Alterations in growth and body composition during puberty. I. Comparing multicompartment body composition models

Overweight and Obese Children Aged 6-17 Years in China Had Lower Level of Hydration Status: A Cross-Sectional Study

PURPOSE

The aims of this study were to explore the differences in total body water and hydration status among Chinese children aged 6-17 years.

METHODS

A cross-sectional study was implemented among children aged 6-17 years in China. The total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were determined by bioelectrical impedance analysis (BIA). The participants were divided according to age-age 6-8 years, age 9-11 years, age 12-14 years, age 15-17 years-and body mass index (BMI) of China-underweight, normal weight, overweight, and obese groups. The differences of variables of groups were compared using analysis of variance, Student's t-test, and Kruskal-Wallis test. Significance levels were set at 0.05 (p < 0.05).

RESULTS

A total of 59,643 participants (30,103 males and 29,540 females) completed the study. As children became older, the TBW, ICW, ECW, ICW/TBW, and TBW/FFM (TBW to fat free mass ratio) increased simultaneously (all p < 0.05); concurrently, the ECW/TBW decreased with age (all p < 0.05). Boys had higher TBW, ICW, ECW, ICW/TBW, TBW/BW, and TBW/FFM than those of girls at each age (all p < 0.05). For all BMI groups, increases in TBW, ICW, ECW were observed from the underweight group to the obese group, both in boys and girls (all p < 0.001). For the increase in BMI in all age groups, the values of TBW made a significantly lower percentage compared to BW. The higher BMI groups showed higher levels of TBW/FFM, both in girls and boys (all p < 0.001).

CONCLUSIONS

The body water contents of children aged 6-17 years varied according to their age, sex, and BMI. Overweight and obese individuals may have inferior hydration status compared to those with normal weight.

One-Year Changes in Bioelectrical Impedance Data in Adolescent Athletes

Raw bioelectrical impedance (BI) data and vector analysis (BIVA) have been used to evaluate fat-free mass (FFM) cross-sectionally in adolescent athletes; however, there have been no longitudinal studies about it. This study aimed to assess the magnitude of changes in raw BI data (resistance [R], reactance [Xc], and phase angle [PhA]), BIVA, and FFM in adolescent athletes (n = 137, 40% female). BI data were collected using a single-frequency device at baseline and after one year of sports practice. Baseline chronological age categorized the participants (11, 12, or 13 years [y]). In females, Xc/H increased (13 to 14 y, p = 0.04) while R/H decreased in all age groups (p = 0.001). PhA (11 to 12 y, p = 0.048) and FFM (11 to 12 y and 12 to 13 y groups p = 0.001) increased and showed the lowest magnitude of changes in the 13 to 14 y group (p = 0.05). In males, Xc/H decreased (11 to 12 and 12 to 13 y groups, p = 0.001) with a higher magnitude of changes in the 13 to 14 y group (p = 0.004); R/H decreased (p = 0.001); FFM increased in all groups (p = 0.001); however, no magnitude of changes was observed. PhA increased in the 13 to 14 y group (p = 0.004). BIVA showed no differences among ellipse distances in females. In males, a high distance was observed in the 11 to 12 y group. "Time interval" influenced PhA and Xc/H in the female group and R/H and Xc/H in the male group. "Initial age" and "time interval" influenced the increase in PhA in the male group. Raw BI data and BIVA patterns can detect the magnitude of the changes in a sex-dependent manner.

Phenotyping children and adolescents with obesity using behavioral, psychological, and familial data

OBJECTIVE

This prospective cohort study aimed to empirically derive phenotypes of children and adolescents with overweight and obesity.

METHODS

Latent class analyses using Mplus were carried out in the Growing Up Today Study. Information on participants' weight status, disordered eating behaviors, body image and weight concerns, depressive symptoms, and pubertal timing, as well as and maternal weight status, were included in the latent class analyses, which were stratified by sex. Mixed-effects regression was used to examine associations of the obesity phenotypes with adult weight gain, between age 20 and 35 years, independent of weight at beginning of follow-up and duration of follow-up.

RESULTS

Among the girls, four obesity phenotypes were identified: 1) "early puberty"; 2) "mothers with obesity"; 3) "high weight concerns"; and 4) "mixed." Only three phenotypes were identified among the boys: 1) "high weight concerns"; 2) "mothers with obesity"; and 3) "mixed." Participants who had overweight or obesity in childhood or adolescence gained more weight in young adulthood than their leaner peers, but the patterns of weight gain in young adulthood varied by phenotype of obesity in childhood and adolescence.

CONCLUSIONS

These results support examining risk factors for and treatment outcomes by obesity phenotypes.

Body water percentage from childhood to old age

BACKGROUND

Total body water (TBW) increases with growth, but the body water percentage (TBW%) decreases with aging. The objective of our study was to delineate TBW% in males and females by bioelectrical impedance analysis (BIA) from early childhood to old age.

METHODS

We enrolled 545 participants aged 3 to 98 years (258 male, 287 female). Among the participants, 256 had a normal weight and 289 were overweight. The TBW was measured by BIA, and TBW% was derived by dividing the TBW (L) value by body weight (kg). For analysis, we divided participants into the four age groups of 3-10, 11-20, 21-60, and ≥61 years.

RESULTS

In normal-weight subjects, the TBW% was similar at 62% between males and females in the 3-10-year group. It remained unchanged in males until and through adult life, then decreased to 57% in the ≥61-year group. In normal-weight female subjects, the TBW% decreased to 55% in the 11-20-year group, remained relatively unaltered in the 21-60-year group, then decreased to 50% in the ≥61-year group. In overweight subjects, the TBW% values in males, as well as females, were significantly lower as compared to those with normal weight.

CONCLUSION

Our study showed that the TBW% in normal-weight males changes very little from early childhood to adult life compared to that of females, who showed a decrease in TBW% during the pubertal years. In normal-weight subjects of both sexes, the TBW% decreased after the age of 60 years. Overweight subjects had significantly lower TBW% as compared to those with normal weight.

Body Composition in Youths Aged 10‒17 Years by Deuterium Oxide Dilution, Air Displacement Plethysmography, and DXA: Validation of the Medical Body Composition Analyzer Bioimpedance Device by a 4-Compartment Model

BACKGROUND

The medical body composition analyzer (mBCA) incorporates advances in multifrequency technology and has been validated using a 4-compartment (4C) model in adults but not in youths aged <18 y.

OBJECTIVES

This study aimed to formulate a 4C model based on 3 reference methods and develop and validate a body composition prediction equation for the mBCA in youths aged 10‒17 y.

METHODS

The body density of 60 female and male youths was measured by air displacement plethysmography, total body water by deuterium oxide dilution, and BMC by DXA. Data from the equation group (n = 30) were used to formulate a 4C model. The all-possible-regressions method was used to select variables. The model was validated in a second cohort (n = 30) in a random split design. The accuracy, precision, and potential bias were evaluated by the Bland and Altman procedure.

