Alterations in growth and body composition during puberty. I. Comparing multicompartment body composition models

Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents

OBJECTIVE

To compare estimates of adiposity by dual emission X-ray absorptiometry (DXA), skinfolds and body mass index (BMI); and to evaluate the relation of these measures to cardiovascular risk in adolescents.

DESIGN

In a cohort of adolescents participating in a longitudinal study of insulin resistance, Slaughter formulas were used to estimate adiposity from skinfolds and DXA was used to estimate adiposity as % body fat (%BF) and fat mass (FBM). BMI, blood pressure, lipids and insulin resistance were measured.

SUBJECTS

Male and female, 11-17 y old (n=130).

MEASUREMENTS

To compare DXA with two office-based methods of assessing fatness and cardiovascular risk.

RESULTS

Slaughter estimates were highly correlated with DXA (%BF r=0.92, P=0.0001; FBM r=0.96, P=0.0001). Correlations were similar in heavy and thin children. BMI was also highly correlated with DXA (%BF r=0.85, P=0.0001; FBM r=0.95, P=0.0001), and these relations were stronger in heavy than thin children. BMI and the Slaughter formulas were similar to DXA in their relations to cardiovascular risk factors.

CONCLUSIONS

Adiposity by BMI and Slaughter formulas are highly correlated with DXA and similarly related to cardiovascular risk factors. BMI is easy to obtain and is an acceptable method for initial office estimation of body fatness. BMI and skinfolds compare well with DXA in predicting adverse cardiovascular risk profile.

Endocrine control of body composition in infancy, childhood, and puberty

Body composition exhibits marked variations across the early human lifetime. The precise physiological mechanisms that drive such developmental adaptations are difficult to establish. This clinical challenge reflects an array of potentially confounding factors, such as marked intersubject differences in tissue compartments; the incremental nature of longitudinal intrasubject variations in body composition; technical limitations in quantitating the unobserved mass of mineral, fat, water, and muscle ad seriatim; and the multifold contributions of genetic, dietary, environmental, hormonal, nutritional, and behavioral signals to physical and sexual maturation. From an endocrine perspective (reviewed here), gonadal sex steroids and GH/IGF-I constitute prime determinants of evolving body composition. The present critical review examines hormonal regulation of body composition in infancy, childhood, and puberty.

Measuring nutritional status in children with chronic kidney disease

Children with chronic kidney disease (CKD) are at risk of protein-energy malnutrition. Existing clinical practice guidelines recognize this and recommend specific methods to assess nutritional status in patients with CKD. This review summarizes the methods for nutritional assessment currently recommended in the United States for children with CKD and details the strengths and limitations of these techniques in the clinical setting. Dietary assessment, serum albumin, height, estimated dry weight, weight/height index, upper arm anthropometry, head circumference, and the protein equivalent of nitrogen appearance are reviewed. We also describe methods for body-composition assessment, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis (BIA), total body potassium, densitometry, and in vivo neutron activation analysis, pointing out some advantages and disadvantages of each. In CKD, fluid overload is the most important factor leading to misinterpretation of nutritional assessment measures. Abnormalities in the distribution of fat and lean tissue may also compromise the interpretation of some anthropometric measures. In addition, metabolic abnormalities may influence the results obtained by some techniques. Issues specific to evaluating nutritional status in the pediatric population are also discussed, including normalization of nutritional measures to body size and sexual maturity. We stress the importance of expressing body-composition measures relative to height in a population in whom short stature is highly prevalent.

Regression equations to estimate percentage body fat in African prepubertal children aged 9 y

BACKGROUND

The regression equations of Slaughter and Dezenberg, which are based on mixed ethnic samples, are currently recommended for predicting body fat from skinfold-thickness measures in prepubescent children of African ancestry. These equations contain methodologic problems that could make them inappropriate for African children.

OBJECTIVE

The objective was to apply the Slaughter and Dezenberg equations to predict body fat in African prepubertal children and to compare the results with body fat measured by dual-energy X-ray absorptiometry (DXA). If significantly different outcomes were observed, then the objective was to develop new prediction equations and validate them on African children.

DESIGN

The Slaughter and Dezenberg equations were applied to a cross-sectional sample of 214 prepubescent (Tanner stage 1) African children (118 boys). Body fat was determined by DXA, and subcutaneous fat at triceps, biceps, subscapular, suprailiac, thigh, and calf sites was measured with use of Holtain calipers. A randomly selected sample of 134 participants (78 boys) was used to generate new prediction equations that were validated on the remaining 80 participants (40 boys).

RESULTS

The Slaughter and Dezenberg equations significantly underestimated (P < 0.001) body fat compared with DXA in both boys and girls. The best combination of skinfold thicknesses to predict body fat in African prepubertal boys, controlling for chronologic age, was triceps, biceps, subscapular, suprailiac, and thigh (SEE = 2.87), and for girls it was biceps, subscapular, suprailiac, thigh, and calf (SEE = 3.51).

CONCLUSION

The Slaughter and Dezenberg equations are unsuitable for predicting body fat in 9-y-old African prepubertal children. New equations that are based on skinfold-thickness combinations from African children provide more accurate estimates.

Measurement of percentage of body fat in 411 children and adolescents: a comparison of dual-energy X-ray absorptiometry with a four-compartment model

OBJECTIVE

Pediatricians are encountering body composition information more frequently, with percentage of body fat (%BF) measurement receiving particular attention as a result of the obesity epidemic. One confounding issue is that different methods may yield different %BF results in the same person. The objective of this study was to compare dual-energy X-ray absorptiometry (DXA) with the criterion 4-compartment model (4-CM) for measurement of %BF in a large pediatric cohort and to assist pediatricians in appropriate interpretation of body composition information by recognizing differences between techniques.

METHODS

Height, weight, anthropometrics, body density by underwater weighing, total body water by deuterium dilution, and bone mineral content and %BF by DXA (Lunar DPX/DPX-L) were measured in 411 healthy subjects, aged 6 to 18 years. Values for %BF by 4-CM and DXA were compared using regression analysis.

