Comparison of total body and abdominal adiposity indexes to dual x-ray absorptiometry scan in obese adolescents

Performance of Body Adiposity Index and Relative Fat Mass in Predicting Bioelectric Impedance Analysis-Derived Body Fat Percentage: A Cross-Sectional Study among Patients with Type 2 Diabetes in the Ho Municipality, Ghana

Objective

The study sought to determine the diagnostic accuracy of body adiposity index (BAI) and relative fat mass (RFM) to predict BIA-derived BFP among patients with type 2 diabetes in the Ho municipality. Materials and Method. This hospital-based cross-sectional study involved 236 patients with type 2 diabetes. Demographic data, including age and gender were obtained. Height, waist circumference (WC), and hip circumference (HC) were measured using standard methods. BFP was estimated on a bioelectrical impedance analysis (BIA) scale. The validity of BAI and RFM as alternative estimates for BIA-derived BFP was evaluated based on mean absolute percentage error (MAPE), Passing-Bablok regression, Bland-Altman plots, receiver-operating characteristic curve (ROC), and kappa statistics analyses. A p value less than 0.05 was considered statistically significant.

Results

BAI showed systematic bias in estimating BIA-derived BFP in both genders, but this was not evident between RFM and BFP among females (t = -0.62; p = 0.534). While BAI showed "good" predictive accuracy in both genders, RFM exhibited "high" predictive accuracy for BFP (MAPE: 7.13%; 95% CI: 6.27-8.78) among females according to MAPE analysis. From the Bland-Altman plot analysis, the mean difference between RFM and BFP was acceptable among females [0.3 (95% LOA: -10.9 to 11.5)], but both BAI and RFM recorded large limits of agreement and low Lin's concordance correlation coefficient with BFP (Pc < 0.90) in the two gender populations. The optimal cut-off, sensitivity, specificity, and Youden index for RFM were >27.2, 75%, 93.75%, and 0.69, respectively, while those of BAI were >25.65, 80%, 84.37%, and 0.64, respectively, among males. Among females, the values for RFM were >27.26, 92.57%, 72.73%, and 0.65, whereas those of BAI were >29.4, 90.74%, 70.83%, and 0.62, respectively. The accuracy of discriminating between BFP levels was higher among females [BAI (AUC: 0.93) and RFM (AUC: 0.90)] compared to males [BAI (AUC: 0.86) and RFM (AUC: 0.88)].

Conclusion

RFM had a better predictive accuracy of BIA-derived BFP in females. However, both RFM and BAI failed as valid estimates for BFP. Furthermore, gender-specific performance in the discrimination of BFP levels for RFM and BAI was observed.

Body adiposity index to analyze the percentage of fat in young men aged between 7 and 17 years

BACKGROUND

The body adiposity index (BAI), uses anthropometry to estimate percent body fat (%F). However, previous studies have shown that the BAI has limited accuracy for children and adolescents.

OBJECTIVE

We propose to develop and validate an adjusted BAI for use in male children and adolescents from 7 to 17 years of age.

METHODS

The sample consisted of 141 physically active male children and adolescents (age: 12.5 ± 2.14). The %F was determined by X-ray dual energy absorptometry equipment (DXA) as the standard method and by BAI, using an equation that uses height and hip circumference. Arithmetic modeling was used to adjust the structure of the BAI mathematical model.

RESULTS

The BAI arithmetic adjustment was successful, resulting in the mathematical model named in the present study of adjusted body adiposity index (BAI_ADJ ). BAI and BAI_ADJ correlated with DXA (r ≤ .70, p < .001). Regression analyzes indicate that, BAI (CI 95% β: [1.35; 1.90], p < .0001) and BAI_ADJ (CI 95% β: [1.40; 1.90], p < .0001) have the potential to estimate %F. BAI pointed out a difference in relation to DXA (p = .04). While there was no difference between BAI_ADJ and DXA (p = .1). There was a proportion bias of 13.2% for BAI (p < .05), but not for BAI_ADJ (p > .05).

CONCLUSION

The adjusted model of the body adiposity index proves to be an effective tool for the analysis of the fat percentage in young males. In addition, it demonstrated significant degrees of agreement and validity in relation to DXA.

