Métodos de avaliação da composição corporal em crianças

[Body composition models based on anthropometry, systematic literature review]

Introduction

The body composition determination is carried out through measurement methods that require the use of specialized equipment that is difficult to acquire and manipulate. Therefore, different authors have developed mathematical models for its calculation. The target of this review was to analyze the work carried out on mathematical models of body composition variables from different anthropometric measurements, answering the following questions: what is the corporal variable that the model predicts?, what are the input variables for model development?, how is the patients typification in each model?, what data analysis method has been used?, and how has been the model evaluated? The search was limited to journals found in repositories in the areas of Medicine, Nursing, Biochemistry, Biology, Health, Pharmacology, Immunology, Engineering, and Mathematics. Four hundred and twenty-four articles were found, which were reduced to 30 by applying the systematic literature review process. The analyzed studies are oriented to the prediction of variables related to body fat mass. The evaluation results found for fat-free mass, fat mass and metabolic rate differ according to the comparison technique and the body segments analyzed. The evaluation is mainly based on the intraclass correlation, the Pearson correlation and the coefficient of determination (r2), and they present a good correlation for the population under study.

PUNTO ÓPTIMO CARDIORRESPIRATORIO, COMPOSICION CORPORAL Y MEDIDAS BIOQUÍMICAS: UN ESTUDIO CON GEMELOS

El propósito de este estudio fue investigar la relación de la composición corporal y las variables bioquímicas con el POC, así como observar la tendencia de la heredabilidad. Estudio transversal con gemelos monocigóticos y dicigóticos adultos. Para obtener los valores del POC, la prueba de ejercicio cardiopulmonar fue realizada se realizó un protocolo con sobre cinta rodante. Para la composición corporal, se utilizaron laabsorciometríade energía dual y la antropometría. Para las inferencias, se realizaron la concordancia de Spearman y la prueba de hipótesisMann-Whitney.Los resultados mostraron que lasvariables de composición corporal no se correlacionaron significativamente con el punto óptimo cardiorrespiratorio. El Punto Óptimo Cardiorrespiratorio y las variables bioquímicas en general demostraron una mayor tendencia a ser influenciados por factores ambientales. El comportamiento de las variables de composición corporal demostró una mayor influencia de la heredabilidad.

Metabolic Profile and Body Composition in Twins Concordant and Discordant for Physical Exercise

The aim of this study was to evaluate the differences in the metabolic profile and body composition of monozygotic (MZ) twins concordant and discordant for the practice of physical exercise. The sample consisted of 92 MZ twins (72.5% female and 27.5% male, mean age 25.4 ± 5.69 years), registered with the Brazilian Registry of Twins, residing in Natal, Brazil. Data collection was carried out between the years 2016 and 2018. On day 1, subjects underwent a whole-body fitness evaluation, including measures of weight, height, body composition by Dual-Energy X-ray Absorptiometry and the Cardiorespiratory Exercise Test. On day 2, 10 ml blood samples were collected (overnight fasting) to determine the lipid profile and fasting glucose. The sample was separated into three groups: Active Concordant twins (Concordant A, n = 44 subjects), Inactive Concordant twins (Concordant I, n = 22 subjects) and Discordant pairs for Physical Exercise (Discordant PE, n = 26 subjects). The results demonstrated a difference between the discordant twins for exercise and also between the active versus sedentary groups, indicating a causal effect of exercise on the fat percentage, maximum oxygen consumption (VO2max) and second ventilatory threshold variables. Between groups, a difference was also observed between the groups in ventilatory threshold, very low-density lipoprotein and triglycerides. We concluded that, regardless of genetics, the practice of physical exercise was sufficient to generate alterations in body composition and VO2max in MZ twins, but not in the lipid profile or fasting glucose.

Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul-RS

OBJECTIVE

To analyze the prevalence and impact of asthma in schoolchildren from the city of Caxias do Sul, RS, Brazil.

