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Asif M, Aslam M, Wyszyńska J, Altaf S. Establishing Body Mass Index growth charts for Pakistani children and adolescents using the lambda-mu-sigma (LMS) and quantile regression method. Minerva Pediatr (Torino) 2023; 75:866-875. [PMID: 32508076 DOI: 10.23736/s2724-5276.20.05745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Assessment of growth and nutritional status is an essential part of clinical evaluation and care in pediatrics. Therefore, we aimed to establish age and gender specific smoothed BMI growth reference charts of Pakistani children and adolescents aged 2-18 years and to compare our LMS median percentile values with WHO 2007 international references and with references from other foreign studies. METHODS A representative cross-sectional sample of 10,668 healthy Pakistani subjects aged 2 to 18 years was studied. For calculation of BMI (kg/m2), height (cm) and weight (kg) were measured using standard procedures. Age and gender specific smoothed BMI growth reference values and associated charts were obtained using lambda-mu-sigma (LMS) as well as quantile regression (QR) statistical methods. RESULTS In the sample studied, the mean (±SD) BMI of all subjects was 16.50 (±2.83 kg/m2). Smoothed BMI percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) obtained by using LMS and QR methods, showed that BMI increased with age in both sexes. During pubertal age, girls had larger percentiles than boys. Centile values estimated by the LMS and QR procedure had small variability from the empirical centiles. Comparison of LMS BMI 50th percentile with references from WHO 2007 and data from other countries demonstrated that Pakistani children had substantially lower BMI percentiles than their counterparts in the reference population. CONCLUSIONS This comprehensive study suggests that WHO 2007 references are not suitable for Pakistani children. The QR method should be considered as an alternative method to develop growth charts.
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Affiliation(s)
- Muhammad Asif
- Department of Statistics, Govt. Degree College, Qadir Pur Raan Multan, Pakistan -
| | - Muhammad Aslam
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Saima Altaf
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
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2
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Kuriyan R, Hills AP, Murphy-Alford A, Padmanabha R, Nyati LH, Byrne NM, Kurpad AV, Norris S. Body composition of infants at 6 months of age using a 3-compartment model. Eur J Clin Nutr 2023:10.1038/s41430-023-01351-2. [PMID: 37833566 DOI: 10.1038/s41430-023-01351-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND/OBJECTIVES Two compartment (2 C) models of body composition, including Air Displacement Plethysmography (ADP) and Deuterium Dilution (DD), assume constant composition of fat-free mass (FFM), while 3-compartment (3 C) model overcomes some of these assumptions; studies are limited in infants. The objective of the present study is to compare 3 C estimates of body composition in 6-mo. old infants from Australia, India, and South Africa, including FFM density and hydration, compare with published literature and to evaluate agreement of body composition estimates from ADP and DD. METHODS Body volume and water were measured in 176 healthy infants using ADP and DD. 3C-model estimates of fat mass (FM), FFM and its composition were calculated, compared between countries (age and sex adjusted) and with published literature. Agreement between estimates from ADP and DD were compared by Bland-Altman and correlation analyses. RESULTS South African infants had significantly higher % FM (11.5%) and density of FFM compared to Australian infants. Australian infants had significantly higher % FFM (74.7 ± 4.4%) compared to South African infants (71.4 ± 5.0) and higher FFMI (12.7 ± 0.8 kg/m2) compared to South African (12.3 ± 1.2 kg/m2) and Indian infants (11.9 ± 1.0 kg/m2). FFM composition of present study differed significantly from literature. Pooled three country estimates of FM and FFM were comparable between ADP and DD; mean difference of -0.05 (95% CI: -0.64, +0.55) kg and +0.05 (95% CI: -0.55, +0.64) kg. CONCLUSIONS 3C-model estimates of body composition in infants differed between countries; future studies are needed to confirm these findings and investigate causes for the differences.
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Affiliation(s)
| | | | | | | | | | | | | | - Shane Norris
- University of Witwatersrand, Johannesburg, South Africa
- University of Southampton, Southampton, UK
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3
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Mahaffey R, Brown N, Cramp M, Morrison SC, Drechsler WI. Evaluation of bioelectrical impedance analysis in measuring body fat in 6-to-12-year-old boys compared with air displacement plethysmography. Br J Nutr 2023; 130:1098-1104. [PMID: 36562205 DOI: 10.1017/s0007114522004019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Air displacement plethysmography (ADP) has been considered as the 'standard' method to determine body fat in children due to superior validity and reliability compared with bioelectrical impedance analysis (BIA). However, ADP and BIA are often used interchangeably despite few studies comparing measures of percentage body fat by ADP (%FMADP) with BIA (%FMBIA) in children with and without obesity. The objective of this study was to measure concurrent validity and reliability of %FMADP and %FMBIA in 6-to-12-year-old boys with and without obesity. Seventy-one boys (twenty-five with obesity) underwent body composition assessment. Ten boys participated in intra-day reliability analysis. %FMADP was estimated by Bodpod using sex- and age-specific equations of body density. %FMBIA was estimated by a multi-frequency, hand-to-foot device using child-specific equations based on impedance. Validity was assessed by t tests, correlation coefficients and limits of agreement (LoA); and reliability by technical error of measurement (TEM) and intraclass correlation coefficients (ICC). Compared with %FMADP, %FMBIA was significantly underestimated in the cohort (-3·4 ± 5·6 %; effect size = 0·42) and in both boys with obesity (-5·2 ± 5·5 %; ES = 0·90) and without obesity (-2·4 ± 5·5 %; ES = 0·52). A strong, significant positive correlation was found between %FMADP and %FMBIA (r = 0·80). Across the cohort, LoA were 22·3 %, and no proportional bias was detected. For reliability, TEM were 0·65 % and 0·55 %, and ICC were 0·93 and 0·95 for %FMBIA and %FMADP, respectively. Whilst both %FMADP and %FMBIA are highly reliable methods, considerable differences indicated that the devices cannot be used interchangeably in boys age 6-to-12 years.
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Affiliation(s)
- Ryan Mahaffey
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK
| | - Nicola Brown
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK
| | - Mary Cramp
- Department of Allied Health Professions, University of the West of EnglandBristol, UK
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, UK
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Yanchis D, So S, Patterson C, Belza C, Garofalo E, Wong-Sterling S, Silva C, Avitzur Y, Wales PW, Hulst JM, Kong D, Xuyx L, Courtney-Martin G. Assessment of body composition in pediatric intestinal failure: A comparison study. JPEN J Parenter Enteral Nutr 2023; 47:920-929. [PMID: 37355855 DOI: 10.1002/jpen.2540] [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: 02/16/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The objective of the study was to compare bioelectrical impedance analysis (BIA) and skinfolds with dual energy x-ray absorptiometry (DXA) in the assessment of body composition of children with intestinal failure. DXA is the reference method for body composition assessment in clinical settings. METHODS Children aged 1-18 years with intestinal failure whohave DXA as part of routine clinical monitoring were eligible. BIA measured total body water on the same day as DXA. Skinfold measurements were taken at four sites: triceps, biceps, subscapular, and suprailiac. Percentage of fat mass (%FM) and fat-free mass (%FFM) were derived from resistance and reactance measured by BIA by using age-specific equations. Percentage of FM was calculated from skinfold measures by using age-specific equations. Data on patient characteristics, intestinal failure-related factors, and feeding method were collected. Paired t test examined differences in %FM and %FFM and Bland-Altman analysis determined the agreement between BIA, skinfolds, and DXA. Marginal linear model assessed the effect of age, sex, and feeding method on the difference in body composition obtained between DXA and BIA and between DXA and skinfolds. RESULTS Sixty-eight children with intestinal failure, mean age 8.9 ± 4.2 years, were studied. There was no difference between %FFM and %FM obtained by DXA and BIA (P = 0.26), with a mean bias (95% CI) of -0.69 (-1.9 to 0.5) for %FFM. Sex and age were individually and jointly associated with the bias observed between DXA and BIA (P < 0.05). Skinfold and DXA measurements were significantly different (P < 0.05). CONCLUSIONS BIA is an acceptable clinical tool for assessing body composition in pediatric intestinal failure.
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Affiliation(s)
- Dianna Yanchis
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephanie So
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Patterson
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Christina Belza
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Garofalo
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sylvia Wong-Sterling
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carina Silva
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Paul W Wales
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessie M Hulst
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Dehan Kong
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Libai Xuyx
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Glenda Courtney-Martin
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Polfuss M, Bandini LG, Ravelli MN, Huang Z, Moosreiner A, Schoeller DA, Huang CC, Ding D, Berry C, Marston E, Hussain A, Shriver TC, Sawin KJ. Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol. Front Pediatr 2023; 11:1151797. [PMID: 37547107 PMCID: PMC10397728 DOI: 10.3389/fped.2023.1151797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS. Methods This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS. Discussion The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
| | - Linda G. Bandini
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Michele N. Ravelli
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Zijian Huang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Moosreiner
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Dale A. Schoeller
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Chiang-Ching Huang
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cristen Berry
- Pediatric Translational Research Unit, Children’s Wisconsin, Milwaukee, WI, United States
| | - Emma Marston
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Azeem Hussain
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Timothy C. Shriver
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Kathleen J. Sawin
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
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Lu H, Ayers E, Patel P, Mattoo TK. Body water percentage from childhood to old age. Kidney Res Clin Pract 2023; 42:340-348. [PMID: 37313612 DOI: 10.23876/j.krcp.22.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Total body water (TBW) increases with growth, but the body water percentage (TBW%) decreases with aging. The objective of our study was to delineate TBW% in males and females by bioelectrical impedance analysis (BIA) from early childhood to old age. METHODS We enrolled 545 participants aged 3 to 98 years (258 male, 287 female). Among the participants, 256 had a normal weight and 289 were overweight. The TBW was measured by BIA, and TBW% was derived by dividing the TBW (L) value by body weight (kg). For analysis, we divided participants into the four age groups of 3-10, 11-20, 21-60, and ≥61 years. RESULTS In normal-weight subjects, the TBW% was similar at 62% between males and females in the 3-10-year group. It remained unchanged in males until and through adult life, then decreased to 57% in the ≥61-year group. In normal-weight female subjects, the TBW% decreased to 55% in the 11-20-year group, remained relatively unaltered in the 21-60-year group, then decreased to 50% in the ≥61-year group. In overweight subjects, the TBW% values in males, as well as females, were significantly lower as compared to those with normal weight. CONCLUSION Our study showed that the TBW% in normal-weight males changes very little from early childhood to adult life compared to that of females, who showed a decrease in TBW% during the pubertal years. In normal-weight subjects of both sexes, the TBW% decreased after the age of 60 years. Overweight subjects had significantly lower TBW% as compared to those with normal weight.
