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Murphy-Alford AJ, Johnson W, Nyati LH, Santos IS, Hills AP, Ariff S, Wickramasinghe VP, Kuriyan R, Lucas MN, Costa CS, Slater C, Ahmad T, Byrne NM, Divya PJ, Kurpad AV, Cheikh Ismail LI, Loechl CU, Norris SA. Body composition reference charts for infants from birth to 24 months: Multicenter Infant Body Composition Reference Study. Am J Clin Nutr 2023; 117:1262-1269. [PMID: 37270290 DOI: 10.1016/j.ajcnut.2023.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Body composition assessment in the first 2 y of life provides important insights into child nutrition and health. The application and interpretation of body composition data in infants and young children have been challenged by a lack of global reference data. OBJECTIVES We aimed to develop body composition reference charts of infants aged 0-6 mo based on air displacement plethysmography (ADP) and those aged 3-24 mo based on total body water (TBW) by deuterium dilution (DD). METHODS Body composition was assessed by ADP in infants aged 0-6 mo from Australia, India, and South Africa. TBW using DD was assessed for infants aged 3-24 mo from Brazil, Pakistan, South Africa, and Sri Lanka. Reference charts and centiles were constructed for body composition using the lambda-mu-sigma method. RESULTS Sex-specific reference charts were produced for FM index (FMI), FFM index (FFMI), and percent FM (%FM) for infants aged 0-6 mo (n = 470 infants; 1899 observations) and 3-24 mo (n = 1026 infants; 3690 observations). When compared with other available references, there were observable differences but similar patterns in the trajectories of FMI, FFMI, and %FM. CONCLUSIONS These reference charts will strengthen the interpretation and understanding of body composition in infants across the first 24 mo of life.
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Affiliation(s)
- Alexia J Murphy-Alford
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Lukhanyo H Nyati
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Ina S Santos
- Post-graduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Shabina Ariff
- Department of Pediatric and Child Health, Medical College, The Aga Khan University, Sindh, Pakistan
| | | | | | - M Nishani Lucas
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Caroline S Costa
- Post-graduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Christine Slater
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Tanvir Ahmad
- Life Science Group, Isotope Application Division, Pakistan; Institute of Nuclear Science and Technology (PINSTECH), Nilore, Islamabad, Pakistan
| | - Nuala M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | | | | | - Leila I Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Nuffield Department of Women's & Reproductive Health, University of Oxford, United Kingdom
| | - Cornelia U Loechl
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa; School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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El Kari K, Mankai A, El Kouki D, Mehdad S, Benjeddou K, El Hsaini H, El Mzibri M, Aguenaou H. Anthropometry-Based Prediction Equation of Body Composition in a Population Aged 12-88 Years. J Nutr 2023; 153:657-664. [PMID: 36931748 DOI: 10.1016/j.tjnut.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Direct anthropometric measurements to assess body composition have limited precision and/or specificity. OBJECTIVES The study aimed to develop a prediction equation based on anthropometric measurements for estimating total body water (TBW) in a healthy population. METHODS TBW was assessed using the deuterium dilution method in 398 Moroccan participants (235 women and 163 men) aged 11.6-88 y, then compared to the estimations made by previously published anthropometric equations. By sex, participants were randomly assigned into development (n = 199) and validation subgroups (n = 199). A new anthropometric equation was developed in the development subgroup from data obtained on body volume (BV), weight, and sex, where the BV was calculated from participants' height. Then the equation was validated in the validation subgroup using the Bland and Altman procedure, bias, and pure error. External validation was performed using a sample from Tunisia (n = 220, 51.8% female, 18-65 y). RESULTS Bias in predicting TBW showed unacceptable value for all previously published equations as it was significantly overestimated. The following new equation using anthropometric measurements [TBW (kg) = -5.249 + 107.502 BV (L) + 0.289 weight (kg) + 2.015 sex (male: 1, female: 0); (R2 = 0.91, RMSE = 1.885 kg)] was developed, and its internal validation was confirmed. The generated bias and pure error values were 0.047 kg (95% CI: -0.235, 0.330) and 2.02 kg (95% CI: 1.73, 2.31), respectively. The external validation of the new TBW prediction equation on a Tunisian sample showed a bias and pure error values of 0.07 kg (95% CI: -0.289, 0.429) and 2.36 kg, respectively. CONCLUSIONS The results indicate that the new anthropometric-based prediction equation provides a good estimation of TBW and other body composition compartments. It could be recommended as an alternative method to assess body composition for epidemiological and clinical studies.
