and obesity were associated with reduced forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Furthermore, the associations between BMI and FEV1, as well as FVC, were reversed U-shape in both males and females. Similar non-linear association shape occurred in WC, PBF, BRI and ABSI. Conclusion: BMI, WC, PBF, BRI, ABSI are non-linearly associated with pulmonary function. Reduced pulmonary function is a risk factor for future all-cause mortality and cardiovascular events; thus, this nonlinearity may explain the U-shape or J-shape association of BMI with overall mortality and cardiovascular events.
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11
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Development of population-specific prediction equations for bioelectrical impedance analyses in Vietnamese children. Br J Nutr 2020; 124:1345-1352. [PMID: 32616079 DOI: 10.1017/s000711452000241x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a need for accurate, inexpensive and field-friendly methods to assess body composition in children. Bioelectrical impedance analysis (BIA) is a promising approach; however, there have been limited validation and use among young children in resource-poor settings. We aim to develop and validate population-specific prediction equations for estimating total fat mass (FM), fat free-mass (FFM) and percentage body fat (PBF) in Vietnamese children (4-7 years) using reactance and resistance from BIA, anthropometric variables and demographic information. We conducted a cross-sectional survey of 120 children. Body composition was measured using dual-energy X-ray absorptiometry (DXA), BIA and anthropometry. To develop prediction equations, we split all data into development (70 %) and validation datasets (30 %). The model performance was evaluated using predicted residual error sum of squares, root mean squared error (RMSE), mean absolute error (MAE) and R2. We identified a top performing model with the least number of parameters (age, sex, weight and resistance index or resistance and height), low RMSE (FM 0·70, FFM 0·74, PBF 3·10), low MAE (FM 0·55, FFM 0·62, PBF 2·49), high R2 (FM 0·95, FFM 0·92, PBF 0·82) and the least difference between predicted values and actual values from DXA (FM 0·03 kg or 0·01 sd, FFM 0·06 kg or 0·02 sd, PBF 0·27 % or 0·04 sd). In conclusion, we developed the first valid and highly predictive equations to estimate FM, FFM and PBF in Vietnamese children using BIA. These findings have important implications for future research on the double burden of disease and risks associated with overweight and obesity in young children.
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12
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Kahkoska AR, Nguyen CT, Jiang X, Adair LA, Agarwal S, Aiello AE, Burger KS, Buse JB, Dabelea D, Dolan LM, Imperatore G, Lawrence JM, Marcovina S, Pihoker C, Reboussin BA, Sauder KA, Kosorok MR, Mayer-Davis EJ. Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood. BMJ Open Diabetes Res Care 2020; 8:e000886. [PMID: 32049631 PMCID: PMC7039605 DOI: 10.1136/bmjdrc-2019-000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/27/2019] [Accepted: 01/04/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Individuals with type 1 diabetes (T1D) present with diverse body weight status and degrees of glycemic control, which may warrant different treatment approaches. We sought to identify subgroups sharing phenotypes based on both weight and glycemia and compare characteristics across subgroups. RESEARCH DESIGN AND METHODS Participants with T1D in the SEARCH study cohort (n=1817, 6.0-30.4 years) were seen at a follow-up visit >5 years after diagnosis. Hierarchical agglomerative clustering was used to group participants based on five measures summarizing the joint distribution of body mass index z-score (BMIz) and hemoglobin A1c (HbA1c) which were estimated by reinforcement learning tree predictions from 28 covariates. Interpretation of cluster weight status and glycemic control was based on mean BMIz and HbA1c, respectively. RESULTS The sample was 49.5% female and 55.5% non-Hispanic white (NHW); mean±SD age=17.6±4.5 years, T1D duration=7.8±1.9 years, BMIz=0.61±0.94, and HbA1c=76±21 mmol/mol (9.1±1.9)%. Six weight-glycemia clusters were identified, including four normal weight, one overweight, and one subgroup with obesity. No cluster had a mean HbA1c <58 mmol/mol (7.5%). Cluster 1 (34.0%) was normal weight with the lowest HbA1c and comprised 85% NHW participants with the highest socioeconomic position, insulin pump use, dietary quality, and physical activity. Subgroups with very poor glycemic control (ie, ≥108 mmol/mol (≥12.0%); cluster 4, 4.4%, and cluster 5, 7.5%) and obesity (cluster 6, 15.4%) had a lower proportion of NHW youth, lower socioeconomic position, and reported decreased pump use and poorer health behaviors (overall p<0.01). The overweight subgroup with very poor glycemic control (cluster 5) showed the highest lipids and blood pressure (p<0.01). CONCLUSIONS There are distinct subgroups of youth and young adults with T1D that share weight-glycemia phenotypes. Subgroups may benefit from tailored interventions addressing differences in clinical care, health behaviors, and underlying health inequity.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Crystal T Nguyen