METHODS

Cross-sectional observational and case-control study with children and adolescents between 7 and 15 years old, from public schools in Caxias do Sul, RS. The study is composed of two phases: Phase I analyzed the prevalence of asthma in the delimited population, investigating 1915 schoolchildren; Phase II quality of life questionnaires, asthma control and classification (for the asthmatic group), physical activity, school performance, pulmonary function tests and anthropometric measures were applied to 266 asthmatics and 288 controls.

RESULTS

The estimated prevalence of asthma was 16.1%. In the comparison between asthmatics and nonasthmatics premature birth (p<0.001) and diagnosis of another chronic disease at birth (p<0.001) were found. Regarding pulmonary function, significant differences were found in the values between groups in FEV₁, FEV₁/FVC and forced expiratory flow in the 25 and 75% (FEF_25-75%), being that asthmatics presented lower values. Among asthmatics, 133 (50.8%) did not have the disease controlled. In the anthropometric variables, significant differences were observed, with higher values in controls, in the the waist-to-height ratio (p=0.009) and in the perception of health (p<0.001). Quality of life is lower in asthmatics in the physical well-being domain (p=0.001) and in the total score (p=0.016). The total school performance score did not present a statistically significant difference between the groups.

CONCLUSION

The prevalence of asthma is similar to that of other industrialized urban centers and may negatively affect some areas of the development of schoolchildren.

Associations between adiposity indicators and hypertension among children and adolescents with intellectual disability-A case-control study

BACKGROUND

Adiposity is closely related to hypertension (HTN) in paediatric population. However, which adiposity indicator is most associated with HTN among children and adolescents with intellectual disability remains unknown. The aim of this study was to evaluate the associations between HTN prevalence and different adiposity indicators: body mass index (BMI) percentile, body fat percentage (BFP), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR) and waist-to-height ratio (WHtR) in students with intellectual disability.

METHODS

Cross-sectional study included a sample of 568 schoolchildren with intellectual disability, aged 7-18 years. Blood pressure, BMI, body composition, WC and HC were determined using standardized equipment.

RESULTS

Multivariate logistic regression showed that male gender, adolescence, high HC and excessive BFP were significant independent factors that increased risk of HTN occurrence in population with intellectual disability.

CONCLUSIONS

Findings indicated that HC and BFP, in particular, may be helpful tools to detect HTN in population with intellectual disability.

DANCE IN THE TREATMENT OF CHILDHOOD OBESITY: A PROPOSED PROTOCOL

ABSTRACT Introduction: Low levels of daily physical activity is considered to be one of the causes of the exorbitant increase in overweight and obese children, and associated comorbidities. Therefore, it is vital to develop strategies that will be implemented consistently, to improve this situation. Studies have used dance as a resource for training overweight and obese children, but the lack of information about the creation process and its respective stages reduce the possibility of these proposals being effectively applied. Objectives: To describe the steps in the creation of a dance protocol as a training resource, and its effectiveness in improving the health parameters of overweight and obese children. Methods: 30 children (9 ± 1.1 years) underwent training sessions consisting of a five-minute warm-up at 60% HRmax., and four 10-minute sessions at 70% to 80% at HRmax. interspersed with five 2-minute active recovery periods at 60% HRmax. The sessions were carried out three times a week, and lasted 60 minutes each, over a 13-week period. Before and after the training, the body composition, body mass index (BMI), BMI z-score, waist circumference (WC), waist-to-height ratio (WHtR), systolic (SBP) and diastolic (DBP) blood pressure and blood variables were measured. Statistical analysis was performed using a mixed effects regression model. Results: After training with Afro-Brazilian dance, there was a significant reduction (p<0.05) in the BMI z-score and waist-to-height ratio. Conclusion: Afro-Brazilian dance training was a strategy with a positive effect on BMI z-score and waist-to-height ratio in overweight and obese children. Level of evidence IV; Case series.