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Affiliation(s)
- Hong Lu
- Division of Nephrology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eric Ayers
- Wayne Health, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pragnesh Patel
- Department of Geriatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tej K Mattoo
- Division of Nephrology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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Bandyopadhyay S, Puttaswamy D, Gabriel MP, J J, Finkelstein JL, Selvam S, Kurpad AV, Kuriyan R. Estimation of Hydration and Density of Fat-Free Mass in Indian Children Using a 4-Compartment Model: Implications for the Estimation of Body Composition Using 2-Compartment Models. J Nutr 2023; 153:435-442. [PMID: 36894236 DOI: 10.1016/j.tjnut.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Accurate methods are needed to measure body fat mass (FM), particularly in South Asian children who are thought to have greater adiposity for a given body size. The accuracy of simple 2-compartment (2C) models of measuring FM depends on the primary measurement of the fat free mass (FFM) and the validity of assumed constants for FFM hydration and density. These have not been measured in this particular ethnic group. OBJECTIVES To measure FFM hydration and density in South Indian children using a 4-compartment (4C) model and to compare FM estimates from this 4C-model with 2C-model-based estimates from hydrometry and densitometry, using literature-reported FFM hydration and density in children. METHODS This study included 299 children (45% boys), aged 6-16 y from Bengaluru, India. Total body water (TBW), bone mineral content (BMC), and body volume were measured using deuterium dilution, dual-energy X-ray absorptiometry, and air displacement plethysmography, respectively, to calculate the FFM hydration and density, and the FM using 4C and 2C models. The agreement between FM estimates from 2C and 4C models was also evaluated. RESULTS Mean FFM hydration and density were 74.2% ± 2.1% and 71.4% ± 2.0% and 1.095 ± 0.008 kg/L and 1.105 ± 0.008 kg/L in boys and girls respectively, which were significantly different from published values. Using the presently estimated constants, the mean hydrometry-based FM (as % body weight) estimates decreased by 3.5% but increased by 5.2% for densitometry-based 2C methods. When 2C-FM (using previously reported FFM hydration and density) were compared with 4C-FM estimates, the mean difference was -1.1 ± 0.9 kg for hydrometry and 1.6 ± 1.1 kg for densitometry. CONCLUSIONS Previously published constants of hydration and density of FFM may induce errors of -12% to +17% in FM (kg) when using different 2C models in comparison to the 4C models in Indian children. J Nutr 20xx;x:xx.
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Affiliation(s)
- Sulagna Bandyopadhyay
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Deepa Puttaswamy
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Mamatha Philip Gabriel
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Jayakumar J
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Julia L Finkelstein
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India; Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Anura V Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 189] [Impact Index Per Article: 189.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Aguilar-Troncoso J, Díaz-Zavala RG, Antúnez-Román LE, Robles-Sardín AE, Valencia ME. Body Composition in Youths Aged 10‒17 Years by Deuterium Oxide Dilution, Air Displacement Plethysmography, and DXA: Validation of the Medical Body Composition Analyzer Bioimpedance Device by a 4-Compartment Model. J Nutr 2023; 153:443-450. [PMID: 36894237 DOI: 10.1016/j.tjnut.2022.12.011] [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: 09/15/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The medical body composition analyzer (mBCA) incorporates advances in multifrequency technology and has been validated using a 4-compartment (4C) model in adults but not in youths aged <18 y. OBJECTIVES This study aimed to formulate a 4C model based on 3 reference methods and develop and validate a body composition prediction equation for the mBCA in youths aged 10‒17 y. METHODS The body density of 60 female and male youths was measured by air displacement plethysmography, total body water by deuterium oxide dilution, and BMC by DXA. Data from the equation group (n = 30) were used to formulate a 4C model. The all-possible-regressions method was used to select variables. The model was validated in a second cohort (n = 30) in a random split design. The accuracy, precision, and potential bias were evaluated by the Bland and Altman procedure. RESULTS Mean age, weight (W), height (H), waist circumference, and z-score of BMI were 13.6 ± 2.3 y, 54.5 ± 15.5 kg, 156 ± 11.9 cm, 75.5 ± 10.9 cm, and 0.70 ± 1.32 z, respectively. The prediction equation was as follows: FFM in kg (FFMkg) = ([0.2081] ∗ [W] + [0.8814] ∗ [H2cm/RΩ] + [0.2055 ∗ XcΩ])-15.343; R2 = 0.96; standardized root-mean-square error (SRMSE) = 2.18 kg. FFM did not differ between the 4C method (38.9 ± 12.0 kg) and the mBCA (38.4 ± 11.4 kg) (P > 0.05). The relationship between these 2 variables did not deviate from the identity line, was not significantly different from 0, and the slope was not significantly different from 1.0. In the precision prediction model of mBCA, the R2 value was 0.98 and SRMSE was 2.1. No significant bias was found when regressing differences between methods and their means (P = 0.08). CONCLUSIONS The equation for the mBCA was accurate, precise, had no significant bias, had substantial strength of agreement and could be used in this age group when subjects were preferentially within the constraints of a specified body size.
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Affiliation(s)
| | - Rolando G Díaz-Zavala
- Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico
| | - Lesley E Antúnez-Román
- Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico
| | - Alma E Robles-Sardín
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, A.C. Hermosillo, Sonora, Mexico
| | - Mauro E Valencia
- Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico.
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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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11
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Beyond the BMI: Validity and Practicality of Postpartum Body Composition Assessment Methods during Lactation: A Scoping Review. Nutrients 2022; 14:nu14112197. [PMID: 35683995 PMCID: PMC9182963 DOI: 10.3390/nu14112197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
The assessment of body composition during lactation is an important indicator of maternal nutritional status, which is central to the overall health of the mother and child. The lactating woman’s nutritional status potentially impacts on breastmilk composition and the process of lactation itself. The purpose of this scoping review was to synthesize comparative studies that sought to validate various body composition assessment techniques for use in lactating women in the postpartum period. Using the PRISMA-ScR guidelines, a comprehensive, systematic literature search was conducted using Scopus, Web of Science, and PubMed. Eight comparative studies were included in the review, with data from 320 postpartum women. The design methodologies varied substantially across studies, and included a range of simple techniques to advanced multi-compartment models for assessing body composition. The validity and reliability of measurement tools must be considered alongside issues of safety, practicality, and appropriateness to guide the research design when applied to lactating women.
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12
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Skipping breakfast and excess weight among young people: the moderator role of moderate-to-vigorous physical activity. Eur J Pediatr 2022; 181:3195-3204. [PMID: 35648230 PMCID: PMC9352742 DOI: 10.1007/s00431-022-04503-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/29/2022]
Abstract
UNLABELLED The present study aimed to test whether the daily minutes of moderate-to-vigorous physical activity (MVPA) engaged moderate the relationship between breakfast status and excess weight (i.e., overweight and/or obesity) in a Spanish sample of young people. A cross-sectional study involving a total sample of 2890 Spanish schoolchildren (46% girls) aged 6-17 years (M = 12.3 ± 2.6) was conducted. To determine the habit of having breakfast, a dichotomous item about breakfast status (yes/no) from the Mediterranean Diet Quality Index for children and teenagers (KIDMED) was used. Physical Activity Questionnaire for Older Children and the Physical Activity Questionnaire for Adolescents were fulfilled to offer an estimation of the minutes of MVPA that individuals had in the last seven days. Body mass index (BMI) was converted into z-scores and, therefore, excess weight status (i.e., overweight and/or obesity) was established according to World Health Organization criteria for sex and age. Skipping breakfast was positively related with BMI (z-score) and excess weight. Moderation analyses suggested that daily MVPA minutes moderated the association between skipping breakfast and BMI (boys: β = - 0.175; girls: β = - 0.073) or the excess weight (boys: OR = 1.10; CI 95%, 1.02 to 1.07; girls: OR = 1.14; CI 95%, 1.04 to 1.24), meaning that physical activity of sufficient intensity seems to reduce the effect of skipping breakfast on the body weight status of young people. CONCLUSION Our results indicate that promotion of having breakfast should be accompanied by daily MVPA, as young participants who have breakfast and with higher daily MVPA seem to be more likely to have no excess weight. WHAT IS KNOWN • Some of the well-studied factors associated with childhood obesity have been skipping breakfast and insufficient physical activity. • Some studies have pointed out the association between having breakfast and both body mass index and physical activity level, in isolation. WHAT IS NEW • Daily minutes of moderate-to-vigorous physical activity moderate the association between skipping breakfast and excess weight. • Breakfast promotion as a healthy eating habit should be accompanied by increases in moderate-to-vigorous physical activity, since participants who have breakfast and with higher moderate-to-vigorous physical activity seem to be more likely to have no excess weight.
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Wright CM, Cole TJ, Fewtrell M, Williams JE, Eaton S, Wells JC. Body composition data show that high BMI centiles overdiagnose obesity in children aged under 6 years. Am J Clin Nutr 2021; 116:122-131. [PMID: 34967839 PMCID: PMC9257461 DOI: 10.1093/ajcn/nqab421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most authorities define childhood overweight/obesity as a BMI exceeding the same high centile cutoff at all ages, but it seems unlikely that true obesity prevalence (excess body fat) is constant throughout childhood. OBJECTIVES We investigated how fat mass (FM) and lean mass (LM), adjusted for height, relate to BMI and each other across childhood, using a uniquely large database of body composition measures, estimated using gold standard methods. METHODS Cross-sectional and cohort data were collated from representative samples of healthy children aged 6 wk to 20 y and children attending obesity clinics aged 7-16 y. Body composition was measured by deuterium dilution up to age 4 y, and by either deuterium or the criterion 4-component model from 4 to 20 y. FM and LM were expressed, respectively, as fat mass index (FMI; FM/height2) and lean mass index (LMI; LM/height2). RESULTS There were 2367 measurements of weight, height, and body composition from 1953 individuals. Before age 6 y, the variability in FMI, LMI, and BMI was much less than after; FMI was low (mainly <8 kg/m2) and FMI and LMI were weakly negatively correlated. From mid-childhood, upper limits for both BMI and FMI rose, but FMI in children with BMI <91st centile still rarely exceeded 8. With increasing age, the correlation of FMI with LMI rose to 0.5-0.7, driven mainly by children with a high FMI also having a high LMI. CONCLUSIONS Raised fat levels are much less common at younger than older ages, and young children with a high BMI centile have lower FMI than older children with the same BMI centile. Current BMI centile cutoffs thus overdiagnose obesity in younger groups. More stringent cutoffs are required for children aged <6 y, matching the WHO recommendation for 0-5 y.