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Affiliation(s)
- Khalid El Kari
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco.
| | - Amani Mankai
- Institut National de Nutrition et Technologie alimentaire de Tunis, Tunis, Tunisia
| | - Donia El Kouki
- Institut National de Nutrition et Technologie alimentaire de Tunis, Tunis, Tunisia
| | - Slimane Mehdad
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco; Institut National de Nutrition et Technologie alimentaire de Tunis, Tunis, Tunisia; Physiology and Physiopathology Research Team, Research Centre of Human Pathologies Genomics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Kaoutar Benjeddou
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco
| | - Houda El Hsaini
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco; Institut National de Nutrition et Technologie alimentaire de Tunis, Tunis, Tunisia; Physiology and Physiopathology Research Team, Research Centre of Human Pathologies Genomics, Faculty of Sciences, Mohammed V University, Rabat, Morocco; College of Health Sciences, International University of Rabat, Salé, Morocco
| | - Mohammed El Mzibri
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco
| | - Hassan Aguenaou
- RDC-Nutrition, Ibn Tofaïl University, Centre National de l'Énergie, des Sciences et Techniques Nucléaires, Kenitra, Morocco
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Lewis JI, Friis H, Mupere E, Wells JC, Grenov B. Calibration of Bioelectrical Impedance Analysis Against Deuterium Dilution for Body Composition Assessment in Stunted Ugandan Children. J Nutr 2023; 153:426-434. [PMID: 36894235 DOI: 10.1016/j.tjnut.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND BIA represents an important tool in body composition (BC) assessment, especially in low-income settings in which simple and affordable options are preferred. There is a particular need to measure BC in stunted children, in which cases population-specific BIA estimating equations are lacking. OBJECTIVES We calibrated an equation to estimate body composition from BIA using deuterium dilution (2H) as the criterion method in stunted children. METHODS We measured BC with 2H and performed BIA in stunted Ugandan children (n = 50). Multiple linear regression models were constructed to predict 2H-derived FFM from BIA-derived whole-body impedance and other relevant predictors. Model performance was expressed as adjusted R2 and RMSE. Prediction errors were also calculated. RESULTS Participants were aged 16-59 mo, of whom 46% were girls, and their median (IQR) height-for-age z-score (HAZ) was -2.58 (-2.92 to -2.37) according to the WHO growth standards. Impedance index (height2/impedance measured at 50 kHz) alone explained 89.2% variation in FFM and had an RMSE of 583 g (precision error 6.5%). The final model contained age, sex, impedance index, and height-for-age z-score as predictors and explained 94.5% variation in FFM with an RMSE of 402 g (precision error 4.5%). CONCLUSIONS We present a BIA calibration equation for a group of stunted children with a relatively low prediction error. This may help evaluate the efficacy of nutritional supplementation in large-scale trials in the same population. J Nutr 20XX;xxx:xx.
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Affiliation(s)
- Jack I Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy, and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
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Lopez-Gonzalez D, Wells JCK, Parra-Carriedo A, Bilbao G, Mendez M, Clark P. 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. Nutrients 2022; 14:1073. [PMID: 35268047 DOI: 10.3390/nu14051073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Watson LPE, Carr KS, Orford ER, Venables MC. The Importance of Hydration in Body Composition Assessment in Children Aged 6-16 Years. J Clin Densitom 2021; 24:481-489. [PMID: 33454177 PMCID: PMC8354559 DOI: 10.1016/j.jocd.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023]
Abstract
Body composition is associated with many noncommunicable diseases. The accuracy of many simple techniques used for the assessment of body composition is influenced by the fact that they do not take into account tissue hydration and this can be particularly problematic in paediatric populations. The aims of this study were: (1) to assess the agreement of two dual energy X-ray absorptiometry (DXA) systems for determining total and regional (arms, legs, trunk) fat, lean, and bone mass and (2) to compare lean soft tissue (LST) hydration correction methods in children. One hundred and twenty four healthy children aged between 6 and 16 years old underwent DXA scans using 2 GE healthcare Lunar systems (iDXA and Prodigy). Tissue hydration was either calculated by dividing total body water (TBW), by 4-component model derived fat free mass (HFFMTBW) or by using the age and sex specific coefficients of Lohman, 1986 (HFFMLohman) and used to correct LST. Regression analysis was performed to develop cross-calibration equations between DXA systems and a paired samples t-test was conducted to assess the difference between LST hydration correction methods. iDXA resulted in significantly lower estimates of total and regional fat and lean mass, compared to Prodigy. HFFMTBW showed a much larger age/sex related variability than HFFMLohman. A 2.0 % difference in LST was observed in the boys (34.5 kg vs 33.8 kg respectively, p < 0.05) and a 2.5% difference in the girls (28.2 kg vs 27.5 kg respectively, p < 0.05) when corrected using either HFFMTBW or HFFMLohman. Care needs to be exercised when combining data from iDXA and Prodigy, as total and regional estimates of body composition can differ significantly. Furthermore, tissue hydration should be taken into account when assessing body composition as it can vary considerably within a healthy paediatric population even within specific age and/or sex groups.