Occurrence of overweight in schoolchildren and analysis of agreement between anthropometric methods

Abstract The child population is strongly affected by obesity. Accessible and reliable strategies for the obesity diagnosis are of utmost importance.. The aim of this study was to identify childhood obesity according the WHO (World Health Organization): malnourished, healthy weight, overweight and obese. It was collected measures of height, Body Mass Index (BMI), Waist Circumference (WC) and Triceps Skinfold Thickness (TSF) of 449 children from Municipal School of Araras/SP, from 7 to 10 years old. It was performed a Spearman correlation test between BMI, WC and TSF variables. Also, was realized cross tabulation between the found results by the different methods, constructing a contingency table 2x2, with absolute frequency of boys and girls classified as “without overweight” and “with overweight”. The concordance between methods was analyzed by kappa index. In the results, 28.3% of children presented overweight according to BMI, with higher prevalence in boys. Generally, the found results through TSF showed strong correlation with both BMI and WC (rs=0.7994 e rs=0.7519, respectively). The same was observed when data was analyzed separately by sex. When crossed the TSF data with BMI and WC, the kappa index demonstrated a satisfactory concordance (0.4419 e 0.5161, respectively). The TSF can be suggested a method to body composition assessment and cardiometabolic risk in children.

Tri-Ponderal Mass Index: A Screening Tool for Risk of Central Fat Accumulation in Brazilian Preschool Children

Background and Objectives: To verify the use of the tri-ponderalmass index (TMI) as a screening tool for risk of central fat accumulation in preschool children. Materials and Methods: An observational, analytical study was carried out on samples from children 2 to 5 years of age. The body mass index (BMI) and the tri-ponderalmass index (TMI: Weight/height3) were calculated. The waist circumference-to-height ratio (WHtR) was used to classify central fat accumulation risk. Preschoolers whose WHtRwas in the upper tertile of the sample were classified as at risk for central fat accumulation. A comparison of the two indicators (BMI and TMI) was made from the area under the receiver operator characteristics (ROC) curve (AUC) in the discrimination of the WHtR. Results: The sample used for analysis was 919 preschoolers. The mean age of the children was 3.9 years (SD = 0.7). The difference in AUC was 5% higher for TMI (p < 0.0001). In the individual analysis of the ROC curve of the TMI, favoring a higher sensitivity, the cutoff point of 14.0 kg/m³ showed a sensitivity of 99.3% (95% CI: 97.6-99.9). Conclusion: Considering WHtR as a marker of possible future metabolic risk among preschool children, TMI proved to be a useful tool, superior to BMI, in screening for risk of central fat accumulation in preschool children.

Evidence on nutritional assessment techniques and parameters used to determine the nutritional status of children and adolescents: systematic review

This article aims to review systematically the evidence on nutritional assessment techniques and parameters used to determine the nutritional status of children and adolescents. The literature review and the selection of publications were performed using the Medline, Lilacs, SciELO, Embase, personal files. 17 studies were identified, 7 addressed the anthropometric indices as the main outcome, 7 analyzed the growth and development of children and adolescents through growth curves, and the remainder surveyed body composition. In general, all met the quality criteria, unless 6 of the articles who did not discuss the limitations. The literature review suggests several techniques and parameters that can be applied to determine the nutritional status of children and adolescents from different countries. Growth graphs are essential to assess the health of children, but depend greatly of the growth tables used. Although BMI can be practical, it does not distinguish body fat from lean mass. The best interpretation of anthropometry will depend of valid reference values for age range of the study population. BIA is a quick feasible method, but the measurement has some various nationalities.

Body composition estimation in children and adolescents by bioelectrical impedance analysis: A systematic review

BACKGROUND

Bioelectrical impedance analysis (BIA) has commonly been used to assess the body composition of children and adolescents. BIA validation studies have found distinct correlation values with reference methods.

OBJECTIVES

To assess the reproducibility, correlation and mean differences in body composition estimated by BIA and reference methods, we systematically reviewed the literature in the pediatric population.

