Foot-to-foot bioelectrical impedance analysis: a valuable tool for the measurement of body composition in children

Assessment of the Diagnostic Performance of MUAC in Malnutrition Screening and Its Correlation with Other Anthropometric Indicators in Healthy Children and Adolescents

BACKGROUND/OBJECTIVES

This study aimed to evaluate the correlation of mid-upper arm circumference (MUAC) z-scores with body mass index (BMI) and weight-for-height (WFH) z-scores to determine its reliability in identifying malnutrition and its potential in clinical practice in healthy children and adolescents.

METHODS

Our study included 906 healthy children and adolescents aged between 2 months and 18 years who were admitted to University Hospital's General Pediatrics Clinic and attended 12 primary schools in 6 additional Izmir provinces. Anthropometric measurements (weight, length/standing height, MUAC, BMI, WFH) were performed. The relationship between MUAC z-scores, BMI, and WFH z-scores of cases with malnutrition were evaluated.

RESULTS

According to the WHO BMI z-score classification, 6 (0.7%) of the children were defined as having severe undernutrition, 43 (4.7%) as moderate undernutrition, 146 (16.1%) as mild undernutrition, 486 (53.6%) as normal, 142 (15.7%) as overweight, and 83 (9.2%) as obese. At any age over two years, fair agreement was observed between MUAC z-scores and WHO BMI z-scores in defining malnutrition alone compared to other growth measures (weighted kappa = 0.371). Under two years of age, the correlation between MUAC z-scores and BMI z-scores showed moderate agreement in detecting overweight and obesity (weighted kappa = 0.479), and between MUAC and WHO WFH z-scores showed moderate agreement (kappa = 0.252).

CONCLUSIONS

The study found a moderate and fair connection between MUAC z-scores and other criteria. However, further MUAC z-score screening and diagnostic power testing in larger pediatric populations are needed to validate its use alongside other key anthropometric indicators in malnutrition diagnosis. MUAC measurement should be popularized in routine pediatric outpatient clinics to detect malnutrition quickly.

Effects of an 8-Week Active Play Intervention on Body Composition and Fundamental Motor Skills in Preschool Children

Objective: Examine the effect of an 8-week teacher-guided active play intervention on preschoolers' body composition and fundamental motor skills. Methods: Participants were from two local preschool centers randomly assigned to either the intervention (n = 25, 3.91 ± 0.53 years) or the control group (n = 25, 3.69 ± 0.81 years). All measures were assessed at baseline (week 0), post-intervention (weeks 9-11), and follow-up (weeks 30-33). Bioelectrical Impedance assessed body composition (fat mass (FM) and fat-free mass (FFM)). The Peabody Developmental Motor Scales, Second Edition (PDMS-2) assessed fundamental motor skills (gross motor quartile (GMQ)). Results: A significant Group × Time interaction for GMQ at post-intervention (p = 0.03), with the intervention group scoring significantly higher on GMQ. A significant main effect of Time (p < 0.001) indicated that GMQ increased in both groups across the 33-week period. For FM, a significant main effect of Time at both post-intervention (p < 0.05) and follow-up testing (p < 0.001) indicated that participants increased FM over the 33-week period. Lastly, there was a significant main effect of Time for FFM at post-intervention (p = 0.003) and follow-up (p < 0.001). Interestingly, there was a significant Group × Time interaction (p < 0.05) at follow-up testing showing that FFM increased over time but significantly more for the control group. Conclusions: Results indicate that active play interventions might be a successful pathway to improve gross motor skills in young children. Further research is needed to understand the effect that active play interventions have on body composition in preschoolers.

First body fat reference curves for Macedonian children and adolescents: the MAKFIT study

Introduction

Introduction: childhood obesity is a worldwide chief health problem. Along with body mass index, body fat percentile values can also be used to predict future cardiovascular and metabolic health risks. Objective: the study's aim is to define the percentile values and curves about the fat tissue percentage through which the childhood and adolescent overweight/obesity in the Republic of North Macedonia will be diagnosed. Methods: the research was conducted on a sample of 15,075 children and adolescents aged six to 14 years (7,627 boys and 7,448 girls). Body fat percentage was established by bioelectrical impedance. The LMS method was used in percentile values and curves' construction. Results: the boys' 50th percentile curve shows that the body fat percentage average value has a slight growth from seven to ten years of age, but after their 10th it begins to drop continuously until the age of 14 years. At the same time, the girls' body fat percentage average value increases continuously from six to 14 years of age. Conclusion: since body mass index cannot always establish body fat content, the direct assessment of body fat by bioelectrical impedance would be of great advantage for pediatric and clinical decisions. Therefore, the study provides referent percentile norms for the body fat percentage of healthy Macedonian children and adolescents. For this purpose, a practical and clinically applicable method was used. The obtained referent percentile norms can be useful in assessing overweight and obesity in Macedonian children and adolescents.

Effects of a 10-Week Integrated Curriculum Intervention on Physical Activity, Resting Blood Pressure, Motor Skills, and Well-Being in 6- to 7-Year-Olds

BACKGROUND

Integrated curriculum interventions have been suggested as an effective means to increase physical activity (PA) and health. The feasibility of such approaches in children living in deprivation is unknown. This study sought to pilot an integrated curriculum pedometer intervention in children living in deprivation on school-based PA, body fatness, resting blood pressure, motor skills, and well-being.

METHODS

Using a pilot cluster randomized intervention design, children (6-7 y old, n = 64) from 2 schools in central England undertook: (1) 10-week integrated curriculum intervention or (2) control (regular school-based activity). School-based PA, body fatness, resting blood pressure, motor skills, and well-being were assessed preintervention and postintervention.

RESULTS

For the intervention group, PA was higher on school days when children had physical education lessons or there were physically active integrated curriculum activities. Body fatness significantly decreased, and well-being and perceived physical competence increased, pre-post for the intervention group compared with the control group. Accelerometer-derived PA, motor skills, and resting blood pressure were not significantly different pre-post for intervention or control groups.

CONCLUSIONS

A 10-week integrated curriculum PA intervention is feasible to conduct and can positively impact aspects of health in 6- to 7-year-old children in England.

Association between Urinary Sodium Excretion and Body Fat in School-Aged Children: Insights from the ARIA Study

Childhood obesity has been associated with increased sodium intake. Nonetheless, evidence linking sodium intake to Body Mass Index (BMI) and Body Fat Mass Percentage (%BF) remains limited, especially in the pediatric age group. Therefore, this study aims to investigate whether there is an association between 24 h urinary sodium excretion with BMI and %BF in a sample group of children from the ARIA study. This cross-sectional analysis included 303 children aged 7 to 12 from across 20 public schools in Porto, Portugal. Weight and %BF were assessed using the Tanita™ BC-418 Segmental Body Analyzer. Children's Total Energy Intake (TEI) was estimated through a single 24 h Recall Questionnaire, and urinary sodium and potassium excretion was estimated by a 24 h urine collection. The association of %BF and BMI with 24 h sodium excretion was estimated by a binary logistic regression adjusted for sex, age, physical activity, total energy intake, parental education, and 24 h urinary excreted potassium. There was a significant positive association between higher levels of urinary sodium excretion and higher %BF values, even after adjusting for confounders. However, the same was not observed for BMI. Our findings suggest that higher sodium intake is associated with higher values of %BF among children, regardless of TEI and potassium intake.

A comparative study on the reliability and validity of body composition results by impedance method measurement device

The purpose of this study was to analyze the reliability and validity of the body composition results for each impedance device and use them as primary data for body composition research. Total of 58 participants, including 24 men and 34 women, were recruited. The correlation was analyzed by measuring two repetitive measurements for each device. Dual energy x-ray absorptiometry (DEXA) equipment was used as reference equipment for body composition research. All data were analyzed as IBM SPSS Statistics ver. 25.0, and the validity and reliability were estimated by calculating the timely correlation coefficient. As a result of the study, repeated measurements of the measuring instrument showed high reliability by gender and age, especially in the child age group, with relatively higher reliability than those in their 50s or older. In the validity analysis between DEXA, in the case of the male group, the validity of the fat mass amount was relatively higher than the body fat amount and body fat rate. In the case of the women's group, the validity of the body fat amount and body fat rate was relatively higher than that of the fat mass amount. The company B had the highest validity for body fat rate and body fat amount in both men and women. However, the validity for men's fat mass amount was the lowest. In subsequent studies, it is believed that studies that have expanded the population further and studies targeting special groups such as athletes should be conducted.

