Anthropometric measurements in both sides of the body in the assessment of nutritional status in prepubertal children

Association between frequency of breakfast consumption and cardiometabolic risk in Peruvian university teachers, 2019-2020

Background

Although the relationship between health status and dietary intake has been extensively studied in the general population, there is a lack of research that has specifically examined the association between frequency of breakfast consumption and cardiometabolic risk in university teachers.

Objective

To determine the association between the frequency of breakfast consumption and cardiometabolic risk in university teachers.

Methods

A cross-sectional study was conducted in 176 teachers from a private university located in the eastern region of Lima, Peru (Mage: 37.0 years; SD: 0.8, range: 24-59 years). The study was conducted during the period from December 2019 to February 2020. Information was collected on anthropometric and biochemical parameters and frequency of breakfast consumption. Multinomial logistic regression models were used to explore the association between frequency of breakfast with sociodemographic, anthropometric, and biochemical variables.

Results

The highest prevalence of excess body weight (44.4%) was observed in those who consumed breakfast 0 to 2 days/week, but without statistical differences. Those who reported Low-density lipoprotein cholesterol (LDL-C) < 160 mg/dL were 77% less likely to fall into the 3-5 day/week breakfast frequency category than those who reported a regular frequency of breakfast (6 to 7 days/week) (Adjusted OR = 0.23, 95% CI 0.08 to 0.73; p < 0.05). In addition, teachers who reported a breakfast frequency of 3 to 5 days/week were 83% more likely to have a glucose concentration < 110 mg/dL compared to those who consumed breakfast of 6 to 7 days/week (Adjusted OR = 0.17, 95% CI 0.04 to 0.75; p < 0.05).

Conclusion

Skipping breakfast for an extended period of time can have detrimental effects on cardiometabolic health. Promoting the benefits of breakfast could be a health message of great public health interest.

Somatic characteristic, morphological asymmetry and postural stability of youth male canoeists compared to control. A cross-sectional study

OBJECTIVE

To determine the relationships between selected morphological characteristics and the level of body composition asymmetry with postural stability among canoeists and a control group.

METHODS

The sample consisted of 43 males (21 canoeists 21.8±3.29 years and 22 university students 21.7±1.32 years). Measurements included body height and weight. Segmental body composition analysis was assessed using the bioelectrical impedance by determining: fat mass (FM, kg, %), fat-free mass (FFM, kg) and predicted muscle mass (PMM, kg). Postural stability was tested using the BIODEX Balance System. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and overall stability index (OSI) were calculated.

RESULTS

Our findings suggest that the canoeists had statistically lower level of fatty tissue compared to controls. There was a statistically important difference between groups in lower limb FM (% and kg). In both groups morphological asymmetry was observed, but in most cases-in athletes. Asymmetries between right and left arms appeared in all parameters, while asymmetries between right and left legs were noted in all parameters except FM (kg). There were relationships between stature and body weight with postural stability in canoeists. Canoeists demonstrated better balance than controls, particularly in the APSI. For all stability indices, significant differences were observed between right and left legs across all participants.

CONCLUSIONS

Athletes, with larger asymmetries or poorer balance, require more attention to improve performance and reduce the risk of overload injury. Future studies needed to develop sport-specific level of morphofunctional asymmetry which would be optimal for sport results and health as well.

Association between Handgrip Strength, Skinfold Thickness, and Trunk Strength among University Students

OBJECTIVES

The main goal was to explore the relationship between hand grip strength (HGS), the thickness of the skinfold at multiple sites, and the trunk flexor (TF) and extensor (TE) muscle strength among healthy participants.

METHODS

We employed a cross-sectional design and randomly recruited 40 participants. Ultimately, only 39 participants were included. First, measurements for demographic and anthropometric variables were carried out. After that, the evaluation of hand grip strength and skinfold was performed.

DATA ANALYSIS

Descriptive statistics were used to explore the amount of interaction between the smoking and nonsmoking groups, and a repeated measures analysis of variance was employed. Furthermore, associations between dependent and independent variables were discovered through a multiple linear regression model.

RESULTS

The participants had a mean age of 21.59 ± 1.19 years. The results of the repeated measures analysis of variance validated an acceptable interaction between the trunk and hand grip strength at a significance level of p < 0.01, further emphasized by their moderate association (p < 0.05). Multiple regressions between TE, TF, the independent variables T score, height, and age were also significant (p < 0.05).

CONCLUSIONS

The trunk muscle strength can be used as a health indicator for comprehensive evaluation. The present study also found a moderate relationship between hand grip strength, trunk strength, and T score.

Equations based on anthropometric measurements for adipose tissue, body fat, or body density prediction in children and adolescents: a scoping review

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).

Use of Physical Activity and Exercise to Reduce Inflammation in Children and Adolescents with Obesity

Childhood obesity is a leading public health problem worldwide, as it is increasingly prevalent and therefore responsible for serious obesity-related comorbidities, not only in childhood but also in adulthood. In addition to cardio-metabolic obesity-related disorders, recent evidence suggests that excess adipose tissue in turn is associated with immune cell infiltration, increased adipokine release, and the development of low-grade systemic inflammation obesity. Exercise is considered a non-pharmacological intervention that can delay obesity-related comorbidities, improving cardiovascular fitness and modulating the inflammatory processes. It has been reported that the anti-inflammatory effect of regular exercise may be mediated by a reduction in visceral fat mass, with a subsequent decrease in the release of adipokines from adipose tissue (AT) and/or by the induction of an anti-inflammatory environment. In this narrative review, we discuss the role of AT as an endocrine organ associated with chronic inflammation and its role in obesity-related complications, focusing on the effect of exercise in reducing inflammation in children and adolescents with obesity. Regular physical exercise must be considered as a natural part of a healthy lifestyle, and promoting physical activity starting from childhood is useful to limit the negative effects of obesity on health. The crucial role of the immune system in the development of obesity-induced inflammatory processes and the efficacy of exercise as an anti-inflammatory, non-pharmacological intervention may provide possible targets for the development of new treatments and early preventive strategies.