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Affiliation(s)
| | - Tim J Cole
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jane E Williams
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Simon Eaton
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan C Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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14
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Association between Body Fat and Elevated Blood Pressure among Children and Adolescents Aged 7-17 Years: Using Dual-Energy X-ray Absorptiometry (DEXA) and Bioelectrical Impedance Analysis (BIA) from a Cross-Sectional Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179254. [PMID: 34501843 PMCID: PMC8431661 DOI: 10.3390/ijerph18179254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/04/2022]
Abstract
To investigate the associations between body fat percentage (BF%) with childhood blood pressure (BP) levels and elevated BP (EBP) risks, and further examine the validity of bioelectrical impedance analysis (BIA), we conducted a cross-sectional study of 1426 children and adolescents aged 7–17 years in Beijing, 2020. EBP, including elevated systolic BP (ESBP) and elevated diastolic BP (EDBP), was defined based on the age- and sex-specific 90th BP reference values of children and adolescents in China. BF% was measured by dual-energy X-ray absorptiometry (DEXA) and BIA devices, and was divided into four quartiles. Log-binomial models were applied to calculate odds ratios (ORs) and 95% confidence intervals (95%CI). Girls tended to have higher BF% levels than boys (p < 0.05). There was 41.0% of girls who developed EBP. High BF% was associated with increased BP levels with ORs of 0.364 (95%CI = 0.283–0.444) for SBP, 0.112 (95%CI = 0.059–0.165) for DBP, and 1.043 (95%CI = 1.027–1.059) for EBP, while the effects were more pronounced in girls and older-aged children. BIA devices agreed well with BF% assessment obtained by DEXA. High BF% might have negative effects on childhood BP. Convenient measurements of body fat might help to assess childhood obesity and potential risks of hypertension.
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15
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von Graffenried T, Godin JP, Schoepfer A, Breton I, Martin FP, Nydegger A. Body composition assessment in children with inflammatory bowel disease: A comparison of different methods. J Paediatr Child Health 2021; 57:1414-1419. [PMID: 33847432 DOI: 10.1111/jpc.15491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/10/2023]
Abstract
AIM To assess different techniques to measure body composition in paediatric patients with inflammatory bowel disease using dual energy X-ray absorptiometry as a reference method. We hypothesised that a three-compartment model may demonstrate superiority over other methods as skinfold thickness equations and bioelectrical impedance analysis. METHODS Body composition was assessed using skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model. Data obtained with these methods were compared to the results obtained by dual energy X-ray absorptiometry. Statistical analysis was performed using Spearman's correlation and Bland-Altman's limits of agreement method. RESULTS Twenty-one paediatric patients with inflammatory bowel disease were included: 11 females and 10 males; mean age for the entire group: 14.3 years, range 12-16 years. In children with inflammatory bowel disease, skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model showed reliable measurements with small differences in the percentage of total body fat and good limits of agreements. CONCLUSION The assessment of body composition using bioelectrical impedance analysis provides a valid and accurate method in children with inflammatory bowel disease as compared to dual energy X-ray absorptiometry. In the future, superiority of 3-compartment model in research and clinical settings of nutritional intervention and disease status in children with inflammatory bowel disease remains to be demonstrated.
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Affiliation(s)
- Thea von Graffenried
- Pediatric Gastroenterology Unit, Department of Pediatrics, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Philippe Godin
- Nestle Research, Nestlé Institute of Food Safety and Analytical Sciences, Lausanne, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Isabelle Breton
- Nestle Research, Nestlé Institute of Food Safety and Analytical Sciences, Lausanne, Switzerland
| | - Francois-Pierre Martin
- Nestlé Research, Nestlé Institute of Health Sciences, EPFL Innovation Park, Lausanne, Switzerland
| | - Andreas Nydegger
- Pediatric Gastroenterology Unit, Department of Pediatrics, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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16
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Anthropometric and bioimpedance equations for fat and fat-free mass in Chilean children 7-9 years of age. Br J Nutr 2021; 126:37-42. [PMID: 33028443 DOI: 10.1017/s0007114520003906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Assessing children's growth adequately is important due to the necessary prevention of adequate body composition, especially at pre-pubertal age. Simpler measurements such as anthropometry or bioimpedance, using equations validated in Caucasian children, have been demonstrated to overestimate or underestimate fat mass percentage (FM%) or fat-free mass (FFM) in Chilean children. In a sample of 424 children (198 boys and 226 girls) of 7-9 years old, the three component (3C) model was assessed, where total body water was determined by 2H dilution and body volume by air displacement plethysmography, in order to design and validate anthropometry and bioimpedance equations. The FM (%) equation specific for Chilean children was validated as (1·743 × BMI z-score) + (0·727 × triceps skinfold) + (0·385 × biceps skinfold) + 15·985, against the 3C model (R2 0·79). The new FFM equation (kg) generated was (log FFM = (0·018 × age) + (0·047 × sex) + (0·006 × weight) + (0·027 × resistance) + 2·071), with an R2 0·93 (female = 1 and male = 2). The Bland-Altman analysis shows a mean difference of 0·27 (sd 3·5) for the FM% in the whole group as well as 0·004 (sd 0·9) kg is the mean difference for the bioelectrical impedance analysis (BIA) FFM (kg) equation. The new equations for FM (%) and FFM (kg) in Chilean children will provide a simple and valid tool for the assessment of body composition in cohort studies or to assess the impact of nutritional programmes or public policies.
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17
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Nickerson BS. Evaluation of Obesity Cutoff Values in Hispanic Adults: Derivation of New Standards. J Clin Densitom 2021; 24:388-396. [PMID: 33183918 DOI: 10.1016/j.jocd.2020.10.010] [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: 09/11/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED The diagnostic accuracy of clinical-based body composition methods such as body mass index (BMI), waist circumference (WC), bioimpedance analysis (BIA), and dual energy X-ray absorptiometry (DXA) has yet to be evaluated in Hispanic adults. Moreover, it has also been suggested that previously established obesity cutoff values may need adjusting. PURPOSE The primary aim of this study was to investigate the diagnostic accuracy of BMI, WC, BIA, and DXA for obesity classification in Hispanic adults. The secondary aim was to internally derive obesity cutoff values producing equal sensitivity and specificity for the respective tests. METHODS Hispanic females (n = 101) and males (n = 90) volunteered to participate in this study (18-45 years). Body fat percentage was estimated with BIA, DXA, and a 4-compartment (4C) model. Obesity-defined criteria was employed as follows: (Body fat percentage ≥ 25% and 35% and WC ≥ 102cm and 88cm for males and females, respectively; BMI ≥ 30 kg/m2). A 4C model was used as a criterion to evaluate BMI, WC, DXA, and BIA. RESULTS Sensitivity of DXA and BIA (74.1%-96.9%) was greater than BMI and WC (25.8%-51.9%) when using previously established standards. However, specificity was poor for DXA (<70%), but considered good to excellent for BMI, WC, and BIA (83.1%-96.6%) when using previously established standards. Internally derived cutoff values improved sensitivity for BMI and WC (74.2%-81.5%) and improved specificity for DXA (>80.0%). CONCLUSION The internally derived cutoff values, producing identical sensitivity, and specificity, were developed and shown to improve the diagnostic performance of the body composition methods compared to previously established obesity cutoff standards. Consequently, the internally derived obesity cutoff values are recommended for use by allied health professionals in clinical practice when equal sensitivity and specificity is desired.
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Affiliation(s)
- Brett S Nickerson
- College of Nursing and Health Sciences, Texas A&M International University, Laredo, TX.
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18
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Watson LPE, Carr KS, Orford ER, Venables MC. The Importance of Hydration in Body Composition Assessment in Children Aged 6-16 Years. J Clin Densitom 2021; 24:481-489. [PMID: 33454177 PMCID: PMC8354559 DOI: 10.1016/j.jocd.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023]
Abstract
Body composition is associated with many noncommunicable diseases. The accuracy of many simple techniques used for the assessment of body composition is influenced by the fact that they do not take into account tissue hydration and this can be particularly problematic in paediatric populations. The aims of this study were: (1) to assess the agreement of two dual energy X-ray absorptiometry (DXA) systems for determining total and regional (arms, legs, trunk) fat, lean, and bone mass and (2) to compare lean soft tissue (LST) hydration correction methods in children. One hundred and twenty four healthy children aged between 6 and 16 years old underwent DXA scans using 2 GE healthcare Lunar systems (iDXA and Prodigy). Tissue hydration was either calculated by dividing total body water (TBW), by 4-component model derived fat free mass (HFFMTBW) or by using the age and sex specific coefficients of Lohman, 1986 (HFFMLohman) and used to correct LST. Regression analysis was performed to develop cross-calibration equations between DXA systems and a paired samples t-test was conducted to assess the difference between LST hydration correction methods. iDXA resulted in significantly lower estimates of total and regional fat and lean mass, compared to Prodigy. HFFMTBW showed a much larger age/sex related variability than HFFMLohman. A 2.0 % difference in LST was observed in the boys (34.5 kg vs 33.8 kg respectively, p < 0.05) and a 2.5% difference in the girls (28.2 kg vs 27.5 kg respectively, p < 0.05) when corrected using either HFFMTBW or HFFMLohman. Care needs to be exercised when combining data from iDXA and Prodigy, as total and regional estimates of body composition can differ significantly. Furthermore, tissue hydration should be taken into account when assessing body composition as it can vary considerably within a healthy paediatric population even within specific age and/or sex groups.
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Affiliation(s)
- Laura P E Watson
- National Institute Health Research Cambridge Clinical Research Facility, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Katherine S Carr
- National Institute Health Research Cambridge Clinical Research Facility, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Elise R Orford
- Stable Isotope Laboratory, National Institute for Health Research Cambridge Biomedical Research Centre Nutritional Biomarker Laboratory, MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, United Kingdom
| | - Michelle C Venables
- Stable Isotope Laboratory, National Institute for Health Research Cambridge Biomedical Research Centre Nutritional Biomarker Laboratory, MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, United Kingdom
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Firman N, Boomla K, Hudda MT, Robson J, Whincup P, Dezateux C. Is child weight status correctly reported to parents? Cross-sectional analysis of National Child Measurement Programme data using ethnic-specific BMI adjustments. J Public Health (Oxf) 2021; 42:e541-e550. [PMID: 31950165 PMCID: PMC7685848 DOI: 10.1093/pubmed/fdz188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 11/14/2022] Open
Abstract
Background BMI underestimates and overestimates body fat in children from South Asian and Black ethnic groups, respectively. Methods We used cross-sectional NCMP data (2015–17) for 38 270 children in three inner-London local authorities: City & Hackney, Newham and Tower Hamlets (41% South Asian, 18.8% Black): 20 439 4–5 year-olds (48.9% girls) and 17 831 10–11 year-olds (49.1% girls). We estimated the proportion of parents who would have received different information about their child’s weight status, and the area-level prevalence of obesity—defined as ≥98th centile—had ethnic-specific BMI adjustments been employed in the English National Child Measurement Programme (NCMP). Results Had ethnic-specific adjustment been employed, 19.7% (3112/15 830) of parents of children from South Asian backgrounds would have been informed that their child was in a heavier weight category, and 19.1% (1381/7217) of parents of children from Black backgrounds would have been informed that their child was in a lighter weight category. Ethnic-specific adjustment increased obesity prevalence from 7.9% (95% CI: 7.6, 8.3) to 9.1% (8.7, 9.5) amongst 4–5 year-olds and from 17.5% (16.9, 18.1) to 18.8% (18.2, 19.4) amongst 10–11 year-olds. Conclusions Ethnic-specific adjustment in the NCMP would ensure equitable categorization of weight status, provide correct information to parents and support local service provision for families.