Measurement of body composition by DXA, BIA, Leg-to-leg BIA and near-infrared spectroscopy in breast cancer patients - comparison of the four methods

BACKGROUND & AIMS

Body composition plays a crucial role in therapy adherence and the prognosis of cancer patients. The aim of this work was to compare four measurement methods for determining body composition regarding their validity, reliability and practicability in order to be able to draft a practical recommendation as to which method is most suitable as a standard measurement method in oncology.

METHODS

Fat mass (FM) and fat-free mass (FFM) was estimated for 100 breast cancer patients with ages of 18-70 years during a defined 20-week inpatient and outpatient rehabilitation process after primary therapy or follow-up rehabilitation. The four methods used were dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), leg-to-leg BIA and near-infrared spectroscopy (NIRS). At baseline (t0) and after 20 weeks (t20) the agreement between the four body composition analysis methods was quantified by pairwise method comparisons using Bland-Altman bias and limits of agreement estimates, t-tests and Lin's concordance correlation coefficients (CCCs).

RESULTS

CCCs and Bland-Altman plots indicated that DXA and BIA, DXA and NIRS as well as BIA and NIRS showed an excellent agreement concerning FM estimation at both time points (CCC>0.9). In contrast, no methods agreed with a CCC higher than 0.9 with respect to FFM estimation. However, most estimates were also significantly different between two methods, except for BIA and NIRS which yielded comparable FFM and FM estimates at both time points, albeit with large 95% limits of agreement intervals. The agreement between DXA and BIA was best in the lowest BMI tertile and worsened as BMI increased. Significant differences were also found for FFM changes measured with DXA versus BIA (mean difference -0.4 kg, p = 0.0049), DXA versus to Leg-to-leg BIA (-0.6 kg, p = 0.00073) and for FM changes measured with DXA versus Leg-to-leg BIA (0.5 kg, p = 0.0011).

CONCLUSIONS

For accurate and valid body composition estimates, Leg-to-leg BIA cannot be recommended due to its significant underestimation of FM or significant overestimation of FFM, respectively. BIA and NIRS results showed good agreement with the gold standard DXA. Therefore both measurement methods appear to be very well suitable to assess body composition of oncological patients and should be used more frequently on a routine basis to monitor the body composition of breast cancer patients.

Sociodemographic and Socioeconomic Factors Influencing the Body Mass Composition of School-Age Children

The purpose of the study was to evaluate the components of overweight, obesity, and body mass components among children aged 7 to 13 years against important sociodemographic factors. The analyses considered 315 school-age children from 7 to 13 years of age (164 boys and 151 girls). Each subject was assessed for body weight and height, body weight category, and main sociodemographic factors. Body mass components of body mass (body-fat percentage (BFP), muscle tissue, fat-free mass (FFM), and total body water (TBW) levels) were evaluated using the electrical bioimpedance method (BIA) and the TANITA 780 MC analyzer. A statistical analysis showed significant differences between the body composition of children living in cities in relation to children living in small towns and villages, and no significant differences were found between the results of children living in small towns and children living in villages. The presence of statistically significant differences between the values of the parameters of body composition of the studied children was demonstrated depending on the level of education of their fathers. The presence of statistically significant relationships between BMI of mothers and BFP of their children (p = 0.003), FFM (p = 0.003), muscle tissue (p = 0.001), and TBW (p = 0.001) has been demonstrated. The higher content of adipose tissue in children is strongly dependent on the higher BMI and body mass category of the mother, as well as the lower level of education of the father. The place of residence also significantly affects both the body fat content and the total body water content of body hydration. Living in the city is associated with better body composition.

Determinants and Predictors of Body Fat in Indian Children and Adolescents

OBJECTIVE

To study determinants and predictors of body fat in Indian children and adolescents.

METHODS

In this cross-sectional study, 5175 children and adolescents [3014 boys, age 12.8 (3) y, 5-18 y] participated. Determinants and predictors of body fat were assessed using partial correlation (corrected for age, and gender) and linear regression.

RESULTS

Fat percentage correlated negatively with the duration of physical activity (r = -0.091, p < 0.01) and sleep (r = -0.044, p = 0.01) and positively with parental body mass index (BMI) (r = 0.202, p < 0.01 for father and r = 0.235, p < 0.01 for mother), and birth weight (r = 0.050, p < 0.01). On linear regression, fat percentage was positively associated with parental BMI and birth weight, and negatively with physical activity and sleep duration. All adiposity markers [BMI standard deviation score (SDS) (r = 0.863, p < 0.01), weight SDS (r = 0.827, p < 0.01) waist to height ratio (r = 0.819, p < 0.01), waist circumference SDS (r = 0.765, p < 0.01) wrist circumference (r = 0.21, p < 0.01), and neck circumference (r = 0.19, p < 0.01)] correlated significantly with fat percentage, showing highest correlation with BMI SDS.

CONCLUSION

Reduced sleep and physical activity are the key modifiable risk factors for adiposity. BMI SDS is the best clinical surrogate of body fat in Indian children and adolescents. There is a need to explore the impact of lifestyle interventions targeting sleep and physical activity on adiposity.

Prenatal exposure to insecticides and child cardiometabolic risk factors in the VHEMBE birth cohort

As part of malaria control programs, many countries spray dichlorodiphenyltrichloroethane (DDT) or pyrethroid insecticides inside dwellings in a practice called indoor residual spraying that results in high levels of exposure to local populations. Gestational exposure to these endocrine- and metabolism-disrupting chemicals may influence child cardiometabolic health.

NCS Assessments of the Motor, Sensory, and Physical Health Domains

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.

Associations between body composition and fundamental motor skill competency in children

Background

Evidence supports an inverse relationship between weight status and motor competence, but most work utilizes body mass index as the proxy for weight status. Body mass index fails to account for essential components of body composition, which may be critical for motor performance. The purpose of this investigation was to examine the relationship between fundamental motor skills competency and body composition (i.e., fat mass, fat percentage, and fatfree mass) as measured by bio-electrical impedance analysis and body mass index in children.

Methods

Two hundred forty-four children from the Southeastern portion of the United States participated in this project (6.05 ± 2.01 years, 53.3% male). Fundamental motor skills were measured using the Test of Gross Motor Development – 2nd edition and body composition was assessed with the Tanita SC-331S Body Composition Analyzer (bio-electrical impedance analysis). Body mass index was calculated using CDC normative growth charts.

Results

Bio-electrical impedance analysis measures accounted for 23.1%, F(3, 241) = 24.10, p < .001 and 2.7%, F(3, 241) = 2.22, p = .086 variance in locomotor and object control subscales, respectively; body mass index accounted for 8.4% (locomotor) and 0.1% (object control) variance. For the Test of Gross Motor Development -2nd edition total score, bio-electrical impedance analysis measures accounted for 24.4% F(3, 241) = 25.90, p < .001 compared to body mass index which accounted for 7.9% F(1, 244) = 20.86, p < .001 of the variance. Only fat free mass (p < .001) was a significant predictor for locomotor skills and total models for the Test of Gross Motor Development – 2nd edition; BMI was also a significant predictor (p < .001) in both the locomotor and total models.

Conclusions

Different components of body composition (i.e., fat free mass) were associated with different aspects of fundamental motor skills competency. Excess body fat may be a morphological constraint to proficient locomotor performance when transporting the body through space. In contrast, body composition did not significantly predict object manipulation performance. More work is needed to understand the causality and directionality of this relationship; however, bio-electrical impedance analysis accounts for more variance in fundamental motor skills performance than body mass index in a field-based setting.