The range of non-traditional anthropometric parameters to define obesity and obesity-related disease in children: a systematic review

Obesity is defined as an abnormal/excessive accumulation of body fat, associated with health consequences. Although overall obesity does confer a significant threat to the health of individuals, the distribution of body fat, especially abdominal/central obesity is of greater importance. For practical reasons, proxy anthropometric measurements have been developed to identify central obesity, however, major limitations are noted in these traditional measurements. The present study aims to evaluate the literature, to identify and describe non-traditional anthropometric measurements of overweight and obesity in children. The current systematic review was conducted in accordance with the PRISMA guidelines, and the search was undertaken in the PubMed^® database, using MeSH (Medical Subject Headings) terms. Data extracted from each study were: (a) details of the study, (b) anthropometric parameter(s) evaluated in the study and its details, (c) study methods, (d) objectives of the study and/or comparisons, and (e) main findings/conclusions of the study. The search yielded a total of 3697 articles, of which 31 studies were deemed eligible to be included. The literature search identified 13 non-traditional anthropometric parameters. Data on non-traditional anthropometric parameters were derived from 24 countries. Majority were descriptive cross-sectional studies (n = 29), while sample size varied from 65 to 23,043. Non-traditional anthropometric parameters showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were based on a single anthropometric measurement or derived from traditional measures. Most studies lacked comparison with a 'gold standard' assessment of body fat, hence further research is required to determine their accuracy and precision.

Assessment of body composition in pediatric overweight and obesity: A systematic review of the reliability and validity of common techniques

Accurate measurement of body composition is required to improve health outcomes in children and adolescents with overweight or obesity. This systematic review aimed to summarize the reliability and validity of field and laboratory body composition techniques employed in pediatric obesity studies to facilitate technique selection for research and clinical practice implementation. A systematic search in MEDLINE (via PubMed), EMBASE, CINAHL, and SPORTDiscus from inception up to December 2019 was conducted, using a combination of the following concepts: body composition, pediatric overweight/obesity, and reliability/validity. The search strategy resulted in 66 eligible articles reporting reliability (19.7%), agreement between body composition techniques cross sectionally (80.3%), and/or diagnostic test accuracy (10.6%) in children and adolescents with overweight or obesity (mean age range = 7.0-16.5 years). Skinfolds, air-displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA), and ultrasound presented as reliable techniques. DXA, ADP, and isotope dilution showed similar and the best agreement with reference standards. Compared with these laboratory techniques, the validity of estimating body composition by anthropometric equations, skinfolds, and BIA was inferior. In conclusion, the assessment of body composition by laboratory techniques cannot be replaced by field techniques due to introduction of measurement errors, which potentially conceal actual changes in body components.

Agreement of body adiposity index (BAI) and paediatric body adiposity index (BAIp) in determining body fat in Brazilian children and adolescents

Objective

To evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents.

Design

Cross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland–Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA.

Setting

Viçosa, Minas Gerais, Brazil.

Subjects

Children and adolescents aged 8–19 years (n 1049).

Results

Of the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18–19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %.

Conclusions

BAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.

Validity of the Body Adiposity Index in Predicting Body Fat in Adults: A Systematic Review

The Body Adiposity Index (BAI) is a practical anthropometric method used to measure body fat (BF) percentage (BF%). Recently developed, the validity and precision of BAI has been studied with adult samples of men and women, populations from different countries and ethnicities, varying amounts of BF, and sensitivity to detecting change over time. However, it is still necessary to determine its potential use in clinical practice and epidemiologic studies. Thus, our objective was to verify, through a systematic review, the validity of the BAI in predicting BF% in adults. Two independent researchers performed a search using PubMed, Web of Science, Science Direct, and Scopus databases. In order to be included, the studies had to use dual-energy X-ray absorptiometry (DXA) as a reference method. We excluded studies with samples from individuals with diseases or syndromes that alter the regional distribution of BF%. We included 19 studies with samples on individuals from different continents, varied ethnicities, both sexes, and a wide age range (18-83 y). The concordance of the BAI with DXA assessed by Lin's concordance correlation coefficient showed results classified as poor (pc < 0.90). Bland-Altman plots showed that the BAI produced large individual errors when predicting BF% in all studies using this analysis. The studies were consistent in affirming that the BAI showed limited capacity to estimate BF% in adults. The BAI shows wide individual errors, in agreement with the reference method, and a lack of sensitivity in detecting change in BF% over time. The method presents a systematic error of BF% overestimation in individuals with ≤20% of BF, and underestimation in individuals with >30% of BF, regardless of sex, age, and ethnicity. The results of this systematic review show enough evidence that the BAI does not present satisfying results, and its use is not recommended for BF% determination in adults.