RESULTS

Mean age, weight (W), height (H), waist circumference, and z-score of BMI were 13.6 ± 2.3 y, 54.5 ± 15.5 kg, 156 ± 11.9 cm, 75.5 ± 10.9 cm, and 0.70 ± 1.32 z, respectively. The prediction equation was as follows: FFM in kg (FFM_kg) = ([0.2081] ∗ [W] + [0.8814] ∗ [H²_cm/R_Ω] + [0.2055 ∗ Xc_Ω])-15.343; R² = 0.96; standardized root-mean-square error (SRMSE) = 2.18 kg. FFM did not differ between the 4C method (38.9 ± 12.0 kg) and the mBCA (38.4 ± 11.4 kg) (P > 0.05). The relationship between these 2 variables did not deviate from the identity line, was not significantly different from 0, and the slope was not significantly different from 1.0. In the precision prediction model of mBCA, the R² value was 0.98 and SRMSE was 2.1. No significant bias was found when regressing differences between methods and their means (P = 0.08).

CONCLUSIONS

The equation for the mBCA was accurate, precise, had no significant bias, had substantial strength of agreement and could be used in this age group when subjects were preferentially within the constraints of a specified body size.

Body mass index percentiles versus body composition assessments: Challenges for disease risk classifications in children

Background

Identifying at-risk children with optimal specificity and sensitivity to allow for the appropriate intervention strategies to be implemented is crucial to improving the health and well-being of children. We determined relationships of body mass indexes for age and sex percentile (BMI%) classifications to actual body composition using validated and convenient methodologies and compared fat and non-fat mass estimates to normative cut-off reference values to determine guideline reliability. We hypothesized that we would achieve an improved ability to identify at-risk children using simple, non-invasive body composition and index measures.

Methods

Cross-sectional study of a volunteer convenience sample of 1,064 (537 boys) young children comparing Body Fat Percentage (BF%), Fat Mass Index (FMI), Fat-Free Mass Index (FFMI), determined via rapid bioimpedance methods vs. BMI% in children. Comparisons determined among weight classifications and boys vs. girls.

Results

Amongst all subjects BMI% was generally correlated to body composition measures and indexes but nearly one quarter of children in the low-risk classifications (healthy weight or overweight BMI%) had higher BF% and/or lower FFMI than recommended standards. Substantial evidence of higher than expected fatness and or sarcopenia was found relative to risk status. Inaccuracies were more common in girls than boys and girls were found to have consistently higher BF% at any BMI%.

Conclusions

The population studied raises concerns regarding actual risks for children of healthy or overweight categorized BMI% since many had higher than expected BF% and potential sarcopenia. When body composition and FMI and FFMI are used in conjunction with BMI% improved sensitivity, and accuracy of identifying children who may benefit from appropriate interventions results. These additional measures could help guide clinical decision making in settings of disease-risks stratifications and interventions.

Magnetic Resonance Imaging to Assess Body Composition Change in Adolescents With Obesity After Sleeve Gastrectomy

OBJECTIVES

Metabolic and bariatric surgery is the most effective weight loss treatment for severe obesity. The number of adolescents undergoing sleeve gastrectomy is increasing. We investigated changes in body composition in adolescents undergoing sleeve gastrectomy 12-26 weeks post-operatively using whole-body magnetic resonance imaging (WB-MRI).

METHODS

This prospective cohort study assessed changes in adipose tissue compartments (ie, visceral, subcutaneous, and intermuscular) and muscle in 18 obese adolescents, ages 14-19, 89% female, with body mass index z -score of 2.6 ± 0.25 (range 2.16-3.2). All underwent WB-MRI 1.5-17 weeks pre-operatively and 12-26 weeks post-operatively.

RESULTS

Pre- and post-operative WB-MRI showed decreases in all adipose tissue compartments, as well as decreased skeletal muscle and liver fat fraction ( P < 0.0001). The post-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments (89.0%, 5.8%, 5.2%, respectively) was similar to the pre-operative percentages of corresponding adipose tissue compartments (90.5%, 5.0%, 4.5%, respectively). Of note, participants with obstructive sleep apnea had significantly higher pre-operative volume of subcutaneous and intermuscular adipose tissue than participants without obstructive sleep apnea ( P = 0.003).

CONCLUSIONS

We found, contrary to what is reported to occur in adults, that pre-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments was similar to the post-operative percentage loss of corresponding adipose tissue compartments in adolescents 12-26 weeks after sleeve gastrectomy.

Body Composition Assessment in Mexican Children and Adolescents. Part 1: Comparisons between Skinfold-Thickness, Dual X-ray Absorptiometry, Air-Displacement Plethysmography, Deuterium Oxide Dilution, and Magnetic Resonance Imaging with the 4-C Model

The evaluation of body composition (BC) is relevant in the evaluation of children’s health-disease states. Different methods and devices are used to estimate BC. The availability of methods and the clinical condition of the patient usually defines the ideal approach to be used. In this cross-sectional study, we evaluate the accuracy of different methods to estimate BC in Mexican children and adolescents, using the 4-C model as the reference. In a sample of 288 Mexican children and adolescents, 4-C body composition assessment, skinfold-thickness (SF), dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP), and deuterium dilution (D₂O) were performed, along with MRI in a subsample (52 participants). The analysis of validity was performed by correlation analysis, linear regression, and the Bland–Altman method. All methods analyzed showed strong correlations for FM with 4-C values and between each other; however, DXA and MRI overestimated FM, whereas skinfolds and ADP under-estimated FM. Conclusion: The clinical assessment of BC by means of SF, ADP, DXA, MRI and D₂O correlated well with the 4-C model and between them, providing evidence of their clinical validity and utility. The results from different methods are not interchangeable. Preference between methods may depend on their availability and the specific clinical setting.

Growth and Body Composition in PKU Children-A Three-Year Prospective Study Comparing the Effects of L-Amino Acid to Glycomacropeptide Protein Substitutes

Protein quality and quantity are important factors in determining lean body (muscle) mass (LBM). In phenylketonuria (PKU), protein substitutes provide most of the nitrogen, either as amino acids (AA) or glycomacropeptide with supplementary amino acids (CGMP-AA). Body composition and growth are important indicators of long-term health. In a 3-year prospective study comparing the impact of AA and CGMP-AA on body composition and growth in PKU, 48 children were recruited. N = 19 (median age 11.1 years, range 5–15 years) took AA only, n = 16 (median age 7.3 years, range 5–15 years) took a combination of CGMP-AA and AA, (CGMP50) and 13 children (median age 9.2 years, range 5–16 years) took CGMP-AA only (CGMP100). A dual energy X-ray absorptiometry (DXA) scan at enrolment and 36 months measured LBM, % body fat (%BF) and fat mass (FM). Height was measured at enrolment, 12, 24 and 36 months. No correlation or statistically significant differences (after adjusting for age, gender, puberty and phenylalanine blood concentrations) were found between the three groups for LBM, %BF, FM and height. The change in height z scores, (AA 0, CGMP50 +0.4 and CGMP100 +0.7) showed a trend that children in the CGMP100 group were taller, had improved LBM with decreased FM and % BF but this was not statistically significant. There appeared to be no advantage of CGMP-AA compared to AA on body composition after 3-years of follow-up. Although statistically significant differences were not reached, a trend towards improved body composition was observed with CGMP-AA when it provided the entire protein substitute requirement.