Bioelectrical impedance analysis for assessment of body composition in infants and young children-A systematic literature review

Bioelectrical impedance analysis (BIA) is an easy to use, portable tool, but the accuracy of the technique in infants and young children (<24 months) remains unclear. A systematic literature review was conducted to identify studies that have developed and validated BIA equations in this age group. MEDLINE, Scopus, EMBASE, and CENTRAL were searched for relevant literature published up until June 30, 2020, using terms related to bioelectrical impedance, body composition, and paediatrics. Two reviewers independently screened studies for eligibility, resulting in 15 studies that had developed and/or validated equations. Forty-six equations were developed and 34 validations were conducted. Most equations were developed in young infants (≤6 months), whereas only seven were developed among older infants and children (6-24 months). Most studies were identified as having a high risk of bias, and only a few included predominantly healthy children born at term. Using the best available evidence, BIA appears to predict body composition at least as well as other body composition tools; however, among younger infants BIA may provide little benefit over anthropometry-based prediction equations. Currently, none of the available equations can be recommended for use in research or in clinical practice.

Prevalence of Overweight, Obesity, Abdominal Obesity, and Obesity-Related Risk Factors in Polish Preschool Children: A Cross-Sectional Study

The aim of this study was to assess the prevalence of overweight, obesity, abdominal obesity (AO), and obesity-related risk factors in children aged 5–6 years from Poland. The study was conducted at 22 randomly selected kindergartens representing each city district. A cross-sectional study of 1172 children aged 5–6 years was conducted using questionnaire forms and physical measurements. The physical measurements included body height, weight, waist circumference (WC), and body fat percentage (BFP). A univariate and multivariate logistic regressions were performed to evaluate the risk factors for excess weight, excess adiposity, and abdominal obesity (AO). The prevalence of excess weight (BMI ≥ 85th percentile) was 11.0%. The prevalence of excess adiposity (BFP ≥ 85th percentile) was 42.3%. Prevalence of AO (WC ≥ 90th percentile) was higher in girls compared to boys (14.9% vs. 10.7%, respectively). Multivariate logistic regression analysis indicated that children whose both parents were obese had significantly higher risk of excess weight, excess adiposity, and AO. Lower education level of fathers was associated with higher risk of excess weight and excess adiposity in children, while a lower level of maternal education was associated with higher risk of AO in children. Screen time over 120 min per day, participating less than once a week in at least 60 min of moderate-to-vigorous physical activity (MVPA) and birth weight over 4000 g were associated with excess weight, excess adiposity and AO. Moreover, cesarean delivery was associated with higher risk of excess weight and excess adiposity, and lower socio-economic status with higher risk of AO. This study revealed that excess adiposity and AO differed by gender. Parental obesity, screen time, MVPA, and birth weight could be significant determinants of excess weight, excess adiposity and AO in Polish preschool children.

The association of actigraphic sleep measures and physical activity with excess weight and adiposity in kindergarteners

Insufficient sleep duration and physical activity (PA) are known risk factors for overweight and obesity in children; however, there are no studies on comprehensive associations of objectively-measured sleep parameters and PA with excess weight and excess adiposity in kindergarteners. Therefore, the aim of this study was to determine the associations between objectively measured sleep parameters and PA with excess weight and excess adiposity, defined as BMI ≥ 85th percentile and body fat percentage (BFP) ≥ 85th percentile, respectively. Sleep parameters and PA were measured in 676 subjects aged 5–6 years using accelerometers for 7 days, worn at the participant’s hip. Bioelectrical impedance analysis was used to estimate BFP. In the total sample, lower sleep duration, sleep efficiency, vigorous PA and the number of steps per day were associated with excess weight. However, excess adiposity was associated with lower sleep duration, total PA, vigorous PA, moderate-to-vigorous physical activity (MVPA) and the number of steps per day. Logistic regression by the stepwise progressive method showed that the strongest predictor of excess adiposity in boys and girls was vigorous PA, while the strongest predictor of excess weight in boys was sleep efficiency. A holistic approach to health targeting all of these factors synergistically is needed to optimize the effectiveness of obesity prevention and treatment interventions.

Association between objectively measured body composition, sleep parameters and physical activity in preschool children: a cross-sectional study

OBJECTIVE

Associations between self-reported sleep duration and obesity indices in children are well recognised; however, there are no studies on associations between objectively measured other sleep parameters and physical activity with body composition in preschoolers. Therefore, the aim of this study was to determine the associations between sleep parameters and moderate-to-vigorous physical activity (MVPA) with body composition indices in preschoolers using objective measures.

DESIGN

A cross-sectional study.

PARTICIPANTS

The study group consisted of 676 children aged 5-6 years, who were enrolled in kindergartens in the 2017/2018 school year.

OUTCOME MEASURES

Sleep parameters and MVPA were measured using accelerometers for 7 days. Bioelectrical impedance analysis was used to estimate body composition.

RESULTS

Sleep duration and sleep efficiency were inversely associated with body fat percentage (BFP) (β=-0.013 and β from -0.311 to -0.359, respectively) and body mass index (BMI) (β from -0.005 to -0.006 and from -0.105 to -0.121, respectively), and directly associated with fat-free mass (FFM) (β from 0.010 to 0.011 and from 0.245 to 0.271, respectively) and muscle mass (β from 0.012 to 0.012 and from 0.277 to 0.307, respectively) in unadjusted and adjusted models. BFP was inversely associated with MVPA and positively associated with number of awakenings and sleep periods. Number of sleep periods was inversely associated with FFM, and positively with BMI and muscle mass. Correlation matrix indicated significant correlation between BFP, FFM and muscle mass with sleep duration, sleep efficiency, number of sleep periods and MVPA.

CONCLUSIONS

Periodic assessment of sleep parameters and MVPA in relation to body composition in preschool children may be considered, especially in those who are at risk for obesity.

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China

Objectives:

To determine which set of BMI cut-offs is the most appropriate to define child and adolescent obesity in urban China.

Design:

A cross-sectional study was carried out between 1 November and 31 December in 2017.

Setting:

Community Healthcare Center in Minhang District, Shanghai, China.

Participants:

A total of 12 426 children and adolescents aged 7–17 years were selected by cluster random sampling. Bioelectrical impedance analysis was the gold standard to measure body composition.

Results:

Comparisons of three sets of BMI cut-offs by sensitivity and κ value revealed that the Working Group on Obesity in China (WGOC) (sensitivity 39·9–84·0 %; κ 0·51–0·79) and WHO (sensitivity 25·5–74·5 %; κ 0·35–0·78) cut-offs were not superior to the International Obesity Task Force (IOTF) (sensitivity 47·9–92·4 %; κ 0·58–0·85) cut-offs across all subgroups. The WGOC and WHO cut-offs yielded higher misclassification rates, in the worst case, categorising 11·2 % of girls with high adiposity as normal and 44·4 % of them as overweight, while the IOTF cut-offs categorised 2·3 % as normal and 30·7 % as overweight. Individuals who were classified by the IOTF cut-offs as overweight had the lowest ratios of high adiposity (4·2–41·6 %) than by the BMI cut-offs for each subgroup. Among pubertal girls, none of the BMI-based cut-offs indicated excellent agreement with body fat percentage, and κ value of the WHO cut-offs (0·35 (95 % CI 0·29, 0·41)) was lower than the other two sets of BMI cut-offs (all P < 0·001).

Conclusions:

The IOTF cut-offs for Asian should be recommended for child obesity screening in urban China. Pubertal individuals need a more accurate indicator of obesity screening.

Obesity and Body Composition in Preschool Children with Different Levels of Actigraphy-Derived Physical Activity-A Cross-Sectional Study

Detailed associations between physical activity (PA) and body composition in preschoolers remain unclear. The aim of this study was to assess body composition among preschool children differentiated according to their levels of PA and to assess whether meeting the current PA recommendations is associated with a lower risk of obesity, determined by body mass index (BMI) and body fat percentage (BFP). Free-living PA was measured using accelerometers for 7 days in children aged 5 to 6 years. Bioelectrical impedance analysis was used to estimate body composition. Significant differences in content of BFP, fat-free mass (FFM), and total body water (TBW) were found between boys meeting and not meeting moderate-to-vigorous PA (MVPA) recommendations. Meeting the MVPA recommendation was associated with a twofold lower risk of obesity determined by BFP in boys but not in girls. In contrast, the total number of recommended steps per day was not related to adiposity in boys or girls. No statistically significant differences were observed in body composition indices and quintiles of MVPA. Boys in the 3rd–5th quintiles of steps per day presented significantly lower BFP and higher muscle mass and TBW than their peers in quintile 1. However, different associations were observed between body composition indices and quintiles of PA.