The value of hip circumference/heightx ratio for identifying childhood hypertension

To investigate the value of hip circumference related indexes for identifying childhood hypertension. In 2011, 1,352 Han children aged 7–12 years were recruited in our study. Hypertension was defined as systolic blood pressure or diastolic blood pressure ≥95th percentile for all three screenings. We set the power value of the hip circumference/height^x ratio (x = 0, 0.8, 1 and 1.5) and studied the association with blood pressure. Hip circumference, hip circumference/height^0.8, hip circumference/height and hip circumference/height^1.5 all showed a positive correlation with systolic blood pressure and diastolic blood pressure(P < 0.05). Area under the curve (AUC) was used to evaluate the abilities of hip circumference related indexes. Hip circumference/height^0.8, hip circumference/height and hip circumference/height1.5 were not superior to hip circumference. The present study demonstrates that hip circumference measurement is a helpful tool to detect the presence of hypertension in Han children 7–12 years old.

Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio

Frequently reported poor dietary habits of young adults increase their risk of metabolic syndrome (MetS). Excess adiposity is the most established predictor of MetS, and numerous anthropometric measures have been proposed as proxy indicators of adiposity. We aimed to assess prevalence of MetS in young adult population and to make comparison between weight- and shape-oriented measures of adiposity to identify the best index in association with measured body fat and as a risk predictor for MetS. Healthy males and females aged 18-25 years from the Northwest of England were recruited using convenience sampling (n=550). As part of the assessment of the overall health of young adults, the biochemical variables and adiposity measures BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), new BMI, Body Adiposity Index (BAI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and A Body Shape Index (ABSI) were assessed. Linear regression analysis was used to investigate the association between the proxy indices of adiposity and measured percentage body fat. The odds ratio with 95% confidence interval was used to investigate the relationship between cardiometabolic (CM) risk factors and proxy measures of adiposity. The discriminatory power of these measures for diagnosis of MetS was investigated using area under the receiver operating characteristic curve. Body weight-related indicators of adiposity, particularly CUN-BAE, had stronger association with measured body fat compared with body shape-related indices. In relation with MetS, body shape-related indices, particularly elevated WC and WHtR, had stronger associations with CM risk compared with body weight-related measures. Amongst all indices, the best predictor for CM risk was WHtR, while ABSI had the weakest correlation with body fat, MetS, and CM risk. Indices directly associated with WC and specifically WHtR had greater diagnostic power in detection of CM risk in young adults.

Comparison of Three Adiposity Indexes and Cutoff Values to Predict Metabolic Syndrome Among University Students

PURPOSE

Obesity and high body fat are related to diabetes and metabolic syndrome (MetS) in all ethnic groups. Based on the International Diabetes Federation (IDF) definition of MetS, the aim of the present study was to compare body adiposity indexes (BAIs) and to assess their various cutoff values for the prediction of MetS in university students from Colombia.

METHODS

A cross-sectional study was conducted on 886 volunteers (51.9% woman; age mean 21.4 years). Anthropometric characteristics (height, weight, waist circumference [WC], and hip circumference [HC]) were measured, and body composition was assessed by bioelectrical impedance analysis. MetS was defined as including ≥3 of the metabolic abnormalities (WC, high-density lipoprotein cholesterol [HDL-C], triglycerides, fasting glucose, and systolic and diastolic blood pressure [BP]) in the definition provided by the IDF. The BAIs (i.e., BAI-HC [BAI], BAI-WC [BAI-w], and [BAI-p]) were calculated from formulas taking into account, height, weight, and WC, and for the visceral adiposity indexes, a formula, including WC, HDL-C, and triglycerides, was used.

RESULTS

The overall prevalence of MetS was 5.9%, higher in men than in women. The most prevalent components were low HDL-C, high triglyceride levels, WC, and BP levels. The receiver operating characteristic curves analysis showed that BAI, BAI-w, and BAI-p could be useful tools to predict MetS in this population.

CONCLUSION

For women, the optimal MetS threshold was found to be 30.34 (area under curve [AUC] = 0.720-0.863), 19.10 (AUC = 0.799-0.925), and 29.68 (AUC = 0.779-0.901), for BAI, BAI-w, and BAI-p, respectively. For men, the optimal MetS threshold was found to be 27.83 (AUC = 0.726-0.873), 21.48 (AUC = 0.755-0.906), and 26.18 (AUC = 0.766-0.894), for BAI, BAI-w, and BAI-p, respectively. The three indexes can be useful tools to predict MetS according to the IDF criteria in university students from Colombia. Data on larger samples are needed.