Comparison of bioimpedance spectroscopy and dual energy X-ray absorptiometry for assessing body composition changes in obese children during weight loss

BACKGROUND

Obesity and age influence the reliability of dual energy X-ray absorptiometry scanning (DEXA) and bioimpedance spectroscopy (BIS). Both are used in clinical settings, but have not been compared for measurements in obese children. We compared DEXA and BIS for evaluating body composition and inherent changes in obese children before and after a 10-month weight loss programme.

METHODS

DEXA and BIS were used to evaluate 130 patients at baseline and 75 at follow-up. We tested agreement between the two techniques using Bland-Altman plots and proportional bias using Passing-Bablok regressions.

RESULTS

The Bland-Altman plots showed wide agreement limits before and after weight loss and when monitoring longitudinal changes. At baseline, the Passing-Bablok regressions revealed a proportional bias for all body compartments. After significant weight loss no proportional bias was found for fat mass and percentage, although BIS systematically underestimated fat mass by 2.9 kg. Longitudinally, no proportional bias was found in the measured changes of absolute fat, fat-free mass and fat-free percentage between both methods, although BIS systematically underestimated fat and fat-free mass by 2.6 and 0.7 kg, respectively.

CONCLUSION

While BIS and DEXA are not interchangeable at baseline, the agreement between the two improved after significant weight loss. Proportional changes in fat mass, fat-free mass and fat-free percentage were similar for both techniques. BIS is a viable alternative to DEXA for future paediatric obesity studies measuring treatment effect at group levels, but is not superior to DEXA and cannot be used for monitoring individual changes due to wide limits of agreement.

Influence of sex-specific concurrent changes in age, maturity status, and morphological covariates on the development of peak ventilatory variables in 10-17-year-olds

Purposes

(i) To investigate the influence of concurrent changes in age, maturity status, stature, body mass, and skinfold thicknesses on the development of peak ventilatory variables in 10–17-year-olds; and, (ii) to evaluate the interpretation of paediatric norm tables of peak ventilatory variables.

Methods

Multiplicative multilevel modelling which allows both the number of observations per individual and the temporal spacing of the observations to vary was used to analyze the expired ventilation (peak \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E) and tidal volume (peak V_T) at peak oxygen uptake of 420 (217 boys) 10–17-year-olds. Models were founded on 1053 (550 from boys) determinations of peak ventilatory variables supported by anthropometric measures and maturity status.

Results

In sex-specific, multiplicative allometric models, concurrent changes in body mass and skinfold thicknesses (as a surrogate of FFM) and age were significant (p < 0.05) explanatory variables of the development of peak \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E, once these covariates had been controlled for stature had no additional, significant (p > 0.05) effect on peak \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E. Concurrent changes in age, stature, body mass, and skinfold thicknesses were significant (p < 0.05) explanatory variables of the development of peak V_T. Maturity status had no additional, significant (p > 0.05) effect on either peak \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E or peak V_T once age and morphological covariates had been controlled for.

Conclusions

Elucidation of the sex-specific development of peak \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E requires studies which address concurrent changes in body mass, skinfold thicknesses, and age. Stature is an additional explanatory variable in the development of peak V_T, in both sexes. Paediatric norms based solely on age or stature or body mass are untenable.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sex-Specific Longitudinal Modeling of Short-Term Power in 11- to 18-Year-Olds

Purpose

To investigate, longitudinally, short-term power output in relation to sex and concurrent changes in age, body mass, fat-free mass (FFM), and maturity status.

Methods

Multiplicative multilevel modeling which enables the effects of variables to be partitioned concurrently within an allometric framework was used to analyze the peak power (PP) and mean power (MP) of 388 11- to 18-yr-olds. Multilevel models were founded on 763 (405 from boys; 358 from girls) determinations of PP and MP from Wingate anaerobic tests, supported by anthropometric measures and maturity status.

Results

In both sexes, PP and MP were significantly (P < 0.001) correlated with age, body mass, and FFM. After controlling for body mass, initial models showed positive effects for age on PP and MP, with negative effects for sex and a sex by age interaction. Sex-specific models showed maturity status to have no additional effect on either PP or MP once age and body mass had been controlled for. Skinfold thicknesses in addition to body mass to provide a surrogate for FFM, yielded a significantly (P < 0.05) better statistical fit in all models compared with those based on either body mass or FFM estimated from youth-specific skinfold equations. Models founded on estimated FFM provided a significantly (P < 0.05) better fit than those based on body mass.

Conclusions

With body mass controlled for boys’ PP and MP are higher than those of girls and sex differences increase with age from 11 to 18 yr. A multilevel modeling approach has showed that in both sexes the most powerful influences on short-term power output are concurrent changes in age and FFM as reflected by the combination of body mass and skinfold thicknesses.

Clarity and Confusion in the Development of Youth Aerobic Fitness

Peak oxygen uptake (V˙O2) is internationally recognized as the criterion measure of youth aerobic fitness, but flawed laboratory assessments and fallacious interpretations of peak V˙O2 in ratio with body mass have confused our understanding of the development of aerobic fitness. Moreover, the recent emergence of specious predictions of peak V˙O2 from performance tests and the promotion of spurious “clinical red flags” and cardiometabolic cut-points have confused our understanding of the relationship between youth aerobic fitness and health. Recent longitudinal studies of 10–18-year-olds using multilevel allometric modeling have empirically demonstrated that peak V˙O2 increases in accord with sex-specific, concurrent changes in age- and maturity status-driven morphological covariates with the timing and tempo of changes specific to individuals. During both cycle ergometry and treadmill running age- and maturity status- driven changes in fat free mass have been revealed as the most powerful morphological influences on the development of youth aerobic fitness. To bring some clarity to current confusion, this paper argues that future studies must be founded on rigorous assessment and interpretation of peak V˙O2 and ensure that they address the development of youth aerobic fitness and its relationship with present and future health in relation to appropriate sex-specific morphological covariates governed by individual biological clocks.

Sex-Specific Longitudinal Modeling of Youth Peak Oxygen Uptake

Purpose: To investigate peak oxygen uptake ( V˙O2 ) in relation to sex, age, body mass, fat-free mass (FFM), maturity, and overweight status. Methods: Multiplicative, allometric models of 10- to 18-year-olds were founded on 1057 determinations of peak V˙O2 supported by anthropometry and estimates of maturity status. Results: Baseline models with body mass controlled for showed age to exert a positive effect on peak V˙O2 , with negative estimates for age², sex, and a sex-by-age interaction. Sex-specific models showed maturity status to have a positive effect on peak V˙O2 in addition to the effects of age and body mass. Introducing skinfold thicknesses to provide, with body mass, a surrogate for FFM explained maturity effects and yielded a significantly (P < .05) better statistical fit in all models compared with those based on FFM estimated from youth-specific skinfold equations. With girls only, the introduction of overweight, defined by body mass index, resulted in a small but significant (P < .05) negative effect, with an age-by-overweight status interaction. Conclusions: FFM has a powerful influence on peak V˙O2 in both sexes. Interpretation of the development of youth aerobic fitness and its application to health should reflect the sex- and maturity-associated variation in FFM.