Associations between adiposity indicators and hypertension among children and adolescents with intellectual disability-A case-control study

BACKGROUND

Adiposity is closely related to hypertension (HTN) in paediatric population. However, which adiposity indicator is most associated with HTN among children and adolescents with intellectual disability remains unknown. The aim of this study was to evaluate the associations between HTN prevalence and different adiposity indicators: body mass index (BMI) percentile, body fat percentage (BFP), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR) and waist-to-height ratio (WHtR) in students with intellectual disability.

METHODS

Cross-sectional study included a sample of 568 schoolchildren with intellectual disability, aged 7-18 years. Blood pressure, BMI, body composition, WC and HC were determined using standardized equipment.

RESULTS

Multivariate logistic regression showed that male gender, adolescence, high HC and excessive BFP were significant independent factors that increased risk of HTN occurrence in population with intellectual disability.

CONCLUSIONS

Findings indicated that HC and BFP, in particular, may be helpful tools to detect HTN in population with intellectual disability.

Sex differences in the longitudinal associations between body composition and bone stiffness index in European children and adolescents

Fat mass (FM) and fat free mass (FFM) may influence bone health differentially. However, existing evidences on associations between FM, FFM and bone health are inconsistent and vary according to sex and maturity. The present study aims to evaluate longitudinal associations between FM, FFM and bone stiffness index (SI) among European children and adolescents with 6 years follow-up. A sample of 2468 children from the IDEFICS/I.Family was included, with repeated measurements of SI using calcaneal quantitative ultrasound, body composition using skinfold thickness, sedentary behaviors and physical activity using self-administrated questionnaires. Regression coefficients (β) and 99%-confidence intervals (99% CI) were calculated by sex-specified generalized linear mixed effects models to analyze the longitudinal associations between FM and FFM z-scores (zFM and zFFM) and SI percentiles, and to explore the possible interactions between zFM, zFFM and maturity. Baseline zFFM was observed to predict the change in SI percentiles in both boys (β = 4.57, 99% CI: 1.36, 7.78) and girls (β = 3.42, 99% CI: 0.05, 6.79) after 2 years. Moreover, baseline zFFM (β = 8.72, 99% CI: 3.18, 14.27 in boys and β = 5.89, 99% CI: 0.34, 11.44 in girls) and the change in zFFM (β = 6.58, 99% CI: 0.83, 12.34 in boys and β = 4.81, 99% CI: -0.41, 10.02 in girls) were positively associated with the change in SI percentiles after 6 years. In contrast, a negative association was observed between the change in zFM and SI percentiles in boys after 6 years (β = -3.70, 99% CI: -6.99, -0.42). Besides, an interaction was observed between the change in zFM and menarche on the change in SI percentiles in girls at 6 years follow-up (p = .009), suggesting a negative association before menarche while a positive association after menarche. Our findings support the existing evidences for a positive relationship between FFM and SI during growth. Furthermore, long-term FM gain was inversely associated with SI in boys, whereas opposing associations were observed across menarche in girls.

Body Fat and Muscle Mass in Association with Foot Structure in Adolescents: A Cross-Sectional Study

Prior studies have investigated associations between body mass index (BMI) and foot structure; however, these studies are limited only to the evaluation of the longitudinal arch of the foot and do not evaluate associations with body composition. Therefore, this study examined associations between body fat percentage (BFP) and muscle mass percentage with foot structure in adolescents. This study was conducted with 158 healthy subjects aged from 11 to 13 years. Body fat percentage and muscle mass percentage were estimated using bioelectrical impedance analysis. A podoscope was used to calculate Clarke's angle (CL), the Wejsflog index (WI), hallux valgus angle (ALPHA), and the angle of the varus deformity of the fifth toe (BETA). Lower values of CL were found in participants with excessive BFP (p = 0.021). No differences were observed in the values of the Wejsflog, ALFA or BETA indices between normal and excessive BFP groups. Participants with the lowest muscle mass percentage were significantly more likely to have lower values of CL and WI (p = 0.014 and p < 0.001, respectively). Excess BFP appeared to have a significant effect on the longitudinal arch and low muscle mass percentage on the longitudinal and transverse arches of the foot in adolescents. There was no association between fat and muscle content with positions of the big and fifth toes.

Intervention Study on the Efficacy and Safety of Platycodon grandiflorus Ethanol Extract in Overweight or Moderately Obese Adults: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Trial

Platycodon grandiflorus root extract (PGE) has shown various properties, such as anti-hyperlipidemia, anti-diabetic, and anti-obesity, but mostly in animal studies. Therefore, we conducted a preliminary study on the anti-obesity effect of PGE in 108 Korean adults (aged 20–60 years, 30 kg/m² ≥ body mass index ≥ 23 kg/m²). The participants were randomly assigned to four groups and were administered the placebo, PGE571 (571 mg as PGE), PGE1142 (1142 mg as PGE), and PGE2855 (2855 mg as PGE), independently, for 12 weeks. Body composition, nutrient intake, computed tomography scan, and plasma adipokines, as well as hepatic/renal function markers, were assessed. The PGE571 group revealed a significant decrease in body fat mass and body fat percentage when compared with the placebo group. Moreover, the total abdominal and subcutaneous fat areas were significantly decreased following PGE (PGE2855 group) supplementation. These results provide useful information on the anti-obesity effect of PGE for overweight and obese adult humans.

Developing an Impedance Based Equation for Fat-Free Mass of Black Preadolescent South African Children

Bioelectrical impedance analysis (BIA) is a practical alternative to dual-energy X-ray absorptiometry (DXA) for determining body composition in children. Currently, there are no population specific equations available for predicting fat-free mass (FFM) in South African populations. We determined agreement between fat-free mass measured by DXA (FFM_DXA) and FFM calculated from published multi-frequency bioelectrical impedance prediction equations (FFM_BIA); and developed a new equation for predicting FFM for preadolescent black South African children. Cross-sectional data on a convenience sample of 84 children (mean age 8.5 ± 1.4 years; 44 {52%} girls) included body composition assessed using Dual X-ray Absorptiometry (FFM_DXA) and impedance values obtained from the Seca mBCA 514 Medical Body Composition analyzer used to calculate FFM using 17 published prediction equations (FFM_BIA). Only two equations yielded FFM estimates that were similar to the DXA readings (p > 0.05). According to the Bland–Altman analysis, the mean differences in FFM (kg) were 0.15 (LOA: −2.68; 2.37) and 0.01 (LOA: −2.68; 2.66). Our new prediction equation, FFM=105.20+0.807×Sex+0.174×Weight+0.01×Reactance+15.71×log(RI), yielded an adjusted R² = 0.9544. No statistical shrinkage was observed during cross-validation. A new equation enables the BIA-based prediction of FFM in the assessment of preadolescent black South African children.

Association between variants of neuromedin U gene and taste thresholds and food preferences in European children: Results from the IDEFICS study

AIM

The neuropeptide neuromedin U (NMU) known for its role in appetite, feeding and energy balance could be involved in the control of food choice and taste sensitivity. We examined the association between NMU polymorphisms/haplotypes and taste thresholds and food preferences in a population of European children.

METHODS

A total of 578 subjects from the IDEFICS study (mean age 7.5 ± 0.8 SD, boys 53.6%) with NMU genotype data and food preference (salty, fatty, sweet, flavour and umami food) and taste threshold (salt, fat, sweet, umami) tests available were analysed. Three single nucleotide polymorphisms (SNPs; rs6827359, T:C; rs12500837, T:C; rs9999653, C:T) of NMU gene were analyzed and five major haplotypes were inferred. The associations between genotypes and food preferences or taste thresholds were investigated (odds ratios -OR, adjusted for age, sex and country). A p < 0.05 after false discovery rate adjustment (pFDR) was considered statistically significant.