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Affiliation(s)
- Nicola Firman
- Centre for Primary Care & Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Kambiz Boomla
- Centre for Primary Care & Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Mohammed T Hudda
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - John Robson
- Centre for Primary Care & Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Carol Dezateux
- Centre for Primary Care & Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
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Kangas ST, Kaestel P, Salpéteur C, Nikièma V, Talley L, Briend A, Ritz C, Friis H, Wells JC. Body composition during outpatient treatment of severe acute malnutrition: Results from a randomised trial testing different doses of ready-to-use therapeutic foods. Clin Nutr 2020; 39:3426-3433. [DOI: 10.1016/j.clnu.2020.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/29/2020] [Accepted: 02/28/2020] [Indexed: 01/12/2023]
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21
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Shypailo RJ, Wong WW. Fat and fat-free mass index references in children and young adults: assessments along racial and ethnic lines. Am J Clin Nutr 2020; 112:566-575. [PMID: 32469402 DOI: 10.1093/ajcn/nqaa128] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fat-free mass index (FFMI) and fat mass index (FMI) are superior to BMI and fat percentage in evaluating nutritional status. However, existing references fail to account for racial/ethnic differences in body composition among children. OBJECTIVES Our goal was to produce age-based normative references for FFMI and FMI in children for specific racial/ethnic groups. METHODS Body composition, weight, and height were measured in 1122 normal healthy children aged 2-21 y. Bone mineral content measured by DXA, total body water by deuterium dilution, and total body potassium by whole-body γ counting were combined to calculate fat-free mass (FFM) and fat mass (FM) using equations based on the Reference Child and Adolescent models. FFMI and FMI were calculated by dividing FFM and FM by height squared, respectively. After outlier removal, the LMS (Lambda-Mu-Sigma) function within R's GAMLSS package was used to produce age-based FFMI and FMI growth curves for black (B), white (W), and Hispanic (H) children for each sex. Combined models were produced in cases where outcomes did not differ by race/ethnicity. Resulting models were compared with previously published FFMI and FMI models. RESULTS FFMI and FMI models based on 1079 children, aged 2-21 y, were created for both sexes. FFMI models for B children showed higher values throughout. W and H children were combined to produce FFMI models for each sex. H boys were modeled individually for FMI, whereas W and B boys were combined. FMI models for girls were created for each race/ethnicity. Models agreed well with those based on children from the United Kingdom of comparable race/ethnicity. CONCLUSIONS Race/ethnicity-specific references for FFMI and FMI will increase the accuracy of health and nutrition status assessment in children over race/ethnicity-generic references. The models allow the calculation of SD scores to assess health and nutrition status in children.
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Affiliation(s)
- Roman J Shypailo
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - William W Wong
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Hudda MT, Owen CG, Rudnicka AR, Cook DG, Whincup PH, Nightingale CM. Quantifying childhood fat mass: comparison of a novel height-and-weight-based prediction approach with DXA and bioelectrical impedance. Int J Obes (Lond) 2020; 45:99-103. [PMID: 32848202 PMCID: PMC7752759 DOI: 10.1038/s41366-020-00661-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/06/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022]
Abstract
Accurate assessment of childhood adiposity is important both for individuals and populations. We compared fat mass (FM) predictions from a novel prediction model based on height, weight and demographic factors (height–weight equation) with FM from bioelectrical impedance (BIA) and dual-energy X-ray absorptiometry (DXA), using the deuterium dilution method as a reference standard. FM data from all four methods were available for 174 ALSPAC Study participants, seen 2002–2003, aged 11–12-years. FM predictions from the three approaches were compared to the reference standard using; R2, calibration (slope and intercept) and root mean square error (RMSE). R2 values were high from ‘height–weight equation’ (90%) but lower than from DXA (95%) and BIA (91%). Whilst calibration intercepts from all three approaches were close to the ideal of 0, the calibration slope from the ‘height–weight equation’ (slope = 1.02) was closer to the ideal of 1 than DXA (slope = 0.88) and BIA (slope = 0.87) assessments. The ‘height–weight equation’ provided more accurate individual predictions with a smaller RMSE value (2.6 kg) than BIA (3.1 kg) or DXA (3.4 kg). Predictions from the ‘height–weight equation’ were at least as accurate as DXA and BIA and were based on simpler measurements and open-source equation, emphasising its potential for both individual and population-level FM assessments.
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Affiliation(s)
- Mohammed T Hudda
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, London, UK
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Influence of Adiposity on Physical Activity in Schoolchildren: The Moderator Role of Adherence to the Mediterranean Diet. SUSTAINABILITY 2020. [DOI: 10.3390/su12166474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Studies were performed in order to determine the existing relationship between body composition and both physical activity (PA) levels and food habits. Nevertheless, no study has yet examined if the association between adiposity and PA in children is moderated by adherence to the Mediterranean diet (MD). Methods: the cross-sectional and associative analysis involved a total of 370 children (55.1% boys) aged 6–13, from six different schools from the Murcia region of Spain. Results: The different values of moderator [adherence to the MD expressed as a Mediterranean Diet Quality Index (KIDMED) score] are shown by the slope and the different areas of significance. The first area was shown below ≤3.8, indicating that the unfavorable influence of excess of adiposity on PA could be intensified for children in this area. The second area was a significant positive area was shown above ≥9.3, expressing that the unfavorable influence of adiposity could be reduced for those who were above this estimation point. Conclusion: Our findings reveal that the adverse effects of excess adiposity on PA can be moderated by adherence to the MD among schoolchildren.
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A novel approach to assess body composition in children with obesity from density of the fat-free mass. Clin Nutr 2020; 40:1102-1107. [PMID: 32741681 DOI: 10.1016/j.clnu.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Assessment of Fat Mass (FM) and fat-free mass (FFM) using Air-displacement plethysmography (ADP) technique assumes constant density of FFM (DFFM) by age and sex. It has been recently shown that DFFM further varies according to body mass index (BMI), meaning that ADP body composition assessments of children with obesity could be biased if DFFM is assumed to be constant. The aim of this study was to validate the use of the calculations of DFFM (rather than constant density of the FFM) to improve accuracy of body composition assessment in children with obesity. METHODS cross-sectional validation study in 66 children with obesity (aged 8-14 years) where ADP assessments of body composition assuming constant density (FFMBODPOD and FMBODPOD) were compared to those where DFFM was adjusted in relation to BMI (FFMadjusted and FMadjusted), and both compared to the gold standard reference, the 4-component model (FFM4C and FM4C). RESULTS FFMBODPOD was overestimated by 1.50 kg (95%CI -0.68 kg, 3.63 kg) while FFMadjusted was 0.71 kg (-1.08 kg, 2.51 kg) (percentage differences compared to FFM4C were 4.9% (±2.9%) and 2.8% (±2.1%), respectively (p < 0.001)). Consistently, FM was underestimated by both methods, representing a mean difference between methods of 4.0% (±2.9%) and 6.8% (±3.8%), respectively, when compared to the reference method. The agreement and reliability of body composition assessments were improved when adjusted using calculations (adjusted models) rather than assuming constant DFFM. CONCLUSIONS The use of constant values for fat-free mass properties may increase bias when assessing body composition (FM and FFM) in children with obesity by two-component techniques such as ADP. Using adjusted corrections as proposed in the present work may reduce the bias by half.
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Wells JC, Williams JE, Ward LC, Fewtrell MS. Utility of specific bioelectrical impedance vector analysis for the assessment of body composition in children. Clin Nutr 2020; 40:1147-1154. [PMID: 32788087 PMCID: PMC7957362 DOI: 10.1016/j.clnu.2020.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
Background & aims Bioelectrical impedance analysis (BIA) is widely considered a body composition technique suitable for routine application. However, its utility in sick or malnourished children is complicated by variability in hydration. A BIA variant termed vector analysis (BIVA) aims to resolve this, by differentiating hydration from cell mass. However, the model was only partially supported by children's data. To improve accuracy, further adjustment for body shape variability has been proposed, known as specific BIVA (BIVAspecific). Methods We re-analysed body composition data from 281 children and adolescents (46% male) aged 4–20 years of European ancestry. Measurements included anthropometry, conventional BIA, BIVA outcomes adjusted either for height (BIVAconventional), or for height and body cross-sectional area (BIVAspecific), and fat-free mass (FFM) and fat mass (FM) by the criterion 4-component model. Graphic analysis and regression analysis were used to evaluate different BIA models for predicting FFM and FM. Results Age was strongly correlated with BIVAconventional parameters, but weakly with BIVAspecific parameters. FFM correlated more strongly with BIVAconventional than with BIVAspecific parameters, whereas the opposite pattern was found for FM. In multiple regression analyses, the best prediction models combined conventional BIA with BIVAspecific parameters, explaining 97.0% and 89.8% of the variance in FFM and FM respectively. These models could be further improved by incorporating body weight. Conclusions The prediction of body composition can be improved by combining two different theoretical models, each of which appears to provide different information about the two components FFM and FM. Further work should test the utility of this approach in pediatric patients.
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Affiliation(s)
- Jonathan Ck Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Reseach and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Jane E Williams
- Childhood Nutrition Research Centre, Population, Policy and Practice Reseach and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, Population, Policy and Practice Reseach and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Lee LW, Liao YS, Lu HK, Hsieh KC, Chi CC. Performance of Bioelectrical Impedance Analysis in the Estimation of Bone Mineral Content in Healthy Children Aged 6-12 Years. J Clin Densitom 2020; 23:411-417. [PMID: 30979543 DOI: 10.1016/j.jocd.2019.03.002] [Citation(s) in RCA: 4] [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] [Received: 12/20/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a widely available tool which provides mineral estimate. However, BIA is not currently recognized as a bone mineral measuring method. This study aimed to explore the ability of BIA to predict bone mineral content (BMC) in children, using dual-energy X-ray absorptiometry as a gold standard. METHODS Healthy children aged 6-12 years (n = 176) were recruited for BIA and dual-energy X-ray absorptiometry measurements. Predictive models were generated using basic indices (age, height, weight, waist circumference, hip circumference, etc.) and BIA parameters (minerals, fat mass, and fat free mass). RESULTS The root-mean-square deviation and R2 for the total BMC predictive model were 0.089 kg and 0.926, respectively using height and weight as predictors whereas 0.113 kg and 0.886, respectively using minerals by BIA. The root-mean-square deviation and R2 for the subtotal BMC predictive model were 0.080 kg and 0.935, respectively using height and weight as predictors whereas 0.098 kg and 0.906, respectively using minerals by BIA. The best predictive models included basic indices and BIA parameters as predictors, but they had only slightly better performance over simple models. CONCLUSIONS Mineral content by BIA was good predictor of total and subtotal BMC in healthy children but with similar overall model performance compared to basic indices. More complex models combined all the predictive variables gave better prediction power, but of little improvement to these simple models. The BIA instrument does not appear to be useful in estimating BMC in healthy children as basic indices are more widely available measures but provide comparable performance. Future studies are needed to determine the clinical usefulness of the more complex prediction model in children with disease or children in other subgroups.
