Evaluation of lean tissue density for use in air displacement plethysmography in obese children and adolescents

Mental health from childhood to adolescence predicts excessive weight and body composition at 18 years

OBJECTIVE

To investigate the association of mental health in childhood and adolescence with four outcomes at 18 years: ultra-processed food (UPF) consumption, body mass index (BMI), excessive weight (EW), and body composition, including fat mass (FM) and fat free mass (FFM) in kg, FM index (FMI) and FFM index (FFMI) in kg/m2.

METHODS

Cohort study in which The Development and Well-Being Assessment (DAWBA) (6 and 11 years) and the MINI International Neuropsychiatric Interview (MINI) (18 years) provided information on internalizing (INT), externalizing (EXT) and any mental disorder (ANY). The exposure was classified in: "never", "at 6 and/or 11 years", "at 18 years only" and "at 6, 11, and 18 years". Linear and logistic regression were run. All analyses were stratified by sex.

RESULTS

A total of 2722 participants were analyzed. At 18 years, female with EXT disorders at 6 and/or 11 years presented higher BMI (β: 1.70; 0.18-3.23), FM (β: 4.74; 1.42-8.06), and FMI (β: 1.53; 0.28-2.79) than those who never had. The odds of EW at 18 years was also higher in females with EXT disorders at 6 and/or 11 years (OR: 3.39; 1.56-7.36) and at the three time points (OR: 7.08; 1.69-29.59). Males with EXT disorders at 6 and/or 11 years presented higher FM (β: 4.45; 1.85-7.06) and FMI (β: 1.47; 0.63-2.31).

CONCLUSIONS

Among children and adolescents showing symptoms of EXT disorders, weight should be monitored carefully, thus ultimately contributing to reduce the burden of EW in adolescence.

Variation in ultra-processed food consumption from 6 to 15 years, body weight and body composition at 15 years of age at The Pelotas 2004 Birth Cohort

BACKGROUND

The association of ultra-processed food (UPF) consumption with obesity and adipose tissue in children/adolescents remains poorly understood.

OBJECTIVE

To assess the association of UPF consumption with excessive weight (EW-defined as BMI-for-age ≥+1 z-score) and body composition at 15 years.

METHODS

In a birth cohort, daily UPF consumption was estimated by Food Frequency Questionnaires at 6 and 15 years. Those in the higher tercile of UPF consumption at both follow-ups were the 'always-high consumers'. Air-displacement plethysmography provided fat mass (FM-kg), fat-free mass (FFM-kg), %FM, %FFM, FM index (FMI-kg/m2 ) and FFM index (FFMI-kg/m2 ). Logistic regression and linear regression were used to estimate, respectively, odds ratios and beta coefficients.

RESULTS

Amongst 1584 participants, almost one in every seven were always-high consumers. In crude analyses, there was no association between variation in UPF consumption and EW, and body fat parameters were lower in the always-high consumer group than amongst the always-low consumers, in both sexes. With adjustment for confounders, the odds ratio for EW was higher in the always-high consumer than amongst the always-low consumer group, and the direction of the associations with FM parameters was reversed: males from the always-high consumer group presented almost twice as high FM (10.5 vs. 18.6 kg; p < 0.001) and twice as high FMI (3.4 vs. 6.3 kg/m2 ; p < 0.001) than the always-low consumer group, and females from the always-high consumer group presented on average 32% more FM and FMI than the always-low consumer group.

CONCLUSIONS

In crude and adjusted analyses there was a strong association between high UPF consumption from childhood to adolescence, EW and higher body fat parameters at 15 years, but its deleterious association with body adiposity was only uncovered after adjusting for confounders.

Evaluation of bioelectrical impedance analysis in measuring body fat in 6-to-12-year-old boys compared with air displacement plethysmography