Development of peak oxygen uptake from 11-16 years determined using both treadmill and cycle ergometry

PURPOSES

To investigate the development of peak oxygen uptake ([Formula: see text]) assessed on both a treadmill and a cycle ergometer in relation with sex and concurrent changes in age, body mass, fat-free mass (FFM), and maturity status and to evaluate currently proposed 'clinical red flags' or health-related cut-points for peak [Formula: see text].

METHODS

Multiplicative multilevel modelling, which enables the effects of variables to be partitioned concurrently within an allometric framework, was used to analyze the peak [Formula: see text]s of 138 (72 boys) students initially aged 11-14 years and tested on three annual occasions. Models were founded on 640 (340 from boys) determinations of peak [Formula: see text], supported by anthropometric measures and maturity status.

RESULTS

Mean peak [Formula: see text]s were 11-14% higher on a treadmill. The data did not meet the statistical assumptions underpinning ratio scaling of peak [Formula: see text] with body mass. With body mass appropriately controlled for boys' peak [Formula: see text]s were higher than girls' values and the difference increased with age. The development of peak [Formula: see text] was sex-specific, but within sex models were similar on both ergometers with FFM the dominant anthropometric factor.

CONCLUSIONS

Data should not be pooled for analysis but data from either ergometer can be used independently to interpret the development of peak [Formula: see text] in youth. On both ergometers and in both sexes, FFM is the most powerful morphological influence on the development of peak [Formula: see text]. 'Clinical red flags' or health-related cut-points proposed without consideration of exercise mode and founded on peak [Formula: see text] in ratio with body mass are fallacious.

Geographic variation in ringed seal (Pusa hispida) growth rate and body size

We summarize geographical patterns in ringed seal (Pusa hispida (Schreber, 1775)) body length and girth growth using 3012 samples collected by Inuit hunters in the eastern Canadian Arctic from 1990 to 2016. Spatial structure was detected using cluster analysis of environmental variables separating a northern region in the eastern Canadian High Arctic and a southern region in Hudson Bay. The north was characterized by more fast ice, multiyear ice, greater snow depth, colder temperatures, and greater sea-ice concentration in the spring seal breeding season. Hierarchical Bayesian models described length and axillary girth growth of northern seals as slower than in the south, reaching asymptotic size 5–7 years later. Northern females were larger than males (asymptotic length of 149 versus 140 cm, respectively) and both were larger than southern seals (males and females 126 cm). We conclude that environmental variation was best represented by regions rather than latitude, regional body size differences were driven by differential growth rates, and northern ringed seals may be characterized by reverse sexual size dimorphism.

Predictive validity of body fat percentage by bioimpedance compared with deuterium oxide dilution in Costa Rican schoolchildren

OBJECTIVE

The purpose of this study was to verify the validity of body fat percentage (BF%) by bioelectrical impedance analysis (BIA) in a sample of Costa Rican schoolchildren.

METHODS

The sample consisted of 52 male (mean age 8.1 ± 0.9 years) and 49 female (mean age 7.5 ± 1.0 years) schoolchildren. Deuterium oxide dilution was the reference method used as the "gold standard" to determine the fat mass (FM) expressed as BF%. Linear regression analyses and paired sample t-tests were used to test the association and mean differences between BIA and deuterium oxide dilution BF%. Concordance between BIA and deuterium oxide dilution BF% was determined by Lin's concordance correlation coefficient. Measurement of agreement between the two methods was analyzed using the Bland-Altman procedure.

RESULTS

Significant associations between BIA and deuterium oxide dilution BF% were found in males (R = 0.97, R²  = 0.95, P < .0001) and in females (R = 0.98, R²  = .96, P < .0001). The measurements of BF% (mean ± SD) were not significantly different between males (BIA 31.1 ± 7.6% vs. deuterium oxide dilution 31.0 ± 7.4%) and females (BIA 25.9 ± 7.9% vs. deuterium oxide dilution 26.3 ± 7.8%) by t-test. Lin's concordance correlation coefficient identified an almost perfect strength of agreement between males and females. Bland-Altman plots showed that the Bodystat measured similar BF% compared to the deuterium oxide dilution in both males and females.

CONCLUSIONS

BIA Bodystat presented high agreement with BF% measured by deuterium oxide dilution; therefore BIA Bodystat is recommended for estimating BF% in Costa Rican schoolchildren.

[Evaluation of isometric force in lower limbs and body composition in preterm infants]

INTRODUCTION

Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass.

MATERIAL AND METHODS

Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls.

RESULTS

Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight.

CONCLUSIONS

Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

The four-compartment model of body composition in obese Chilean schoolchildren, by pubertal stage: comparison with simpler models

OBJECTIVES

We assessed the agreement of body fat and fat-free mass measured by simpler methods against the four-compartment model (4C).

METHODS

In 60 obese schoolchildren (body mass index ≥95th percentile) between the ages of 8 and 13 y who were recruited from one school in Chile, multicompartmental body composition was estimated with the use of isotopic dilution, plethysmography (BodPod), radiographic absorptiometry (DEXA), and anthropometric equations. These results were compared to those of the 4C model, which is considered the gold standard.

RESULTS

For body fat, the 4C model showed the best agreement with DEXA for boys in Tanner stages I and II (r = 0.971) and with isotopic dilution for boys in Tanner stages III and IV (r = 0.984). The best agreement in girls occurred with isotopic dilution, regardless of pubertal stage (r = 0.948 for Tanner stages I and II; r = 0.978 for Tanner stages III and IV). Both isotopic dilution and the Huang, Ellis, and Deurenberg anthropometric equations underestimated body fat in boys; by contrast, DEXA, BodPod, and the Slaughter equation overestimated body fat in boys. All of the equations underestimated body fat in girls. For fat-free mass in both boys and girls, the 4C model showed the best agreement with isotopic dilution, regardless of pubertal stage. The Huang equation showed the best agreement for boys (r = 0.730 for Tanner stages I and II; r = 0.695 for Tanner stages III and IV) and for girls in Tanner stages I and II (r = 0.884). The Ellis equation had the best agreement for girls in Tanner stages III and IV (r = 0.917).

CONCLUSIONS

For obese Chilean children of both sexes, isotopic dilution and DEXA were the two-compartment methods that had the best agreement with the gold-standard 4C model for both body fat and fat-free mass; these were followed by the Huang and Ellis anthropometric equations.

Racial/ethnic differences in clinical and biochemical type 2 diabetes mellitus risk factors in children

OBJECTIVE

To examine whether periadolescent children demonstrate the significant racial/ethnic differences in body fatness relative to BMI and in the prevalence and relationship of body composition to risk factors for type 2 diabetes (T2DM) as in adults.

DESIGN AND METHODS

Family history of obesity and T2DM, anthropometry, insulin sensitivity and secretory capacity, lipids, and cytokines (IL-6, CRP, TNF-α, and adiponectin) were examined in a cohort of 994 middle school students (47% male, 53%, female; 12% African American, 14% East Asian, 13% South Asian, 9% Caucasian, 44% Hispanic, and 8% other).

