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Body Composition Assessment in Infancy and Early Childhood: Comparison of Anthropometry with Dual-Energy X-Ray Absorptiometry in Low-Income Group Children from India

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Body Composition Assessment in Infancy and Early Childhood: Comparison of Anthropometry with Dual-Energy X-Ray Absorptiometry in Low-Income Group Children from India European Journal of Clinical Nutrition (2014) 68, 658–663 © 2014 Macmillan Publishers Limited All rights reserved 0954-3007/14 www.nature.com/ejcn BODY COMPOSITION ORIGINAL ARTICLE Body composition assessment in infancy and early childhood: comparison of anthropometry with dual-energy X-ray absorptiometry in low-income group children from India B Kulkarni, RS Mamidi, N Balakrishna and KV Radhakrishna BACKGROUND/OBJECTIVE: Anthropometry is a simple, inexpensive method of body composition assessment, but its validity has not been examined adequately in young children. The study therefore compared the body composition estimates using anthropometry with those using dual-energy X-ray absorptiometry (DXA) in infants and young children. METHODS: Body composition estimates using anthropometry and DXA were assessed and compared at 6, 12 and 18 months in a cohort of 137 infants enrolled at birth. RESULTS: Fat mass (FM) and body fat percent (%BF) estimates by anthropometry were lower than those using DXA. Mean differences (DXA − skinfold thickness) in FM, fat free mass (FFM) and %BF were highest at 6 months (350 g, − 226 g and 4%, respectively); the differences reduced with increase in age and were lowest at 18 months (46 g, 56 g and 0%, respectively). Bland–Altman analyses showed good agreement between the FM, FFM and %BF estimates by the two methods only at 18 months. Accretion of FM and FFM during follow-up, estimated by the two methods, was significantly different, with agreement between the methods seen only for increment in FFM from 6 to 12 months. CONCLUSIONS: Substantial differences were found in the body composition estimates by anthropometry compared with DXA and also in the longitudinally assessed tissue accretion patterns by the two methods. As the body composition patterns may be influenced by the method used for body composition assessment, results of studies assessing body composition by anthropometry during infancy should be interpreted with caution. European Journal of Clinical Nutrition (2014) 68, 658–663; doi:10.1038/ejcn.2014.37; published online 19 March 2014 INTRODUCTION air displacement plethysmography are expensive and not suitable 10 Although periodic measurement of weight during childhood is for use in community-based studies in developing countries. important for growth monitoring, it cannot differentiate between Anthropometry using the skinfold thickness (SFT) measurements the accretion of fat mass (FM) and fat free mass (FFM) during is a valuable technique in these settings, which has been validated 11–13 growth. Examination of body composition in childhood and in adults, indicating reasonable precision and accuracy. changes in tissue accretion during growth is important to monitor However, some researchers have argued that skinfold measure- the optimal growth of FM and FFM compartments. Body ments are difficult to perform in infants and are associated with 14 composition in childhood tracks to adulthood and a body operator-related imprecision. composition with a higher FM and lower FFM is known to be Only a few studies have validated anthropometric assessment of associated with a higher risk of metabolic syndrome and body composition against a reference method in infants and young 15,16 cardiovascular disease in adults.1–3 Muscle mass, a major children. Majority of these were carried out in developed component of FFM, is an important determinant of physical work countries. Similar evidence based on studies carried out in the capacity and has a protective role in chronic degenerative community settings of developing countries is not available. diseases such as osteoporosis.4,5 We therefore compared the body composition estimates by Epidemiologic studies have shown that poor growth during anthropometry with those measured using DXA, which has been early life followed by rapid weight gain in later life is associated shown to measure FM and FFM with high precision in pediatric 17 with an increased risk of obesity and adult onset chronic diseases population. like diabetes and cardiovascular disease.6–8 This could be partly explained by the body composition changes as the growth in MATERIALS AND METHODS initial 2 years of life is related to FFM, whereas growth during later childhood is related to FM in adulthood.9 Understanding the This study was conducted according to the guidelines laid down in the patterns of accretion of FFM and FM during childhood growth Declaration of Helsinki Principles and all procedures involving human subjects were approved by the Institutional Ethics Committee of National may help us devise strategies to promote optimal growth. Institute of Nutrition (Hyderabad, India). Written informed consent was There is a paucity