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Nasreddine L, Bakir MA, Al-Ati T, Alzaben AS, Barham R, Bawazeer N, Fares EJ, Hammad K, Kaestel P, Reilly JJ, Taktouk M. Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome. PLoS One 2024; 19:e0298306. [PMID: 38394061 PMCID: PMC10889849 DOI: 10.1371/journal.pone.0298306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region.
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Affiliation(s)
- Lara Nasreddine
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad Adel Bakir
- Department of Radiation Medicine, Atomic Energy Commission, Damascus, Syrian Arab Republic
| | - Tareq Al-Ati
- Food and Nutrition Program, Environment and Life Sciences Research Institute Center, Kuwait Institute for Scientific Research, Safat, Kuwait
| | - Abeer Salman Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rawhieh Barham
- Department of Nutrition, Ministry of Health, Amman, Jordan
| | - Nahla Bawazeer
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Elie-Jacques Fares
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Kholoud Hammad
- Department of Radiation Medicine, Atomic Energy Commission, Damascus, Syrian Arab Republic
| | - Pernille Kaestel
- Department of Nuclear Sciences and Applications, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - John J. Reilly
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Mandy Taktouk
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
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Equations based on anthropometric measurements for adipose tissue, body fat, or body density prediction in children and adolescents: a scoping review. Eat Weight Disord 2022; 27:2321-2338. [PMID: 35699918 DOI: 10.1007/s40519-022-01405-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds. METHODS A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework ( https://osf.io/35uhc/ ). RESULTS We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations. CONCLUSION Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias. LEVEL IV Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Muhanna RG, Aljuraiban GS, Almadani NK, Alquraishi M, El-Sharkawy MS, Abulmeaty MMA. Value of Adding Bioelectrical Impedance Analysis to Anthropometric Indices in the Diagnosis of Metabolic Syndrome in 10–16 Years Old Schoolgirls. Healthcare (Basel) 2022; 10:healthcare10030419. [PMID: 35326897 PMCID: PMC8950802 DOI: 10.3390/healthcare10030419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
The use of bioelectrical impedance analysis (BIA) in clinical settings is common. However, the value of BIA-based parameters in diagnosing metabolic syndrome (MetS) in children is under-investigated. Herein, we aimed to study the usefulness of BIA-indices in the diagnoses of MetS in 6–10-year-old girls. Therefore, a diagnostic accuracy case-control study was conducted, which included 75 girls aged 10–16 years, divided into three age-matched groups (normal, None-MetS, and MetS). Anthropometric indices, BIA parameters (including fat-free mass (FFM), body fat percent (BFP), and total body water (TBW)), blood pressure (BP), and blood samples were collected. Our main findings show that for girls in None-MetS and MetS groups, the waist circumference (WC) correlated positively with waist-hip ratio and mid-arm circumference (r = 0.58, 0.47, respectively), but not with BFP based on skinfold thickness (SFT), or mid-arm muscle area. WC was positively correlated with FFM and TBW, while high-density lipoprotein was inversely correlated with FFM. However, fasting blood glucose, triglycerides and BP showed no association with anthropometric measurements and BIA components. WC was the best indicator of MetS (AUC = 0.88, cut-off = 81.5 cm), followed by BMI (AUC = 0.84, cut-off = 26.9 kg/m2), while BFP based on SFT was the least sensitive (62.5%). In conclusion, apart from the FM index, anthropometric parameters such as WC are more valuable in diagnosing MetS in young adolescent girls.
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Affiliation(s)
- Rawan G. Muhanna
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11362, Saudi Arabia; (R.G.M.); (G.S.A.); (N.K.A.); (M.A.)
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11362, Saudi Arabia; (R.G.M.); (G.S.A.); (N.K.A.); (M.A.)
| | - Najwa K. Almadani
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11362, Saudi Arabia; (R.G.M.); (G.S.A.); (N.K.A.); (M.A.)
| | - Mohammed Alquraishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11362, Saudi Arabia; (R.G.M.); (G.S.A.); (N.K.A.); (M.A.)
| | - Mohamed S. El-Sharkawy
- Department of Radiology and Medical Imaging, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh P.O. Box 11922, Saudi Arabia;
| | - Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11362, Saudi Arabia; (R.G.M.); (G.S.A.); (N.K.A.); (M.A.)