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Affiliation(s)
- Laura P E Watson
- National Institute Health Research Cambridge Clinical Research Facility, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Katherine S Carr
- National Institute Health Research Cambridge Clinical Research Facility, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Elise R Orford
- Stable Isotope Laboratory, National Institute for Health Research Cambridge Biomedical Research Centre Nutritional Biomarker Laboratory, MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, United Kingdom
| | - Michelle C Venables
- Stable Isotope Laboratory, National Institute for Health Research Cambridge Biomedical Research Centre Nutritional Biomarker Laboratory, MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, United Kingdom
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Suri DJ, Potani I, Singh A, Griswold S, Wong WW, Langlois B, Shen Y, Chui KHK, Rosenberg IH, Webb P, Rogers BL. Body Composition Changes in Children during Treatment for Moderate Acute Malnutrition: Findings from a 4-Arm Cluster-Randomized Trial in Sierra Leone. J Nutr 2021; 151:2043-2050. [PMID: 33880554 PMCID: PMC8245884 DOI: 10.1093/jn/nxab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed. OBJECTIVES We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes. METHODS The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk. RESULTS Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different. CONCLUSIONS Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897.
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Affiliation(s)
- Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Isabel Potani
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Akriti Singh
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Stacy Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - William W Wong
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Breanne Langlois
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Ye Shen
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
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Fabiansen C, Yaméogo CW, Devi S, Friis H, Kurpad A, Wells JC. Deuterium dilution technique for body composition assessment: resolving methodological issues in children with moderate acute malnutrition. Isotopes Environ Health Stud 2017; 53:344-355. [PMID: 28276731 DOI: 10.1080/10256016.2017.1295043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
Childhood malnutrition is highly prevalent and associated with high mortality risk. In observational and interventional studies among malnourished children, body composition is increasingly recognised as a key outcome. The deuterium dilution technique has generated high-quality data on body composition in studies of infants and young children in several settings, but its feasibility and accuracy in children suffering from moderate acute malnutrition requires further study. Prior to a large nutritional intervention trial among children with moderate acute malnutrition, we conducted pilot work to develop and adapt the deuterium dilution technique. We refined procedures for administration of isotope doses and collection of saliva. Furthermore, we established that equilibration time in local context is 3 h. These findings and the resulting standard operating procedures are important to improve data quality when using the deuterium dilution technique in malnutrition studies in field conditions, and may encourage a wider use of isotope techniques.
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Affiliation(s)
- Christian Fabiansen
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Frederiksberg C , Denmark
- b Médecins Sans Frontières - Denmark , Copenhagen , Denmark
- c Alliance for International Medical Action , Dakar , Sénégal
| | - Charles W Yaméogo
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Frederiksberg C , Denmark
- d Département Biomédical et Santé Publique , Institut de Recherche en Sciences de la Santé , Ouagadougou , Burkina Faso
| | - Sarita Devi
- e Division of Nutrition , St John's Research Institute , Bangalore , India
| | - Henrik Friis
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Frederiksberg C , Denmark
| | - Anura Kurpad
- e Division of Nutrition , St John's Research Institute , Bangalore , India
| | - Jonathan C Wells
- f Childhood Nutrition Research Centre , UCL Institute of Child Health , London , UK
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Milani GP, Groothoff JW, Vianello FA, Fossali EF, Paglialonga F, Edefonti A, Agostoni C, Consonni D, van Harskamp D, van Goudoever JB, Schierbeek H, Oosterveld MJS. Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis. Am J Kidney Dis 2017; 69:428-435. [PMID: 28089477 DOI: 10.1053/j.ajkd.2016.10.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/09/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. STUDY DESIGN A study of diagnostic test accuracy. SETTING & PARTICIPANTS 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands. INDEX TEST TBW and ECW volumes assessed by multifrequency bioimpedance. REFERENCE TESTS TBW and ECW volumes measured by deuterium and bromide dilution, respectively. RESULTS Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2±8.7 (SD) and 19.3±8.3L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of -0.09 (95% limits of agreement, -2.1 to 1.9) L. Mean ECW volumes were 8.9±4.0 and 8.3±3.3L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95% limits of agreement, -2.3 to 3.5). LIMITATIONS Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. CONCLUSIONS Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.