RESULTS

The association between NMU genotypes and food preference showed two NMU SNPs associated with preference for food containing sodium glutamate (umami taste; rs6827359C, OR = 1.61, 95% confidence interval (CI):1.20-2.17; rs9999653T, OR = 1.59, 95%CI:1.18-2.13). In the haplotype analysis, the CTT haplotype showed an OR of 1.70 (95%CI:1.16-2.5) for the umami food preference, while CCT haplotype showed an OR of 1.63 (95%CI:1.11-2.40), compared to the most frequent haplotype (TTC). Carriers of CCT/CCT vs subjects with no CCT haplotype showed an OR of 4.78 (95%CI:1.86-12.30). Umami food preference was associated with low values of BMI z-score, arm circumferences, skinfolds and fat mass (pFDR<0.05). No association between NMU genetic variants and taste thresholds was found.

CONCLUSIONS

This study shows for the first time in children an association between preference for umami food and a NMU haplotype, previously found associated with low BMI values.

Bioimpedance analysis with a novel predictive equation - A reliable technique to estimate fat free mass in birth weight based cohorts of Asian Indian males

AIM

To validate bioimpedance based predictive equations for fat free mass (FFM) against DEXA and to derive a novel birth weight based predictive equation for FFM in a birth weight based cohort of healthy Asian Indian men.

METHODOLOGY

Whole body composition was done using DEXA and bioimpedance in 117 young Asian Indian men, born of normal birth weight (n = 59, birth weight ≥2.5 kg) or low birth weight (n = 58, birth weight < 2.5 kg). Predictive accuracy of 11 different bioimpedance based equations for FFM was evaluated using Pearson's correlation analysis and the root of mean squared prediction error (RMSE) analysis.

RESULTS

The mean FFM (on DEXA) and total lean mass & impedance index (on bioimpedance) were significantly higher in the low birth weight cohort. Significantly higher body fat percentage was noted on bioimpedance, for the normal birth weight cohort, but not on DEXA. In addition, the mean values of predicted FFM were significantly higher in the low birth weight cohort for 9 different predictive equations. Specifically, the mean FFM values obtained using the predictive equations of Schaefer et al., Hoot cooper et al. and Hughes et al. were in close agreement with the actual FFM values on DEXA. A novel predictive equation (CMC equation) for FFM based on birth weight was derived. FFM = 32.637 + (-0.222*age) + (-32.51*waist-to-hip ratio) + (0.33*body mass index) + (1.58 * 1 or 2 (1 = normal birth weight, 2 = low birth weight) + (0.510*waist circumference).

CONCLUSIONS

Our study findings substantiate the validity of Bio-impedance analysis (BIA) as a reliable and noninvasive tool for estimating body composition measures in birth-weight based cohorts of Asian Indian males. Further, we have devised a novel BIA-based predictive equation that can be useful in larger epidemiological studies to look at alterations in body fat in this cohort.

Tri-ponderal mass index in survivors of childhood brain tumors: A cross-sectional study

Survivors of childhood brain tumors (SCBT) face a higher risk of cardiometabolic disorders and premature mortality compared to the general population. Excess adiposity is a known risk factor for these comorbidities. However, while SCBT have higher adiposity compared to healthy controls, measuring adiposity in clinical practice involves access to specialized equipment and may impact busy clinical services. Tri-ponderal Mass Index (TMI; kg/m3) may be a superior measure of adiposity when compared to Body Mass Index (BMI; kg/m2). However, its use in determining adiposity in SCBT has not been assessed. This study aims to validate TMI as a clinical measure of adiposity in SCBT. This was a cross-sectional study including 44 SCBT (n = 20 female) and 137 (n = 64 female) non-cancer control children, 5-17 years of age. BMI and TMI were calculated from height and weight measurements. Fat mass percentage was assessed using bioelectrical impedance analysis and waist to hip and waist to height ratios were used to assess central adiposity. Regression analyses were adjusted for age, sex, puberty and treatment. TMI demonstrated strong correlations to measures of total and central adiposity and predicted adiposity in SCBT and non-cancer controls, with stronger trends in the latter group. TMI may serve as a reliable clinical measure of adiposity in both SCBT and healthy children.

Fat-free mass in adolescent athletes: Accuracy of bioimpedance equations and identification of new predictive equations

OBJECTIVES

The aims of this study were to evaluate the effect of biological maturity on body composition in Brazilian adolescent athletes, to verify the accuracy of previous bioimpedance predictive equations for estimating fat-free mass (FFM), and to develop new predictive equations, considering sexual and skeletal maturity.

METHODS

There were 318 Brazilian adolescent athletes (52% male) involved in this study. FFM was determined using single-frequency (50 kHz) bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DXA), which was used as the reference method. The adolescents were classified into skeletally mature using bone age (both sexes), and sexually mature using menarche occurrence (female). The effect of maturity on bioelectrical values was tested using bioelectrical impedance vector analysis. Three predictive BIA equations to estimate FFM were selected from the reviewed literature. Lin's concordance correlation coefficient and Bland-Altman test were used to test the concordance and accuracy of BIA equations. Stepwise multiple regression was used to develop new predictive equations, considering BIA vectors, age, skeletal, and sexual maturity.

RESULTS

DXA and BIA results showed wide limits of disagreement for FFM for all the three equations. Two new equation models were developed, including age and skeletal maturity for both sexes and menarche status for females. Both models showed high R² (males = 0.92 and females = 0.84).

CONCLUSIONS

The assessment of body composition in adolescent athletes should consider sexual (female) or skeletal (male) maturity. The newly proposed equations showed promising results in Brazilian adolescent athletes. A test in different groups and populations is necessary to evaluate the general suitability of the equations in adolescents.

Dietary Patterns in Primary School are of Prospective Relevance for the Development of Body Composition in Two German Pediatric Populations

This study performed comparative analyses in two pediatric cohorts to identify dietary patterns during primary school years and examined their relevance to body composition development. Nutritional and anthropometric data at the beginning of primary school and two or four years later were available from 298 and 372 participants of IDEFICS-Germany (Identification and prevention of Dietary-induced and lifestyle-induced health Effects In Children and infants Study) and the KOPS (Kiel Obesity Prevention Study) cohort, respectively. Principal component analyses (PCA) and reduced rank regression (RRR) were used to identify dietary patterns at baseline and patterns of change in food group intake during primary school years. RRR extracted patterns explaining variations in changes in body mass index (BMI), fat mass index (FMI), and waist-to-height-ratio (WtHR). Associations between pattern adherence and excess gain in BMI, FMI, or WtHR (>75th percentile) during primary school years were examined using logistic regression. Among PCA patterns, only a change towards a more Mediterranean food choice during primary school years were associated with a favorable body composition development in IDEFICS-Germany (p < 0.05). In KOPS, RRR patterns characterized by a frequent consumption of fast foods or starchy carbohydrate foods were consistently associated with an excess gain in BMI and WtHR (all p < 0.005). In IDEFICS-Germany, excess gain in BMI, FMI, and WtHR were predicted by a frequent consumption of nuts, meat, and pizza at baseline and a decrease in the consumption frequency of protein sources and snack carbohydrates during primary school years (all p < 0.01). The study confirms an adverse impact of fast food consumption on body composition during primary school years. Combinations of protein and carbohydrate sources deserve further investigation.

Blood lipid profile and body composition in a pediatric population with different levels of physical activity

Background

Associations between physical activity and lipid/lipoprotein levels and body composition among pediatric populations are not completely consistent in the literature. Accordingly, the aim of this study was to analyze lipid and lipoprotein profiles and body composition among children and adolescents differentiated according to their level of physical activity.

Methods

The study sample consisted of 69 participants that ranged from 6 to 17 years of age. Objective measures of physical activity were obtained over 7 days with accelerometers. Total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG) were measured from a fasting blood sample. High-risk values for these lipids/lipoproteins were determined using age- and sex-specific thresholds. Body composition estimates were obtained using a foot-to-foot bioelectrical impedance analysis.

Results

Almost half (47.8%) of the participants did not meet daily moderate-to-vigorous intensity physical activity (MVPA) recommendations. This group had lower free fat mass (by 5.51%), muscle mass content (by 5.17%), and a higher risk for abnormal HDL level (OR = 4.19) and excessive body fat content (OR = 3.05).