- Correspondence:
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Development of population-specific prediction equations for bioelectrical impedance analyses in Vietnamese children. Br J Nutr 2020; 124:1345-1352. [PMID: 32616079 DOI: 10.1017/s000711452000241x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a need for accurate, inexpensive and field-friendly methods to assess body composition in children. Bioelectrical impedance analysis (BIA) is a promising approach; however, there have been limited validation and use among young children in resource-poor settings. We aim to develop and validate population-specific prediction equations for estimating total fat mass (FM), fat free-mass (FFM) and percentage body fat (PBF) in Vietnamese children (4-7 years) using reactance and resistance from BIA, anthropometric variables and demographic information. We conducted a cross-sectional survey of 120 children. Body composition was measured using dual-energy X-ray absorptiometry (DXA), BIA and anthropometry. To develop prediction equations, we split all data into development (70 %) and validation datasets (30 %). The model performance was evaluated using predicted residual error sum of squares, root mean squared error (RMSE), mean absolute error (MAE) and R2. We identified a top performing model with the least number of parameters (age, sex, weight and resistance index or resistance and height), low RMSE (FM 0·70, FFM 0·74, PBF 3·10), low MAE (FM 0·55, FFM 0·62, PBF 2·49), high R2 (FM 0·95, FFM 0·92, PBF 0·82) and the least difference between predicted values and actual values from DXA (FM 0·03 kg or 0·01 sd, FFM 0·06 kg or 0·02 sd, PBF 0·27 % or 0·04 sd). In conclusion, we developed the first valid and highly predictive equations to estimate FM, FFM and PBF in Vietnamese children using BIA. These findings have important implications for future research on the double burden of disease and risks associated with overweight and obesity in young children.
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Brantlov S, Jødal L, Lange A, Rittig S, Ward LC. Standardisation of bioelectrical impedance analysis for the estimation of body composition in healthy paediatric populations: a systematic review. J Med Eng Technol 2017; 41:460-479. [DOI: 10.1080/03091902.2017.1333165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Steven Brantlov
- Department of Procurement & Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Jødal
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Aksel Lange
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Rittig
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Chula de Castro JA, Lima TRD, Silva DAS. Body composition estimation in children and adolescents by bioelectrical impedance analysis: A systematic review. J Bodyw Mov Ther 2017; 22:134-146. [PMID: 29332738 DOI: 10.1016/j.jbmt.2017.04.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/06/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- João Antônio Chula de Castro
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil.
| | - Tiago Rodrigues de Lima
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil
| | - Diego Augusto Santos Silva
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil
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Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, Monteiro M, Vilanova M, Ferraz FP. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016; 2:272-281. [PMID: 27708844 PMCID: PMC5043499 DOI: 10.1002/osp4.51] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/31/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To develop and cross‐validate predictive models for percentage body fat (%BF) from anthropometric measurements [including BMI z‐score (zBMI) and calf circumference (CC)] excluding skinfold thickness. Methods A descriptive study was carried out in 3,084 pre‐pubertal children. Regression models and neural network were developed with %BF measured by Bioelectrical Impedance Analysis (BIA) as the dependent variables and age, sex and anthropometric measurements as independent predictors. Results All %BF grade predictive models presented a good global accuracy (≥91.3%) for obesity discrimination. Both overfat/obese and obese prediction models presented respectively good sensitivity (78.6% and 71.0%), specificity (98.0% and 99.2%) and reliability for positive or negative test results (≥82% and ≥96%). For boys, the order of parameters, by relative weight in the predictive model, was zBMI, height, waist‐circumference‐to‐height‐ratio (WHtR) squared variable (_Q), age, weight, CC_Q and hip circumference (HC)_Q (adjusted r2 = 0.847 and RMSE = 2.852); for girls it was zBMI, WHtR_Q, height, age, HC_Q and CC_Q (adjusted r2 = 0.872 and RMSE = 2.171). Conclusion %BF can be graded and predicted with relative accuracy from anthropometric measurements excluding skinfold thickness. Fitness and cross‐validation results showed that our multivariable regression model performed better in this population than did some previously published models.