Excess Weight and Body Fat Percentage Associated with Waist Circumference as a Cardiometabolic Risk Factor in University Students

BACKGROUND

Obesity is one of the most important public health problems for university students. The objective of the study was to evaluate the association between body mass index (BMI) and body fat percentage (%BF) with waist circumference (WC) as a cardiometabolic risk factor (CMR) among university students.

METHODS

A cross-sectional study was carried out in 2,048 students from a private university located in Lima, Peru. Anthropometric data (weight, height, %BF, and WC) were collected. Chi-square test was used. Association analysis was performed using multiple logistic regression.

RESULTS

The findings indicated that 36.9% and 61.1% of men were overweight and had higher %BF, respectively, compared to women. Women (OR, 0.22; 95% CI, 0.17, 0.29), Peruvian students (OR, 0.59; 95% CI, 0.39, 0.90), and students enrolled in the faculty of health sciences (OR = 0.76; 95% CI, 0.62, 0.94) are less likely to manifest CMR. Also, excess body weight (OR, 17.28; 95% CI, 13.21, 22.59) and a high %BF (OR, 4.55; 95% CI, 3.55, 5.84) were strongly associated with CMR.

CONCLUSION

CMRs are a public health problem among university students. Therefore, it is important to carry out healthy lifestyle programs to promote better control and prevention, particularly among male students and those who have excess weight and body fat.

The current review of adolescent obesity: the role of genetic factors

Obesity, a complex, multi-factor and heterogeneous condition, is thought to result from the interaction of environmental and genetic factors. Considering the result of adolescence obesity in adulthood, the role of genetic factors comes to the fore. Recently, many genome-wide association studies (GWAS) have been conducted and many loci associated with adiposity have been identified. In adolescents, the strongest association with obesity has been found in single nucleotide polymorphisms (SNP) in the FTO gene. Besides FTO, GWAS showed consistent effects between variants in MC4R, TMEM18, TNNI3K, SEC16B, GNPDA2, POMC and obesity. However, these variants may not have similar effects for all ethnic groups. Although recently genetic factors are considered to contribute to obesity, relatively little is known about the specific loci related to obesity and the mechanisms by which they cause obesity.

Bilateral asymmetry in arm anthropometric measurements according to laterality and nutritional status in children and adolescents from 6 to 12 years old

OBJECTIVE

To compare and correlate anthropometric measurements of the left arm versus the right arm and to establish their relation to laterality, sex, and nutritional status in children and adolescents from 6 to 12 years of age.

METHODS

A cross-sectional study included 605 children and adolescents (285 males; 320 females), with a middle socioeconomic status, that attended an urban elementary school. Anthropometric measurements were taken in both arms, along with height and weight, to assess nutritional status. Self-reported hand preference was recorded.

RESULTS

A total of 49.3% were females and 93% of the subjects were right-handed (n = 563). The mean comparison of right arm and left arm measurements and areas, according to laterality, showed differences in arm fat measurements, with higher values in the right arm. However, the mean difference in triceps skinfold and upper arm measurements between the right arm and left arm was smaller than the technical error of measurement. Significant differences were observed between arm measurements and areas. Upper arm and total upper arm areas of both arms had the highest regression coefficients, with an adjusted R² of .98, whereas the arm fat index had the lowest (adjusted R² of .88). Adjusting the previous differences between the right arm and left arm by age, sex, BMI, and laterality produced similar results.

CONCLUSIONS

Statistical but not clinically significant differences were found between some measurements and areas of both arms, discretely modified in models adjusted for age and BMI, so the measurements can be made on either arm.

Assessment of Nutritional Status and Body Composition in Tibetan Adolescent girls of Kangra district, Himachal Pradesh

Malnutrition among adolescents is an important public health issue in India. The aim of the present study was to assess nutritional status and body composition characteristics of adolescent girls and their interrelationships with physical activity and socioeconomic status (SES). Nutritional status and body composition characteristics were assessed in terms of body mass index (BMI), upper arm muscle area by height (UAMAH) and percent body fat (PBF) among 276 Tibetan adolescent girls from Kangra district, Himachal Pradesh. Overall, 12.7% of the girls were in the wasting category (using Z-score based classification for UAMAH) and 9.8% were thin. About 16.3% girls were obese. Significant variabilities of PBF have been observed with respect to age and levels of physical activity and wasting. Adolescent girls were observed to have higher lean body mass than body fat.

Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents?

(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent β-cell function (HOMA-β), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents.

Validity of Slaughter Equations and Bioelectrical Impedance Against Dual-Energy X-Ray Absorptiometry in Children

OBJECTIVE

This study aimed to 1) analyze the criterion validity of the Slaughter equations (Slg-Eq) and bioelectrical impedance analysis (BIA) to estimate body fat percentage (BFP) and fat mass index (FMI) at different degrees of obesity in children compared with dual-energy x-ray absorptiometry (DXA) and 2) determine their agreement over time.

METHODS

Ninety-two children with overweight or obesity (10.0 [SD 1.2] years; 34.8% girls) participated in this 20-week study. Anthropometric, BIA, and DXA measurements were performed.

RESULTS

Both Slg-Eq and BIA methods underestimated BFP and FMI against DXA, and the bias was markedly larger with BIA (mean absolute percentage error = 11% for Slg-Eq vs. 18%-21% for BIA); a larger underestimation was observed in girls compared with boys for Slg-Eq (P ≤ 0.001), and the observed underestimation in adiposity was reduced as weight status increased. Systematic errors were kept constant over time, so no large differences between methods were observed in the change in adiposity.