METHOD

The search for articles was conducted in March 2016 and was limited to articles published from 2005 to 2015 in the PubMed, Embase, EBSCO, Web of Science, Scopus and SciELO databases. Two reviewers independently performed data selection and extraction of studies that investigated the BIA validity, responsiveness, reliability and/or measurement error (reproducibility) to estimate body composition in children and adolescents with an average age ≤ 18 years.

RESULTS

The search produced 48 articles. Almost perfect reproducibility was found in the body fat percentage estimated by BIA, and there was almost perfect correlation between the BIA ratings and reference methods for fat mass and fat-free mass. Regarding component estimates, BIA underestimated the fat mass in both sexes.

CONCLUSIONS

The body fat percentage estimated by BIA exhibited almost perfect reproducibility. The fat mass and fat-free mass estimated by BIA correlated almost perfectly with the reference methods in both sexes. BIA underestimated the fat mass in both sexes.

Association between nutritional status and outcomes in critically-ill pediatric patients - a systematic review

OBJECTIVES

To systematically review the evidence about the impact of nutritional status in critically-ill pediatric patients on the following outcomes during hospitalization in pediatric intensive care units: length of hospital stay, need for mechanical ventilation, and mortality.

DATA SOURCE

The search was carried out in the following databases: Lilacs (Latin American and Caribbean Health Sciences), MEDLINE (National Library of Medicine United States) and Embase (Elsevier Database). No filters were selected.

RESULTS

A total of seven relevant articles about the subject were included. The publication period was between 1982 and 2012. All articles assessed the nutritional status of patients on admission at pediatric intensive care units and correlated it to at least one assessed outcome. A methodological quality questionnaire created by the authors was applied, which was based on some references and the researchers' experience. All included studies met the quality criteria, but only four met all the items.

CONCLUSION

The studies included in this review suggest that nutritional depletion is associated with worse outcomes in pediatric intensive care units. However, studies are scarce and those existing show no methodological homogeneity, especially regarding nutritional status assessment and classification methods. Contemporary and well-designed studies are needed in order to properly assess the association between children's nutritional status and its impact on outcomes of these patients.

Evaluation of the predictive capacity of vertical segmental tetrapolar bioimpedance for excess weight detection in adolescents

OBJECTIVE

To analyze the predictive capacity of the vertical segmental tetrapolar bioimpedance apparatus in the detection of excess weight in adolescents, using tetrapolar bioelectrical impedance as a reference.

METHODS

This was a cross-sectional study conducted with 411 students aged between 10 and 14 years, of both genders, enrolled in public and private schools, selected by a simple and stratified random sampling process according to the gender, age, and proportion in each institution. The sample was evaluated by the anthropometric method and underwent a body composition analysis using vertical bipolar, horizontal tetrapolar, and vertical segmental tetrapolar assessment. The ROC curve was constructed based on calculations of sensitivity and specificity for each point of the different possible measurements of body fat. The statistical analysis used Student's t-test, Pearson's correlation coefficient, and McNemar's chi-squared test. Subsequently, the variables were interpreted using SPSS software, version 17.0.

RESULTS

Of the total sample, 53.7% were girls and 46.3%, boys. Of the total, 20% and 12.5% had overweight and obesity, respectively. The body segment measurement charts showed high values of sensitivity and specificity and high areas under the ROC curve, ranging from 0.83 to 0.95 for girls and 0.92 to 0.98 for boys, suggesting a slightly higher performance for the male gender. Body fat percentage was the most efficient criterion to detect overweight, while the trunk segmental fat was the least accurate indicator.

CONCLUSION

The apparatus demonstrated good performance to predict excess weight.