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda A Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shivani Agarwal
- Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kyle S Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John B Buse
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers of Disease Control and Prevention, Atlanta, Georgia
| | - Jean Marie Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Southern California, USA
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Catherine Pihoker
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A Reboussin
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Katherine A Sauder
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Hwaung P, Heo M, Kennedy S, Hong S, Thomas DM, Shepherd J, Heymsfield SB. Optimum waist circumference-height indices for evaluating adult adiposity: An analytic review. Obes Rev 2020; 21:e12947. [PMID: 31507076 DOI: 10.1111/obr.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
Phenotyping adults for excess adiposity and related health risks usually include three body size measurements: height, weight and waist circumference (WC). Height and weight are now widely used as components of the body shape measure, body mass index (BMI, weight/height2 ), with the height power referred to as the scaling factor, α. At present, WC is usually not adjusted for height or is expressed as WC/height in which α = 1. Although other α values have been proposed, a critical review of these shape measures is lacking. Here, we examine classical pathways by which the scaling exponent for height used in BMI was developed and then apply this strategy to identify the optimum WC index characteristic of adult shape. Our analyses explored anthropometric, body composition and clinically-relevant data from US and Korean National Health and Nutrition Surveys. Our findings provide further support for the WC index of WC/height0.5 as having the strongest associations with adiposity while having the weakest correlations with height across non-Hispanic white and black, Mexican American and Korean men and women. The WC index, defined as WC/height0.5 , when combined with BMI, can play an important role when phenotyping adults for excess adiposity and associated health risks in research and clinical settings.
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Affiliation(s)
- Phoenix Hwaung
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Samantha Kennedy
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
| | - Sangmo Hong
- Department of Internal Medicine, Hallym University, Seoul, Republic of Korea
| | - Diana M Thomas
- United States Military Academy, West Point, New York, USA
| | - John Shepherd
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
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14
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Woolcott OO, Bergman RN. Relative Fat Mass as an estimator of whole-body fat percentage among children and adolescents: A cross-sectional study using NHANES. Sci Rep 2019; 9:15279. [PMID: 31649287 PMCID: PMC6813362 DOI: 10.1038/s41598-019-51701-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023] Open
Abstract
We evaluated the ability of the Relative Fat Mass (RFM) to estimate whole-body fat percentage among children and adolescents who participated in the National Health and Nutrition Examination Survey from 1999 through 2006 (n = 10,390). The RFM equation for adults (64 − (20 × height/waist circumference) + (12 × sex)) may be used for adolescents 15 to 19 years of age. For children and adolescents 8 to 14 years of age, we suggest a modified RFM equation, named as the RFMp (RFM pediatric): 74 − (22 × height/waist circumference) + (5 × sex). In both equations, sex equals 0 for boys and 1 for girls. RFMp was more accurate than BMI to estimate whole-body fat percentage (measured by dual energy X-ray absorptiometry, DXA) among girls (percentage of estimates that were <20% of measured body fat percentage, 88.2% vs. 85.7%; P = 0.027) and boys 8 to 14 years of age (83.4% vs. 71.0%; P < 0.001). RFM was more accurate than BMI among boys 15 to 19 years of age (82.3% vs. 73.9%; P < 0.001) but slightly less accurate among girls (89.0% vs. 92.6%; P = 0.002). Compared with BMI-for-age percentiles, RFMp had lower misclassification error of overweight or obesity (defined as a DXA-measured body fat percentage at the 85th percentile or higher) among boys 8 to 14 years of age (6.5% vs. 7.9%; P = 0.018) but not girls (RFMp: 8.2%; BMI-for-age: 7.9%; P = 0.681). Misclassification error of overweight or obesity was similar for RFM and BMI-for-age percentiles among girls (RFM: 8.0%; BMI-for-age: 6.6%; P = 0.076) and boys 15 to 19 years of age (RFM: 6.9%; BMI-for-age: 7.8%; P = 0.11). RFMp for children and adolescents 8 to 14 years of age and RFM for adolescents 15 to 19 years of age were useful to estimate whole-body fat percentage and diagnose body fat-defined overweight or obesity.