CONCLUSIONS

At the group level, Slg-Eq provides a more valid estimation of BFP and FMI than BIA. At the individual level, Slg-Eq shows larger estimation errors. The validity of these methods might differ in sex and weight status. Nevertheless, both methods seem to be valid for monitoring changes in adiposity.

The relationship between Cormic Index and uterine contractions' pattern in the active phase of the first stage of labour

Uterine contractions are indicators of labour progress. The relationship between anthropometric indices and types of childbirth has been investigated. One of these indices is referred to as the Cormic Index, which provides an estimation of the sitting height and leg length. This cross-sectional study was performed to determine the relationship between the Cormic Index and the uterine contractions' pattern in the active phase of the first stage of labour. The standing and sitting heights of 150 pregnant women were measured to calculate the Cormic Index. Then, two Cardiotocographic traces were recorded during the 3 to 5 and 6 to 8 centimetres' dilations, by which the uterine contractions' pattern were determined. The mean Cormic Index was 51.84 ± 2.62. The results indicated that the Cormic Index had a positive linear correlation with MTIME (frequency of contractions) in the first monitoring episode and SDTIME (regularity of contractions) in the first and the second monitoring episode, which was significant (p < .05). However, there was no significant correlation between the Cormic Index and F:R ratio (shape of contractions) in both monitoring episodes. With the rise of the mother's Cormic Index, the frequency of contractions in the acceleration phase, and also their regularity in the acceleration phase and the phase of the maximum slope, were decreased during the active phase of labour.IMPACT STATEMENTWhat is already known on this subject? Uterine Contraction as an indicator of labour progress enforces cervical dilation. If uterine activity is analysed through electronic methods, one could assess labour outcome through some patterns of the contractions. Anthropometry provides a quick determination of the body proportions. The Cormic Index provides an estimation of the upper and lower body length. Several studies have investigated the relationship between the anthropometric indices and the types of childbirth. Despite the various approaches available, there is no objective means of precisely distinguishing the fact that whether labour can be successful in effecting vaginal delivery or not and diagnosis of dystocia still relies on the trial of labour.What do the results of this study add? The results of this study add to the growing body of research on the progression of labour that Cormic Index has a positive linear correlation with the frequency of contractions in acceleration phase, and with the regularity of contractions in the acceleration phase and the phase of maximum slope.What are the implications of these findings for clinical practice and/or further research? The results can help professionals to evaluate the progress of labour based on the type of uterine contractions in the latent phase or the early active phase of labour using the Cormic Index.

Circulating Salicylic Acid and Metabolic Profile after 1-Year Nutritional⁻Behavioral Intervention in Children with Obesity

Objectives and Study: Salicylic acid (SA), a phenolic compound produced by plants, may play a beneficial role on health. A pilot study showed that children with obesity had lower serum SA than normal-weight children. The aim of this trial was to evaluate the effect of a 1-year nutritional–behavioral intervention on serum SA levels and to study a possible association between SA levels and metabolic profile changes in children with obesity. Methods: This was an interventional longitudinal observational uncontrolled cohort study. Forty-nine children with obesity, aged >6 years were evaluated. BMI (body mass index) z-scores were calculated. Fasting blood samples were analyzed for lipids, insulin, and glucose. The most significant metabolic variables were calculated. Serum SA was measured using a gas chromatography–mass spectrometry method. The 1-year intervention was based on the promotion of a balanced and normocaloric diet, in accordance with the national guidelines for treatment of childhood obesity. Additionally, behavioral education, based on the revised CALO-RE (Coventry, Aberdeen, and London-REfined) taxonomy, was performed. Results: At the end of intervention, children showed an increase in serum SA levels (mean (Standard Deviation, SD) 0.06 (0.02) vs. 0.09 (0.05) µmol/L; p < 0.001), a reduction of BMI z-score (3.14 (0.79) vs. 3.02 (0.82); p < 0.001), TyG index (4.52 (0.20) vs. 4.48 (0.23); p < 0.001), AIP (atherogenic index of plasma) (0.36 (0.21) vs. 0.27 (0.25); p < 0.001), and triglycerides/HDL (high density lipoprotein) cholesterol (2.57 (1.28) vs. 2.18 (1.22); p < 0.001) ratio. No statistically significant change in HOMA-IR (homeostasis model assessment index) was observed (4.20 (3.29) vs. 4.03 (2.28)). An association between the longitudinal variation of serum SA and HOMA-IR was found (correlation coefficient: −0.338, p = 0.02). Conclusion: Nutritional–behavioral intervention may improve the circulating SA and the metabolic profile in children with obesity. Serum SA could influence mainly glucose metabolism. Further larger studies are needed to evaluate whether a nutritional intervention based on specific advice regarding the quantity and type of fruit and vegetables (FV) consumption could provide benefits in terms of metabolic syndrome.

Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment

Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be "adult" diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents.

Change in Metabolic Profile after 1-Year Nutritional-Behavioral Intervention in Obese Children

Research findings are inconsistent about improvement of specific cardio-metabolic variables after lifestyle intervention in obese children. The aim of this trial was to evaluate the effect of a 1-year intervention, based on normocaloric diet and physical activity, on body mass index (BMI), blood lipid profile, glucose metabolism and metabolic syndrome. Eighty-five obese children aged ≥6 years were analyzed. The BMI z-score was calculated. Fasting blood samples were analyzed for lipids, insulin and glucose. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated and insulin resistance was defined as HOMA-IR >3.16. HOMA-β%, quantitative insulin sensitivity check index and triglyceride glucose index were calculated. The metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. At the end of intervention children showed a reduction (mean (95% CI)) in BMI z-score (-0.58 (-0.66; -0.50)), triglycerides (-0.35 (-0.45; -0.25) mmol/L) and triglyceride glucose index (-0.29 (-0.37; -0.21)), and an increase in HDL cholesterol (0.06 (0.01; 0.11) mmol/L). Prevalence of insulin resistance declined from 51.8% to 36.5% and prevalence of metabolic syndrome from 17.1% to 4.9%. Nutritional-behavioral interventions can improve the blood lipid profile and insulin sensitivity in obese children, and possibly provide benefits in terms of metabolic syndrome.