Air displacement plethysmography (ADP) has been considered as the 'standard' method to determine body fat in children due to superior validity and reliability compared with bioelectrical impedance analysis (BIA). However, ADP and BIA are often used interchangeably despite few studies comparing measures of percentage body fat by ADP (%FMADP) with BIA (%FMBIA) in children with and without obesity. The objective of this study was to measure concurrent validity and reliability of %FMADP and %FMBIA in 6-to-12-year-old boys with and without obesity. Seventy-one boys (twenty-five with obesity) underwent body composition assessment. Ten boys participated in intra-day reliability analysis. %FMADP was estimated by Bodpod using sex- and age-specific equations of body density. %FMBIA was estimated by a multi-frequency, hand-to-foot device using child-specific equations based on impedance. Validity was assessed by t tests, correlation coefficients and limits of agreement (LoA); and reliability by technical error of measurement (TEM) and intraclass correlation coefficients (ICC). Compared with %FMADP, %FMBIA was significantly underestimated in the cohort (-3·4 ± 5·6 %; effect size = 0·42) and in both boys with obesity (-5·2 ± 5·5 %; ES = 0·90) and without obesity (-2·4 ± 5·5 %; ES = 0·52). A strong, significant positive correlation was found between %FMADP and %FMBIA (r = 0·80). Across the cohort, LoA were 22·3 %, and no proportional bias was detected. For reliability, TEM were 0·65 % and 0·55 %, and ICC were 0·93 and 0·95 for %FMBIA and %FMADP, respectively. Whilst both %FMADP and %FMBIA are highly reliable methods, considerable differences indicated that the devices cannot be used interchangeably in boys age 6-to-12 years.

Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review

The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.

Role of ultra-processed food in fat mass index between 6 and 11 years of age: a cohort study

BACKGROUND

Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age.

METHODS

We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat.

RESULTS

At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content.

CONCLUSIONS

Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.

Prematurity and body composition at 6, 18, and 30 years of age: Pelotas (Brazil) 2004, 1993, and 1982 birth cohorts

Background

We aimed to investigate the association between preterm birth and body composition at 6, 18, and 30 years of age using data from three population-based birth cohort studies.

Methods

Gestational age (GA), defined by the date of the last menstrual period (categorized in ≤33, 34–36, and ≥ 37 weeks), was gathered in the first 24-h after delivery for all live births occurring in the city of Pelotas, Brazil, in 2004, 1993 and 1982. Body composition was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent FM (%FM), FM index (FMI, kg/m²), fat-free mass (FFM, kg); percent FFM (%FFM), FFM index (FFMI, kg/m²), body mass index (BMI, kg/m² at 18 years in the 1993 cohort and 30 years in the 1982 cohort), and BMI Z-score (at 6 years in the 2004 cohort). We further explored the association of birth weight for GA with body composition indicators and BMI. Crude and adjusted linear regressions provided beta coefficients with 95% confidence intervals (95%CI).

Results

A total of 3036, 3027, and 3369 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, preterm boys (born at 34–36 weeks) presented lower adjusted mean of FM (β = − 0.80 kg, − 1.45;-0.16, p = 0.046), %FM (β = − 2.39%, − 3.90;-0.88, p = 0.008), FMI (β = − 0.70 kg/m², − 1.13;-0.27, p = 0.004) as well as lower FFM (β = − 0.4 kg, − 0.77; − 0.12, p = 0.010) and FFMI (β = − 0.3 kg/m², − 0.46;-0.10, p < 0.001), and BMI Z-score (β = − 0.69,; − 0.99;-0.40, p < 0.001); but higher %FFM (β = 2.4%, 0.87;-3.90, p = 0.008), when compared to boys born at term (≥37). At 30 years, FM (15.7 kg, 0.25;31.1, p = 0.102) was higher among males born at ≤33 weeks. No association was observed for females from the three cohorts and for 18-year-old males. The association of birth weight for GA with body composition and BMI was not significant in any cohort. At 6 years, SGA boys had lower FFMI than boys AGA.

Conclusions

Our results suggest that preterm birth is associated with decreased body fat and fat-free mass in childhood but higher fat mass in adulthood. Nevertheless, results were only significant for males. SGA boys also showed lower FFMI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10368-w.

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.

Evaluating body composition in infancy and childhood: A comparison between 4C, QMR, DXA, and ADP

BACKGROUND

Accurate and precise methods to measure of body composition in infancy and childhood are needed.

OBJECTIVES

This study evaluated differences and precision of three methods when compared with the four-compartment (4C) model for estimating fat mass (FM).

METHODS

FM of children (age 14 days to 6 years of age, N = 346) was obtained using quantitative nuclear magnetic resonance (QMR, EchoMRI-AH), air-displacement plethysmography (ADP, PeaPod, less than or equal to 8 kg, BodPod age 6 years or older), and dual-energy X-ray absorptiometry (DXA, Hologic QDR). The 4C model was computed. Correlation, concordance, and Bland-Altman analyses were performed.

RESULTS

In infants, PeaPod had high individual FM accuracy, whereas DXA had high group FM accuracy compared with 4C. In children, DXA had high group and individual FM accuracies compared with 4C. QMR underestimated group FM in infants and children (300 and 510 g, respectively). The instrument FM precision was best for QMR (10 g) followed by BodPod (34 g), PeaPod (38 g), and DXA (45 g).