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Affiliation(s)
- Orison O Woolcott
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Richard N Bergman
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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15
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Hudda MT, Fewtrell MS, Haroun D, Lum S, Williams JE, Wells JCK, Riley RD, Owen CG, Cook DG, Rudnicka AR, Whincup PH, Nightingale CM. Development and validation of a prediction model for fat mass in children and adolescents: meta-analysis using individual participant data. BMJ 2019; 366:l4293. [PMID: 31340931 PMCID: PMC6650932 DOI: 10.1136/bmj.l4293] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop and validate a prediction model for fat mass in children aged 4-15 years using routinely available risk factors of height, weight, and demographic information without the need for more complex forms of assessment. DESIGN Individual participant data meta-analysis. SETTING Four population based cross sectional studies and a fifth study for external validation, United Kingdom. PARTICIPANTS A pooled derivation dataset (four studies) of 2375 children and an external validation dataset of 176 children with complete data on anthropometric measurements and deuterium dilution assessments of fat mass. MAIN OUTCOME MEASURE Multivariable linear regression analysis, using backwards selection for inclusion of predictor variables and allowing non-linear relations, was used to develop a prediction model for fat-free mass (and subsequently fat mass by subtracting resulting estimates from weight) based on the four studies. Internal validation and then internal-external cross validation were used to examine overfitting and generalisability of the model's predictive performance within the four development studies; external validation followed using the fifth dataset. RESULTS Model derivation was based on a multi-ethnic population of 2375 children (47.8% boys, n=1136) aged 4-15 years. The final model containing predictor variables of height, weight, age, sex, and ethnicity had extremely high predictive ability (optimism adjusted R2: 94.8%, 95% confidence interval 94.4% to 95.2%) with excellent calibration of observed and predicted values. The internal validation showed minimal overfitting and good model generalisability, with excellent calibration and predictive performance. External validation in 176 children aged 11-12 years showed promising generalisability of the model (R2: 90.0%, 95% confidence interval 87.2% to 92.8%) with good calibration of observed and predicted fat mass (slope: 1.02, 95% confidence interval 0.97 to 1.07). The mean difference between observed and predicted fat mass was -1.29 kg (95% confidence interval -1.62 to -0.96 kg). CONCLUSION The developed model accurately predicted levels of fat mass in children aged 4-15 years. The prediction model is based on simple anthropometric measures without the need for more complex forms of assessment and could improve the accuracy of assessments for body fatness in children (compared with those provided by body mass index) for effective surveillance, prevention, and management of clinical and public health obesity.