RESULTS

Fractional body fat content was significantly greater at any BMI among South Asians. There were racial/ethnic specific differences in lipid profiles, insulin secretory capacity, insulin sensitivity, and inflammatory markers corrected for body fatness that are similar to those seen in adults. Family history of T2DM was associated with lower insulin secretory capacity while family history of obesity was more associated with insulin resistance.

CONCLUSIONS

Children show some of the same racial/ethnic differences in risk factors for adiposity-related comorbidities as adults. BMI and waist circumference cutoffs to identify children at-risk for adiposity-related comorbidities should be adjusted by racial/ethnic group as well as other variables such as birthweight and family history.

Validity of the methods to assess body fat in children and adolescents using multi-compartment models as the reference method: a systematic review

OBJECTIVE

To analyze the validity of methods to assess body fat in children and adolescents using a systematic review.

METHODS

The search was conducted by two independent researchers using the MEDLINE, BioMed Central, SciELO and LILACS electronic databases. For inclusion, the articles should be written in English or Portuguese, and must have used multi-compartment models as the criterion measure of the model, with body fat measurement of whole body in non-athlete children and adolescents.

RESULTS

A preliminary search resulted in 832 studies. After all selection steps were performed, 12 articles were included. The selected studies were published between 1997 and 2010, whose samples consisted of children and adolescents with levels of relative body fat ranging from 20.7% to 41.4%. The methods used were: dual energy X-ray absorptiometry (58.3%), isotope dilution (41.6%), skinfold thickness (33.3%), hydrostatic weighing (25%), bioelectrical impedance analysis (25%), air displacement plethysmography (16.6%), and total body electrical conductivity (8.3%).

CONCLUSIONS

Based on the analysis of the studies, isotope dilution and air displacement plethysmography methods were the most reliable, despite the limited number of studies. As for clinical use or for population-based studies, the equation of Slaughter et al. (1998), which uses the triceps and subscapular skinfolds thickness, showed the best results for assessment of body fat in this population.

Use of fat mass and fat free mass standard deviation scores obtained using simple measurement methods in healthy children and patients: comparison with the reference 4-component model

Background

Clinical application of body composition (BC) measurements for individual children has been limited by lack of appropriate reference data.

Objectives

(1) To compare fat mass (FM) and fat free mass (FFM) standard deviation scores (SDS) generated using new body composition reference data and obtained using simple measurement methods in healthy children and patients with those obtained using the reference 4-component (4-C) model; (2) To determine the extent to which scores from simple methods agree with those from the 4-C model in identification of abnormal body composition.

Design

FM SDS were calculated for 4-C model, dual-energy X-ray absorptiometry (DXA; GE Lunar Prodigy), BMI and skinfold thicknesses (SFT); and FFM SDS for 4CM, DXA and bioelectrical impedance analysis (BIA; height²/Z)) in 927 subjects aged 3.8–22.0 y (211 healthy, 716 patients).

Results

DXA was the most accurate method for both FM and FFM SDS in healthy subjects and patients (mean bias (limits of agreement) FM SDS 0.03 (±0.62); FFM SDS −0.04 (±0.72)), and provided best agreement with the 4-C model in identifying abnormal BC (SDS ≤−2 or ≥2). BMI and SFTs were reasonable predictors of abnormal FM SDS, but poor in providing an absolute value. BIA was comparable to DXA for FFM SDS and in identifying abnormal subjects.

Conclusions

DXA may be used both for research and clinically to determine FM and FFM SDS. BIA may be used to assess FFM SDS in place of DXA. BMI and SFTs can be used to measure adiposity for groups but not individuals. The performance of simpler techniques in monitoring longitudinal BC changes requires investigation. Ultimately, the most appropriate method should be determined by its predictive value for clinical outcome.

Air displacement plethysmography, dual-energy X-ray absorptiometry, and total body water to evaluate body composition in preschool-age children

Anthropometrics and body mass index are only proxies in the evaluation of adiposity in the pediatric population. Air displacement plethysmography technology was not available for children aged 6 months to 9 years until recently. Our study was designed to test the precision of air displacement plethysmography (ADP) in measuring body fat mass in children at ages 3 to 5 years compared with a criterion method, deuterium oxide dilution (D(2)O), which estimates total body water and a commonly used methodology, dual-energy x-ray absorptiometry (DXA). A prospective, cross-sectional cohort of 66 healthy children (35 girls) was recruited in the central Arkansas region between 2007 and 2009. Weight and height were obtained using standardized procedures. Fat mass (%) was measured using ADP, DXA, and D(2)O. Concordance correlation coefficient and Bland-Altman plots were used to investigate the precision of the ADP techniques against D(2)O and DXA in children at ages 3 to 5 years. ADP concordance correlation coefficient for fat mass was weak (0.179) when compared with D(2)O. Bland-Altman plots revealed a low accuracy and large scatter of ADP fat mass (%) results (mean=-2.5, 95% CI -20.3 to 15.4) compared with D(2)O. DXA fat mass (%) results were more consistent although DXA systematically overestimated fat mass by 4% to 5% compared with D(2)O. Compared with D(2)O, ADP does not accurately assess percent fat mass in children aged 3 to 5 years. Thus, D(2)O, DXA, or quantitative nuclear magnetic resonance may be considered better options for assessing fat mass in young children.

Effects of obesity on human sexual development

Puberty is a period of physical and psychological maturation, with long-term effects on health. During the 20(th) century, a secular trend towards earlier puberty occurred in association with improvements in nutrition. The worldwide pandemic of childhood obesity has renewed interest in the relationship between body composition in childhood and the timing and tempo of puberty. Limited evidence suggests that earlier puberty is associated with a tendency towards central fat deposition; therefore, pubertal status needs to be carefully considered in the categorization of childhood and adolescent overweight and obesity. In the other direction, rapid early weight gain is associated with advanced puberty in both sexes, and a clear association exists between increasing BMI and earlier pubertal development in girls. Evidence in boys is less clear, with the majority of studies showing obesity to be associated with earlier puberty and voice break, although a subgroup of boys with obesity exhibits late puberty, perhaps as a variation of constitutional delay in growth and puberty. The possible mechanisms linking adiposity with pubertal timing are numerous, but leptin, adipocytokines and gut peptides are central players. Other possible mediators include genetic variation and environmental factors such as endocrine disrupting chemicals. This Review presents current evidence on this topic, highlighting inconsistencies and opportunities for future research.

Interactive effects of dietary restraint and adiposity on stress-induced eating and the food choice of children

The Individual Differences Model posits that individual differences in physiological and psychological factors explain eating behaviors in response to stress. The purpose was to determine the effects of individual differences in adiposity, dietary restraint and stress reactivity on children's energy intake and food choices. A total of 40 boys and girls, age 8-12 years, with wide ranges of dietary restraint, adiposity, and stress reactivity were measured for total energy intake and choice of energy dense 'comfort' and lower density 'healthy' foods following reading and speech stressor manipulations. When exploring the interaction of dietary restraint and stress reactivity, lower restraint/lower reactivity and lower restraint/higher reactivity were associated with reductions in energy intake (37-62 kcal) and comfort food (33-89 kcal). Higher restraint/lower reactivity was associated with consuming 86 fewer total kcal and 45 fewer kcal of comfort food. Only higher restraint/higher reactivity predicted increased energy intake (104 kcal) and comfort food (131 kcal). The interaction of dietary restraint and percentage body fat revealed that lower restraint/lower adiposity was associated with consuming 123 fewer kcal after being stressed with the entire reduction due to a decrease in comfort food. Lower restraint/higher adiposity was associated with consuming 116 kcal more after being stressed with 70% (81 kcal) of the increase in the form of comfort foods. Higher restraint/lower adiposity and higher restraint/higher adiposity were associated with smaller changes in total energy intake of 22 kcal and 1 kcal; respectively. Both restraint and adiposity moderated the effect of stress on energy intake and food choice. Children with greater adiposity may be at risk for stress-induced eating to contribute to their obesity.