The association between maternal dietary micronutrient intake and neonatal anthropometry - secondary analysis from the ROLO study

Background

Micronutrients are necessary for fetal growth. However increasingly pregnant women are nutritionally replete and little is known about the effect of maternal micronutrient intakes on fetal adiposity in mothers with increased BMI. The aim of this study was to examine the association of maternal dietary micronutrient intake with neonatal size and adiposity in a cohort at risk of macrosomia.

Methods

This was a cohort analysis of 554 infants from the ROLO study. Three day food diaries from each trimester were collected. Neonatal weight, length, circumferences and skinfold thicknesses were measured at birth. Multiple linear regression was used to identify associations between micronutrient intakes and neonatal anthropometry.

Results

Birthweight was negatively associated with maternal trimester 3 vitamin D intake and positively associated with trimester 3 vitamin B12 intake R2adj 19.8 % (F = 13.19, p <0.001). Birth length was positively associated with trimester 3 magnesium intake R2adj 12.9 % (F = 8.06, p <0.001). In terms of neonatal central adiposity; abdominal circumference was positively associated with maternal trimester 3 retinol intake and negatively associated with trimester 3 vitamin E and selenium intake R2adj 11.9 % (F = 2.93, p = 0.002), waist:length ratio was negatively associated with trimester 3 magnesium intake R2adj 20.1 % (F = 3.92, p <0.001) and subscapular:triceps skinfold ratio was negatively associated with trimester 1 selenium intake R2adj7.2 % (F = 2.00, p = 0.047).

Conclusions

Maternal micronutrient intake was associated with neonatal anthropometry even in women not at risk of malnutrition. Further research is necessary to determine optimal micronutrient intake in overweight and obese pregnant women.

Trial registration

Current Controlled Trials ISRCTN54392969.

Electronic supplementary material

The online version of this article (doi:10.1186/s12937-015-0095-z) contains supplementary material, which is available to authorized users.

Inflammation profile in overweight/obese adolescents in Europe: an analysis in relation to iron status

BACKGROUND/OBJECTIVES

The objectives of this study were to investigate the relationship between inflammatory parameters (CRP, c-reactive protein; AGP, α1-acid glycoprotein), iron status indicators (SF, serum ferritin; sTfR, soluble transferrin receptor) and body mass index (BMI) z-score, fat-free mass (FFM) and fat mass (FM) in European adolescents. Differences in intake for some nutrients (total iron, haem and non-haem iron, vitamin C, calcium, proteins) were assessed according to BMI categories, and the association of nutrient intakes with BMI z-score, FM and FFM was evaluated.

METHODS

A total of 876 adolescents participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross Sectional Study were included in the study sample.

RESULTS

Mean CRP values (standard error; s.e.) were significantly higher in overweight/obese adolescents (1.7±0.3 and 1.4±0.3 mg/l in boys and girls, respectively) than in thin/normal-weight adolescents (1.1±0.2 and 1.0±0.1 mg/l in boys and girls, respectively) (P<0.05). For boys, mean SF values (s.e.) were significantly higher in overweight/obese adolescents (46.9±2.7 μg/l) than in thin/normal-weight adolescents (35.7±1.7 μg/l) (P<0.001), whereas median sTfR values did not differ among BMI categories for both boys and girls. Multilevel regression analyses showed that BMI z-score and FM were significantly related to CRP and AGP (P<0.05). Dietary variables did not differ significantly among BMI categories, except for the intake of vegetable proteins, which, for boys, was higher in thin/normal-weight adolescents than in overweight/obese adolescents (P<0.05).

CONCLUSIONS

The adiposity of the European adolescents was sufficient to cause chronic inflammation but not sufficient to impair iron status and cause iron deficiency.

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.

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.

Influence of the Mediterranean diet on carotid intima-media thickness in hypercholesterolaemic children: a 12-month intervention study

BACKGROUND AND AIMS

The Mediterranean diet has been recognised as having a protective role on the cardiovascular system due to its low lipid and high antioxidant content. Lipid profile and oxidant status represent two important risk factors related to endothelial dysfunction, even at early stages of cardiovascular diseases. The aim of the study was to evaluate the influence of a 12-month Mediterranean diet on the variation of lipid profile and carotid intima-media thickness (cIMT) in pre-pubertal hypercholesterolaemic children.

METHODS AND RESULTS

We performed a cross-sectional study comparing lipid profile and cIMT in a group of 68 pre-pubertal children (36 with hypercholesterolaemia and 32 controls). In addition, in the hypercholesterolaemic children a 12-month intervention programme with a Mediterranean diet was started to evaluate the variation of lipid profile and cIMT. At baseline, hypercholesterolaemic children showed a significantly higher cIMT (both right and left carotid artery) compared to controls (both p < 0.05). After 12 months of diet intervention, a significant reduction of total cholesterol, LDL-cholesterol and cIMT was documented (all p < 0.05). Furthermore, at the end of follow-up, delta body mass index-Standard Deviation score and delta LDL-cholesterol were significantly and independently related to the changes of cIMT (both p < 0.05).

CONCLUSION

The Mediterranean diet represents a valid approach in the treatment of hypercholesterolaemia even during childhood.