Conclusions

Participants who met daily recommended MVPA were found to have more favorable HDL and body fat levels compared to those who did not meet these recommendations.

Validity of electrical impedance myography to estimate percent body fat: comparison to bio-electrical impedance and dual-energy X-ray absorptiometry

BACKGROUND

Assessment of percent body fat (%BF) is typically measured with bioelectrical impedance (BIA) as a proxy for dual-energy X-ray absorptiometry (DXA). Notably, poorer agreement between BIA and DXA among persons who are overweight or obese has been reported. The use of electrical impedance myography (EIM) as a proxy for DXA has not been validated. The objective was to evaluate an EIM device and two multi-frequency BIA devices with the reference standard (DXA) stratified by weight status and gender.

METHODS

In a convenience sample of 82 adults, %BF assessed by EIM and two BIA devices was compared to DXA. Agreement between devices was tested with intra-class correlation coefficients (ICC) and Bland-Altman plots.

RESULTS

Agreement between DXA and EIM (ICC=0.77) was poorer than the agreement between either BIA device with DXA (ICC>0.87). Stratified by sex, agreement between EIM and DXA was greater for men than women (ICC=0.81 and ICC=0.61, respectively). Stratified by BMI, agreement between EIM and DXA was best for normal-weight individuals (ICC=0.89) and progressively poorer for overweight (ICC=0.80) and obese (ICC=0.67) individuals. Bland-Altman plots revealed wide limits of agreement and an increase in EIM mean difference as average %BF increased. Similar trends were seen in BIA assessments.

CONCLUSIONS

EIM and BIA substantially underestimate %BF in overweight and obese individuals. Wide limits of agreement coupled with variable ICC limit device interchangeability with one another and limit clinical utility.

Perceived Exertion during Exercise Is Associated with Children's Energy Intake

PURPOSE

To examine the individual-level factors that predict energy intake (EI) after imposed exercise (EX) and sedentary time (SED) in children.

METHODS

Healthy-weight children ages 9-12 yr (n = 20) reported to the laboratory for one baseline and two experimental visits (EX and SED) each separated by 1 wk in a randomized crossover design. Percent body fat, weight (kg), and height (m) were used to calculate fat-mass index (FM index) and fat-free mass index (FFM index; kg·m). On the EX day, children exercised at 70% estimated V˙O2peak for 30 min on a cycle ergometer, whereas cardiovascular responses and RPE were measured. Objective EI (kcal) was measured at identical meals (breakfast, lunch, snack, and dinner) on the EX and SED days.

RESULTS

Total EI was not statistically different between the EX and SED days (t = 1.8, P = 0.09). FFM index was positively associated with EI on the EX day (r = 0.54, P < 0.05). RPE was also positively associated with EI on the EX day (r = 0.82, P < 0.001). Together, FFM index and RPE explained 77% of the variability in EX day EI (F(2,17) = 26.4, P < 0.001). For each unit increase in RPE, children consumed approximately 270 more calories on the EX day. A similar pattern of associations was observed on the SED day.

CONCLUSIONS

FFM index was positively associated with EI on the EX day. Despite experiencing the same 70% relative exercise intensity, increased perceived difficulty predicted greater EI on both the EX and SED day. These findings demonstrate a role for both FFM and RPE in explaining EI variability in children.

The role of neuromedin U in adiposity regulation. Haplotype analysis in European children from the IDEFICS Cohort

BACKGROUND AND AIMS

Neuromedin U (NMU) is a hypothalamic neuropeptide with important roles in several metabolic processes, recently suggested as potential therapeutic target for obesity. We analysed the associations between NMU gene variants and haplotypes and body mass index (BMI) in a large sample of European children.

METHODS AND RESULTS

From a large European multi-center study on childhood obesity, 4,528 children (2.0-9.9 years, mean age 6.0±1.8 SD; boys 52.2%) were randomly selected, stratifying by age, sex and country, and genotyped for tag single nucleotide polymorphisms (SNPs; rs6827359, T:C; rs12500837, T:C; rs9999653,C:T) of NMU gene, then haplotypes were inferred. Regression models were applied to estimate the associations between SNPs or haplotypes and BMI as well as other anthropometric measures. BMI was associated with all NMU SNPs (p<0.05). Among five haplotypes inferred, the haplotype carrying the minor alleles (CCT, frequency = 22.3%) was the only associated with lower BMI values (beta = -0.16, 95%CI:-0.28,-0.04, p = 0.006; z-score, beta = -0.08, 95%CI:-0.14,-0.01, p = 0.019) and decreased risk of overweight/obesity (OR = 0.81, 95%CI:0.68,0.97, p = 0.020) when compared to the most prevalent haplotype (codominant model). Similar significant associations were also observed using the same variables collected after two years' time (BMI, beta = -0.25, 95%CI:-0.41,-0.08, p = 0.004; z-score, beta = -0.10, 95%CI:-0.18,-0.03, p = 0.009; overweight/obesity OR = 0.81, 95%CI:0.66,0.99, p = 0.036). The association was age-dependent in girls (interaction between CCT haplotypes and age, p = 0.008), more evident between 7 and 9 years of age. The CCT haplotype was consistently associated with lower levels of fat mass, skinfold thickness, hip and arm circumferences both at T0 and at T1, after adjustment for multiple testing (FDR-adjusted p<0.05).

CONCLUSIONS

This study shows an association between a NMU haplotype and anthropometric indices, mainly linked to fat mass, which appears to be age- and sex-specific in children. Genetic variations within or in linkage with this haplotype should be investigated to identify functional variants responsible for the observed phenotypic variation.

Body mass index may overestimate the prevalence of overweight and obesity among the Inuit

Body mass index (BMI) is a widely used body weight classification system but has known limitations, and may need to be adjusted for sitting height in order to be useful as an indicator of health risks in special populations. Data confirm that Inuit and Far East Asians have shorter legs and relatively higher sitting heights compared with all other populations. Using standing height alone to calculate the BMI may overestimate the number of individuals that are overweight and obese, and at risk for type 2 diabetes mellitus and cardiovascular disease among the Inuit. Measuring sitting height allows for the calculation of a sitting height-to-standing height ratio (SH/S) which can be used to correct the observed BMI. Incorporating sitting height measurements into health research could help formulate Inuit-specific screening guidelines.

Feasibility study and pilot cluster-randomised controlled trial of the GoActive intervention aiming to promote physical activity among adolescents: outcomes and lessons learnt

OBJECTIVES

Assess the feasibility of implementing the GoActive intervention in secondary schools, to identify improvements, test study procedures, determine preliminary effectiveness to increase moderate-to-vigorous physical activity (MVPA), and inform power calculations to establish programme effectiveness.

SETTING

Feasibility study (1 school) and pilot cluster-randomised controlled trial (CRCT; 2 intervention; 1 control school(s)).

PARTICIPANTS

460 participants (46.6% female; 13.2 (0.4) years old).

INTERVENTIONS

8-week intervention (2013) involved: classes choosing weekly activities encouraged by mentors (older adolescents) and in-class peer leaders. Students gain points for trying activities which are entered into an intramural competition.

PRIMARY AND SECONDARY OUTCOME MEASURES

Planned quantitative (questionnaire) and qualitative (focus groups) process evaluation addressed enjoyment, confidence, participation, suggested improvements. Outcomes were assessed at baseline and follow-up (week 8) in pilot CRCT and included accelerometer-assessed MVPA; adolescent-reported activity type, well-being, peer support, shyness, sociability. Analysis of covariance was used to assess preliminary effectiveness as change in MVPA adjusted for baseline.

RESULTS

All year 9 students in intervention schools were exposed to the intervention; over all schools 77% of eligible students were measured. 71% boys and 74% girls found GoActive 'fun'; 38% boys and 32% girls said it increased confidence, and 64% boys and 59% girls said they would continue with a GoActive activity. Suggested improvements included more mentorship; improved training; streamlined points recording. Pilot results indicated potential effectiveness ((adjusted mean difference (95% CI) p value; MVPA mins; 5.1 (1.1 to 9.2) p=0.014)) and suggest recruitment of 16 schools (2400 adolescents) for a full trial. Compared with control, intervention students reported greater peer support 0.5 (0.1 to 0.9) p=0.03, well-being 1.8 (0.1 to 3.4) p=0.04 but no difference in shyness/sociability. Participation in activity types approached significance (intervention group 2.3 (-0.2 to 4.7) p=0.07 more activity types).