of data on body composition of infants as obtained from mothers of infants who were enrolled in the study. simple, inexpensive, safe and reliable methods are not readily The study included infants who were prospectively followed up from available. Precise methods for body composition assessment such birth along with their mothers who participated in a study assessing the as isotope dilution, dual-energy X-ray absorptiometry (DXA) and effect of calcium-rich food supplementation on the bone density changes Clinical Division, National Institute of Nutrition, Hyderabad, India. Correspondence: Dr B Kulkarni, Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad 500007, India. E-mail: [email protected] Received 28 September 2013; revised 31 January 2014; accepted 5 February 2014; published online 19 March 2014 Body composition assessment in infants B Kulkarni et al 659 during lactation. The study was carried out during the period 2007–2011 in FFM, TM and body fat percent (%BF) were calculated at 6, 12 and 18 months. an urban slum in Hyderabad, India and the mothers and their infants were Differences (DXA − skinfold method) in increments of FM, FFM, TM and %BF enrolled soon after delivery. In case of some children, enrollment was during the two consecutive follow-ups, that is, baseline to 6, 6–12 and 12–18 delayed till 2 months after delivery because of local customs. A total of 137 months were also calculated. Pearson's correlation coefficients were infants were enrolled at baseline and follow-up measurements were calculated to assess the relationship between the FM, FFM, TM and %BF carried out at 6, 12 and 18 months. A written informed consent was estimates by the two methods at all follow-ups and for all increments. obtained from the mothers before the start of the study. A pretested Bland–Altman analysis was used to examine the agreement between the questionnaire was administered to the mothers to record the birth two methods.23 A test was considered significant when P-value was o0.05. history as well as breast feeding and complementary feeding practices. Body composition assessment RESULTS Body composition was assessed by two methods: by DXA at baseline and All the infants belonged to the low socioeconomic group. Most at 6, 12 and 18 months and by anthropometry at 6, 12 and 18 months. (74%) of the mothers were home makers and 64% of fathers were Anthropometric measurements included weight and length along with skilled laborers. The infants were born at term and their mean (s.d.) crown rump length and the length measurements of the upper arm and age at baseline measurement was 33 (8) days. Mean birth weight of lower arm. In addition, circumferences of head, chest, mid-arm, mid-thigh the babies (based on hospital records) was 2.8 kg and 32% of the and mid-calf were measured along with SFT measurements at triceps and babies were born with low birth weight (o2.5 kg). About 60% of subscapular region. All the measurements were carried out by two trained fi field investigators. Weight was measured to the nearest 1 g using a digital the babies were exclusively breast fed for the rst 6 months and SECA weighing scale (Seca, Hamburg, Germany). Length was measured to rest of them were given animal milk and water along with breast the nearest 0.1 cm using an infantometer scale made in-house at our milk. Data on 137 children (48% boys) were available for analysis. institute, which has been validated and used in previous studies at our center.18 Lengths of the upper and lower arm along with the circumferences were measured to the nearest 0.1 cm using a non-stretchable measuring Comparison of body composition estimates by two methods tape. SFT was measured to the nearest 0.1 mm using Harpenden Calipers during follow-up (British Indicators, Burgess Hill, UK). Training sessions for the field Table 1 shows mean values of FM, FFM, TM and %BF by investigators were repeated every 6 months and regular assessment of anthropometry and DXA at baseline (only DXA) and at three intra- and interindividual variation in anthropometric measurements was follow-ups. The estimates by DXA are useful in understanding the carried out for quality control. Estimates of FM and FFM from the above patterns of tissue growth during infancy and early childhood. anthropometric indices were calculated using the method described by There were no sex-related differences in the FM and %BF either at Dauncey et al.19 The method assumes the body to be a sphere (head) and various hollow cylinders (the trunk and the limbs). The estimate of FM is baseline or at any of the follow-ups, but boys had higher FFM and calculated from the volume of the fat component of these cylinders by using TM than girls at all the time points (based on the DXA triceps and subscapular SFT. We chose Dauncey’s method over the other estimates—data not shown) similar to the previously reported 24 commonly used method described by Weststrate and Deurenberg20 because studies. Anthropometric method underestimated FM and %BF at in an earlier study in young children carried out at our institute (unpublished), 6 and 12 months.
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