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Affiliation(s)
- Mohammed T Hudda
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Mary S Fewtrell
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dalia Haroun
- College of Natural and Health Sciences, Department of Public Health and Nutrition, Zayed University, Dubai, UAE
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia section of III Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane E Williams
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
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16
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Reynolds KR, Stevens J, Cai J, Lewis CE, Choh AC, Czerwinski SA. External Validation of Equations that Use Demographic and Anthropometric Measurements to Predict Percent Body Fat. Obes Sci Pract 2018; 4:515-525. [PMID: 30574345 PMCID: PMC6298207 DOI: 10.1002/osp4.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/23/2018] [Accepted: 08/26/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Numerous equation to predict percent body fat using demographics and anthropometrics have been published but external validation of these equations is limited. The objective of this study was to validate published equations that use anthropometrics for prediction of percent body fat using external data. METHODS Data were from the Visceral Fat, Metabolic Rate, and Coronary Heart Disease Risk I (VIM I) Study and the Fels Longitudinal Study (Fels). VIM I was conducted in a subset of subjects from the CARDIA study and included black and white adults 28-40 years (n = 392). Fels consisted of white participants 8-88 years (n = 1,044). Percent body fat assessed by dual X-ray absorptiometry (DXA) in these two studies was compared to results calculated using 13 equations from Stevens et al. and nine other published equations. RESULTS In general, the Stevens equations performed better than equations from other studies. For example, equation "I" in women in VIM I, Fels adults, and Fels youth, R2 estimates were 0.765, 0.757 and 0.789, respectively. In men the estimates were 0.702 in VIM I, 0.822 in Fels adults and 0.905 in Fels youth. None of the results from the nine published equations showed R2 this high in corresponding groups. CONCLUSIONS Our results indicate that several of the Stevens equations have external validity superior to that of nine other published equations among varying age groups, genders and races.
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Affiliation(s)
- K. R. Reynolds
- Departments of EpidemiologyUniversity of North CarolinaChapel HillNCUS
| | - J. Stevens
- Departments of EpidemiologyUniversity of North CarolinaChapel HillNCUS
- Departments of NutritionUniversity of North CarolinaChapel HillNCUS
| | - J. Cai
- Departments of BiostatisticsUniversity of North CarolinaChapel HillNCUS
| | - C. E. Lewis
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamALUS
| | - A. C. Choh
- School of Public HealthUniversity of Texas Health Science Center at HoustonBrownsvilleTXUS
| | - S. A. Czerwinski
- School of Public HealthUniversity of Texas Health Science Center at HoustonBrownsvilleTXUS
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17
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Kahkoska AR, Shay CM, Couch SC, Crandell J, Dabelea D, Gourgari E, Lawrence JM, Liese AD, Pihoker C, Reboussin BA, The N, Mayer-Davis EJ. Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes. Pediatr Diabetes 2018; 19:1429-1440. [PMID: 30129111 PMCID: PMC6249094 DOI: 10.1111/pedi.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
Excess adiposity is common in youth with type 1 diabetes, yet little is known about the sociodemographic factors that predict longitudinal trajectories of body fat. We analyzed data from 363 females and 379 males with type 1 diabetes over ~9 years of follow-up (mean baseline age 12.8 ± 2.3 years in females, 13.2 ± 2.4 years in males). Estimated body fat percentage (eBFP) was calculated with validated sex- and race/ethnicity-specific equations. Group-based modeling identified three eBFP trajectories for each sex. All female trajectories showed gradual increases, while male trajectories showed gradual decreases (<5% in eBFP) that plateaued around 7 years of diabetes duration. Female trajectories showed differences in baseline eBFP: Group F1 (38.0%), mean eBFP 27.8 ± 3.0%: Group F2 (47.9%), mean eBFP 33.9 ± 3.0%: and Group F3 (14.1%), mean eBFP 41.7 ± 4.1%. Male trajectories also showed differences in baseline eBFP: Group M1 (57.2%), mean eBFP 22.0 ± 3.0%: Group M2 (30.9%), mean eBFP 33.9 ± 3.0%: and Group M3 (12.9%), mean eBFP 36.1 ± 3.7%. In multinomial models, adjusted for clinical factors (eg, insulin regimen, insulin dose, and hemoglobin A1c), females who reported a single-parent household (adjusted odds ratio [aOR] = 3.34, 95% confidence interval [CI]: 1.49, 7.47), parental education of less than a college degree (aOR = 3.79, 95% CI: 1.60, 9.60), and a lack of private health insurance (aOR = 3.74, 95% CI: 1.45, 9.60), and a household income of less than $75 000 per year (aOR = 3.13, 95% CI: 1.27, 7.70) were approximately three to four times more likely to be in the highest eBFP trajectory group relative to the lowest eBFP trajectory group. Males who reported a household income of <$75 000/year were almost twice as likely to be in the Group M3 than the Group M1 in the unadjusted model only (aOR = 1.79, 95% CI: 0.91, 4.01 vs unadjusted OR: 2.48, 95% CI: 1.22, 5.06). Lower socioeconomic status may be associated with excess body fat throughout adolescence in type 1 diabetes, particularly among females.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | | | - Sarah C. Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati. Cinncinati, OH;