CONCLUSIONS

Results suggest feasibility and indicate potential effectiveness of GoActive to increase MVPA and support a fully powered evaluation of effectiveness and cost-effectiveness. Process evaluation data were used to refine GoActive prior to a full trial.

TRIAL REGISTRATION NUMBER

ISRCTN31583496; pre-results.

Impact of imposed exercise on energy intake in children at risk for overweight

Background

Exercise not only has a direct effect on energy balance through energy expenditure (EE), but also has an indirect effect through its impact on energy intake (EI). This study examined the effects of acute exercise on daily ad libitum EI in children at risk for becoming overweight due to family history.

Methods

Twenty healthy-weight children (ages 9–12 years, 12 male/8 female) with at least one overweight biological parent (body mass index ≥ 25 kg/m²) participated. Children reported to the laboratory for one baseline and two experimental visits (EX = exercise, SED = sedentary) each separated by 1 week in a randomized crossover design. Two hours into the EX day session, children exercised at 70 % estimated VO_2max for 30 min on a cycle ergometer. Objective EI (kcal) was measured at a standard breakfast (~285 kcal) and ad libitum lunch, snack and dinner. Meals were identical on the EX and SED days. Activity-related EE (kcal) was estimated with accelerometers worn on the non-dominant wrist and ankle. Relative EI (kcal) was computed as the difference between Total EI and Activity-related EE for each testing day. Paired t-tests were performed to test differences in Total EI, Activity-related EE and Relative EI between the EX and SED days.

Results

Across all meals, Total EI was not statistically different between the EX and SED days (t = 1.8, p = 0.09). Activity-related EE was greater on the EX day compared to the SED day (t = 10.1, p < 0.001). By design, this difference was predominantly driven by activity during the morning (t = 20.4, p < 0.001). Because children consumed a similar number of kcal on each day, but had greater Activity-related EE on the EX day, Relative EI was lower (t = −5.15, p < 0.001) for the EX day (1636 ± 456 kcal) relative to the SED day (1862 ± 426 kcal).

Conclusions

Imposed exercise was effective in reducing Relative EI compared to being sedentary. Morning exercise may help children at risk for becoming overweight to better regulate their energy balance within the course of a day.

Urinary Mineral Concentrations in European Pre-Adolescent Children and Their Association with Calcaneal Bone Quantitative Ultrasound Measurements

This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS) in 4322 children (3.1–11.9 years, 50.6% boys) from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI) in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa) was positively correlated with urinary calcium (uCa), and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK) was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias.

Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area

OBJECTIVES

To compare the accuracy of abdominal visceral fat area (VFA) measurements between abdominal dual bioelectrical impedance analysis (BIA) and whole-body BIA referenced to computed tomography (CT) measures.

METHODS

Abdominal VFAs were measured in 102 individuals: 59 men and 43 women with a mean age of 44.2 ± 16.3 years (range 21 - 76), body mass index 23.9 ± 7.8 kg/m(2) (range 18 - 35) using a DUALSCAN HDS-2000 machine (dual abdominal BIA) and an InBody720 machine (whole-body BIA). The VFA values from each machine were compared with those from CT under various conditions.

RESULTS

Mean abdominal VFAs were 116 ± 69 cm(2) by CT, 89 ± 47 cm(2) by dual abdominal BIA, and 84 ± 33 cm(2) by whole-body BIA. The former measure showed a higher correlation with the CT measure than the latter (r=0.89 vs. r=0.64, P<0.001). Both BIA methods tended to underestimate abdominal VFAs compared with CT scans when CT VFA was not small. The dual abdominal BIA had less bias than the whole-body BIA in the assessment of VFAs. The whole-body BIA was affected by subcutaneous fat area.

CONCLUSIONS

Dual BIA was more accurate in assessing abdominal VFA than whole-body BIA.

The independent prospective associations of activity intensity and dietary energy density with adiposity in young adolescents

There is limited evidence on the prospective association of time spent in activity intensity (sedentary (SED), moderate (MPA) or vigorous (VPA) physical activity) and dietary intake with adiposity indicators in young people. This study aimed to assess associations between (1) baseline objectively measured activity intensity, dietary energy density (DED) and 4-year change in adiposity and (2) 4-year change in activity intensity/DED and adiposity at follow-up. We conducted cohort analyses including 367 participants (10 years at baseline, 14 years at follow-up) with valid data for objectively measured activity (Actigraph), DED (4-d food diary), anthropometry (waist circumference (WC), %body fat (%BF), fat mass index (FMI), weight status) and covariates. Linear and logistic regression models were fit, including adjustment for DED and moderate-to-vigorous physical activity. Results showed that baseline DED was associated with change in WC (β for 1kJ/g difference: 0·71; 95% CI 0·26, 1·17), particularly in boys (1·26; 95% CI 0·41, 2·16 v. girls: 0·26; 95% CI −0·34, 0·87), but not with %BF, FMI or weight status. In contrast, baseline SED, MPA or VPA were not associated with any of the outcomes. Change in DED was negatively associated with FMI (β for 1kJ/g increase: −0·86; 95% CI −1·59, −0·12) and %BF (−0·86; 95% CI −1·25, −0·11) but not WC (−0·27; 95% CI −1·02, 0·48). Change in SED, MPA and VPA did not predict adiposity at follow-up. In conclusion, activity intensity was not prospectively associated with adiposity, whereas the directions of associations with DED were inconsistent. To inform public health efforts, future studies should continue to analyse longitudinal data to further understand the independent role of different energy-balance behaviours in changes in adiposity in early adolescence.

Impact of physical activity, sedentary behaviour and muscle strength on bone stiffness in 2-10-year-old children-cross-sectional results from the IDEFICS study

Background

Physical activity (PA), weight-bearing exercises (WBE) and muscle strength contribute to skeletal development, while sedentary behaviour (SB) adversely affects bone health. Previous studies examined the isolated effect of PA, SB or muscle strength on bone health, which was usually assessed by x-ray methods, in children. Little is known about the combined effects of these factors on bone stiffness (SI) assessed by quantitative ultrasound. We investigated the joint association of PA, SB and muscle strength on SI in children.

Methods

In 1512 preschool (2- < 6 years) and 2953 school children (6–10 years), data on calcaneal SI as well as on accelerometer-based sedentary time (SED), light (LPA), moderate (MPA) and vigorous PA (VPA) were available. Parents reported sports (WBE versus no WBE), leisure time PA and screen time of their children. Jumping distance and handgrip strength served as indicators for muscle strength. The association of PA, SB and muscle strength with SI was estimated by multivariate linear regression, stratified by age group. Models were adjusted for age, sex, country, fat-free mass, daylight duration, consumption of dairy products and PA, or respectively SB.

Results

Mean SI was similar in preschool (79.5 ± 15.0) and school children (81.3 ± 12.1). In both age groups, an additional 10 min/day in MPA or VPA increased the SI on average by 1 or 2 %, respectively (p ≤ .05). The negative association of SED with SI decreased after controlling for MVPA. LPA was not associated with SI. Furthermore, participation in WBE led to a 3 and 2 % higher SI in preschool (p = 0.003) and school children (p < .001), respectively. Although muscle strength significantly contributed to SI, it did not affect the associations of PA with SI. In contrast to objectively assessed PA, reported leisure time PA and screen time showed no remarkable association with SI.

Conclusion

This study suggests that already an additional 10 min/day of MPA or VPA or the participation in WBE may result in a relevant increase in SI in children, taking muscle strength and SB into account. Our results support the importance of assessing accelerometer-based PA in large-scale studies. This may be important when deriving dose–response relationships between PA and bone health in children.