Índice de adiposidade visceral como preditor de risco cardiometabólico em crianças e adolescentes

RESUMO Introdução: O risco cardiometabólico está associado a diversos fatores, entre os quais, o estado nutricional tem papel destacado. Objetivos: Este estudo verificou a influência do estado nutricional sobre o Índice de Adiposidade Visceral (VAI, do inglês) e seus componentes em crianças e adolescentes. Métodos: Estudo descritivo-associativo, de caráter transversal, realizado com 290 sujeitos de 10 a 18 anos, de ambos os sexos. Foram avaliados estatura, massa corporal, IMC, HDL-c, TG e VAI. Realizaram-se os testes Shapiro-Wilk, teste t de Student independente, U de Mann-Whitney, ANOVA One-Way, Kruskal-Wallis, Post Hoc de Bonferroni, Correlação de Pearson e cálculo da razão de chances (odds ratio). A significância adotada foi de p < 0,05. Resultados: Os testes demonstraram haver diferenças significativas entre os sexos para a idade, HDL-c e VAI. Nas variáveis HDL-c, TG e VAI foram constatadas diferenças significativas entre os adolescentes eutróficos e as demais classificações do estado nutricional. Verificou-se também uma piora das variáveis utilizadas para o cálculo do VAI para os adolescentes com classificação do estado nutricional alterado (não eutróficos), indicando, portanto, maior risco cardiometabólico associado ao excesso de peso. Verificou-se forte correlação entre o VAI e o TG (0,865) e correlação moderada negativa entre VAI e HDL-c (-0,405). Após o odds ratio, constatou-se que os participantes com excesso de peso e CC alterada, respectivamente, apresentaram 2,3 e 1,5 vezes mais chance de risco cardiometabólico (VAI alterado). Conclusões: O estado nutricional é capaz de influenciar as variáveis de risco cardiometabólico, VAI, CC, TG e HDL-c em crianças e adolescentes. Nesta população, independente do sexo, à medida que o valor do IMC se eleva, há progressão de alterações metabólicas. Em complemento, o VAI apresentou uma correlação significativa com TG, HDL-c, IMC e CC das crianças e adolescentes do estudo, podendo assim ser visto como alternativa de predição do risco cardiometabólico.

Evaluation of Hip/HeightP Ratio as an Index for Adiposity and Metabolic Complications in Obese Children: Comparison with Waist-related Indices

Aim: To investigate whether body adiposity index (BAI; hip/height^1.5–18), pediatric BAI (BAIp; hip/height^0.8–38), and other hip/height^P ratios are useful in obese children.

Method: Ninety obese Japanese children, 55 boys and 35 girls, who visited our University Clinic, were enrolled. The age was 9.92 ± 2.6 (mean ± SD) years, and the percentage overweight (POW) was 51.6 ± 18.8%. We set the power value of the hip/height^P 0, 0.5, 0.8, 1, 1.5, and 2 and studied the association with overweight indices, biochemical data, and fat area measured by computed tomography. Waist, waist/height ratio, and waist/hip ratio were also evaluated.

Results: Hip/height and hip/height^0.8 (BAIp) were more closely correlated with POW, body mass index percentile, and percentage body fat than hip/height^1.5 (BAI). The correlation coefficient of hip/height with POW (r = 0.855) was the highest among the studied hip/height^P indices. The approximate line to predict POW was 411 × hip/height−207. The waist/height was also highly correlated with POW (r = 0.879). Hip and hip/height^0.5 were more closely correlated with visceral fat area than hip/height, BAIp, and hip/height^1.5. Hip and hip/height^0.5 were significantly correlated with insulin. Only hip was also significantly associated with dyslipidemia. All hip/height^P indices were not significantly correlated with alanine aminotransferase (ALT). Waist was significantly correlated with serum lipids, ALT, and insulin.

Conclusion: Hip/height and BAIp are better markers for overweight (adiposity) in obese children than BAI. However, hip/height, BAIp, and BAI are not useful to predict metabolic complications. Waist appears to be the best index for obese children overall at this time.