RESULTS

The mean +/- standard deviation values for %BF by DXA (22.73% +/- 11.23%) and by 4-CM (21.72% +/- 9.42%) were different, but there was a strong relationship between the 2 methods (R2 = 0.85). DXA underestimated %BF in subjects with lower %BF and overestimated it in those with higher %BF. The relationship between the 2 methods was not affected by gender, age, ethnicity, pubertal stage, height, weight, or body mass index. The standard error of the estimate was 3.66%.

CONCLUSION

This analysis demonstrates a predictable relationship between DXA and 4-CM for %BF measurement. Because of its ease of use, consistent relationship with 4-CM, and availability, we propose that DXA has the capacity for clinical application including prediction of metabolic abnormalities associated with excess %BF in pediatrics.

Estimates of percentage body fat in young adolescents: a comparison of dual-energy X-ray absorptiometry and air displacement plethysmography

OBJECTIVE

To evaluate the accuracy of percentage body fat (%fat) estimates from air displacement plethysmography (ADP) against an increasingly recognised criterion method, dual-energy X-ray absorptiometry (DXA), in young adolescents.

DESIGN

Cross-sectional evaluation.

SETTING

Leeds General Infirmary, Centre for Bone and Body Composition Research, Leeds, UK.

SUBJECTS

In all, 28 adolescents (12 males and 16 females), age (mean+/-s.d.) 14.9+/-0.5 y, body mass index 21.2+/-2.9 kg/m(2) and body fat (DXA) 24.2+/-10.2% were assessed.

RESULTS

ADP estimates of %fat were highly correlated with those of DXA in both male and female subjects (r=0.84-0.95, all P<0.001; s.e.e.=3.42-3.89%). Mean %fat estimated by ADP using the Siri (1961) equation (ADP(Siri)) produced a nonsignificant overestimation in males (0.67%), and a nonsignificant underestimation in females (1.26%). Mean %fat estimated by ADP using the Lohman (1986) equations (ADP(Loh)) produced a nonsignificant underestimation in males (0.90%) and a significant underestimation in females (3.29%; P<0.01). Agreement between ADP and DXA methods was examined using the total error (TE) and methods of Bland and Altman (1986). Males produced a smaller TE (ADP(Siri) 3.28%; ADP(Loh) 3.49%) than females (ADP(Siri) 3.81%; ADP(Loh) 4.98%). The 95% limits of agreement were relatively similar for all %fat estimates, ranging from +/-6.57 to +/-7.58%. Residual plot analyses, of the individual differences between ADP and DXA, revealed a significant bias associated with increased %fat (DXA), only in girls (P<0.01).

CONCLUSIONS

We conclude that ADP, at present, has unacceptably high limits of agreement compared to a criterion DXA measure. The ease of use, suitability for various populations and cost of ADP warrant further investigation of this method to establish biological variables that may influence the validity of body fat estimates.

Comparison of body composition methods in overweight and obese children

The objective of the present study was to investigate the accuracy of percent body fat (%fat) estimates from dual-energy X-ray absorptiometry, air-displacement plethysmography (ADP), and total body water (TBW) against a criterion four-compartment (4C) model in overweight and obese children. A volunteer sample of 30 children (18 male and 12 female), age of (mean ± SD) 14.10 ± 1.83 yr, body mass index of 31.6 ± 5.5 kg/m, and %fat (4C model) of 41.2 ± 8.2%, was assessed. Body density measurements were converted to %fat estimates by using the general equation of Siri (ADPSiri) (Siri WE. Techniques for Measuring Body Composition. 1961) and the age- and gender-specific constants of Lohman (ADPLoh) (Lohman TG. Exercise and Sport Sciences Reviews. 1986). TBW measurements were converted to %fat estimates by assuming that water accounts for 73% of fat-free mass (TBW73) and by utilizing the age- and gender-specific water contents of Lohman (TBWLoh). All estimates of %fat were highly correlated with those of the 4C model ( r ≥ 0.95, P < 0.001; SE ≤ 2.14). For %fat, the total error and mean difference ± 95% limits of agreement compared with the 4C model were 2.50, 1.8 ± 3.5 (ADPSiri); 1.82, -0.04 ± 3.6 (ADPLoh); 2.86, -2.0 ± 4.1 (TBW73); 1.90, -0.3 ± 3.8 (TBWLoh); and 2.74, 1.9 ± 4.0 DXA (dual-energy X-ray absorptiometry), respectively. In conclusion, in overweight and obese children, ADPLoh and TBWLoh were the most accurate methods of measuring %fat compared with a 4C model. However, all methods under consideration produced similar limits of agreement.

Evaluation of air-displacement plethysmography in children aged 5-7 years using a three-component model of body composition

The aim of the present study was to evaluate air-displacement plethysmography (ADP) in children aged 5-7 years. Body-composition measurements were obtained by ADP, (2)H dilution and anthropometry in twenty-eight children. Calculation of body volume by ADP was undertaken using adult and children's equations for predicting lung volume and surface area. Fat-free mass (FFM) was calculated using a three-component model. Measured FFM hydration was then compared with values from the reference child. Differences between measured and reference hydration were back-extrapolated, to calculate the error in ADP that would account for any disagreement. Propagation of error was used to distinguish the contributions of methodological precision and biological variability to total hydration variability. The use of children's equations influenced the results for lung volume but not surface area. The mean difference between measured and reference hydration was 0.6 (sd 1.7) % (P<0.10), equivalent to an error in body volume of 0.04 (sd 0.20) litres (P<0.30), and in percentage fat of 0.4 (sd 1.9) (P<0.28). The limits of agreement in individuals could be attributed to methodological precision and biological variability in hydration. It is concluded that accuracy of ADP was high for the whole group, with a mean bias of <0.5 % fat using the three-component model, and after taking into account biological variability in hydration, the limits of agreement were around +/-2 % fat in individuals. Paediatric rather than adult equations for lung volume estimation should be used.