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Affiliation(s)
- Sílvia M Almeida
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal; Instituto Superior de Ciências da Saúde Egas Moniz Campus Universitário Monte da Caparica Portugal
| | - José M Furtado
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal; Instituto Superior de Ciências da Saúde Egas Moniz Campus Universitário Monte da Caparica Portugal
| | - Paulo Mascarenhas
- Instituto Superior de Ciências da Saúde Egas Moniz Campus Universitário Monte da Caparica Portugal
| | - Maria E Ferraz
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal
| | - Luís R Silva
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal; Instituto Superior de Ciências da Saúde Egas Moniz Campus Universitário Monte da Caparica Portugal
| | - José C Ferreira
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal; Department of Obstetrics and Gynecology of University of Medicine of Warsaw Warsaw Poland
| | - Mariana Monteiro
- Clinical and Experimental Endocrinology Group, Unit for Multidisciplinary Research in Biomedicine UMIB, ICBAS University of Porto Portugal
| | - Manuel Vilanova
- Instituto de Investigação e Inovação em Saúde, and IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Portugal; Instituto de Ciências Biomédicas de Abel Salazar Universidade do Porto Portugal
| | - Fernando P Ferraz
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz Campus Universitário Monte da Caparica Portugal; Instituto Superior de Ciências da Saúde Egas Moniz Campus Universitário Monte da Caparica Portugal
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Noradilah MJ, Ang YN, Kamaruddin NA, Deurenberg P, Ismail MN, Poh BK. Assessing Body Fat of Children by Skinfold Thickness, Bioelectrical Impedance Analysis, and Dual-Energy X-Ray Absorptiometry: A Validation Study Among Malay Children Aged 7 to 11 Years. Asia Pac J Public Health 2016; 28:74S-84S. [PMID: 27073201 DOI: 10.1177/1010539516641505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to validate skinfold (SKF) and bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in determining body fat percentage (BF%) of Malay children aged 7 to 11 years. A total of 160 children had their BF% assessed using SKF and BIA, with DXA as the criterion method. Four SKF equations (SKFBray, SKFJohnston, SKFSlaughter, and SKFGoran) and 4 BIA equations (BIAManufacturer, BIAHoutkooper, BIARush, and BIAKushner) were used to estimate BF%. Mean age, weight, and height were 9.4 ± 1.1years, 30.5 ± 9.9 kg, and 131.3 ± 8.4 cm. All equations significantly underestimated BF% (P < .05). BIA equations had reasonable agreement with DXA and were independent of BF% with BIAManufacturer being the best equation. Although BIA underestimates BF% as compared with DXA, BIA was more suitable to measure BF% in a population that is similar to this study sample than SKF, suggesting a need to develop new SKF equations that are population specific.
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Affiliation(s)
| | - Yeow Nyin Ang
- Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | | | - Bee Koon Poh
- Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Abstract
OBJECTIVES The aim of the present study was to establish the correlations between the polymorphisms of the genes interleukin-6 (IL-6) 572, 190, and 174 in children's malnutrition. METHODS We assessed 283 hospitalized children and divided them into 2 groups: group I (control) included 110 patients with normal nutritional status, median (range) age 10.90 (1-18) years; and group II consisted of 173 malnourished patients, median (range) age 10.70 (1-18) years. RESULTS The 2 groups underwent IL-6 572 cytosine allele (C)/guanine allele (G), 190 C/thymine allele (T), and 174 G/C polymorphism testing, measurement of anthropometric indicators (mid-upper arm circumference and tricipital skinfold thickness [TST]), and paraclinical evaluation (protein, albumin). We observed that the GG and CG genotypes were more frequent in malnourished children for the IL-6 174 gene (P = 0.0001), whereas the CT heterozygous genotype was more frequent in the malnourished group for the IL-6 190 gene (P = 0.003). Body mass index (BMI), middle upper arm circumference (MUAC), TST, and low serum albumin levels correlated with the GG and CG genotypes of the IL-6 572 and IL-6 174 genes, and with the CT genotype of the IL-6 190 gene, in children with malnutrition, whereas the IL-6 190 TT genotype was a protective factor for malnutrition (P = 0.0001). CONCLUSIONS Malnutrition is more frequently associated in children with IL-6 174 G allele carriers (GG and CG genotypes), whereas IL-6 190 TT genotype has a protective function. In malnourished children, the IL-6 572/190/174 GG/CT/CG, GG/CT/GG, GG/CC/GG, and GG/CC/CG combined genotypes are more frequent.
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Talma H, Chinapaw MJM, Bakker B, HiraSing RA, Terwee CB, Altenburg TM. Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error. Obes Rev 2013; 14:895-905. [PMID: 23848977 DOI: 10.1111/obr.12061] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 12/21/2022]
Abstract
Bioelectrical impedance analysis (BIA) is a practical method to estimate percentage body fat (%BF). In this systematic review, we aimed to assess validity, responsiveness, reliability and measurement error of BIA methods in estimating %BF in children and adolescents.We searched for relevant studies in Pubmed, Embase and Cochrane through November 2012. Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies. We performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. We included 50 published studies. Mean differences between BIA and reference methods (gold standard [criterion validity] and convergent measures of body composition [convergent validity]) were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity. We found strong evidence for a good reliability, i.e. (intra-class) correlations ≥0.82. However, test-retest mean differences ranged from 7.5% to 13.4% of total %BF in the included study samples, indicating considerable measurement error. Our systematic review suggests that BIA is a practical method to estimate %BF in children and adolescents. However, validity and measurement error are not satisfactory.
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Affiliation(s)
- H Talma
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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