| | - Jamie Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO;
| | - Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington, DC;
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA;
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of Southern Carolina, Columbia, SC;
| | | | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC;
| | - Natalie The
- Department of Health Sciences, Furman University, Greenville, South Carolina;
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;
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18
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Woolcott OO, Bergman RN. Relative fat mass (RFM) as a new estimator of whole-body fat percentage ─ A cross-sectional study in American adult individuals. Sci Rep 2018; 8:10980. [PMID: 30030479 PMCID: PMC6054651 DOI: 10.1038/s41598-018-29362-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023] Open
Abstract
High whole-body fat percentage is independently associated with increased mortality. We aimed to identify a simple anthropometric linear equation that is more accurate than the body mass index (BMI) to estimate whole-body fat percentage among adult individuals. National Health and Nutrition Examination Survey (NHANES) 1999–2004 data (n = 12,581) were used for model development and NHANES 2005–2006 data (n = 3,456) were used for model validation. From the 365 anthropometric indices generated, the final selected equation was as follows: 64 − (20 × height/waist circumference) + (12 × sex), named as the relative fat mass (RFM); sex = 0 for men and 1 for women. In the validation dataset, compared with BMI, RFM better predicted whole-body fat percentage, measured by dual energy X-ray absorptiometry (DXA), among women and men. RFM showed better accuracy than the BMI and had fewer false negative cases of body fat-defined obesity among women and men. RFM reduced total obesity misclassification among all women and all men and, overall, among Mexican-Americans, European-Americans and African-Americans. In the population studied, the suggested RFM was more accurate than BMI to estimate whole-body fat percentage among women and men and improved body fat-defined obesity misclassification among American adult individuals of Mexican, European or African ethnicity.
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Affiliation(s)
- Orison O Woolcott
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Richard N Bergman
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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Aristizabal JC, Estrada-Restrepo A, Giraldo García A. Development and validation of anthropometric equations to estimate body composition in adult women. COLOMBIA MEDICA (CALI, COLOMBIA) 2018; 49:154-159. [PMID: 30104807 PMCID: PMC6084924 DOI: 10.25100/cm.v49i2.3643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To develop anthropometric equations to predict body fat percentage (BF%). Methods In 151 women (aged 18-59) body weight, height, eight- skinfold thickness (STs), six- circumferences (CIs), and BF% by hydrodensitometry were measured. Subjects data were randomly divided in two groups, equation-building group (n= 106) and validation group (n= 45). The equation-building group was used to run linear regression models using anthropometric measurements as predictors to find the best prediction equations of the BF%. The validation group was used to compare the performance of the new equations with those of Durnin-Womersley, Jackson-Pollock and Ramirez-Torun. Results There were two preferred equations: Equation 1= 11.76 + (0.324 x tricipital ST) + (0.133 x calf ST) + (0.347 x abdomen CI) + (0.068 x age) - (0.135 x height) and Equation 2= 11.37 + (0.404 x tricipital ST) + (0.153 x axilar ST) + (0.264 x abdomen CI) + (0.069 x age) - (0.099 x height). There were no significant differences in BF% obtained by hydrodensitometry (31.5 ±5.3) and Equation 1 (31.0 ±4.0) and Equation 2 (31.2 ±4.0). The BF% estimated by Durning-Womersley (35.8 ±4.0), Jackson-Pollock (26.5 ±5.4) and Ramirez-Torun (32.6 ±4.8) differed from hydrodensitometry (p <0.05). The interclass correlation coefficient (ICC) was high between hydrodensitometry and Equation 1 (ICC= 0.77), Equation 2 (ICC= 0.76), and Ramirez-Torun equation (ICC= 0.75). The ICC was low between hydrodensitometry and Durnin-Womersley (ICC= 0.51) and Jackson-Pollock (ICC= 0.53) equations. Conclusion The new Equations-1 and 2, performed better than the commonly used anthropometric equations to predict BF% in adult women.