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Affiliation(s)
- Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Yu-San Liao
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Hsueh-Kuan Lu
- Sport Science Research Center, National Taiwan University of Sport, Taichung, Taiwan
| | - Kuen-Chang Hsieh
- Office of Physical Education and Sport, National Chung Hsing University, Taichung, Taiwan; Research Center, Charder Electronic Co, Ltd, Taichung, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Heard-Lipsmeyer ME, Hull H, Sims CR, Cleves MA, Andres A. Evaluating body composition in infancy and childhood: A comparison between 4C, QMR, DXA, and ADP. Pediatr Obes 2020; 15:e12617. [PMID: 31986239 PMCID: PMC7323309 DOI: 10.1111/ijpo.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/11/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accurate and precise methods to measure of body composition in infancy and childhood are needed. OBJECTIVES This study evaluated differences and precision of three methods when compared with the four-compartment (4C) model for estimating fat mass (FM). METHODS FM of children (age 14 days to 6 years of age, N = 346) was obtained using quantitative nuclear magnetic resonance (QMR, EchoMRI-AH), air-displacement plethysmography (ADP, PeaPod, less than or equal to 8 kg, BodPod age 6 years or older), and dual-energy X-ray absorptiometry (DXA, Hologic QDR). The 4C model was computed. Correlation, concordance, and Bland-Altman analyses were performed. RESULTS In infants, PeaPod had high individual FM accuracy, whereas DXA had high group FM accuracy compared with 4C. In children, DXA had high group and individual FM accuracies compared with 4C. QMR underestimated group FM in infants and children (300 and 510 g, respectively). The instrument FM precision was best for QMR (10 g) followed by BodPod (34 g), PeaPod (38 g), and DXA (45 g). CONCLUSIONS In infants, PeaPod was the best method to estimate individual FM whereas DXA was best to estimate group FM. In children, DXA was best to estimate individual and group FM. QMR had the highest instrument precision.
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Affiliation(s)
- Melissa E. Heard-Lipsmeyer
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Department of Pediatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas,Division of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine-Louisiana Campus, Monroe, Louisiana
| | - Holly Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Clark R. Sims
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mario A. Cleves
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Aline Andres
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Department of Pediatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Relative Accuracy of Bioelectrical Impedance Analysis for Assessing Body Composition in Children With Severe Obesity. J Pediatr Gastroenterol Nutr 2020; 70:e129-e135. [PMID: 32443048 PMCID: PMC7283978 DOI: 10.1097/mpg.0000000000002666] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The accuracy of different bioelectrical impedance analysis (BIA) devices for assessing body composition in children with obesity is unclear. We determined the relative accuracy of 2 BIA devices compared to dual x-ray absorptiometry (DXA) in obese and severely obese children. METHODS We measured body composition in a cross-sectional study of 78 obese children by a handheld single frequency tetrapolar BIA device (Omron), a stationary multifrequency octopolar BIA device (InBody 370) and DXA. Intermethod agreement was assessed by intraclass correlations, paired t tests, and Bland-Altman analyses. RESULTS Participants (37% female, age 14.8 ± 2.7 years) had mean (±standard deviation) body mass index of 36.7 ± 7.5 kg/m, body fat percentage of 46.4% ± 5.2%, and appendicular lean mass of 22.5 ± 6.0 kg by DXA. Intraclass correlations with DXA for body fat percentage were 0.39 and 0.87 for single frequency tetrapolar and multifrequency octopolar BIA devices, respectively. The single frequency tetrapolar BIA underestimated body fat percentage by 5.5% ± 2.9% (P < 0.0001). Differences between the multifrequency octopolar BIA and DXA for body fat percentage (-1.1% ± 2.8%) and appendicular lean mass (-0.3 ± 1.4 kg) were small, and 95% limits of agreement were approximately ±5%. CONCLUSIONS BIA machines vary in relative accuracy in measuring body composition in children who are obese and severely obese. The multifrequency octopolar BIA device accurately estimated body fat percentage and appendicular lean mass relative to DXA and has the advantage of point of care performance.
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Langer RD, de Fatima Guimarães R, Gonçalves EM, Guerra-Junior G, de Moraes AM. Phase Angle is Determined by Body Composition and Cardiorespiratory
Fitness in Adolescents. Int J Sports Med 2020; 41:610-615. [DOI: 10.1055/a-1152-4865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractThe phase angle is used to evaluate nutritional status and is an indicator of
cellular health. Cardiorespiratory fitness and body composition are strong
indicators of health during adolescence. We aimed to evaluate if body
composition and cardiorespiratory fitness have an association with phase angle
among adolescents. 203 girls and 220 boys (12.8±1.3 years) were
evaluated. Peak height velocity, percentage fat mass, fat-free mass,
cardiorespiratory fitness, and phase angle measurements were collected. Linear
regression adjusted by peak height velocity was used to verify if predictor
variables were associated with phase angle among adolescents. Phase angle showed
correlation with fat-free mass (girls: r=0.42 and boys: r=0.37);
with percent fat mass (girls: r=0.23); and with cardiorespiratory
fitness (boys: r=0.19). Linear regression showed that percentage fat
mass (in girls) and cardiorespiratory fitness (in boys) had an effect of 11 and
17% in phase angle, respectively, while fat-free mass had an effect of
22 and 26% in phase angle for girls and boys, respectively. Changes in
phase angle seem to be more associated with the percentage fat mass in girls,
cardiorespiratory fitness in boys, and fat-free mass in both when controlled by
peak height velocity.
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Affiliation(s)
- Raquel David Langer
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
| | | | - Ezequiel Moreira Gonçalves
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
| | - Gil Guerra-Junior
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
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Relationship between BMI and adiposity among different ethnic groups in 2-year-old New Zealand children. Br J Nutr 2020; 121:670-677. [PMID: 30912736 DOI: 10.1017/s000711451800380x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Age- and sex-based BMI cut-offs are used to define overweight and obesity, but the relationship between BMI and body composition has not been very well studied in children or compared between children of different ethnic groups. Body size and composition in childhood are also influenced by size at birth. Our aim was to compare body size and composition at 2 years in children with different ethnicity and size at birth. We prospectively followed a multi-ethnic cohort of 300 children born with risk factors for neonatal hypoglycaemia (infants of diabetics, large or small at birth or late preterm) to 2 years corrected age. Complete data on weight, height and head circumference and body composition using bioelectrical impedance 24±1 months corrected age were available in 209 children. At birth, compared with European children, Chinese, Indian and other ethnicity children were lighter, and Indian children had smaller head circumferences, but birth lengths were similar in all ethnic groups. At 2 years, Pacific children were heavier and had higher BMI z scores, and Indian children had smaller head circumferences and lower BMI z scores than those from other ethnic groups. However, fat mass and fat-free mass indices were similar in all groups. At median BMI, fat mass:fat-free mass ratio was 23 % lower in Pacific than in Indian children (0·22 v. 0·27, P=0·03). BMI is not a good indicator of adiposity in this multi-ethnic cohort of 2-year-old New Zealand children.
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Woodrow G, Oldroyd B, Wright A, Coward WA, Turney JH, Brownjohn AM, Smith MA, Truscott JG. Abnormalities of Body Composition in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080402400208] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Body composition changes occur in peritoneal dialysis (PD) due to abnormalities in nutrition and hydration. We investigated abnormalities of nutrition and hydration in PD patients compared with healthy controls by measurement of total body potassium (TBK) and body water compartments. Design Cross-sectional comparison study. Methods We measured TBK — an indicator of body cell mass — by whole body counting, total body water (TBW) by deuterium oxide dilution, and extracellular water (ECW) by bromide dilution in 29 PD patients and 32 controls. Results The absolute mean value of TBK for PD patients was not significantly lower than in controls. The ratios of observed TBK to predicted TBK from prediction formulas were compared. Equations used were those of Boddy, Bruce, Burkinshaw, and Ellis and our own equation derived from a local control database (Leeds). Observed/predicted ratios of TBK were significantly less in PD than in control subjects for all equations. Water volumes did not differ between PD and control groups. Observed/predicted ratios for TBK in PD patients correlated with serum potassium (Boddy r = 0.355, p = 0.06; Bruce r = 0.411, p < 0.05; Burkinshaw r = 0.457, p < 0.01; Leeds r = 0.412, p ≤ 0.05; Ellis r = 0.356, p = 0.06) and tended to correlate with serum albumin (Bruce r = 0.343, p = 0.07; Burkinshaw r = 0.421, p < 0.05; Leeds r = 0.357, p = 0.06; Ellis r = 0.310, p = NS). There was no relationship with serum potassium in controls. Serum albumin in PD correlated with TBK ( r = 0.445, p < 0.02), TBK/height ( r = 0.419, p < 0.05), TBK/weight ( r = 0.554, p = 0.002), and TBK/TBW ( r = 0.586, p = 0.0001). Extracellular water/intracellular water (ECW/ICW) was inversely related to TBK ( r = –0.455, p < 0.02 in PD; r = –0.387, p < 0.05 in controls) and to TBK/height ( r = –0.446, p < 0.02 in PD; r = –0.411, p = 0.02 in controls). TBK/weight reduced with age in PD ( r = –0.445, p < 0.02), as did TBK/TBW in PD ( r = –0.463, p < 0.02). ECW/ICW tended to increase with age in PD ( r = 0.351, p = 0.06). Conclusions Observed/predicted ratio of TBK is reduced in PD patients relative to healthy controls, indicating reduced body cell mass. Serum albumin and potassium reflect TBK indices in PD. Body water volumes did not differ between PD and controls, implying no overall abnormality in hydration in the PD group. However, ECW is relatively increased compared to ICW with decreasing TBK indices, suggesting relative ECW expansion with reduction in body cell mass.
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Affiliation(s)
- Graham Woodrow
- Renal Unit, Leeds General Infirmary, University of Leeds, United Kingdom
| | - Brian Oldroyd
- Centre for Bone and Body Composition Research, University of Leeds, United Kingdom
| | - Antony Wright
- MRC-Human Nutrition Research, Cambridge, University of Leeds, United Kingdom
| | - W. Andrew Coward
- MRC-Human Nutrition Research, Cambridge, University of Leeds, United Kingdom
| | - John H. Turney
- Renal Unit, Leeds General Infirmary, University of Leeds, United Kingdom
| | - Aleck M. Brownjohn
- Renal Unit, Leeds General Infirmary, University of Leeds, United Kingdom
| | - Michael A. Smith
- Academic Unit of Medical Physics, University of Leeds, United Kingdom
| | - John G. Truscott
- Centre for Bone and Body Composition Research, University of Leeds, United Kingdom
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Forsum EK, Flinke E, Olhager E. Premature birth was not associated with increased body fatness in four-year-old boys and girls. Acta Paediatr 2020; 109:327-331. [PMID: 31461786 DOI: 10.1111/apa.14990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/03/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
AIM Premature birth is a worldwide problem and increases the risk of chronic disease later in life. Prematurely born infants may have a high percentage of body fat at term-equivalent age, but it is unclear if this characteristic is maintained in childhood. Therefore, we compared the size and body composition of four-year-old prematurely born children to such values of full-term controls. METHODS Between 2013 and 2015, we assessed weight, height, fat mass and fat-free mass, using air displacement plethysmography in 188 reasonably healthy prematurely born four-year-olds (98 boys). RESULTS At four years of age, prematurely born children (gestational weeks at birth: 23.3-36.9) tended to be lighter and shorter and to contain less fat mass and fat-free mass than did full-term controls. The gestational age at birth of the prematurely born children correlated positively and significantly (P < .05) with height, weight, body mass index, fat mass (kg, %), fat mass index and fat-free mass (kg) in girls but not in boys. CONCLUSION Prematurity was not associated with increased body fatness in our four-year-olds. Our findings are relevant in relation to previously published results showing that premature birth is associated with chronic disease later in life.