Reliability and intermethod agreement for body fat assessment among two field and two laboratory methods in adolescents

To increase knowledge about reliability and intermethods agreement for body fat (BF) is of interest for assessment, interpretation, and comparison purposes. It was aimed to examine intra- and inter-rater reliability, interday variability, and degree of agreement for BF using air-displacement plethysmography (Bod-Pod), dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold measurements in European adolescents. Fifty-four adolescents (25 females) from Zaragoza and 30 (14 females) from Stockholm, aged 13-17 years participated in this study. Two trained raters in each center assessed BF with Bod-Pod, DXA, BIA, and anthropometry (DXA only in Zaragoza). Intermethod agreement and reliability were studied using a 4-way ANOVA for the same rater on the first day and two additional measurements on a second day, one each rater. Technical error of measurement (TEM) and percentage coefficient of reliability (%R) were also reported. No significant intrarater, inter-rater, or interday effect was observed for %BF for any method in either of the cities. In Zaragoza, %BF was significantly different when measured by Bod-Pod and BIA in comparison with anthropometry and DXA (all P < 0.001). The same result was observed in Stockholm (P < 0.001), except that DXA was not measured. Bod-Pod, DXA, BIA, and anthropometry are reliable for %BF repeated assessment within the same day by the same or different raters or in consecutive days by the same rater. Bod-Pod showed close agreement with BIA as did DXA with anthropometry; however, Bod-Pod and BIA presented higher values of %BF than anthropometry and DXA.

Changes in cardiometabolic risk factors, appetite-controlling hormones and cytokines after a treatment program in overweight adolescents: preliminary findings from the EVASYON study

OBJECTIVE

We investigated the effects of the EVASYON program on body fatness, cardiometabolic risk factors, gut appetite-controlling hormones and serum levels of cytokines in adolescents with overweight or obesity (OW/OB).

METHODS

This study comprised 13 boys (10 obese) and 12 girls (8 obese), aged 13-16 years, from a Madrid Hospital. The EVASYON program was based on a calorie-restricted diet (10-40%), increased physical activity (at least 60 min/day 5 days a week), psychological therapy and nutritional education for 13 months. Anthropometric and blood pressure measurements were measured before and after intervention. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, total peptide YY and insulin levels were determined before and after intervention. Serum levels of cytokines IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and TNF-α were also assessed before and after intervention.

RESULTS

A decrease in body mass index (BMI), BMI z-score, skinfolds (triceps, biceps, subscapular, thigh, and calf), sum of six skinfolds and body circumferences (arm relaxed and flexed, waist, hip, and proximal thigh) values were observed after the intervention program (all p < 0.05). In addition, diastolic blood pressure also decreased (p < 0.05). A decrease in serum leptin levels (-48.4%, p < 0.001) was observed after intervention without changes in total peptide YY and insulin levels. Levels of IL-8, IL-10, and TNF-α also decreased (all p < 0.05) after the intervention program.

CONCLUSIONS

These preliminary results evidence that the EVASYON program may improve body fat, leptin, and some pro-inflammatory cytokines in adolescents with OW/OB.

Role of nutrition in pediatric chronic liver disease

The liver plays a central role in energy and nutrient metabolism. Malnutrition is highly prevalent among patients with chronic liver disease and leads to increased morbidity and mortality rates. This review addresses the causes of malnutrition, methods used to assess nutrition status, and appropriate treatment strategies in pediatric patients with chronic liver disease.

Anthropometry of hand in sex determination of dismembered remains - A review of literature

Sex determination is an important and one of the foremost criteria in establishing the identity of an individual. Identification of dismembered/severed human remains that are frequently found in cases of mass disasters and criminal mutilation is a challenging task for the medicolegal experts. The paper presents a review of anthropometric studies conducted on hand with regard to identification of the deceased from dismembered remains. The review further discusses the anthropometric landmarks, techniques, methods, reliability and accuracy and the overall significance of hand anthropometry in personal identification. This review is an attempt to discuss the sexual dimorphism exhibited by the anthropometry of the hand that can assist forensic experts in the identification of amputated/dismembered remains.

Weight gain and insulin resistance in children treated with valproate: the influence of time

This study was undertaken in 2 parts to investigate the relationship between body size and insulin resistance during treatment with valproic acid in children. The cross-sectional part revealed differences in terms of body size and homeostasis model assessment of insulin resistance, which were higher in the group on medication. The longitudinal part showed a major increase in body size and insulin resistance during the first year of therapy. There was a subsequent decrease in insulin resistance in association with the rise of body size, however with a trend to level off. These results might be helpful to enhance the knowledge of valproic acid action on both insulin resistance and weight gain, allowing to plan appropriate approach for the prevention of the consequences of the treatment with valproic acid.

Comparação entre a adiposidade subcutânea dos hemicorpos direito e esquerdo

O objetivo deste estudo foi comparar os níveis de adiposidade subcutânea dos hemicorpos direito e esquerdo e, posteriormente, analisar o impacto dessas informações para o estudo da composição corporal. Setenta e seis indivíduos fisicamente ativos, 47 homens (21,6 ± 4,3 anos) e 29 mulheres (21,0 ± 2,6 anos), fizeram parte da amostra. As espessuras das dobras cutâneas abdominal, suprailíaca, subescapular, tricipital, bicipital, axilar média e perna medial foram mensuradas com um compasso Lange. Em valores médios absolutos, as maiores diferenças verificadas foram de 0,9mm (6,9%) e 0,8mm (6,8%), na dobra cutânea suprailíaca de homens e mulheres, respectivamente. Entretanto, nenhuma diferença estatisticamente significante foi encontrada na comparação entre os lados, em ambos os sexos, nas sete dobras cutâneas analisadas (P > 0,05). Similarmente, quando os valores medidos foram aplicados em equações preditivas para a determinação da gordura corporal relativa, de acordo com o sexo, nenhuma diferença significante foi encontrada (P > 0,05). Os resultados sugerem que fatores como o erro técnico de medida do avaliador, o tipo de compasso e a escolha da equação preditiva a ser utilizada, provavelmente tenham maior impacto para a estimativa da composição corporal pelo método de espessura de dobras cutâneas do que o lado a ser adotado como referência para a obtenção das medidas.