Relationship Between Adiposity Indices, Lipodystrophy, and Sarcopenia in HIV-Positive Individuals With and Without Lipodystrophy

Metabolism disorders, as well as body shape abnormalities, have been associated with the introduction of antiretroviral therapy. The objective of this study was to compare the diagnostic ability of adiposity indices and to discuss criteria for the classification of lipodystrophy and sarcopenia (SP) in HIV-positive individuals. Anthropometric measurements were determined in 268 individuals of both genders, also submitted to the dual-energy X-ray absorptiometry exam. The adiposity indices calculated were body mass index, body mass index adjusted for fat mass (BMIfat), body adiposity index, body adiposity Index for the Fels Longitudinal Study sample, and The Clínica Universidad de Navarra body adiposity estimator. The presence of lipodystrophy was evaluated using the fat mass ratio (FMR). SP was classified using the appendicular lean mass/height² ratio. The subjects were divided into 3 groups: HIV⁺LIPO⁺ (n = 41), HIV⁺LIPO^- (n = 65), and control (C, HIV-negative individuals; n = 162). Among the adiposity indices assessed, BMIfat showed the strongest correlation with total body fat (in percent) for men (r = 0.87, p < 0.001) and women (r = 0.92, p < 0.001). The frequency of SP was 44.8% and 41.7% in HIV⁺LIPO⁺, 27.8% and 20.7% in HIV⁺LIPO^- and 63.3% and 45.45% in C, for men and women, respectively. The cutoff point suggested for the diagnosis of lipodystrophy according to the FMR was 1.14. The adiposity indices, particularly the BMIfat, have strong correlation with body fat determined by dual-energy X-ray absorptiometry in HIV-positive patients. The implementation of FMR is recommended for more standardized estimates of the frequency of lipodystrophy.

Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity

BACKGROUND

The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity.

METHODS

Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScore_BMI and MetScore_WC).

RESULTS

Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScore_BMI and MetScore_WC (p<0.05) in obese children. There is no association between SDB and PAL.

CONCLUSIONS

In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.

Predictive Validity of the Body Adiposity Index in Overweight and Obese Adults Using Dual-Energy X-ray Absorptiometry

The body adiposity index (BAI) is a recent anthropometric measure proven to be valid in predicting body fat percentage (BF%) in some populations. However, the results have been inconsistent across populations. This study was designed to verify the validity of BAI in predicting BF% in a sample of overweight/obese adults, using dual-energy X-ray absorptiometry (DEXA) as the reference method. A cross-sectional study was conducted in 48 participants (54% women, mean age 41.0 ± 7.3 years old). DEXA was used as the “gold standard” to determine BF%. Pearson’s correlation coefficient was used to evaluate the association between BAI and BF%, as assessed by DEXA. A paired sample t-test was used to test differences in mean BF% obtained with BAI and DEXA methods. To evaluate the concordance between BF% as measured by DEXA and as estimated by BAI, we used Lin’s concordance correlation coefficient and Bland–Altman agreement analysis. The correlation between BF% obtained by DEXA and that estimated by BAI was r = 0.844, p < 0.001. Paired t-test showed a significant mean difference in BF% between methods (BAI = 33.3 ± 6.2 vs. DEXA 39.0 ± 6.1; p < 0.001). The bias of the BAI was −6.0 ± 3.0 BF% (95% CI = −12.0 to 1.0), indicating that the BAI method significantly underestimated the BF% compared to the reference method. Lin’s concordance correlation coefficient was considered stronger (ρc = 0.923, 95% CI = 0.862 to 0.957). In obese adults, BAI presented low agreement with BF% measured by DEXA; therefore, BAI is not recommended for BF% prediction in this overweight/obese sample studied.

Body adiposity index performance in estimating body fat in a sample of severely obese Brazilian patients

Background/objectives

The body adiposity index (BAI) estimates the amount of body fat (BF) in humans. In Mexican-American and African-American populations, BAI has performed better than body mass index (BMI). The aim of this study was to evaluate the performance of BAI in estimating percentage (BF%) in severely obese Brazilian patients, with air displacement plethysmography (ADP) used as the reference method.

Subjects/methods

Estimation of BF% by ADP, anthropometric measurements (height, abdominal and hip circumferences, body weight, and BMI) and BAI calculation were performed in 72 obese subjects (BMI ≥ 30 kg/m²) aged 30–55 years.

Results

The mean BF% estimates ± standard deviation were 52.1 ± 5.7 % for ADP and 47.7 ± 7.4 % for BAI, with a positive Pearson correlation (r_p = 0.66) and a positive Lin’s concordance correlation (r_c = 0.479) observed between these methods. The 95 % limits of individual agreement between BAI and ADP ranged from -5.769 % to 16.036 %, with BAI exhibiting an average positive bias of 5.13 % compared to the reference method. For each studied variable, BAI exhibited a systematic bias, as evidenced by a tendency for low BF% values to be overestimated.

Conclusion

For Brazilian patients with severe obesity, BAI does not provide an accurate estimate of BF%.