Growth, body composition and hormonal axes in children and adolescents

Growth and physical maturation are dynamic processes that encompass a broad range of cellular and somatic changes. Most investigators who study growth have focused on linear growth (change in height over time), but alterations in the relative body proportions, body composition, and the regional distribution of body fat (upper body vs lower body, axial vs appendicular, and sc vs deep visceral) are essential elements for growth and sexual maturation. In fact, cardiovascular risk assessment in the adult relies heavily on the regional distribution of body fat. The antecedents for the adult pattern of fat are clearly present in the adolescent, if not the younger child. Standards for each of these parameters have been developed for multiple ethnic and racial populations and aid materially in the identification of children with normal growth and physical development, variations within the broad normal (physiological) range, and those with clearly pathological growth patterns.

Magnitude and variation of fat-free mass density: a cellular-level body composition modeling study

The mean density of fat-free mass (FFM) is remarkably stable at 1.10 g/cm(3) in healthy adult humans, and this stability is a cornerstone of the widely applied densitometry-based two-compartment model for estimating total body fat. At present, the usual means of exploring FFM density is by in vitro or in vivo experimental studies. The purpose of the present investigation was to develop a cellular-level body composition model that includes seven factors that determine FFM density. The model, when applied with available empirical coefficients, predicted an FFM density similar to that observed in vivo. An analysis of the seven model components indicates that the ratio of extracellular solids to total body water is a major determinant of individual variation in FFM density. The difference in FFM density across sex, race, and age groups was examined with the developed model. The present study thus provides a conceptual framework for the systematic study of FFM density in humans.

Relation of body composition, parental overweight, pubertal stage, and race-ethnicity to energy expenditure among premenarcheal girls

BACKGROUND

Previous studies assessed the influence of parental weight status, sexual maturation, race-ethnicity, and energy expenditure among children, but few examined these issues comprehensively.

OBJECTIVE

The objective was to determine whether differences in energy expenditure among premenarcheal girls are related to the pubertal stage and the race-ethnicity of the girls or to the weight status of their parents.

DESIGN

We measured the body composition and the energy expenditure of 196 nonobese girls enrolled in a longitudinal study. Total body water was measured by the isotopic dilution of (18)O water. We measured resting metabolic rate with the use of indirect calorimetry and daily energy expenditure by the doubly labeled water method. We used established criteria to determine sexual maturation. Parental weight status was based on body mass index.

RESULTS

Resting metabolic rate was higher among girls with >or=1 overweight parent than among girls with 2 normal-weight parents. Total energy expenditure was also higher among girls with >or=1 overweight parent, but these results were of borderline significance. We found no effect of pubertal stage on resting metabolic rate. Nonresting energy expenditure was significantly lower among pubertal girls than among prepubertal girls. After adjustments for age and body composition, we noted that resting metabolic rate, nonresting energy expenditure, and total energy expenditure were all significantly lower among black girls than among white girls.

CONCLUSIONS

Differences in resting metabolic rate and total energy expenditure among premenarcheal girls were associated with parental weight status and the girls' race-ethnicity, whereas differences in nonresting energy expenditure were associated with pubertal stage and race-ethnicity. Whether the observed differences in energy expenditure persist after puberty and predict weight gain during puberty awaits the results of longitudinal analyses.

Bioelectrical impedance analysis models for prediction of total body water and fat-free mass in healthy and HIV-infected children and adolescents

BACKGROUND

Bioelectrical impedance analysis (BIA) is an attractive method of measuring pediatric body composition in the field, but the applicability of existing equations to diverse populations has been questioned.

OBJECTIVE

The objectives were to evaluate the performance of 13 published pediatric BIA-based predictive equations for total body water (TBW) and fat-free mass (FFM) and to refit the best-performing models.

DESIGN

We used TBW by deuterium dilution, FFM by dual-energy X-ray absorptiometry, and BIA-derived variables to evaluate BIA models in a cross-sectional study of 1291 pediatric subjects aged 4-18 y, from several ethnic backgrounds, including 54 children with HIV infection and 627 females. The best-performing models were refitted according to criterion values from this population, cross-validated, and assessed for performance. Additional variables were added to improve the predictive accuracy of the equations.

RESULTS

The correlation between predicted and criterion values was high for all models tested, but bias and precision improved with the refitted models. The 95% limits of agreement between predicted and criterion values were 16% and 11% for TBW and FFM, respectively. Bias was significant for some subgroups, and there was greater loss of precision in specific age groups and pubertal stages. The models with additional variables eliminated bias, but the limits of agreement and the loss of precision persisted.

CONCLUSION

This study confirms that BIA prediction models may not be appropriate for individual evaluation but are suitable for population studies. Additional variables may be necessary to eliminate bias for specific subgroups.

Age-related pattern of body density and body composition in Japanese males and females, 11 and 18 years of age

The age-related pattern of body density and body composition in Japanese males (n = 266) and females (n = 318), 11.00 to 18.99 years of age was studied. Body density (BD) as well as height, body weight, and seven skinfold thicknesses were measured. Percentage fat (%Fat) was calculated using the age- and sex-specific equation of Lohman. Fat mass (FM), fat-free mass (FFM), and the body mass index (BMI) were calculated. The trend for BD in males was lowest at 11 years (1.0530 g/ml) and increased to 1.0695 g/ml at 14 years, and then decreased slightly at 15 to 17 years. In female, BD decreased from 1.0530 g/ml at 13 years to 1.0424 g/ml at 17 years. Mean %Fat was highest in males at 11 years (15.8%), and lowest at 14 years (10.1%). The highest mean %Fat in females occurred at 16 years (22.8%), and the lowest at age 11 years (15.2%). Overall, only 6.8% of males and 3.1% of females were classified as obese. Between 11 and 18 years, FFM of males differed by 20.7 kg or 67.9%, whereas females showed a difference of only 10.8 kg or 34.7%. Consequently, age effects explained approximately 60% of the male variance of FFM but only 26% in females. Body density of each sex and age group in this study did not differ significantly from previous Japanese studies, and the pooled BD data for 1,457 Japanese including the present study are reported as a reference.