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study

Background

The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity).

Methods/Design

The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1^st to 9^th visits), and extensive during the last 11 months (10^th to 20^th visits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined.

Discussion

The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service.

Insulin sensitivity in prepubertal Caucasian normal weight children

BACKGROUND

Determining whether or not a child is insulin resistant is becoming a matter of fundamental interest even in childhood, as the incidence of metabolic complications of insulin resistance is rising. Thus reference values are needed.

AIM

To set percentiles for HOMA-IR and WBISI in Caucasian normal weight prepubertal children.

POPULATION

238 normal weight prepubertal Caucasian children (126 males/112 females).

METHODS

After physical examination including anthropometric measurements all children underwent an oral glucose tolerance test from which HOMA-IR and WBISI were calculated.

RESULTS

HOMA-IR values above the 95th percentile (2.03) and WBISI values below the 5th percentile (5.67) represent the cut-off values for the determination of insulin resistance.

CONCLUSION

These reference values are useful to easily detect insulin resistance within the prepubertal Caucasian population representing a helpful tool for clinicians to target such children in order to improve insulin sensitivity.

Truncal and abdominal fat as determinants of high triglycerides and low HDL-cholesterol in adolescents

We examined whether abdominal and truncal adiposity, assessed with simple anthropometric indices, determines serum triglycerides and high-density lipoprotein (HDL)-cholesterol levels independently of total adiposity amount in adolescents. A total of 547 Spanish adolescents (284 males and 263 females) aged 13-18.5 years were included in this study. Measures of truncal adiposity included subscapular to triceps ratio, and trunk-to-total skinfolds ratio (TTS%). Waist circumference was used as a surrogate of abdominal adiposity, and BMI was used as a measure of total adiposity. The results of the regression models indicated that levels of triglycerides were positively associated with waist circumference and TTS% after controlling for age and Tanner stage in both sexes. Once BMI was entered in the model, these associations remained significant for waist circumference in females. HDL-cholesterol levels were negatively associated with waist circumference in both sexes, and with subscapular to triceps ratio and TTS% in males, after controlling for age and Tanner stage. Once BMI was entered in the model, these associations remained significant for subscapular to triceps ratio and for TTS% in males. The results of this study suggest that in male adolescents, truncal adiposity is negatively associated with levels of HDL-cholesterol, whereas in females, abdominal adiposity is positively associated with levels of triglycerides independently of total adiposity. These findings highlight the deleterious effect of both truncal and abdominal fat depots on the lipid profile already from the first decades of life.

Small birth weight and later body composition and fat distribution in adolescents: the Avena study

OBJECTIVE

To assess the association between birth weight and body composition and fat distribution in adolescents, and to test the possible sex-specific effect in these relationships.

METHODS AND PROCEDURES

A total of 1,223 adolescents 13-18.5 years old (553 male adolescents and 670 female adolescents) born at >35 weeks, were selected from a cross-sectional multicenter study conducted in five Spanish cities in 2000-2002. BMI was calculated from weight and height. Triceps and subscapular skinfold thickness (ST) were measured on the left side, and fat mass (FM) and fat-free mass (FFM) were estimated according to the equations of Slaughter et al. Subscapular skinfold adjusted by tricipital (ST) and waist circumference were used as markers of central adiposity.

RESULTS

Birth weight Z-score was positively associated with FFM in female adolescents (P<0.001), but not in male adolescents, after controlling for age, pubertal stage, gestational age, socioeconomic status, physical activity, and current height (P<0.001 for interaction between adjusted birth weight Z-score and sex). Adjusted birth weight Z-score was inversely associated with central adiposity in male and female adolescents as measured by ST (P=0.026).

DISCUSSION

These results provide further evidence that gender has an important influence on the programming effect of birth weight on later FFM in adolescents because the effect was only observed in female adolescents. Our results suggest that small size for gestational age at birth could program more central subcutaneous fat deposition in adolescents of both sexes, but further research is needed on this issue.

Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children

Obesity in children appears to be associated with increased risk of cardiovascular and metabolic diseases later in life. Early development of insulin resistance and impaired oxidant-antioxidant status may lead to endothelial dysfunction and increased carotid intima media thickness (IMT) even in childhood. The aim of this study was to measure IMT and the relationship between IMT, insulin resistance and oxidant status in obese pre-pubertal children. In 53 obese pre-pubertal children (27M/26F, mean age 8+/-2 years), anthropometric measurements and inflammatory markers (hs-CRP and PGF-2 alpha), were evaluated compared with 41 healthy pre-pubertal subjects (21M/20F, mean age 7+/-2 years). OGTT was performed and insulin resistance (IR) indices (HOMA-IR, WBISI, G/I and QUICKI) were calculated in all patients. High-resolution ultrasound techniques were used to evaluate IMT. Obese children had higher levels of PGF-2 alpha and hs-CRP compared to healthy subjects (p=0.001 and p=0.005). Furthermore, fasting insulin levels and HOMA-IR were higher in obese children than in controls (p=0.001 and p=0.001) while WBISI was significantly lower (p=0.002). In addition, obeses had an increased IMT (p=0.001). In obese children there was a significant correlation between IMT and indices of IR (HOMA-IR: beta=-1.233, p=0.002; WBISI: beta=-0.921, p=0.008; G/I: beta=-0.811, p=0.003) and between IMT and PGF-2 alpha (beta=0.505, p=0.004). After categorizing subjects according to tertiles of body mass index (BMI) (<or=21.42, 21.42-26.23 and >or=26.23 kg/m(2)) and to waist circumference (WC) (<or=68.28, 68.28-79.04 and >or=79.04 cm), no influence of BMI or WC on IMT were found in the three groups. In conclusion, early changes in glucose metabolism and an alteration of oxidant-antioxidant status may be present in obese pre-pubertal children; this could lead to increase IMT and early cardiovascular disease.