CONCLUSIONS

In infants, PeaPod was the best method to estimate individual FM whereas DXA was best to estimate group FM. In children, DXA was best to estimate individual and group FM. QMR had the highest instrument precision.

Accuracy of self-reported physical activity levels in obese adolescents

Introduction. Self-reported measures of habitual physical activity rely completely on the respondent's ability to provide accurate information on their own physical activity behaviours. Our aim was to investigate if obese adolescents could accurately report their physical activity levels (PAL) using self-reported diaries. Methods. Total energy expenditure (TEE) was measured using doubly labelled water (DLW) and resting energy expenditure (REE) was measured via indirect calorimetry. Activity energy expenditure (AEE) and PAL values were derived from measured TEE and REE. Self-reported, four-day activity diaries were used to calculate daily MET values and averaged to give an estimated PAL value (ePAL). Results. Twenty-two obese adolescents, mean age 13.2 ± 1.8 years, mean BMI 31.3 ± 4.6 kg/m², completed the study. No significant differences between mean measured and estimated PAL values were observed (1.37 ± 0.13 versus 1.40 ± 0.34, P = 0.74). Bland Altman analysis illustrated a significant relationship (r = −0.76, P < 0.05) between the two methods; thus the bias was not consistent across a range of physical activity levels, with the more inactive overreporting their physical activity. Conclusion. At an individual level, obese adolescents are unlikely to be able to provide an accurate estimation of their own activity.

Methodologies to assess paediatric adiposity

INTRODUCTION

Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity.

METHODS

The online databases PubMed, CINALH and EMBASE were searched and the abstracts identified were reviewed to determine appropriate studies. Their reference lists were also searched to identify further eligible studies. Publications were included if they described childhood measurement techniques or involved validation.

RESULTS AND DISCUSSION

There are many body composition assessment tools available, none of which are direct. Each technique has limitations and a combination of methods may be used. The main clinical techniques are weight, height, body mass index (BMI) and circumferences which provide sufficient information to enable classification of overweight or obesity when growth centile charts and ratios are employed. Further investigation depends on resources available and examiner skill. Skinfold thicknesses are cost-effective but require technical training and only measure subcutaneous fat. Dual energy X-ray absorptiometry (DEXA), air displacement plethysmography (ADP), magnetic resonance imaging (MRI) and computed tomography (CT) are more costly and intensive, requiring the child to remain still for longer periods. DEXA and ADP are capable of accurately measuring adiposity but are unable to distinguish between fat depots. MRI and CT can distinguish intra-abdominal from subcutaneous adiposity and are considered gold standards, but CT is unsuitable for adiposity measurement in children due to high levels of radiation exposure. Ultrasound is a promising technique capable of measuring intra-abdominal adiposity in children but requires further validation.

CONCLUSION

The core clinical measurements of weight, height, BMI and circumferences are sufficient to enable diagnosis of paediatric overweight and obesity while more technical tools provide further insight.

Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child

BACKGROUND

A routine pediatric clinical assessment of body composition is increasingly recommended but has long been hampered by the following 2 factors: a lack of appropriate techniques and a lack of reference data with which to interpret individual measurements. Several techniques have become available, but reference data are needed.

OBJECTIVE

We aimed to provide body-composition reference data for use in clinical practice and research.

DESIGN

Body composition was measured by using a gold standard 4-component model, along with various widely used reference and bedside methods, in a large, representative sample of British children aged from 4 to ≥20 y. Measurements were made of anthropometric variables (weight, height, 4 skinfold thicknesses, and waist girth), dual-energy X-ray absorptiometry, body density, bioelectrical impedance, and total body water, and 4-component fat and fat-free masses were calculated. Reference charts and SD scores (SDSs) were constructed for each outcome by using the lambda-mu-sigma method. The same outcomes were generated for the fat-free mass index and fat mass index.

RESULTS

Body-composition growth charts and SDSs for 5-20 y were based on a final sample of 533 individuals. Correlations between SDSs by using different techniques were ≥0.68 for adiposity outcomes and ≥0.80 for fat-free mass outcomes.

CONCLUSIONS

These comprehensive reference data for pediatric body composition can be used across a variety of techniques. Together with advances in measurement technologies, the data should greatly enhance the ability of clinicians to assess and monitor body composition in routine clinical practice and should facilitate the use of body-composition measurements in research studies.