Pubertal alterations in growth and body composition. VI. Pubertal insulin resistance: relation to adiposity, body fat distribution and hormone release

OBJECTIVE

To investigate the independent influence of alterations in fat mass, body fat distribution and hormone release on pubertal increases in fasting serum insulin concentrations and on insulin resistance assessed by the homeostasis model (HOMA).

DESIGN AND SUBJECTS

Cross-sectional investigation of pre- (n=11, n=8), mid- (n=10, n=11), and late-pubertal (n=10, n=11) boys and girls with normal body weight and growth velocity.

MEASUREMENTS

Body composition (by a four-compartment model), abdominal fat distribution and mid-thigh interfascicular plus intermuscle (extramyocellular) fat (by magnetic resonance imaging), total body subcutaneous fat (by skinfolds), mean nocturnal growth hormone (GH) release and 06:00 h samples of serum insulin, sex steroids, leptin and insulin-like growth factor-I (IGF-I).

RESULTS

Pubertal insulin resistance was suggested by greater (P<0.001) fasting serum insulin concentrations in the late-pubertal than pre- and mid-pubertal groups while serum glucose concentrations were unchanged and greater (P<0.001) HOMA values in late-pubertal than pre- and mid-pubertal youth. From univariate correlation fat mass was most related to HOMA (r=0.59, P<0.001). Two hierarchical regression models were developed to predict HOMA. In one approach, subject differences in sex, pubertal maturation, height and weight were held constant by adding these variables as a block in the first step of the model (r(2)=0.36). Sequential addition of fat mass (FM) increased r(2) (r(2)((inc)remental)=0.08, r(2)=0.44, P<0.05) as did the subsequent addition of a block of fat distribution variables (extramyocellular fat, abdominal visceral fat, and sum of skinfolds; r(2)(inc)=0.11, r(2)=0.55, P<0.05). Sequential addition of a block of hormone variables (serum IGF-I and log((10)) leptin concentrations; r(2)(inc)=0.04, P>0.05) did not reliably improve r(2) beyond the physical characteristic and adiposity variables. In a second model, differences in sex and pubertal maturation were again held constant (r(2)=0.25), but body size differences were accounted for using percentage fat data. Sequential addition of percentage body fat (r(2)((inc)remental)=0.11, r(2)=0.36, P<0.05), then a block of fat distribution variables (percentage extramyocellular fat, percentage abdominal visceral fat, and percentage abdominal subcutaneous fat; r(2)(inc)=0.08, r(2)=0.44, P=0.058), and then a block of serum IGF-I and log((10)) leptin concentrations (r(2)(inc)=0.07, r(2)=0.51, P<0.05) increased r(2). Mean nocturnal GH release was not related to HOMA (r=-0.04, P=0.75) and therefore was not included in the hierarchical regression models.

CONCLUSION

Increases in insulin resistance at puberty were most related to FM. Accumulation of fat in the abdominal visceral, subcutaneous and muscular compartments may increase insulin resistance at puberty beyond that due to total body fat. Serum concentrations of leptin and IGF-I may further modulate HOMA beyond the effects of adiposity and fat distribution. However, the results are limited by the cross-sectional design and the use of HOMA rather than a criterion measure of insulin resistance.

Body-composition assessment via air-displacement plethysmography in adults and children: a review

Laboratory-based body-composition techniques include hydrostatic weighing (HW), dual-energy X-ray absorptiometry (DXA), measurement of total body water (TBW) by isotope dilution, measurement of total body potassium, and multicompartment models. Although these reference methods are used routinely, each has inherent practical limitations. Whole-body air-displacement plethysmography is a new practical alternative to these more traditional body-composition methods. We reviewed the principal findings from studies published between December 1995 and August 2001 that compared the BOD POD method (Life Measurement, Inc, Concord, CA) with reference methods and summarized factors contributing to the different study findings. The average of the study means indicates that the BOD POD and HW agree within 1% body fat (BF) for adults and children, whereas the BOD POD and DXA agree within 1% BF for adults and 2% BF for children. Few studies have compared the BOD POD with multicompartment models; those that have suggest a similar average underestimation of approximate 2-3% BF by both the BOD POD and HW. Individual variations between 2-compartment models compared with DXA and 4 -compartment models are partly attributable to deviations from the assumed chemical composition of the body. Wide variations among study means, -4.0% to 1.9% BF for BOD POD - HW and -3.0% to 1.7% BF for BOD POD - DXA, are likely due in part to differences in laboratory equipment, study design, and subject characteristics and in some cases to failure to follow the manufacturer's recommended protocol. Wide intersubject variations between methods are partly attributed to technical precision and biological error but to a large extent remain unexplained. On the basis of this review, future research goals are suggested.

Estimation of body fatness by air displacement plethysmography in African American and white children