Effect of the Ala12 allele in the PPARgamma-2 gene on the relationship between birth weight and body composition in adolescents: the AVENA study

The intent of this study was to assess whether the effect of birth weight on later body composition is modified by Pro12Pro, Pro12Ala, and Ala12Ala genotypes of the peroxisome proliferator-activated receptor gamma-2 (PPARgamma-2) gene. The PPARgamma-2 gene polymorphism was genotyped in 273 adolescents aged 13-18.5 y, born at term and whose birth weight was known. They were selected from a cross-sectional multicenter study conducted in five Spanish cities in 2000-2002. Body mass index (BMI) was calculated from weight and height measurements, and body composition and fat distribution were estimated from skinfold thickness. A total of 229 subjects (111 males and 118 females) carried the Pro12Pro genotype and 44 (22 males and 22 females) the Pro12Ala and Ala12Ala PPARgamma-2 genotypes. In the Pro12Pro group, birth weight Z score was positively associated with both fat-free mass (FFM) (p < 0.05) and fat mass (FM) (p < 0.05), but these relationships disappeared after controlling for age, gestational age, socioeconomic status (SES), physical activity, Tanner stage, sex, and BMI. In the Ala12 group, birth weight Z score was positively associated with FFM (p < 0.01), and this relationship remained significant after controlling for confounding variables (p < 0.05). Small body weight at birth may program lower FFM in adolescents carrying the Ala12 allele in the PPARgamma-2 gene.

Body fat distribution reference standards in Spanish adolescents: the AVENA Study

OBJECTIVE

To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body.

DESIGN

Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years.

SUBJECTS

A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females).

MEASUREMENTS

Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences.

RESULTS

In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established.

CONCLUSION

These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.

Developmental changes in adiposity in toddlers and preschoolers in the GENESIS study and associations with the ACE I/D polymorphism

OBJECTIVES

To investigate the relationship between the angiotensin I-converting enzyme 1 (ACE) I/D polymorphism and adiposity-related phenotypes in a large cohort of toddlers and preschoolers.

METHODS

Body composition measurements and DNA samples were obtained from 2102 Greek children aged 1-6 years, as part of a large-scale epidemiological study (GENESIS). All children were genotyped for the ACE I/D polymorphism and gender- and age-stratified statistical analyses were performed.

RESULTS

In girls aged 4-6 years, the D-allele was associated with higher measurements of body mass index (BMI) (P=0.018), waist (P=0.001) and upper arm (P=0.013) circumferences, genotype accounting for 2.5, 4 and 3% of the phenotypic variance, respectively. In boys, the D-allele showed strong associations with lower BMI (P=0.001) at the age of 1-2 years that explained 17% of the phenotypic variance and with larger suprailiac skinfold (P=0.008) at 3-4 years old that explained 2% of the variance. No other significant associations between the ACE I/D polymorphism and adiposity-related phenotypes were found. In girls, the age at which significant associations were revealed coincided with the age at which BMI was observed to increase after its developmental nadir, but this feature of the association was not observed in boys.

CONCLUSIONS

The ACE I/D polymorphism is associated with developmental and physiological changes in adiposity-related traits during early childhood in a gender- and age-specific manner.

Assessment of total body fat using the skinfold technique in full-term and preterm infants

BACKGROUND

Assessment of body composition may be of interest when the nutritional status of infants is evaluated but is often difficult since simple and valid methods are lacking. With appropriate validation, measurements based on skinfold thickness (SFT) may be useful for this purpose.

AIMS

To evaluate the potential of a published method, based on measurements of SFT, to assess total body fat (TBF) of infants; and to calculate the fat content of adipose tissue (AT) in infants using previously published information regarding AT volume and total body water.

SUBJECTS AND METHODS

Forty-five full-term infants and eight infants born in gestational weeks 31-33 were studied at a postnatal age of 4-131 and 44-75 d, respectively. The body water dilution method was used to obtain reference estimates of TBF (TBF-BWD).

RESULTS

In full-term infants, TBF assessed using the skinfold method (TBF-SFT) minus TBF-BWD was 1.5+/-10.8% (mean+/-2 SD). Furthermore, TBF-SFT minus TBF-BWD (%, y) was correlated (p<0.0001) with the average of TBF-SFT and TBF-BWD (%, x), showing that TBF-SFT was too high in lean infants and too low in infants with more TBF. In the full-term infants, AT contained 0.68+/-0.14 g fat/ml. In the premature infants, TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures in nine full-term newborns.

CONCLUSION

The results indicate that the SFT method produced inaccurate and biased estimates of TBF in infants. A considerable variation between infants regarding their AT fat content may be an important reason for these findings.