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Affiliation(s)
| | - Eva Flinke
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
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Triffoni-Melo ADT, Monte-Alegre FDA, Leandro-Merhi VA, Diez-Garcia RW. ADDITIONAL ABDOMINAL MEASUREMENTS ARE A USEFUL TOOL TO EVALUATE BODY COMPOSITION IN OBESE WOMEN. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:294-299. [PMID: 31633728 DOI: 10.1590/s0004-2803.201900000-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND During weight gain, most of the excess adipose tissue accumulates in the trunk. This alters the body shape and makes collection of anthropometric measurements, especially waist circumference (WC), difficult. OBJECTIVE To evaluate the sensitivity and applicability of additional abdominal measurements in order to assess body composition of obese women. METHODS A total of 30 women between 20 and 50 years of age and BMI above 30 kg/m² were assessed. Three WC measurements, were performed: at the umbilical scar designated as WC1 and at 8 and 16 cm above the umbilical scar, designated as WC2, and WC3 respectively. The correlation (r) between these anthropometric measurements and their sum was assessed against the parameters fat mass (FM), free fat mass (FFM), body fat percentage (%BF), and trunk fat percentage (%TF), obtained by total and trunk segmental bioelectric impedance analysis (BIA) as well as by the golden standard total and trunk dual energy X-ray absorptiometry (DXA). RESULTS The measurements WC1, WC2, WC3, and their sum correlated strongly and moderately with the parameters FM, FFM, and %BF in total BIA and in both total DXA and trunk DXA. CONCLUSION The results demonstrated a robust correlation between the sum of the three WC measurements and total and trunk DXA in obese women suggesting that such measurements may be a good indicator of body and trunk fat in women, actually superior to BIA results. The use of these three measurements may be an alternative for the assessment of body and trunk fat, in those cases in which the body shape due to adipose tissue trunk accumulation makes accurate classical measurement (WC1) difficult.
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Affiliation(s)
| | | | - Vania Aparecida Leandro-Merhi
- Pontifícia Universidade Católica de Campinas, Programa de Pós-Graduação em Ciências da Saúde e Faculdade de Nutrição, Campinas, SP, Brasil
| | - Rosa Wanda Diez-Garcia
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Laboratório de Práticas e Comportamento Alimentares - PrátiCA, Ribeirão Preto, SP, Brasil
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Gonzalez MC, Orlandi SP, Santos LP, Barros AJ. Body composition using bioelectrical impedance: Development and validation of a predictive equation for fat-free mass in a middle-income country. Clin Nutr 2019; 38:2175-2179. [DOI: 10.1016/j.clnu.2018.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/10/2018] [Accepted: 09/09/2018] [Indexed: 01/10/2023]
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Stojanović D, Branković N, Momčilović V, Kocić J, Savić Z, Momčilović Z, Milenković V. COMPARATIVE ANALYSIS OF DIFFERENT METHODS FOR BODY FAT ASSESSMENT IN ADOLESCENTS. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wibaek R, Vistisen D, Girma T, Admassu B, Abera M, Abdissa A, Jørgensen ME, Kæstel P, Michaelsen KF, Friis H, Wells JCK, Andersen GS. Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years: The Ethiopian iABC birth cohort study. PLoS Med 2019; 16:e1002888. [PMID: 31430287 PMCID: PMC6701744 DOI: 10.1371/journal.pmed.1002888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Accelerated growth in early childhood is an established risk factor for later obesity and cardiometabolic disease, but the relative importance of fat mass (FM) and fat-free mass (FFM) accretion is not well understood. We aimed to study how FM and FFM at birth and their accretion during infancy were associated with body composition and cardiometabolic risk markers at 5 years. METHODS AND FINDINGS Healthy children born at term were enrolled in the Infant Anthropometry and Body Composition (iABC) birth cohort between December 2008 and October 2012 at Jimma University Specialized Hospital in the city of Jimma, Ethiopia. FM and FFM were assessed using air displacement plethysmography a median of 6 times between birth and 6 months of age. In 507 children, we estimated individual FM and FFM at birth and their accretion over 0-3 and 3-6 months of age using linear-spline mixed-effects modelling. We analysed associations of FM and FFM at birth and their accretion in infancy with height, waist circumference, FM, FFM, and cardiometabolic risk markers at 5 years using multiple linear regression analysis. A total of 340 children were studied at the 5-year follow-up (mean age: 60.0 months; girls: 50.3%; mean wealth index: 45.5 out of 100; breastfeeding status at 4.5 to 6 months post-partum: 12.5% exclusive, 21.4% almost exclusive, 60.6% predominant, 5.5% partial/none). Higher FM accretion in infancy was associated with higher FM and waist circumference at 5 years. For instance, 100-g/month higher FM accretion in the periods 0-3 and 3-6 months was associated with 339 g (95% CI: 243-435 g, p < 0.001) and 367 g (95% CI: 250-484 g, p < 0.001) greater FM at 5 years, respectively. Higher FM at birth and FM accretion from 0 to 3 months were associated with higher FFM and cholesterol concentrations at 5 years. Associations for cholesterol were strongest for low-density lipoprotein (LDL)-cholesterol, and remained significant after adjusting for current FM. A 100-g higher FM at birth and 100-g/month higher FM accretion from 0 to 3 months were associated with 0.16 mmol/l (95% CI: 0.05-0.26 mmol/l, p = 0.005) and 0.06 mmol/l (95% CI: 0.01-0.12 mmol/l, p = 0.016) higher LDL-cholesterol at 5 years, respectively. Higher FFM at birth and FFM accretion in infancy were associated with higher FM, FFM, waist circumference, and height at 5 years. For instance, 100-g/month higher FFM accretion in the periods 0-3 and 3-6 months was associated with 1,002 g (95% CI: 815-1,189 g, p < 0.001) and 624 g (95% CI: 419-829 g, p < 0.001) greater FFM at 5 years, respectively. We found no associations of FM and FFM growth with any of the other studied cardiometabolic markers including glucose, HbA1c, insulin, C-peptide, HOMA-IR, triglycerides, and blood pressure. Non-attendance at the 5-year follow-up visit was the main limitation of this study, which may have introduced selection bias and limited the power of the regression analyses. CONCLUSIONS FM accretion in early life was positively associated with markers of adiposity and lipid metabolism, but not with blood pressure and cardiometabolic markers related to glucose homeostasis. FFM accretion was primarily related to linear growth and FFM at 5 years.
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Affiliation(s)
- Rasmus Wibaek
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- * E-mail:
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Marit E. Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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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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Massie R, Smallcombe J, Tolfrey K. Effects of a 12-Week Exercise Intervention on Subsequent Compensatory Behaviors in Adolescent Girls: An Exploratory Study. Pediatr Exerc Sci 2019; 31:495-504. [PMID: 31323644 DOI: 10.1123/pes.2019-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/28/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic exercise programs can induce adaptive compensatory behavioral responses through increased energy intake (EI) and/or decreased free-living physical activity in adults. These responses can negate the benefits of an exercise-induced energy deficit; however, it is unclear whether young people experience similar responses. This study examined whether exercise-induced compensation occurs in adolescent girls. METHODS Twenty-three adolescent girls, heterogeneous for weight status, completed the study. Eleven adolescent girls aged 13 years completed a 12-week supervised exercise intervention (EX). Twelve body size-matched girls comprised the nonexercise control group (CON). Body composition, EI, free-living energy expenditure (EE), and peak oxygen uptake (V˙O2) were measured repeatedly over the intervention. RESULTS Laboratory EI (EX: 9027, 9610, and 9243 kJ·d-1 and CON: 9953, 9770, and 10,052 kJ·d-1 at 0, 12, and 18 wk, respectively; effect size [ES] = 0.26, P = .46) and free-living EI (EX: 7288, 6412, and 5273, 4916 kJ·d-1 and CON: 7227, 7128, and 6470, 6337 kJ·d-1 at 0, 6, 12, and 18 wk, respectively; ES ≤ 0.26, P = .90) did not change significantly over time and were similar between groups across the duration of the study. Free-living EE was higher in EX than CON (13,295 vs 12,115 kJ·d-1, ES ≥ 0.88, P ≥ .16), but no significant condition by time interactions were observed (P ≥ .17). CONCLUSION The current findings indicate that compensatory changes in EI and EE behaviors did not occur at a group level within a small cohort of adolescent girls. However, analysis at the individual level highlights large interindividual variability in behaviors, which suggests a larger study may be prudent to extend this initial exploratory research.
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Gutiérrez-Marín D, Luque V, Ferré N, Fewtrell MS, Williams JE, Wells JCK. Associations of age and body mass index with hydration and density of fat-free mass from 4 to 22 years. Eur J Clin Nutr 2019; 73:1422-1430. [PMID: 31285552 DOI: 10.1038/s41430-019-0447-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/14/2019] [Accepted: 05/30/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Most body composition techniques assume constant properties of fat free mass (FFM) (hydration and density) regardless of nutritional status, which may lead to biased values. AIM To evaluate the interactive associations of age and body mass index (BMI) with hydration and density of FFM. METHODS Data from subjects aged between 4 and 22 years old from several studies conducted in London, UK were assessed. Hydration (HFFM) and density (DFFM) of FFM obtained from the four-component model in 936 and 905 individuals, respectively, were assessed. BMI was converted in to z-scores, and categorised into five groups using z-score cut-offs (thin, normal weight, overweight, obese, and severely obese). Linear regression models for HFFM and DFFM were developed using age, sex, and BMI group as predictors. RESULTS Nearly 30% of the variability in HFFM was explained by models including age and BMI groups, showing increasing HFFM values in heavier BMI groups. On the other hand, ∼40% of variability in DFFM was explained by age, sex, and BMI groups, with DFFM values decreasing in association with higher BMI group. CONCLUSION Nutritional status should be considered when assessing body composition using two-component methods, and reference data for HFFM and DFFM is needed for higher BMI groups to avoid bias. Further research is needed to explain intra-individual variability in FFM properties.
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Affiliation(s)
- Desirée Gutiérrez-Marín
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Veronica Luque
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Natàlia Ferré
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane E Williams
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.