The purpose of this study was to determine the ability of air displacement plethysmography (ADP) to estimate body fatness in prepubertal and early pubertal African American and white children. One hundred nineteen nonoverweight and overweight boys (N = 56) and girls (N = 63), age (mean +/- SD) 9.8 +/- 1.7 y, body mass index 25.9 +/- 7.6 kg/m2 (range, 14.2-47.0 kg/m2), and mean percent body fat (%BF) by dual-energy x-ray absorptiometry (DXA) 39.2 +/- 11.7% (range, 12.2-57.5%), were studied. %BF by ADP was compared with DXA %BF estimates and with body fat by several field methods: skinfold thicknesses using the Slaughter et al. equations (Hum Biol 60: 709-723, 1988), bioelectrical impedance analysis (BIA) using the Houtkooper et al. equation (J Appl Physiol 72: 366-373, 1992), and a predictive equation using skinfold thicknesses, BIA, and weight (Goran et al.: Am J Clin Nutr 63: 299-305, 1996). All methods used to estimate %BF were significantly correlated with DXA (all p < 0.0001), with r2 ranging from 0.85 (skinfold measurements) to 0.95 (ADP). ADP using the Siri equation underestimated %BF by -1.9% (p < 0.001); the Bland-Altman limits of agreement (defined as +/-2 SD) were +/-7.4%. %BF by ADP-Siri underestimated %BF by DXA by 3.0% for girls (p < 0.001) and by 0.6% for boys (NS). Agreement between body fat estimation by ADP and DXA did not vary with age, race, or pubertal stage. Application of the age-adjusted Lohman model to ADP significantly increased the magnitude of the underestimation to -6.9% (p < 0.0001). Prediction of %BF by the Slaughter skinfold thickness equation showed no significant mean bias for the overall data, but significantly underestimated %BF in girls (-3.7%) while overestimating %BF in boys (+2.4%) with wide limits of agreement (+/-17.7%, p < 0.01 versus ADP). %BF by the Houtkooper BIA equation or Goran model underestimated %BF to a significantly greater degree than ADP (Houtkooper, -8.1%; Goran, -10.1%; both p < 0.0001 versus DXA or ADP). Determination of %BF from ADP using the Siri model slightly underestimates %BF as determined by DXA in girls, but appears to be superior to existing field methods both in accuracy and limits of agreement. Because of the ease with which it can be performed, ADP may prove useful for investigations of adiposity in children.

Hormonal changes during puberty and their relationship to fat distribution

In adults, abdominal visceral adiposity is related to an increased risk of cardiovascular diseases, Type 2 diabetes mellitus, and stroke. The antecedents of these conditions likely begin with the alterations in body fat distribution during childhood and adolescence. The sexually dimorphic alterations in fat distribution are influenced by sex differences in hormone concentrations, anatomical differences in the number and density of specific hormone receptors, capillary blood flow, and the activity of enzymes promoting lipid synthesis or degradation. Hormones influencing the amount and regional distribution of adipose tissue during puberty include cortisol, insulin, growth hormone, and the sex steroids. Cortisol and insulin promote fat deposition while the sex steroids and GH stimulate lipolysis. An overly sensitive hypothalamic-pituitary-adrenal axis may exist in obesity and disrupt the balance between the lipogenic effects of cortisol and insulin and the lipolytic effects of sex steroids and growth hormone. Leptin is released from the adipocytes and may act as a metabolic signal to the hypothalamic areas controlling satiety, energy expenditure, and the regulation of cortisol, insulin, sex steroid and growth hormone release. The complex issues of the hormonal control of alterations in body fat distribution during puberty are developed and a working model is proposed. Am. J. Hum. Biol. 11:209-224, 1999. Copyright 1999 Wiley-Liss, Inc.

Body composition in prepubertal girls: comparison of six methods

OBJECTIVE

To compare estimates of fat mass (FM), fat-free mass (FFM) and percentage body fat (%fat) by six different methods in prepubertal girls.

DESIGN

Cross-sectional study.

SUBJECTS

Normal-weight, multi-ethnic, prepubertal girls (age=8.5+/-0.4 y, n=101).

MEASUREMENTS

Body composition was measured in each child by anthropometry (skinfold thickness using Slaughter equation), dual-energy X-ray absorptiometry (DXA), total body potassium (TBK), isotope dilution for total body water measurement (TBW), multifrequency bioelectrical impedance spectroscopy (BIS), and total body electrical conductivity (TOBEC).

RESULTS

TOBEC and skinfold thickness yielded the lowest values of FM followed by DXA, TBK, TBW and BIS, with BIS giving the highest value of FM. All methods were significantly different for FFM, FM and %fat (P<0.001), except FFM by DXA and TBK. The Bland-Altman limits of agreement among the methods reveal that they are not directly interchangeable for FM, FFM, or %fat. The largest mean difference for FM was between TOBEC and BIS (-2.90 kg), whereas the smallest mean difference was between TOBEC and skinfold thickness (-0.14 kg). For FFM, the largest mean difference was also between TOBEC and BIS (2.83 kg), but the smallest mean difference for FFM was between DXA and TBK (-0.03 kg). For %fat, the mean differences were larger, -10.5% for TOBEC and BIS and+9.7% for skinfold thickness and BIS. The closest two techniques for %fat were TOBEC and skinfold thickness (mean difference of -0.62%) and DXA and TBK (-1.81%).

CONCLUSIONS

We found that estimates of body composition in prepubertal 8-y-old girls are highly method-dependent and that the six methods studied (DXA, TBK, TBW, TOBEC, BIS and anthropometry) are not directly interchangeable.

Comparison of the BOD POD with the four-compartment model in adult females

PURPOSE

This study was designed to compare the accuracy and bias in estimates of total body density (Db) by hydrostatic weighing (HW) and the BOD POD, and percent body fat (%fat) by the BOD POD with the four-compartment model (4C model) in 42 adult females. Furthermore, the role of the aqueous and mineral fractions in the estimation of body fat by the BOD POD was examined.

METHODS

Total body water was determined by isotope dilution ((2)H(2)0) and bone mineral was determined by dual-energy x-ray absorptiometry. Db and %fat were determined by the BOD POD and HW. The 4C model of Baumgartner was used as the criterion measure of body fat.

RESULTS

HW Db (1.0352 g x cm(-3)) was not statistically different (P = 0.35) from BOD POD Db (1.0349 g x cm(-3)). The regression between Db by HW and the BOD POD significantly deviated from the line of identity (Db by HW = 0.90 x Db by BOD POD + 0.099; R(2) = 0.94). BOD POD %fat (28.8%) was significantly lower (P < 0.01) than %fat by the 4C model (30.6%). The regression between %fat by the 4C model and the BOD POD significantly deviated from the line of identity (%fat by 4C model = 0.88 x %fat by BOD POD + 5.41%; R(2) = 0.92). BOD POD Db and %fat showed no bias across the range of fatness. Only the aqueous fraction of the fat-free mass (FFM) had a significant correlation with the difference in %fat between the 4C model and the BOD POD.