Estimation of percentage body fat in 6- to 13-year-old children by skinfold thickness, body mass index and waist circumference

We evaluated the accuracy of skinfold thicknesses, BMI and waist circumference for the prediction of percentage body fat (PBF) in a representative sample of 372 Swiss children aged 6-13 years. PBF was measured using dual-energy X-ray absorptiometry. On the basis of a preliminary bootstrap selection of predictors, seven regression models were evaluated. All models included sex, age and pubertal stage plus one of the following predictors: (1) log-transformed triceps skinfold (logTSF); (2) logTSF and waist circumference; (3) log-transformed sum of triceps and subscapular skinfolds (logSF2); (4) log-transformed sum of triceps, biceps, subscapular and supra-iliac skinfolds (logSF4); (5) BMI; (6) waist circumference; (7) BMI and waist circumference. The adjusted determination coefficient (R² adj) and the root mean squared error (RMSE; kg) were calculated for each model. LogSF4 (R² adj 0.85; RMSE 2.35) and logSF2 (R² adj 0.82; RMSE 2.54) were similarly accurate at predicting PBF and superior to logTSF (R² adj 0.75; RMSE 3.02), logTSF combined with waist circumference (R² adj 0.78; RMSE 2.85), BMI (R² adj 0.62; RMSE 3.73), waist circumference (R² adj 0.58; RMSE 3.89), and BMI combined with waist circumference (R² adj 0.63; RMSE 3.66) (P < 0.001 for all values of R² adj). The finding that logSF4 was only modestly superior to logSF2 and that logTSF was better than BMI and waist circumference at predicting PBF has important implications for paediatric epidemiological studies aimed at disentangling the effect of body fat on health outcomes.

Total body water measurements in adolescent athletes: a comparison of six field methods with deuterium dilution

-Assessing hydration, that is, total body water (TBW) in adolescent athletes should be part of a comprehensive training program. However, there are no specific methods to assess TBW in young athletes. Moreover, the use of traditional techniques developed in healthy youths, based on a 2-compartment model, may yield inaccurate TBW estimates in young athletes. Therefore, the purpose of this study was to assess the accuracy of TBW non-reference field methods with a criterion method (i.e., deuterium dilution) in 118 adolescent athletes. Body volume was assessed by air displacement plethysmography, bone mineral was measured by dual-energy X-ray absorptiometry, and TBW by deuterium dilution. Non-reference TBW methods included 2 bioelectrical impedance analysis techniques (Tanita Body Composition Analyzer, model TBF-310) and bioelectrical impedance spectroscopy (BIS) (model 4000B); the Lohman's hydration constants of fat-free mass (FFM); and 3 derived anthropometric equations developed, respectively, by Kushner et al., Wells et al., and Morgenstern et al. The highest accuracy between TBW estimates and the reference model in both girls and boys was observed using the Lohman's constants (r2= 0.94, SEE = 1.56 kg; r2 = 0.92, SEE = 2.42 kg, respectively; p < 0.001), followed by both foot-to-foot Tanita (r2 = 0.88, SEE = 2.15 kg; r2 = 0.87, SEE = 3.01 kg, respectively; p < 0.001) and BIS (r2 = 0.92, SEE = 1.70 kg; r2 = 0.87, SEE = 3.04 kg, respectively; p < 0.001) with slopes and intercepts not significantly different from the line of identity. The regressions between anthropometric equations and the criterion method deviated from the line of identity (p < 0.05). The practical application of this study is that the specific constants of FFM hydration developed by Lohman seem to accurately estimate TBW in adolescent athletes. Foot-to-foot Tanita and BIS were also found to be valid and non-biased tools for predicting TBW. It would appear that the 3 anthropometric equations used are not appropriate for young athletes.

Effect of puberty on body composition

PURPOSE OF REVIEW

Here we examine the effect of puberty on components of human body composition, including adiposity (total body fat, percentage body fat and fat distribution), lean body mass and bone mineral content and density. New methods and longitudinal studies have expended our knowledge of these remarkable changes.

RECENT FINDINGS

Human differences in adiposity, fat free mass and bone mass reflect differences in endocrine status (particularly with respect to estrogens, androgens, growth hormone and IGF-1), genetic factors, ethnicity and the environment. During puberty, males gain greater amounts of fat free mass and skeletal mass, whereas females acquire significantly more fat mass. Both genders reach peak bone accretion during the pubertal years, though males develop a greater skeletal mass. Body proportions and fat distribution change during the pubertal years as well, with males assuming a more android body shape and females assuming a more gynecoid shape. Pubertal body composition may predict adult body composition and affects both pubertal timing and future health.

SUMMARY

Sexual dimorphism exists to a small degree at birth, but striking differences develop during the pubertal years. The development of this dimorphism in body composition is largely regulated by endocrine factors, with critical roles played by growth hormone and gonadal steroids. It is important for clinicians and researchers to know the normal changes in order to address pathologic findings in disease states.

Use of bioelectrical impedance analysis to assess body composition in rural Gambian children

OBJECTIVE

To validate the Tanita BC-418MA Segmental Body Composition Analyser and four-site skinfold measurements for the prediction of total body water (TBW), percentage fat-free mass (%FFM) and percentage body fat (%BF) in a population of rural Gambian children.

SUBJECTS/METHODS

One hundred and thirty-three healthy Gambian children (65 males and 68 females). FFM estimated by the inbuilt equations supplied with the Tanita system was assessed by comparison with deuterium oxide dilution and novel prediction equations were produced. Deuterium oxide dilution was also used to develop equations for %BF based on four-site skinfolds (biceps, triceps, subscapular and suprailiac).

RESULTS

The inbuilt equations underestimated FFM compared to deuterium oxide dilution in all the sex and age categories (P<0.003), with greater accuracy in younger children and in males. The best prediction of %FFM was obtained from the variables height, weight, sex, impedance, age and four skinfold thickness measurements (adjusted R(2)=0.84, root mean square error (MSE)=2.07%).

CONCLUSIONS

These data suggest that the Tanita instrument may be a reliable field assessment technique in African children, when using population and gender-specific equations to convert impedance measurements into estimates of FFM.