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Luque V, Feliu A, Escribano J, Ferré N, Flores G, Monné R, Gutiérrez-Marín D, Guillen N, Muñoz-Hernando J, Zaragoza-Jordana M, Gispert-Llauradó M, Rubio-Torrents C, Núñez-Roig M, Alcázar M, Ferré R, Basora JM, Hsu P, Alegret-Basora C, Arasa F, Venables M, Singh P, Closa-Monasterolo R. The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment. Nutrients 2019; 11:E419. [PMID: 30781525 PMCID: PMC6413236 DOI: 10.3390/nu11020419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
Abstract
The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406.
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Affiliation(s)
- Veronica Luque
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Hospital Universitari de Tarragona Joan XXIII, 43007 Tarragona, Spain.
| | - Albert Feliu
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain.
| | - Joaquín Escribano
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain.
| | - Natalia Ferré
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Gemma Flores
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAPJGol, 43204 Reus, Spain.
| | - Raquel Monné
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAPJGol, 43204 Reus, Spain.
| | - Desirée Gutiérrez-Marín
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Núria Guillen
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain.
| | - Judit Muñoz-Hernando
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Marta Zaragoza-Jordana
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Mariona Gispert-Llauradó
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Carme Rubio-Torrents
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Mercè Núñez-Roig
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Mireia Alcázar
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
| | - Raimon Ferré
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain.
| | - Josep M Basora
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAPJGol, 43204 Reus, Spain.
| | - Pablo Hsu
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAPJGol, 43204 Reus, Spain.
| | - Clara Alegret-Basora
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain.
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAPJGol, 43204 Reus, Spain.
| | - Francesc Arasa
- Hospital Verge de la Cinta, 43500 Tortosa, Tarragona, Spain.
| | | | - Priya Singh
- MRC Elsie Widdowson laboratory, Cambridge CB1 9NL, UK.
| | - Ricardo Closa-Monasterolo
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain.
- Hospital Universitari de Tarragona Joan XXIII, 43007 Tarragona, Spain.
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Gomes A, Hutcheon D, Ziegler J. Association Between Fat-Free Mass and Pulmonary Function in Patients With Cystic Fibrosis: A Narrative Review. Nutr Clin Pract 2019; 34:715-727. [PMID: 30729564 DOI: 10.1002/ncp.10251] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The association between body mass index (BMI) and pulmonary function in patients with cystic fibrosis (CF) is well established, yet BMI as the sole indicator of nutrition status fails to assess body composition, specifically fat-free mass (FFM). Reduced FFM is a characteristic of undernutrition and is associated with decreased pulmonary function. A critical review of the literature was undertaken to explore available evidence on the use of FFM derived from dual-energy X-ray absorptiometry (DXA), compared with BMI, to assess pulmonary function and thereby nutrition status in patients with CF. Four cross-sectional studies that met predefined inclusion and exclusion criteria were selected for review. Based on the evidence reviewed, reduced FFM was associated with reduced pulmonary function in both children and adults with CF. FFM was reduced among patients who may not otherwise be identified as at nutrition risk based on BMI alone. FFM, as compared with BMI, appears to be a better indicator of pulmonary function and nutrition status in patients with CF. Although future research is needed to identify and determine FFM measurements that are associated with improved pulmonary function and nutrition status in patients with CF, these findings highlight the potential value and clinical utility of using FFM measurements derived from DXA among patients with CF. Together, FFM and BMI may provide a more comprehensive picture of nutrition status during the nutrition assessment of the patient with CF.
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Affiliation(s)
- Allison Gomes
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions at Rutgers University, Newark, New Jersey, USA
| | - Deborah Hutcheon
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions at Rutgers University, Newark, New Jersey, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions at Rutgers University, Newark, New Jersey, USA
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Physical Activity Level Using Doubly-Labeled Water in Relation to Body Composition and Physical Fitness in Preschoolers. ACTA ACUST UNITED AC 2018; 55:medicina55010002. [PMID: 30591687 PMCID: PMC6359212 DOI: 10.3390/medicina55010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
Background and objectives: There is a lack of studies investigating associations of physical activity level (PAL) and activity energy expenditure (AEE) using the doubly-labeled water (DLW) method with body composition and physical fitness in young children. Thus, we aimed to examine cross-sectional associations of PAL and AEE with body composition indices and physical fitness components in Swedish preschool children. Materials and methods: PAL was calculated as total energy expenditure measured using DLW divided by the predicted basal metabolic rate in 40 children aged 5.5 (standard deviation 0.2) years. AEE was calculated as total energy expenditure minus basal metabolic rate and the thermic effect of food, and divided by fat-free mass. Body composition was assessed using the 3-component model by combining measurements based on isotope dilution and air-displacement plethysmography. Physical fitness (muscular strength, motor fitness, and cardiorespiratory fitness) was evaluated using the PREFIT test battery. Multiple linear regression models were conducted. Results: PAL and AEE were negatively associated with body mass index, percent body fat, and fat mass index (PAL: standardized β −0.35, −0.41, and −0.45, all p < 0.036; AEE: standardized β −0.44, −0.44, and −0.47, all p < 0.006, respectively). Furthermore, PAL and AEE were positively associated with the standing long jump test (PAL: standardized β 0.37, p = 0.017; AEE: standardized β 0.38, p = 0.014). There were no statistically significant associations found regarding PAL or AEE with fat-free mass index or any other physical fitness test. Conclusions: Greater PAL and AEE at the age 5.5 were significantly associated with body fatness and improved lower-body muscular strength. Therefore, increasing physical activity, and thus energy expenditure, at young ages may be beneficial for preventing overweight/obesity. However, further studies with larger sample sizes are needed to confirm the results.
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Christensen P, Meinert Larsen T, Westerterp‐Plantenga M, Macdonald I, Martinez JA, Handjiev S, Poppitt S, Hansen S, Ritz C, Astrup A, Pastor‐Sanz L, Sandø‐Pedersen F, Pietiläinen KH, Sundvall J, Drummen M, Taylor MA, Navas‐Carretero S, Handjieva‐Darlenska T, Brodie S, Silvestre MP, Huttunen‐Lenz M, Brand‐Miller J, Fogelholm M, Raben A. Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW). Diabetes Obes Metab 2018; 20:2840-2851. [PMID: 30088336 PMCID: PMC6282840 DOI: 10.1111/dom.13466] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
Abstract
AIMS The PREVIEW lifestyle intervention study (ClinicalTrials.gov Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women. MATERIALS AND METHODS All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI ≥ 25 kg/m2 ) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score. RESULTS In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia. CONCLUSIONS An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.
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Affiliation(s)
- Pia Christensen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Thomas Meinert Larsen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | | | - Ian Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreSchool of Life SciencesUniversity of Nottingham, NottinghamNG7 2UH, UK
| | - J. Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- CIBERObn, Obesity and NutritionInstituto de Salud Carlos IIIMadridSpain
- IMDEA AlimentaciónMadridSpain
| | - Svetoslav Handjiev
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Sally Poppitt
- Human Nutrition Unit, School of Biological SciencesUniversity of AucklandAucklandNew Zealand
| | - Sylvia Hansen
- Department of Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Christian Ritz
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Arne Astrup
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Laura Pastor‐Sanz
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Finn Sandø‐Pedersen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program Unit, Diabetes and ObesityUniversity of HelsinkiHelsinkiFinland
- Obesity Center, Abdominal Center, EndocrinologyHelsinki University Hospital, University of HelsinkiHelsinkiFinland
| | - Jouko Sundvall
- National Institute for Health and Welfare THLHelsinkiFinland
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | | | - Santiago Navas‐Carretero
- Department of Nutrition, Food Science and Physiology, Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- CIBERObn, Obesity and NutritionInstituto de Salud Carlos IIIMadridSpain
| | | | - Shannon Brodie
- Charles Perkins Centre and School of Life and Environmental BiosciencesUniversity of SydneySydneyAustralia
| | - Marta P. Silvestre
- Human Nutrition Unit, School of Biological SciencesUniversity of AucklandAucklandNew Zealand
| | - Maija Huttunen‐Lenz
- Department of Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Jennie Brand‐Miller
- Charles Perkins Centre and School of Life and Environmental BiosciencesUniversity of SydneySydneyAustralia
| | - Mikael Fogelholm
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
| | - Anne Raben
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
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De Lorenzo A, Romano L, Di Renzo L, Gualtieri P, Salimei C, Carrano E, Rampello T, de Miranda RC. Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents. Nutrition 2018; 60:41-47. [PMID: 30529185 DOI: 10.1016/j.nut.2018.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/08/2018] [Accepted: 09/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to compare body mass index (BMI) and triponderal mass index (TMI) as predictors of fat mass percentage (FM%) and to develop TMI cutoffs for screening high adiposity. Therefore, TMI- and BMI-based references against FM% criterion for indicating adiposity in Italian children and adolescents were compared. METHODS This was a cross-sectional study conducted at the University of Rome Tor Vergata, Human Nutrition Unit, from 2008 to 2015. The sample included 485 children and adolescents from 8 to 17 y of age from central-southern Italy. Body weight (kg) and height (m) were assessed to calculate BMI and TMI. FM% was assessed by dual-energy x-ray absorptiometry. The prevalence of high adiposity was based on the 75th percentile of FM%, according to Ogden et al. curves. Statistical tests such as Mann-Whitney, Kruskal-Wallis, polynomial regression, receiver operating characteristics curve, and Cohen's κ, were performed using SPSS version 24 and MedCalc version 18. RESULTS Prevalence of high adiposity according to FM% was 50.2% (95% confidence interval [CI], 43.2-57.2) in boys and 43.2% (95% CI, 37.3-49.2) in girls. TMI rather than BMI could better predict FM% for both sexes (boys R2 = 0.67 and girls R2 = 0.79 versus boys R2 = 0.44 and girls R2 = 0.74, respectively). TMI was found to present a significantly higher area under the curve than BMI for indicating high adiposity in children and adolescents. TMI sex- and age-specific cutoffs were responsible by better classification of adiposity, followed by the International Obesity Task Force, World Health Organization, and Cacciari reference curves. CONCLUSION TMI is a useful screening tool in pediatric clinical practice and epidemiologic studies concerning childhood obesity.