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Affiliation(s)
- Gregorio P Milani
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Jaap W Groothoff
- Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Federica A Vianello
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio F Fossali
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Paglialonga
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Edefonti
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dewi van Harskamp
- Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Pediatrics VU University Medical Center, Amsterdam, the Netherlands
| | - Henk Schierbeek
- Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Michiel J S Oosterveld
- Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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Mehta NM, Raphael B, Guteirrez IM, Quinn N, Mitchell PD, Litman HJ, Jaksic T, Duggan CP. Comparison of body composition assessment methods in pediatric intestinal failure. J Pediatr Gastroenterol Nutr 2014; 59:99-105. [PMID: 24614122 DOI: 10.1097/MPG.0000000000000364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to examine the agreement of multifrequency bioelectric impedance analysis (BIA) and anthropometry with reference methods for body composition assessment in children with intestinal failure (IF). METHODS We conducted a prospective pilot study in children 14 years or younger with IF resulting from either short bowel syndrome or motility disorders. Bland-Altman analysis was used to examine the agreement between BIA and deuterium dilution in measuring total body water (TBW) and lean body mass (LBM), and between BIA and dual-energy x-ray absorptiometry (DXA) techniques in measuring LBM and fat mass (FM). FM and percent body fat (%BF) measurements by BIA and anthropometry were also compared in relation to those measured by deuterium dilution. RESULTS Fifteen children with IF, median (interquartile range) age 7.2 (5.0, 10.0) years, and 10 (67%) boys, were studied. BIA and deuterium dilution were in good agreement with a mean bias (limits of agreement) of 0.9 (-3.2 to 5.0) for TBW (L) and 0.1 (-5.4 to 5.6) for LBM (kg) measurements. The mean bias (limits) for FM (kg) and %BF measurements were 0.4 (-3.8 to 4.6) kg and 1.7 (-16.9 to 20.3)%, respectively. The limits of agreement were within 1 standard deviation of the mean bias in 12 of 14 (86%) subjects for TBW and LBM, and in 11 of 14 (79%) for FM and %BF measurements. Mean bias (limits) for LBM (kg) and FM (kg) between BIA and DXA were 1.6 (-3.0 to 6.3) kg and -0.1 (-3.2 to 3.1) kg, respectively. Mean bias (limits) for FM (kg) and %BF between anthropometry and deuterium dilution were 0.2 (-4.2 to 4.6) and -0.2 (-19.5 to 19.1), respectively. The limits of agreement were within 1 standard deviation of the mean bias in 10 of 14 (71%) subjects. CONCLUSIONS In children with IF, TBW and LBM measurements by multifrequency BIA method were in agreement with isotope dilution and DXA methods, with small mean bias and clinically acceptable limits of agreement. In comparison with deuterium dilution, BIA was comparable to anthropometry for FM and %BF assessments with small mean bias, but the limits of agreement were large. BIA is a reliable method for TBW and LBM assessments in population studies; however, its reliability in individual patients, especially for FM assessments, cannot be guaranteed.
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Kupka R, Manji KP, Wroe E, Aboud S, Bosch RJ, Fawzi WW, Kurpad AV, Duggan C. Comparison of isotope dilution with bioelectrical impedance analysis among HIV-infected and HIV-uninfected pregnant women in Tanzania. Int J Body Compos Res 2011; 9:1-10. [PMID: 24244104 PMCID: PMC3826565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a simple tool to assess total body water (TBW), from which body composition can be estimated using statistical equations. However, standard BIA equations have not been sufficiently validated during pregnancy, in HIV infection, or in sub-Saharan Africa. We therefore compared TBW estimates from multifrequency BIA with those from the reference method deuterium isotope dilution (Deut) in a cohort of 30 HIV-uninfected and 30 HIV-infected pregnant women from Tanzania. METHODS We enrolled pregnant women presenting for routine antenatal care and collected data on pregnancy outcomes. At each trimester of gestation and once at 10-wk post-partum, we measured maternal anthropometry, TBWBIA, and TBWDeut. RESULTS TBWBIA was highly correlated at each time point with TBWDeut among HIV-infected (all P ≤0.001) and HIV-uninfected women (all P <0.0001). During pregnancy, mean TBWBIA progressively underestimated TBWDeut in the overall cohort; trimester-specific differences (mean ±SD) were -1.02 ±2.36 kg, -1.47 ±2.43 kg, and -2.42 ±2.63 kg, respectively. The difference at 10-wk postpartum was small (-0.24 ±2.07 kg). In Bland-Altman and regression models, TBWBIA was subject to a systematic predictive bias at each antenatal and postnatal time point (all P ≤0.038). Among HIV-positive women, TBWDeut measured during the first (P =0.02) and second trimester (P =0.03) was positively related to birthweight. CONCLUSIONS The validity of current BIA equations to assess TBW during pregnancy and in the postpartum period among women from sub-Saharan Africa remains uncertain. Deuterium dilution may assess aspects of maternal body composition relevant for pregnancy outcomes among HIV-infected women.
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Affiliation(s)
- R Kupka
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA ; UNICEF Regional Office for West and Central Africa
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