Reproducibility of short-term food intake and subjective appetite scores after a glucose preload, ventilation threshold, and body composition in boys

The objective of these studies was to assess the reproducibility of (i) short-term food intake (FI) and subjective appetite following a glucose preload, (ii) ventilation threshold (VT) and subjective appetite after short-duration exercise, and (iii) body composition assessed by bioelectrical impedance (BIA). On two separate weekend mornings, boys (n = 11; aged 9–14 years) received drinks containing 50 g glucose made up to 250 mL with water 2 h after a standardized breakfast. FI from a pizza meal was measured 30 min later. Subjective appetite was measured before and after the glucose loads and the VT measures. VTs were measured on 2 weekday evenings, 1 week apart. BIA was measured during the FI assessment sessions. Short-term FI after the glucose preload was highly reproducible. Mean energy intake was 925 ± 139 kcal on the first day and 988 ± 147 kcal on the second day (coefficient of repeatability (CR) = 259 kcal; intra-class correlation coefficient (ICC) = 0.96). Moderate reproducibility of the average appetite score was found at 30 min (CR = 24 mm; ICC = 0.82). Subjective appetite was increased similarly by short-duration exercise on both days (CR = 19 mm). Absolute VT was more highly reproducible (CR = 359 mL O2·min–1, ICC = 0.85) than VT expressed on the basis of body weight (CR = 8.0 mL O2·kg–1·min–1, ICC = 0.59). Fat mass (FM) estimated from BIA was highly reproducible (CR = 2.7 kg, ICC = 0.95), but underestimated FM compared with skinfolds. In conclusion, FI and subjective appetite scores in response to glucose preloads, VT, subjective appetite after short-duration exercise, and estimates of FM from BIA are reproducible in boys.

Body composition in girls and young women with anorexia nervosa: comparison of different equations

OBJECTIVE

The weight percentage of body fat in anorexic adolescents on the basis of four distinct formulas (Siri; Lohman; Westrate and Deurenberg; Heyward and Stolarczyk) is compared.

METHOD

The body composition of 238 anorexia nervosa (AN) patients, divided into four age categories (13-15, 15-17, 17-19, and 19-22 years), was measured by means of densitometry (underwater weighing).

RESULTS

Depending on the formula, the results calculated by the formulas differ significantly in each age category. The Siri formula generally results in the highest mean fat percentage (12.76%-13.39%) whereas the Heyward and Stolarczyck formula shows the lowest figures (8.77%-9.31%). Applying the Lohman and the Heyward and Stolarczyck formulas to the 19-22 years category, results in negative fat percentages.

CONCLUSION

A clinically useful formula is important for the estimation of body composition in specific age categories. We recommend with some restrictions, to apply the Siri formula in AN patients.

Body composition assessment for development of an international growth standard for preadolescent and adolescent children

General considerations in assessing body composition in children and youths are described. Various methods are explored and recommendations are made for methods to be used in the International Growth Standard for Preadolescent and Adolescent Children Project. Exclusion of under- and overweight participants is recommended, and a method is proposed to assess both underweight and overweight. In addition to height and weight, we recommend waist circumference, selected skinfolds, and dual-energy x-ray absorptiometry (DXA) as a measure of fat, lean, and bone mineral density. We also propose using both fat mass index and fat-free mass index as an improvement over body-mass index.

Relationships of activity and sugar drink intake on fat mass development in youths

PURPOSE

To determine whether a significant relationship exists between fat mass (FM) development and physical activity (PA) and/or sugar-sweetened drink (SD) consumption in healthy boys and girls aged 8-19 yr.

METHODS

A total of 105 males and 103 females were assessed during childhood and adolescence for a maximum of 7 yr and a median of 5 yr. Height was measured biannually. Fat-free mass (FFM) and FM were assessed annually by dual x-ray absorptiometry (DXA). PA was evaluated two to three times annually using the PAQ-C/A. Energy intake and SD were assessed using a 24-h dietary intake questionnaire also completed two to three times per year. Years from peak height velocity were used as a biological maturity age indicator. Multilevel random effects models were used to test the relationship.

RESULTS

When controlling for maturation, FFM, and energy intake adjusted for SD, PA level was negatively related to FM development in males (P<0.05) but not in females (P>0.05). In contrast, there was no relationship between SD and FM development of males or females (P>0.05). There was also no interaction effect between SD and PA (P>0.05) with FM development.

CONCLUSION

This finding lends support to the idea that increasing PA in male youths aids in the control of FM development. Models employed showed no relationship between SD and FM in either gender.

Body fat measurement in adolescent athletes: multicompartment molecular model comparison

OBJECTIVE

To assess the accuracy of air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) per cent body fat (%BF) estimations in comparison with a reference five-compartment (5C) model used as the reference method.

DESIGN

Cross-sectional study.

SETTING

Outpatient University Laboratory, Lisbon, Portugal.

METHODS

A total of 32 girls (age: 15.1+/-0.3 years) and 46 boys (age: 15.3+/-1.2 years) athletes were measured. Body volume was assessed by ADP; bone mineral content was assessed by DXA; and total-body water was assessed by deuterium dilution. Statistical analyses included examination of the coefficient of correlation (r), standard error of estimation (s.e.e.), slope, intercept, and pure error (p.e.) and the agreement between models.

RESULTS

For boys and girls, differences between the 5C model and ADP %BF were 0.2 and 1.7% (r = 0.86 and 0.98, s.e.e.= 2.50 and 1.55%, p.e.=2.77 and 2.23%), respectively. Differences between the 5C model and DXA %BF were -1.0 and -3.7% (r = 0.85 and 0.91, s.e.e.= 2.60 and 2.91%, p.e.= 2.90 and 4.66%), for boys and girls, respectively. For girls, regression between ADP and DXA against the reference method did not differ from the line of identity (P > 0.05) while for boys differences were found (P < 0.05). Dual energy X-ray absorptiometry overestimated %BF, particularly in girls. For both genders, large limits of agreement were found between the reference method and both techniques, with the exception of ADP in female athletes.

CONCLUSION

We conclude that the two techniques were not precise for individual %BF prediction, though ADP revealed better agreement for girls. However, considering all performance criteria for the mean group, our analysis highlights ADP as a valid and nonbiased tool for the evaluation of body composition in adolescent athletes.

Syndromic obesity and diabetes: changes in body composition with age and mutation analysis of ALMS1 in 12 United Kingdom kindreds with Alstrom syndrome

CONTEXT

Alström syndrome (AS) is a monogenic form of infancy-onset obesity and insulin resistance, caused by ALMS1 mutations. The natural history of the insulin resistance is unknown, in particular how this relates to changes in body composition. It is also unclear how ALMS1 mutations relate to the characteristic phenotype.

OBJECTIVES

Our objectives were to characterize body composition and metabolic parameters, to establish ALMS1 mutation spectrum of United Kingdom AS patients, and to determine whether a genotype-phenotype correlation exists.

DESIGN AND PATIENTS

We conducted a cross-sectional cohort study of 12 unrelated subjects with AS. Age-standardized body composition was assessed by anthropometry and dual-energy x-ray absorptiometry and insulin sensitivity by homeostasis model assessment. The exons and intron-exon boundaries of ALMS1 were directly sequenced.

SETTING

The study was performed during the annual Alström Syndrome UK multidisciplinary screening clinic.