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Affiliation(s)
- Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Lorenzo Romano
- Specialization School of Food Science, University of Rome Tor Vergata, Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Gualtieri
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Salimei
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Tiziana Rampello
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Renata Costa de Miranda
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy; CAPES Scholarship, CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
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Wells JCK, Williams JE, Quek RY, Fewtrell MS. Bio-electrical impedance vector analysis: testing Piccoli's model against objective body composition data in children and adolescents. Eur J Clin Nutr 2018; 73:887-895. [PMID: 30166638 PMCID: PMC6760620 DOI: 10.1038/s41430-018-0292-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/12/2018] [Accepted: 08/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVES Bio-electrical impedance (BI) analysis is a simple body composition method ideal for children. However, its utility in sick or malnourished children is complicated by variability in hydration. BI vector analysis (BIVA) potentially resolves this, using a theoretical model that differentiates hydration from cell mass. We tested this model against reference methods in healthy children varying widely in age and nutritional status. SUBJECTS/METHODS We compiled body composition data from 291 children and adolescents (50% male) aged 4-20 years of European ancestry. Measurements included anthropometry, BIVA outcomes (height-adjusted resistance (R/H) and reactance (Xc/H); phase angle (PA)), and fat-free mass (FFM), fat mass (FM) and FFM-hydration (HFFM) by the criterion 4-component model. All outcomes were converted to age- and sex-standardised standard deviation scores (SDS). Graphic analysis and regression analysis were used to evaluate the BIVA model. RESULTS R/H and Xc/H declined with age in curvilinear manner, whereas PA increased linearly with age. R/H-SDS and Xc-SDS were negatively correlated with FFM-SDS, HFFM-SDS. and FM-SDS. PA was positively correlated with FFM-SDS but unrelated to HFFM-SDS and FM-SDS. CONCLUSIONS While previous studies of adults with major fluid perturbations support the BIVA model, it is less successful in predicting variability in FFM in healthy children and adolescents. BIVA outcomes varied as predicted by the model with HFFM, but not as predicted with FFM. Variability in adiposity also explains some of the variability in BIVA traits. Further work is needed to develop a theoretical BIVA model for application in paediatric patients without major fluid disturbances.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jane E Williams
- Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rina Y Quek
- Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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The paediatric option for BodPod to assess body composition in preschool children: what fat-free mass density values should be used? Br J Nutr 2018; 120:797-802. [PMID: 30132437 DOI: 10.1017/s0007114518002064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Air displacement plethysmography utilises a two-component model to assess body composition, which relies on assumptions regarding the density of fat-free mass (FFM). To date, there is no evidence as to whether Lohman's or Wells et al.'s FFM density values are more accurate in young children. Therefore, the aims of this study were to compare total body fat percentage (TBF%) assessed using the BodPod with both Lohman's and Wells et al.'s FFM density values with TBF% from the three-component (3C) model in forty healthy Swedish children aged 5·5 years. Average TBF% calculated using Lohman's FFM density values underestimated TBF% in comparison with the corresponding value assessed using the 3C model (22·2 (sd 5·7) and 25·1 (sd 5·5) %, respectively; P<0·001). No statistically significant difference was observed between TBF% assessed using Wells et al.'s FFM density values and the 3C model (24·9 (sd 5·5) and 25·1 (sd 5·5) %, respectively; P=0·614). The Bland and Altman plots for TBF% using both Lohman's and Wells et al.'s FFM density values did not show any bias across the range of body fatness (Lohman: r 0·056, P=0·733 and Wells et al.: r -0·006, P=0·970). These results indicate that Wells et al.'s FFM density values should be used when assessing body composition with the paediatric option for BodPod in 5-year-old children. However, future studies are needed to confirm these results in other populations, including a wider age range of children.
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Comparison of Bioelectrical Impedance Analysis, Slaughter Skinfold-Thickness Equations, and Dual-Energy X-ray Absorptiometry for Estimating Body Fat Percentage in Colombian Children and Adolescents with Excess of Adiposity. Nutrients 2018; 10:nu10081086. [PMID: 30110944 PMCID: PMC6115719 DOI: 10.3390/nu10081086] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 01/06/2023] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) has been considered a reference method for measuring body fat percentage (BF%) in children and adolescents with an excess of adiposity. However, given that the DXA technique is impractical for routine field use, there is a need to investigate other methods that can accurately determine BF%. We studied the accuracy of bioelectrical impedance analysis (BIA) technology, including foot-to-foot and hand-to-foot impedance, and Slaughter skinfold-thickness equations in the measurement of BF%, compared with DXA, in a population of Latin American children and adolescents with an excess of adiposity. A total of 127 children and adolescents (11–17 years of age; 70% girls) from the HEPAFIT (Exercise Training and Hepatic Metabolism in Overweight/Obese Adolescent) study were included in the present work. BF% was measured on the same day using two BIA analysers (Seca® 206, Allers Hamburg, Germany and Model Tanita® BC-418®, TANITA Corporation, Sportlife Tokyo, Japan), skinfold measurements (Slaughter equation), and DXA (Hologic Horizon DXA System®, Quirugil, Bogotá, Columbia). Agreement between measurements was analysed using t-tests, Bland–Altman plots, and Lin’s concordance correlation coefficient (ρc). There was a significant correlation between DXA and the other BF% measurement methods (r > 0.430). According to paired t-tests, in both sexes, BF% assessed by BIA analysers or Slaughter equations differ from BF% assessed by DXA (p < 0.001). The lower and upper limits of the differences compared with DXA were 6.3–22.9, 2.2–2.8, and −3.2–21.3 (95% CI) in boys and 2.3–14.8, 2.4–20.1, and 3.9–18.3 (95% CI) in girls for Seca® mBCA, Tanita® BC 420MA, and Slaughter equations, respectively. Concordance was poor between DXA and the other methods of measuring BF% (ρc < 0.5). BIA analysers and Slaughter equations underestimated BF% measurements compared to DXA, so they are not interchangeable methods for assessing BF% in Latin American children and adolescents with excess of adiposity.
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Abstract
PURPOSE To examine the intermethods agreement of dual-energy X-ray absorptiometry (DXA) and foot-to-foot bioelectrical impedance analysis (BIA) to assess the percentage of body fat (%BF) in young male athletes using air-displacement plethysmography (ADP) as the reference method. METHODS Standard measurement protocols were carried out in 104 athletes (40 swimmers, 37 footballers, and 27 cyclists, aged 12-14 y). RESULTS Age-adjusted %BF ADP and %BF BIA were significantly higher in swimmers than footballers. ADP correlates better with DXA than with BIA (r = .84 vs r = .60, P < .001). %BF was lower when measured by DXA and BIA than ADP (P < .001), and the bias was higher when comparing ADP versus BIA than ADP versus DXA. The intraclass correlation coefficients between DXA and ADP showed a good to excellent agreement (r = .67-.79), though it was poor when BIA was compared with ADP (r = .26-.49). The ranges of agreement were wider when comparing BIA with ADP than DXA with ADP. CONCLUSION DXA and BIA seem to underestimate %BF in young male athletes compared with ADP. Furthermore, the bias significantly increases with %BF in the BIA measurements. At the individual level, BIA and DXA do not seem to predict %BF precisely compared with ADP in young athletic populations.
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Machado D, Silva A, Gobbo L, Elias P, de Paula FJA, Ramos N. Anthropometric multicompartmental model to predict body composition In Brazilian girls. BMC Sports Sci Med Rehabil 2018; 9:23. [PMID: 29299316 PMCID: PMC5740741 DOI: 10.1186/s13102-017-0088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022]
Abstract
Background Anthropometric models remain appropriate alternatives to estimate body composition of peripubertal populations. However, these traditional models do not consider other body components that undergo major changes during peripubertal growth spurt, with restrictions to a multicompartimental approach as a quantitative growth. DXA has great potential to determine pediatric body composition in more than one component (3-C), but has limited use in field settings. Thus, the aim of this study was to propose and validate an anthropometric model for simultaneous estimation of lean soft tissue (LST), bone mineral content (BMC) and fat mass (FM) in healthy girls, from a multivariate approach of densitometric technique, as the criterion method. Methods A sample of 84 Brazilian girls (7-17 years) was defined by chronological age and maturity offset. Whole total and regional DXA body scan were performed and, the components were defined (LST, BMC and FM) and considered as dependent variables. Twenty-one anthropometric measures were recorded as independent variables. From a multivariate regression, an anthropometric multicompartmental model was obtained. Results It was possible to predict DXA body components with only four predictive measurements: body weight (BW); supra-iliac skinfold (SiSk); horizontal abdominal skinfold (HaSk) and contracted arm circumference (CaCi) with high coefficients of determination and low estimation errors (LST = 0.6662657 BW - 0. 2157279 SiSk - 0.2069373 HaSk + 0.3411678 CaCi - 1.8504187; BMC = 0.0222185 BW - 0.1001097 SiSk - 0.0064539 HaSk - 0.0084785 CaCi + 0.3733974 and FM = 0.3645630 BW + 0.1000325 SiSk - 0.2888978 HaSk - 0.4752146 CaCi + 2.8461916). The cross-validation was confirmed through the sum of squares of residuals (PRESS) method, presenting accurate coefficients (Q2PRESS from 0.81 to 0.93) and reduced error reliability (SPRESS from 0.01 to 0.30). Conclusions When sophisticated instruments are not available, this model provides valid estimates of multicompartmental body composition of girls in healthy Brazilian pediatric populations.
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Affiliation(s)
- Dalmo Machado
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Bandeirantes Ave. 3900, Monte Alegre, Ribeirão Preto, SP 14040-900 Brazil
| | - Analiza Silva
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Luis Gobbo
- Department of Physical Education, Universidade Estadual Paulista, Presidente Prudente, Ribeirao Preto, Brazil
| | - Paula Elias
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP Brazil
| | - Francisco J A de Paula
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP Brazil
| | - Nilo Ramos
- Department of Graduate and Specialty Studies, Coastal Carolina University, Conway, SC USA
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De Lorenzo A, Di Renzo L, Morini P, de Miranda RC, Romano L, Colica C. New equations to estimate resting energy expenditure in obese adults from body composition. Acta Diabetol 2018; 55:59-66. [PMID: 29086030 DOI: 10.1007/s00592-017-1061-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/26/2017] [Indexed: 12/22/2022]
Abstract
AIMS The aims of this study were: to develop new equations for predicting resting energy expenditure (REE) in obese Italian subjects according to body composition parameters; to compare them with predicted values estimated by other REE prediction equations; and to cross-validate our equations using a validation set cohort. METHODS Four hundred patients were enrolled and divided into three groups. Besides anthropometry and REE (indirect calorimetry), total body fat and lean were evaluated by dual X-ray absorptiometry, and fat mass and fat-free mass by bioelectrical impedance analysis. RESULTS The subjects eligible to participate were 330. Group 1 (n = 174) was used to develop (R 2 = 0.79) and (R 2 = 0.77). Group 2 (n = 115) was used to generate (R 2 = 0.85) and (R 2 = 0.81). Group 3 (n = 41) was used to cross-validate the equations. CONCLUSION Equations 1 and 3 are reliable to measure REE from calorimetry and better than other equations that use anthropometric variables as predictors of REE. Further analysis in different populations is required before it can be applied in clinical practice.
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Affiliation(s)
- Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Casa di Cura Madonna dello Scoglio, 88836, Cotronei (KR), Italy.
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Pietro Morini
- ICANS International Center for Assessment of Nutritional Status, University of Milan, 20133, Milan, Italy
| | - Renata Costa de Miranda
- School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, 00133, Rome, Italy
- CAPES Scholarship (Proc N° BEX 13264/13-3). CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, 70040-020, Brazil
| | - Lorenzo Romano
- Specialisation School of Food Science, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Carmela Colica
- CNR, IBFM UOS of Germaneto, University "Magna Graecia" of Catanzaro, Campus "Salvatore Venuta", 88100, Germaneto, Catanzaro, Italy
- Casa di Cura Madonna dello Scoglio, 88836, Cotronei (KR), Italy
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