CONCLUSION

These data indicate that the BOD POD underpredicted body fat as compared with the 4C model, and the aqueous fraction of the FFM had a significant effect on estimates of %fat by the BOD POD.

Comparison of the body mass index to other methods of body fat evaluation in ethnic Japanese and Caucasian adolescent girls

OBJECTIVE

The aim of this study was to assess the body mass index (BMI) and its relationship with other methods of body fat evaluation in pre- and post-menarcheal, Japanese and Caucasian female adolescents, using two different cut-off points for obesity: 28% and 30%.

DESIGN

A cross-sectional study with incomplete sampling, using the subject as the evaluation unit.

SUBJECTS

A total of 436 Japanese and Caucasian female adolescents in two age groups: 10-11 (pre-menarcheal adolescent); and 16-17 (post-menarcheal adolescents).

METHODS

For the BMI the cut-off point for thinness was set at the 5th percentile of the BMI distribution of the NCHS reference population and the cut-off point for overweight and obesity was set at the 85th percentile. Body composition was assessed using foot-to-foot bioelectrical impedance analysis (BIA), near-infrared interactance (NIR) and Slaughter skinfold equations (SKI). The statistical comparison of the methods was performed using the kappa agreement test and the McNemar disagreement test.

RESULTS

In the 10- and 11-y-old girls, the BMI was considerably and significantly correlated with the other methods. The major agreements were: in Japanese adolescents BMI x NIR=82.3% (cut-off point of 28%), BMI x BIA=85.7% (cut-off point of 30%); in Caucasian adolescents BMI x NIR=80.7% (cut-off point of 28%), BMI x BIA=87.4% (cut-off point of 30%). The disagreement above the diagonal between BMI x NIR was higher within the two groups for both the cut-off points, revealing that the girls identified as obese by the BMI were considered eutrophic by NIR. In the 16- and 17-y-old adolescents, the BMI demonstrated low or no correlation with the other methods. Furthermore, it presented disagreements below the diagonal, revealing that the BMI identified fewer obese subjects than the other methods.

CONCLUSION

Among the 10- and 11-y-olds, the BMI presented a good correlation with the other methods, independent of ethnicity. The BMI can therefore be used in place of these methods, although it may underestimate obesity. Among the 16- and 17-y-olds, the BMI presented low or no agreement with the other methods, suggesting that it is probably not a suitable index for this age-group in studies focusing on the identification of obesity. In such cases the choice of one of the other methods, depending on availability, cost or technical experience, may represent a better approach.

Alterations in growth and body composition during puberty. IV. Energy intake estimated by the youth-adolescent food-frequency questionnaire: validation by the doubly labeled water method

BACKGROUND

Estimates of energy intake are required for an understanding of growth and disease; however, few methods of energy intake in children have been validated.

OBJECTIVE

Our objective was to validate energy intake estimated by the Youth-Adolescent Food-Frequency Questionnaire (YAQ) against the criterion total energy expenditure (TEE) by doubly labeled water (DLW).

DESIGN

Twenty-three boys and 27 girls (8.6-16.2 y of age) completed the YAQ and TEE measurements in 1 y.

RESULTS

Energy intake by the YAQ (10. 03 +/- 3.12 MJ) and energy expenditure by DLW (9.84 +/- 1.79 MJ) were similar (P: = 0.91) with large lower (-6.30 MJ) and upper (6.67 MJ) +/-2 SD limits of agreement. When within-subject CVs of repeated measures of the DLW and YAQ methods were used, 25 of the 50 subjects were deemed to have misreported their energy intake. The discrepancy in energy intake (YAQ - TEE) was related to body weight (r = -0.25, P: = 0.077) and percentage body fat (r = -0.24, P: = 0.09) but not to age (r = -0.07, P: = 0.63) or the time between measures. From logistic regression, fatter boys were more likely to underreport energy intake than were fatter girls.

CONCLUSION

The YAQ provides an accurate estimation of mean energy intake for a group but not for an individual.

Pubertal alterations in growth and body composition. V. Energy expenditure, adiposity, and fat distribution

We determined whether activity energy expenditure (AEE, from doubly labeled water and indirect calorimetry) or physical activity [7-day physical activity recall (PAR)] was more related to adiposity and the validity of PAR estimated total energy expenditure (TEE(PAR)) in prepubertal and pubertal boys (n = 14 and 15) and girls (n = 13 and 18). AEE, but not physical activity hours, was inversely related to fat mass (FM) after accounting for the fat-free mass, maturation, and age (partial r = -0.35, P < or = 0.01). From forward stepwise regression, pubertal maturation, AEE, and gender predicted FM (r(2) = 0.36). Abdominal visceral fat and subcutaneous fat were not related to AEE or activity hours after partial correlation with FM, maturation, and age. When assuming one metabolic equivalent (MET) equals 1 kcal. kg body wt(-1). h(-1), TEE(PAR) underestimated TEE from doubly labeled water (TEE bias) by 555 kcal/day +/- 2 SD limits of agreement of 913 kcal/day. The measured basal metabolic rate (BMR) was >1 kcal. kg body wt(-1). h(-1) and remained so until 16 yr of age. TEE bias was reduced when setting 1 MET equal to the measured (bias = 60 +/- 51 kcal/day) or predicted (bias = 53 +/- 50 kcal/day) BMR but was not consistent for an individual child (+/- 2 SD limits of agreement of 784 and 764 kcal/day, respectively) or across all maturation groups. After BMR was corrected, TEE bias remained greatest in the prepubertal girls. In conclusion, in children and adolescents, FM is more strongly related to AEE than activity time, and AEE, pubertal maturation, and gender explain 36% of the variance in FM. PAR should not be used to determine TEE of individual children and adolescents in a research setting but may have utility in large population-based pediatric studies, if an appropriate MET value is used to convert physical activity data to TEE data.