Early programming of body composition and fat distribution in adolescents

Size at birth and early postnatal growth are determinants of adult height and BMI. The aim of this study was to evaluate the effect of birth weight on body composition and fat distribution in a group of Spanish adolescents. Current body composition was assessed by both skinfold thickness and dual X-ray absorptiometry in 234 adolescents born at term (140 girls and 94 boys), now aged 13-18 y and living in the city of Zaragoza. Relative fat distribution was estimated using the ratio of the subscapular to triceps skinfolds (S:T). Birth weight and gestational age were assessed by a questionnaire. Birth weight was inversely associated with the S:T ratio (P < 0.05) in boys and directly associated with bone mass (P < 0.01) and fat-free mass (P < 0.05) in girls. This association was independent of factors such as age, Tanner stage, gestational age, socioeconomic status, physical activity, and height. In conclusion, our data support the hypothesis that impaired fetal growth, measured by birth weight, may be related to central fat distribution in boys and decreased bone and fat-free mass in girls.

Anthropometric body fat composition reference values in Spanish adolescents. The AVENA Study

OBJECTIVE

To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents).

DESIGN

Multicentre cross-sectional study.

SETTING

Representative sample of Spanish adolescents.

SUBJECTS

The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females).

INTERVENTIONS

Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al.

RESULTS

Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females.

CONCLUSIONS

The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts.

SPONSORSHIP

The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry

OBJECTIVE

To compare the most commonly used equations to predict body fatness from skinfold thickness, in male and female adolescents, with dual-energy X-ray absorptiometry (DXA) as a reference method of fatness measurement.

DESIGN

Cross-sectional nutrition survey.

SETTING

General adolescent population from Zaragoza (Spain).

SUBJECTS AND METHODS

A total of 238 Caucasian adolescents (167 females and 113 males), aged 13.0-17.9 y, were recruited from 15 school groups in 11 public and private schools. The percentage fat mass (%FM) was calculated by using skinfold-thickness equations. Predicted %FM was compared with the reference %FM values, measured by DXA. The lack of agreement between methods was assessed by calculating the bias and its 95% limits of agreement.

RESULTS

Most equations did not demonstrate good agreement compared with DXA. However, in male adolescents, Slaughter et al equations showed relative biases that were not dependent on body fatness and the limits of agreement were narrower than those obtained from the rest of equations. In females, Brook's equation showed nonsignificant differences against DXA and the narrowest 95% limits of agreement. Only biases from Brook and Slaughter et al equations were not dependent on body fatness in female adolescents.

CONCLUSIONS

Accuracy of most of the skinfold-thickness equations for assessment of %FM in adolescents was poor at the individual level. Nevertheless, to predict %FM when a relative index of fatness is required in field or clinical studies, Slaughter et al equations may be used in adolescents from both sexes and the Brook equation in female adolescents.

Overweight, obesity and body fat composition in spanish adolescents. The AVENA Study

OBJECTIVE

To describe the prevalence of overweight and obesity in the Spanish adolescent population and its relationship with the socioeconomic status, and to assess their body fat composition and compare these results with previous data from our own country.

DESIGN

Cross-sectional multicenter study conducted in five Spanish cities (Granada, Madrid, Murcia, Santander and Zaragoza) in 2000-2002.

SUBJECTS

2,320 adolescents with complete set of anthropometric measurements, 1,192 boys and 1,128 girls.

MEASUREMENTS

Body mass index calculated from weight and height measurements, and body fat percentage calculated from skinfold thickness measurements.

RESULTS

Overweight + obesity prevalences were 25.69 and 19.13% in boys and girls, respectively. Overweight + obesity prevalence increased in boys from high to medium-low socioeconomic status categories (p = 0.015); meanwhile, there was not a significant effect of socioeconomic status in girls. In males, overweight + obesity prevalence changed from 1985 to 2000-2002 from 13 to 35% and in females from 16 to 32%. The rate of change in overweight + obesity prevalences seems to increase in the last years; from 0.88 (1985 to 1995) to 2.33%/year (1995 to 2000-2002) in males and from 0.5 (1985 to 1995) to 1.83%/year (1995 to 2000-2002) in females. The rate of body fat percentage increase was similar between 1980 and 1995 and between 1995 and 2000-2002: 0.26 and 0.23%/year, respectively, at 13 years of age, and 0.16 and 0.17%/year, respectively, at 14 years of age.

CONCLUSION

We observed elevated overweight and obesity prevalences in Spanish adolescents, similar to those observed in other European countries. There is a significant inverse relationship between socioeconomic status and overweight + obesity, but only in boys. The rate of change in overweight prevalence in Spanish adolescents seems to increase, and the rate of increase of body fat percentage seems to be similar as in previous years.

Assessment of body fatness in young children using the skinfold technique and BMI vs body water dilution

OBJECTIVES

To compare body fatness estimated using a skinfold technique and body mass index (BMI) with body fatness estimated using the body water dilution method in healthy Swedish children 9 or 14 months of age.

METHODS

Total body fat (TBF) was calculated from total body water, estimated using the doubly labelled water method, and body weight. When expressed in per cent of body weight, these estimates (%TBF-BWD) represented reference values for body fatness. Body fatness was also calculated from skinfold thickness (%TBF-SFT) and as BMI. The children were ranked and grouped into five groups with an increasing level of body fatness using BMI, %TBF-SFT and %TBF-BWD, respectively.

SUBJECTS

A total of 30 infants 9 months of age and 29 children 14 months of age.

RESULTS

On average, the children (n=59) had a BMI=17.5+/-1.6 kg/m(2) and contained 27.8+/-3.7 %TBF-SFT and 29.1+/-4.4 %TBF-BWD. %TBF-BWD minus %TBF-SFT was=1.35+/-4.06%. By measuring %TBF-SFT or BMI, about 35% of the children could be classified in the correct group with respect to body fatness. Serious misclassification (ie two or more groups too high or too low) was, however, more common for %TBF-SFT (29%) than for BMI (17%).

CONCLUSIONS

The capacity of BMI to place children in the correct body fatness group was poor although not quite as poor as the corresponding capacity of the skinfold technique. The latter method produced inaccurate and imprecise estimates of body fatness.