RESULTS

AS patients have early-onset obesity, but body mass index, waist circumference, and body fat from dual-energy x-ray absorptiometry were negatively correlated with age (r = -0.37, P = 0.2; r = -0.84, P = 0.002; and r = -0.6, P = 0.05). Despite this, insulin resistance increased, demonstrated by raised fasting insulin and fall in homeostasis model assessment insulin sensitivity with age (r = -0.64, P = 0.02). ALMS1 mutations were identified in 10 of 12 patients, with a potential founder mutation in exon 16 present in five [np 10775del (C); Del3592fs/ter3597]. No genotype-phenotype correlation was observed.

CONCLUSIONS

We identified mutations in ALMS1 in more than 80% of patients with no genotype-phenotype correlation. In AS, severe childhood obesity, waist circumference, and body fat decrease with age, whereas insulin resistance increases. The abdominal obesity, insulin resistance, diabetes, hypertriglyceridemia, and hypertension suggest that AS could represent a monogenic model for the metabolic syndrome.

Evaluation of Lunar Prodigy dual-energy X-ray absorptiometry for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model

BACKGROUND

Dual-energy X-ray absorptiometry (DXA) is widely used to assess body composition in research and clinical practice. Several studies have evaluated its accuracy in healthy persons; however, little attention has been directed to the same issue in patients.

OBJECTIVE

The objective was to compare the accuracy of the Lunar Prodigy DXA for body-composition analysis with that of the reference 4-component (4C) model in healthy subjects and in patients with 1 of 3 disease states.

DESIGN

A total of 215 subjects aged 5.0-21.3 y (n = 122 healthy nonobese subjects, n = 55 obese patients, n = 26 cystic fibrosis patients, and n = 12 patients with glycogen storage disease). Fat mass (FM), fat-free mass (FFM), and weight were measured by DXA and the 4C model.

RESULTS

The accuracy of DXA-measured body-composition outcomes differed significantly between groups. Factors independently predicting bias in weight, FM, FFM, and percentage body fat in multivariate models included age, sex, size, and disease state. Biases in FFM were not mirrored by equivalent opposite biases in FM because of confounding biases in weight.

CONCLUSIONS

The bias of DXA varies according to the sex, size, fatness, and disease state of the subjects, which indicates that DXA is unreliable for patient case-control studies and for longitudinal studies of persons who undergo significant changes in nutritional status between measurements. A single correction factor cannot adjust for inconsistent biases.

Comparison of techniques to evaluate adiposity in stunted and nonstunted children

OBJECTIVE

The use of anthropometric measures (eg, skinfold thicknesses, BMI) to assess obesity is not without controversy and has not been explored with respect to the use among groups of children with growth retardation (ie, stunting). Therefore, the objective of this study was to determine whether growth retardation affects the accuracy of field methods for assessing body composition in children.

METHODS

A cross-sectional study was conducted in 30 stunted children and 30 nonstunted children who were matched for age- and weight-for-height z score and living in the shantytowns of São Paulo, Brazil. Body composition (fat mass, fat-free mass, and percentage of body fat [%BF]) was measured by H2(18)O dilution (reference technique) using group-specific values for the hydration of fat-free mass and dual-energy x-ray absorptiometry. BMI and body composition that were calculated from 3 pediatric skinfold prediction equations were evaluated for accuracy of %BF in comparison with the reference technique.

RESULTS

Stunted children were shorter and weighed less than nonstunted children, but BMI did not differ significantly between groups. All 3 skinfold equations tested resulted in a calculated %BF that was significantly lower than that measured by H2(18)O dilution for both stunted and nonstunted groups, and %BF as calculated by any of the skinfold equations tested did not significantly predict %BF by H2(18)O dilution. In contrast, BMI significantly predicted %BF in both stunted and nonstunted children, and this relationship did not differ by growth status.

CONCLUSION

BMI but not skinfolds significantly predicted %BF measured by H2(18)O dilution. The relationship between BMI and %BF did not differ between stunted and nonstunted children; this indicates that BMI can be used in field studies of obesity and stunting. However, the prediction of %BF by BMI is relatively poor in both groups of children, and continued investigation of more accurate field methods for measuring %BF is warranted.

Reliability of bioimpedance analysis compared with other adiposity measurements in children: The FLVS II Study

OBJECTIVE

To evaluate the reproducibility of the measurement of% body fat by bipedal biometrical impedance analysis (BIA) compared with anthropometric measurements of adiposity in children and the correlations between these methods in children and adults.

METHODS

A cross-sectional study in a total of 1080 adults and children enrolled in 1999 in the Fleurbaix-Laventie Ville Santé II (FLVS II) population-based study in northern France. The reproducibility of anthropometrical and BIA methods was determined by a nested analysis of variance of repeated measurements by 2 investigators and a bipedal BIA device (Tanita TBF 310) in 64 pupils of two 5th grade classes. The correlation of BIA and anthropometric adiposity measurements with the unknown relative fat mass or volume of the body estimated by a latent adiposity variable (LAV) was established by the triads' method in 1080 subjects of the FLVS II cohort.

RESULTS

The reproducibility was similar for the sum of skinfolds, waist circumference and BIA% fat measurements (intraclass correlation coefficients: 0.979-0.992). Correlation coefficient between BIA body fat% and the LAV was higher than 0.86 in all sex and Tanner stage related groups, and similar in children and adults, except in pubertal boys (0.76).

CONCLUSION

With a high level of reproducibility, foot-to-foot BIA analysis provides a valuable measurement of total% fat for epidemiologic studies in children. However further studies are needed before extrapolating these results to overweight children.

Pubertal alterations in growth and body composition: IX. Altered spontaneous secretion and metabolic clearance of growth hormone in overweight youth

Deconvolution analysis was used to determine 12-hour spontaneous nocturnal growth hormone (GH) secretion and GH half-life in lean (body mass index, <85th percentile; n = 39) and overweight (body mass index, > or =85th percentile; n = 18) youth. The integrated GH concentration, GH burst mass, and half-life were lower (P < .05) in overweight than in lean youth. For each unit increase in percentage of body fat, integrated serum GH concentrations, secretory burst mass, and half-life declined by 83.6 microg/L per minute (r = -0.39, P < .01), 0.22 microg/L (r = -0.28, P < .05), and 0.2 minute (r = -0.38, P < .01), respectively. The effect of overweight on GH secretion was independent of pubertal status. Hierarchical regression models tested the hypothesis that altered GH secretion in youth is more related to total adiposity than abdominal visceral fat. When age, sex, fat-free mass, testosterone, and estradiol were held constant, the sequential addition of abdominal visceral fat did not increase R2 for any GH secretion variable. Sequential addition of percentage of body fat increased R2 (P < .05) for integrated GH concentration, total secretory rate, secretory burst mass, and pulsatile production rate. We conclude that serum GH concentrations are reduced in overweight youth primarily because of reduced GH burst mass with no change in the number of secretory events and secondarily to reduced GH half-life. Based on the model that GH-releasing hormone predominantly increases GH pulse amplitude whereas somatostatin primarily controls GH pulse frequency, these results suggest that overweight in youth diminishes GH-releasing hormone stimulation resulting in truncated GH bursts but does not alter the number of somatostatin withdrawal intervals so that GH burst frequency is conserved.