Body composition techniques and the four-compartment model in children

The purpose of this study was to compare the accuracy, precision, and bias of fat mass (FM) as assessed by dual-energy X-ray absorptiometry (DXA), hydrostatic weighing (HW), air-displacement plethysmography (PM) using the BOD POD body composition system and total body water (TBW) against the four-compartment (4C) model in 25 children (11.4 +/- 1.4 yr). The regression between FM by the 4C model and by DXA deviated significantly from the line of identity (FM by 4C model = 0.84 x FM by DXA + 0.95 kg; R(2) = 0.95), as did the regression between FM by 4C model and by TBW (FM by 4C model = 0. 85 x FM by TBW - 0.89 kg; R(2) = 0.98). The regression between FM by the 4C model and by HW did not significantly deviate from the line of identity (FM by 4C model = 1.09 x FM by HW + 0.94 kg; R(2) = 0. 95) and neither did the regression between FM by 4C (using density assessed by PM) and by PM (FM by 4C model = 1.03 x FM by PM + 0.88; R(2) = 0.97). DXA, HW, and TBW all showed a bias in the estimate of FM, but there was no bias for PM. In conclusion, PM was the only technique that could accurately, precisely, and without bias estimate FM in 9- to 14-yr-old children.

Validation of body composition estimates in male and female distance runners using estimates from a four-component model

This study used estimates of body composition from a four-component model (%Fat(d,w,m)) to determine whether the assumed density (D(ffm)) and the composition of the fat-free mass (FFM), and estimates of body composition from methods based on two- and three-component models are valid in distance runners. Measures of body density (D(b)) by underwater weighing, total body water by deuterium dilution, and bone mineral by dual-energy X-ray absorptiometry (DXA) were obtained in 10 female and 12 male runners and an equal number of controls matched for age, height, weight, gender, and ethnicity. D(ffm) of the runners did not differ from 1.1 g.cm(-3) or from the controls even though the composition of the FFM differed from that assumed. Therefore, percentage of body fat (%Fat) from densitometry did not differ from %Fat(d,w,m) in the runners, although individual variation was substantial (-5.3 to 3.0% body mass, SD(diff) = 2.1% body mass). Three-component model estimates of %Fat from D(b) and body water agreed quite closely with %Fat(d,w,m) (x </= 1.6% body mass, SD(diff) = 0.5% body mass), whereas those from D(b) and body mineral (x(diff) = 1.6-2.9% body mass, SD(diff) = 2.3% body mass) and from DXA (x(diff) = 2.2-4.0% body mass, SD(diff) = 2.1% body mass) were less accurate and underestimated %Fat(d,w,m). We conclude that D(ffm) does not differ from 1.1 g.cm(-3) and that densitometry is a valid method to estimate group mean body composition, but that measurement of D(b) and total body water are necessary for accurate individual estimates of body composition in male and female distance runners. Am. J. Hum. Biol. 12:301-314, 2000. Copyright 2000 Wiley-Liss, Inc.

Role of leptin during childhood growth and development

Leptin, the product of the ob/ob gene in rodents, regulates energy balance and fertility. Two genetic models, the ob/ob mouse (deletion of leptin protein) and the db/db mouse (deletion of leptin receptor) have markedly augmented research in obesity. Human obesity is more closely linked to leptin resistance than to the absence of leptin. Serum leptin concentrations reflect the size of the subcutaneous fat depot better than total fat mass or abdominal visceral fat. At the initiation of puberty there is a divergence in circulating leptin concentrations between boys and girls. In boys, leptin concentrations increase and then markedly decrease to prepubertal concentration levels. In girls there are only increasing concentrations. The authors believe these patterns are relevant to the markedly different alterations in the regional distribution of body fat that occurs in boys and girls at puberty.

Impact of bone mineral estimates on percent fat estimates from a four-component model

PURPOSE

The primary purpose of this study was to determine the impact of bone mineral content (BMC) from QDR 1000/W and DPX-L dual-energy x-ray absorptiometers (DXA(QDR) and DXA(DPX-L) on percent fat (%fat) estimates from a four-component model. A secondary purpose was to test the accuracy of %fat estimates from DXA(QDR) and DXA(DPX-L) using %fat estimates from a four-component model as the criterion.

METHODS

Percent fat, fat mass, and fat-free mass (FFM) were determined from DXA(QDR) and DXA(DPX-L) and from a four-component model based on measures of body density from underwater weighing, body water from deuterium dilution, and BMC from DXA(QDR) (4C(QDR)) or DXA(DPX-L) (4C(DPX-L)) in young men (N = 14) and women (N = 10).

RESULTS

BMC was significantly lower using DXA(QDR) compared with DXA(DPX-L) (approximately 11%), resulting in slightly lower estimates of %fat and fat mass and slightly higher estimates of FFM from 4C(QDR) than 4C(DPX-L). Although estimates of %fat, fat mass, and FFM from DXA(QDR) and DXA(DPX-L) were not different than those from a four-component model, there was considerable individual variability between methods. Furthermore, %fat from DXA(QDR) was lower than %fat from 4C(DPX-L).

CONCLUSIONS

We conclude that using BMC from different DXA instruments has a minimal impact on %fat, fat mass, and FFM estimates from a four-component model. The large variability in %fat estimates between the two DXA instruments and those from a four-component model does not support DXA as a criterion method of body composition. Further studies involving larger sample sizes and specific population groups are needed to assess the validity of body composition measurements from DXA.