Association between bone stiffness and nutritional biomarkers combined with weight-bearing exercise, physical activity, and sedentary time in preadolescent children. A case-control study

Physical activity (PA) and micronutrients such as calcium (Ca), vitamin D (25OHD), and phosphate (PO) are important determinants of skeletal development. This case-control study examined the association of these nutritional biomarkers and different PA behaviours, such as habitual PA, weight-bearing exercise (WBE) and sedentary time (SED) with bone stiffness (SI) in 1819 2-9-year-old children from the IDEFICS study (2007-2008). SI was measured on the calcaneus using quantitative ultrasound. Serum and urine Ca and PO and serum 25OHD were determined. Children's sports activities were reported by parents using a standardised questionnaire. A subsample of 1089 children had accelerometer-based PA data (counts per minute, cpm). Moderate-to-vigorous PA (MVPA) and SED were estimated. Children with poor SI (below the 15th age-/sex-/height-specific percentile) were defined as cases (N=603). Randomly selected controls (N=1216) were matched by age, sex, and country. Odds ratios (OR) for poor SI were calculated by conditional logistic regression for all biomarkers and PA behaviour variables separately and combined (expressed as tertiles and dichotomised variables, respectively). ORs were adjusted for fat-free mass, dairy product consumption, and daylight duration. We observed increased ORs for no sports (OR=1.39, p<0.05), PA levels below 524 cpm (OR=1.85, p<0.05) and MVPA below 4.2% a day (OR=1.69, p<0.05) compared to WBE, high PA levels (<688 cpm) and high MVPA (6.7%), respectively. SED was not associated with SI. ORs were moderately elevated for low serum Ca and 25OHD. However, biomarkers were not statistically significantly associated with SI and did not modify the association between PA behaviours and SI. Although nutritional biomarkers appear to play a minor role compared to the osteogenic effect of PA and WBE, it is noteworthy that the highest risk for poor SI was observed for no sports or low MVPA combined with lower serum Ca (<2.5 mmol/l) or lower 25OHD (<43.0 nmol/l).

Bioelectric Impedance Analysis in the Diagnosis of Vesicoureteral Reflux

BACKGROUND

Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in childhood.

OBJECTIVES

As urine enters the ureters and renal pelvis during voiding in vesicoureteral reflux (VUR), we hypothesized that change in body water composition before and after voiding may be less different in children with VUR.

PATIENTS AND METHODS

Patients were grouped as those with VUR (Group 1) and without VUR (Group 2). Bioelectric impedance analysis was performed before and after voiding, and third space fluid (TSF) (L), percent of total body fluid (TBF%), extracellular fluid (ECF%), and intracellular fluid (ICF%) were recorded. After change of TSF, TBF, ECF, ICF (ΔTSF, ΔTBF%, ΔECF%, ΔICF%), urine volume (mL), and urine volume/body weight (mL/kg) were calculated. Groups 1 and 2 were compared for these parameters. In addition, pre- and post-voiding body fluid values were compared in each group.

RESULTS

TBF%, ECF%, ICF%, and TSF in both pre- and post-voiding states and ΔTBF%, ΔECF%, ΔICF%, and ΔTSF after voiding were not different between groups. However, while post-voiding TBF%, ECF% was significantly decreased in Group 1 (64.5 ± 8.1 vs 63.7 ± 7.2, P = 0.013 for TBF%), there was not post-voiding change in TSF in the same group. On the other hand, there was also a significant TSF decrease in Group 2.

CONCLUSIONS

Bladder and ureter can be considered as the third space. Thus, we think that BIA has been useful in discriminating children with VUR as there was no decreased in patients with VUR, although there was decreased TSF in patients without VUR. However, further studies are needed to increase the accuracy of this hypothesis.

Weight suppression in bulimia nervosa: Associations with biology and behavior

Bulimia nervosa (BN) is a serious eating disorder that can persist for years and contribute to medical complications and increased mortality, underscoring the need to better understand factors maintaining this disorder. Higher levels of weight suppression (WS) have been found to predict both the onset and maintenance of BN; however, no studies have examined mechanisms that may account for the effects of WS on BN. We hypothesized that high WS would lead to reduced leptin levels, which may increase risk of binge eating by modulating reward responses to food. The current study examined the relationship between WS, leptin levels, and the reinforcing value of food in women with BN (n = 32) and noneating disorder controls (n = 30). Participants provided information on WS, completed a fasting blood draw to obtain serum leptin, and completed a progressive ratio task to measure the reinforcing value of food. Individuals with BN had greater WS (p < .01) and reinforcing food value (p < .05) compared with controls. Additionally, higher WS was associated with both lower leptin (p < .05) and increased reinforcing value of food (p < .05). Contrary to hypotheses, BN and control participants did not differ on leptin levels, and leptin levels were not significantly associated with the reinforcing value of food. Findings support that efforts to conform to the thin ideal may alter drive to consume rewarding foods and leave women vulnerable to binge episodes. However, mechanisms through which WS contributes to food reward and binge eating remain unknown.

Validity of Four Commercial Bioelectrical Impedance Scales in Measuring Body Fat among Chinese Children and Adolescents

The aim of the study is to examine the validity in predicting body fat percentage (%BF) of different bioelectrical impedance (BIA) devices among Chinese children and adolescents. A total of 255 Chinese children and adolescents aged 9-19 years old participated in the study. %BF was assessed by BIA scales, namely, Biodynamics-310 (Model A), Tanita TBF-543 (Model B), Tanita BC-545 (Model C), and InBody 520 (Model D). Dual-energy X-ray absorptiometry (DXA) was used as the criterion measurement. Lin's concordance correlation coefficients of estimated %BF between Model A, Model B, Model C, and DXA showed poor agreements for both genders. Moderate agreements for %BF were found between DXA and Model D measurements. In boys, differences in %BF were found between DXA and Model B and Model C. No significant %BF differences were found between Model A, Model D, and DXA. However, the two BIA analyzers showed a significant positive correlation between the bias and average %BF between BIA and DXA. In girls, differences in %BF were observed between Model B, Model C, Model D, and DXA. Model A and DXA showed no significant differences of %BF; however, the bias and the average %BF between the BIA and DXA had a significant positive correlation. Using embedded equations in BIA devices should be validated in assessing the %BF of Chinese children and adolescents.

Predicting body composition using foot-to-foot bioelectrical impedance analysis in healthy Asian individuals

Background

The objectives of this study were to develop a regression model for predicting fat-free mass (FFM) in a population of healthy Taiwanese individuals using standing foot-to-foot bioelectrical impedance analysis (BIA) and to test the model’s performance in predicting FFM with different body fat percentages (BF%).

Methods

We used dual-energy X-ray absorptiometry (DXA) to measure the FFM of 554 healthy Asian subjects (age, 16–75 y; body mass index, 15.8–43.1 kg/m²). We also evaluated the validity of the developed multivariate model using a double cross-validation technique and assessed the accuracy of the model in an all-subjects sample and subgroup samples with different body fat levels.

Results

Predictors in the all-subjects multivariate model included height²/impedance, weight, year, and sex (FFM = 13.055 + 0.204 weight + 0.394 height²/Impedance – 0.136 age + 8.125 sex (sex: Female = 0, Male = 1), r² = 0.92, standard error of the estimate = 3.17 kg). The correlation coefficients between predictive FFM by BIA (FFM_BIA) and DXA-measured FFM (FFM_DXA) in female subjects with a total-subjects BF%_DXA of <20 %, 20 %–30 %, 30 %–40 % and >40 % were r = 0.87, 0.90, 0.91, 0.89, and 0.94, respectively, with bias ± 2SD of 0.0 ± 3.0 kg, −2.6 ± 1.7 kg, −1.5 ± 2.8 kg, 0.5 ± 2.7 kg, and 2.0 ± 2.9 kg, respectively. The correlation coefficients between FFM_BIA and FFM_DXA in male subjects with a total-subjects BF%_DXA of <10 %, 10 %–20 %, 20 %–30 %, and >30 % were r = 0.89, 0.89, 0.90, 0.93, and 0.91, respectively, with bias ± 2SD of 0.0 ± 3.2 kg, −2.3 ± 2.5 kg, −0.5 ± 3.2 kg, 0.4 ± 3.1 kg, and 2.1 ± 3.2 kg, respectively.

Conclusions

The standing foot-to-foot BIA method developed in this study can accurately predict FFM in healthy Asian individuals with different levels of body fat.