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Affiliation(s)
- Juan C Aristizabal
- Physiology and Biochemistry Research Group-PHYSIS, Universidad de Antioquia, Medellin, Colombia.,School of Nutrition and Dietetics, Universidad de Antioquia, Medellin, Colombia
| | - Alejandro Estrada-Restrepo
- School of Nutrition and Dietetics, Universidad de Antioquia, Medellin, Colombia.,Demography and Health Research Group, Universidad de Antioquia, Medellin, Colombia
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Ferrara CT, Geyer SM, Evans-Molina C, Libman IM, Becker DJ, Wentworth JM, Moran A, Gitelman SE, Redondo MJ. The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults. J Clin Endocrinol Metab 2017; 102:4596-4603. [PMID: 29092051 PMCID: PMC5718698 DOI: 10.1210/jc.2017-01490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Given the global rise in both type 1 diabetes incidence and obesity, the role of body mass index (BMI) on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention (PTP) cohort increased risk for progression to type 1 diabetes, but the effects of age and obesity in adults remain largely unknown. OBJECTIVE To determine the effect of age and sustained obesity on the risk for type 1 diabetes in adult participants in the TrialNet PTP cohort (i.e., nondiabetic autoantibody-positive relatives of patients with type 1 diabetes). RESEARCH DESIGN AND METHODS Longitudinally accumulated BMI >25 kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each participant, with ceBMI values ≥0 kg/m2 and ≥5 kg/m2 representing sustained overweight or obese status, respectively. Recursive partitioning analysis yielded sex- and age-specific thresholds for ceBMI that confer the greatest risk for type 1 diabetes progression. RESULTS In this cohort of 665 adults (age 20 to 50 years; median follow-up, 3.9 years), 49 participants developed type 1 diabetes. Age was an independent protective factor for type 1 diabetes progression (hazard ratio, 0.95; P = 0.008), with a threshold of >35 years that reduced risk for type 1 diabetes. In men age >35 years and women age <35 years, sustained obesity (ceBMI ≥5 kg/m2) increased the risk for type 1 diabetes. CONCLUSIONS Age is an important factor for type 1 diabetes progression in adults and influences the impact of elevated BMI, indicating an interplay of excess weight, age, and sex in adult type 1 diabetes pathophysiology.
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Affiliation(s)
- Christine T. Ferrara
- Department of Pediatric Endocrinology, University of California at San Francisco, San Francisco, California 94143
| | - Susan M. Geyer
- Department of Informatics and Biostatistics, University of Southern Florida, Tampa, Florida 33620
| | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Ingrid M. Libman
- Department of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224
| | - Dorothy J. Becker
- Department of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224
| | - John M. Wentworth
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Antoinette Moran
- Department of Pediatric Endocrinology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Stephen E. Gitelman
- Department of Pediatric Endocrinology, University of California at San Francisco, San Francisco, California 94143
| | - Maria J. Redondo
- Section of Pediatric Endocrinology, Texas Children’s Hospital, Houston, Texas 77030
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Development and validation of anthropometric prediction equations for lean body mass, fat mass and percent fat in adults using the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Br J Nutr 2017; 118:858-866. [PMID: 29110742 DOI: 10.1017/s0007114517002665] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Quantification of lean body mass and fat mass can provide important insight into epidemiological research. However, there is no consensus on generalisable anthropometric prediction equations to validly estimate body composition. We aimed to develop and validate practical anthropometric prediction equations for lean body mass, fat mass and percent fat in adults (men, n 7531; women, n 6534) from the National Health and Nutrition Examination Survey 1999-2006. Using a prediction sample, we predicted each of dual-energy X-ray absorptiometry (DXA)-measured lean body mass, fat mass and percent fat based on different combinations of anthropometric measures. The proposed equations were validated using a validation sample and obesity-related biomarkers. The practical equation including age, race, height, weight and waist circumference had high predictive ability for lean body mass (men: R 2=0·91, standard error of estimate (SEE)=2·6 kg; women: R 2=0·85, SEE=2·4 kg) and fat mass (men: R 2=0·90, SEE=2·6 kg; women: R 2=0·93, SEE=2·4 kg). Waist circumference was a strong predictor in men only. Addition of other circumference and skinfold measures slightly improved the prediction model. For percent fat, R 2 were generally lower but the trend in variation explained was similar. Our validation tests showed robust and consistent results with no evidence of substantial bias. Additional validation using biomarkers demonstrated comparable abilities to predict obesity-related biomarkers between direct DXA measurements and predicted scores. Moreover, predicted fat mass and percent fat had significantly stronger associations with obesity-related biomarkers than BMI did. Our findings suggest the potential application of the proposed equations in various epidemiological settings.