Validity of methods of body composition assessment in young and older men and women

We examined the validity of percent body fat (%Fat) estimation by two-compartment (2-Comp) hydrostatic weighing (Siri 2-Comp), 3-Comp dual-energy X-ray absorptiometry (DEXA 3-Comp), 3-Comp hydrostatic weighing corrected for the total body water (Siri 3-Comp), and anthropometric methods in young and older individuals (n = 78). A 4-Comp model of body composition served as the criterion measure of %Fat (Heymsfield 4-Comp; S. B. Heymsfield, S. Lichtman, R. N. Baumgartner, J. Wang, Y. Kamen, A. Aliprantis, and R. N. Pierson Jr., Am. J. Clin. Nutr. 52: 52-58, 1990.). Comparison of the Siri 3-Comp with the Heymsfield 4-Comp model revealed mean differences of </=0.4 %Fat, r values >/= r = 0.997, total error values </= 0.85 %Fat, and 95% confidence intervals (Bland-Altman analysis) of </=1.7 %Fat. Comparison of Siri 2-Comp, DEXA, and anthropometric models with the Heymsfield 4-Comp revealed that total error scores ranged from +/-4. 0 to +/-10.7 %Fat, and 95% confidence intervals associated with the Bland-Altman analysis ranged from +/-5.1 to +/-15.0 %Fat. We conclude that the Siri 3-Comp model provides valid and accurate body composition data when compared with a 4-Comp criterion model. However, the individual variability associated with the Siri 2-Comp, DEXA 3-Comp, and anthropometric models may limit their use in research settings. The use of anthropometric estimation methods resulted in large mean differences and a considerable amount of interindividual variability. These data suggest that the use of these techniques should be viewed with caution.

Dual X-Ray absorptiometry in pediatric studies: changing scan modes alters bone and body composition measurements

The use of dual X-ray absorptiometry (DXA) for measurement of bone mineral and body composition in pediatric subjects faces a major technical issue: body size dictates choice of scan mode. However, different scan modes change results in the same subject, thus affecting the accuracy of bone/body composition measurements and especially the capacity to measure changes owing to either growth or intervention. To evaluate the effect of scan mode selections on measurements of bone mineral and body composition, 13 children with weights at the cutoff point between the pediatric large and adult medium scan modes of Lunar DPX or DPXL (Lunar, Madison, WI) with software 3.6 g (35.3 +/- 0.9 kg or 77.7 +/- 2.0 lb) were scanned by both modes. Adult medium mode gave significantly higher results than pediatric large mode for total body fat mass (11.1%), fat% (10.5%), bone mineral content (8.1%), and bone area (1.3%) (p < 0.02). The differences between pediatric large and adult medium modes in fat measurements increased with increasing body mass index ([BMI], kg/m(2)), body surface area ([BSA], m(2)), and trunk size (mm), whereas the differences in bone mineral measurement tended to be greater only with increasing BMI and BSA. None of the differences were correlated to body weight. This study suggests that scan mode selections based on trunk size, BMI, or BSA instead of body weight may improve continuity of bone and body composition measurements by the DXA technique in pediatric subjects.

Gender differences in leptin levels during puberty are related to the subcutaneous fat depot and sex steroids

Little is known about the influence of adiposity and hormone release on leptin levels in children and adolescents. We utilized criterion methods to examine the relationships among sex steroids, body composition (4 compartment), abdominal visceral and subcutaneous fat (magnetic resonance imagery), total subcutaneous fat (sum of 9 skinfolds), energy expenditure (doubly labeled water), aerobic fitness, and serum leptin levels in prepubertal and pubertal boys (n = 16; n = 13) and girls (n = 12; n = 15). The sum of skinfolds accounted for more variance in leptin levels of all girls [coefficient of determination (R2) = 0.70, P < 0.001] and all boys (R2 = 0.60, P < 0.001) than the total fat mass (girls, R2 = 0.52, P < 0.001; boys, R2 = 0.23, P < 0.001). Total energy expenditure, corrected for the influence of fat-free mass, correlated inversely with leptin (R2 = 0.18, P = 0.02). Gender differences in leptin disappeared when corrected for sex steroid levels or the combination of adiposity and energy expenditure. In multiple regression, the sum of skinfolds and free testosterone and estrogen levels accounted for 74% of the variance in leptin levels. We conclude that serum leptin levels are positively related to subcutaneous adiposity but negatively related to androgen levels. Energy expenditure may be negatively related to leptin levels by reduction of the adiposity, or a common genetic factor may influence both the activity and serum leptin levels.

Alterations in growth and body composition during puberty: III. Influence of maturation, gender, body composition, fat distribution, aerobic fitness, and energy expenditure on nocturnal growth hormone release

We examined the relationships among gender, sexual maturation, four-compartment model estimates of body composition, body fat distribution (magnetic resonance imaging for abdominal visceral fat and anthropometrics), aerobic fitness, basal and total energy expenditure, and overnight GH release in an ultrasensitive chemiluminescence assay in healthy prepubertal and pubertal boys (n = 18 and 11, respectively) and girls (n = 12 and 18, respectively). Blood samples were withdrawn every 10 min from 1800-0600 h to determine the area under the serum GH-time curve (AUC), sum of the GH peak heights (sigma GH peak heights), and the mean nadir GH concentration. GH release was greater in the pubertal than prepubertal subjects due to an increase in sigma GH peak heights (43.8 +/- 3.6 vs. 24.1 +/- 3.5 ng.mL-1, P = 0.0002) and mean nadir (1.7 +/- 0.2 vs. 0.7 +/- 0.2 ng.mL-1, P = 0.0002), but not peak number (4.3 +/- 0.2 vs. 4.5 +/- 0.2). The girls had a greater sigma GH peak heights (39.0 +/- 3.5 vs. 28.8 +/- 3.6 ng.mL-1, P = 0.05) and mean nadir concentration (1.4 +/- 0.2 vs. 0.9 +/- 0.2 ng.mL-1, P = 0.05) than the boys. Significant inverse relationships existed between sigma GH peak heights (r = -0.35, P = 0.06) or mean nadir (r = -0.39, P = 0.04) and four-compartment percent body fat for all boys but not for all girls or when combining all subjects. For all girls, significant inverse relationships existed between sigma GH peak heights (r = -0.39, P = 0.03) or mean nadir (r = -0.37, P = 0.04) and waist/hip ratio. Similar inverse relationships in all boys or all subjects were not significant. Forward stepwise regression analysis determined that bone age (i.e. maturation, primary factor) and gender were the significant predictors of AUC, sigma GH peak heights, and mean nadir. The influence of maturation reflects rising sex steroid concentrations, and the gender differences appear to be because of differences in estradiol concentrations rather than to body composition or body fat distribution.