Comparação de três equações para predição da gordura corporal por bioimpedância em jovens obesas

INTRODUÇÃO: A impedância bioelétrica (BIA) tem sido bastante utilizada para o monitoramento da composição corporal em indivíduos de diferentes idades e estados nutricionais. Entretanto, não se sabe qual das equações propostas para crianças e adolescentes é a mais recomendada para utilização em adolescentes com excesso de peso. Objetivo: Verificar a concordância dos métodos de BIA usando três equações diferentes com a absorciometria de raio-X de dupla energia (DXA), para análise da composição corporal de adolescentes com sobrepeso e obesidade.MÉTODOS: Participaram do estudo 27 adolescentes do sexo feminino, com sobrepeso e obesidade. Foram avaliados o percentual de gordura corporal (%GC), a massa gorda (MG) e a massa livre de gordura (MLG) por DXA e por BIA utilizando as equações propostas por Houtkooper, Schaefer e Deurenberg. ANOVA oneway, gráficos de Bland-Altman e o coeficiente de correlação intraclasse foram utilizados para comparação e verificação da concordância entre os métodos.RESULTADOS: A BIA utilizando a equação proposta por Houtkooper foi a única que não apresentou diferença estatística significativa na estimativa de %GC, MG e MLG em comparação ao DXA e apresentou boa concordância com o DXA na estimativa de %GC (-1,9 ± 3,29%), MG (1,5 ± 2,59 kg) e MLG (1,4 ± 2,60 kg), bem como boa reprodutibilidade para %GC (CCI = 0,81), MG (0,96) e MLG (0,89). As equações de Schaefer e de Deurenberg apresentaram menor concordância com o DXA, superestimando a MG e subestimando a MLG e apresentaram reprodutibilidade de moderada a baixa na maioria das medidas da composição corporal.CONCLUSÃO: Quando comparamos as três equações propostas para BIA com o DXA, verificamos que a equação proposta por Houtkooper foi a que melhor concordou com DXA e apresentou boa reprodutibilidade para estimar %GC, MG e MLG em adolescentes com sobrepeso e obesidade.

Validity of the methods to assess body fat in children and adolescents using multi-compartment models as the reference method: a systematic review

OBJECTIVE

To analyze the validity of methods to assess body fat in children and adolescents using a systematic review.

METHODS

The search was conducted by two independent researchers using the MEDLINE, BioMed Central, SciELO and LILACS electronic databases. For inclusion, the articles should be written in English or Portuguese, and must have used multi-compartment models as the criterion measure of the model, with body fat measurement of whole body in non-athlete children and adolescents.

RESULTS

A preliminary search resulted in 832 studies. After all selection steps were performed, 12 articles were included. The selected studies were published between 1997 and 2010, whose samples consisted of children and adolescents with levels of relative body fat ranging from 20.7% to 41.4%. The methods used were: dual energy X-ray absorptiometry (58.3%), isotope dilution (41.6%), skinfold thickness (33.3%), hydrostatic weighing (25%), bioelectrical impedance analysis (25%), air displacement plethysmography (16.6%), and total body electrical conductivity (8.3%).

CONCLUSIONS

Based on the analysis of the studies, isotope dilution and air displacement plethysmography methods were the most reliable, despite the limited number of studies. As for clinical use or for population-based studies, the equation of Slaughter et al. (1998), which uses the triceps and subscapular skinfolds thickness, showed the best results for assessment of body fat in this population.

Correlação entre índice de massa corporal e circunferência da cintura em crianças

OBJETIVO: Estabelecer uma correlação entre a circunferência da cintura e o Índice de Massa Corporal (IMC) na determinação do excesso de peso e distribuição de gordura em crianças de escolas públicas de Fortaleza - CE. MÉTODOS: Trata-se de um estudo transversal, realizado em 12 escolas da rede da pública da cidade de Fortaleza- CE. Participaram 727 crianças de ambos os sexos, com idade variando entre 6 a 11 anos. A coleta de dados ocorreu de março a junho de 2008. RESULTADOS: Os resultados do inquérito mostraram que, de acordo com o IMC,11,4% das crianças encontravam-se em sobrepeso, 6,6% eram obesas e 30,9% apresentaram obesidade central. CONCLUSÃO: Nem toda criança obesa apresentava obesidade central, demonstrando que uma só medida antropométrica não é eficaz na determinação do padrão de gordura na infância.