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Nationally representative equations that include resistance and reactance for the prediction of percent body fat in Americans. Int J Obes (Lond) 2017; 41:1669-1675. [PMID: 28736441 PMCID: PMC5675766 DOI: 10.1038/ijo.2017.167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
Background/Objectives Resistance and reactance collected by bioelectrical impedance (BIA) can be used in equations to estimate percent body fat at relatively low cost and subject burden. To our knowledge no such equations have been developed in a nationally representative sample. Subjects/Methods Dual-energy X-ray absorptiometry (DXA) assessed percent body fat from the 1999–2004 NHANES was the criterion method for development of sex-specific percent body fat equations using up to 6,467 males or 4,888 females 8 to 49 years of age. Candidate variables were studied in multiple mathematical forms and interactions using the Least Absolute Shrinkage and Selection Operator (LASSO). Models were fit in 2/3′s of the data and validated in 1/3 of the data selected at random. Final coefficients, R2 values and root mean square error (RMSE) were estimated in the full data set. Results Models that included age, ethnicity, height, weight, BMI and BIA assessments (resistance, reactance and height2/resistance) had R2 values of 0.831 in men and 0.864 in women in the full data set. RMSE measurements were between 2 and 3 body fat percentage points, and all equations showed low bias across groups formed by age, race/ethnicity or body mass index category. The addition of triceps skinfold and waist circumference increased the R2 to 0.905 in males and 0.883 in females. Adding other anthropometrics (plus menses in females) had little impact on performance. Reactance and resistance alone (in multiple mathematical forms) performed poorly with R2 ~ 0.2. Conclusions Equations that included BIA assessments along with demographic and anthropometric variables provided percent body fat assessments that had high generalizability, strong predictive ability and low bias.
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Bulathsinhala L, Hughes JM, McKinnon CJ, Kardouni JR, Guerriere KI, Popp KL, Matheny RW, Bouxsein ML. Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers. J Bone Miner Res 2017; 32:1546-1553. [PMID: 28300324 DOI: 10.1002/jbmr.3131] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 11/11/2022]
Abstract
Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in white and Hispanic Soldiers compared with black Soldiers. However, these studies did not account for the large ethnic diversity in the US military. We aimed to identify differences in SF risk among racial/ethnic groups within the US Army. A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex. We identified 21,549 SF cases in 1,299,332 Soldiers (more than 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1000 person-years (7.47 and 2.05 per 1000 person-years in women and men, respectively). Using non-Hispanic blacks as the referent group, non-Hispanic white women had the highest risk of SF, with a 92% higher risk of SF than non-Hispanic black women (1.92 [1.81-2.03]), followed by American Indian/Native Alaskan women (1.72 [1.44-1.79]), Hispanic women (1.65 [1.53-1.79]), and Asian women (1.32 [1.16-1.49]). Similarly, non-Hispanic white men had the highest risk of SF, with a 59% higher risk of SF than non-Hispanic black men (1.59 [1.50-1.68]), followed by Hispanic men (1.19 [1.10-1.29]). When examining the total US Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with non-Hispanic white Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lakmini Bulathsinhala
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Julie M Hughes
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Craig J McKinnon
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Joseph R Kardouni
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Katelyn I Guerriere
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald W Matheny
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Department of Orthopedic Surgery, Harvard Medical School, Boston MA, USA
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Heymsfield SB, Stevens J. Anthropometry: continued refinements and new developments of an ancient method. Am J Clin Nutr 2017; 105:1-2. [PMID: 28003202 DOI: 10.3945/ajcn.116.148346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - June Stevens
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
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