Abstract
Objectives:
(1) To develop a method of manipulating bioelectrical impedance (BIA) that gives indices of lean and fat adjusted for body size, using a large normative cohort of children. (2) To assess the discriminant validity of the method in a group of children likely to have abnormal body composition.
Design:
Two prospective cohort studies.
Setting:
Normative data: Avon Longitudinal Study of Parents and Children (ALSPAC), population based cohort; proof of concept study: tertiary feeding clinic and special needs schools.
Subjects:
Normative data: 7576 children measured aged between 7.25 and 8.25 (mean 7.5) (s.d.=0.2) years; proof of concept study: 29 children with either major neurodisability or receiving artificial feeding, or both, mean age 7.6 (s.d.=2) years.
Measures:
Leg-to-leg (ZT) and arm-to-leg (ZB) BIA, weight and height. Total body water (TBW) was estimated from the resistance index (RI=height2/Z), and fat-free mass was linearly related to TBW. Fat mass was obtained by subtracting fat-free mass from total weight. Fat-free mass was log-transformed and the reciprocal transform was taken for fat mass to satisfy parametric model assumptions. Lean and fat mass were then adjusted for height and age using multiple linear regression models. The resulting standardized residuals gave the lean index and fat index, respectively.
Results:
In the normative cohort, the lean index was higher and fat index lower in boys. The lean index rose steeply to the middle of the normal range of body mass index (BMI) and then slowly for higher BMI values, whereas the fat index rose linearly through and above the normal range. In the proof of concept study, the children as a group had low lean indices (mean (s.d.) −1.5 (1.7)) with average fat indices (+0.21 (2.0)) despite relatively low BMI standard deviation scores (−0.60 (2.3)), but for any given BMI, individual children had extremely wide ranges of fat indices. The lean index proved more stable and repeatable than BMI.
Conclusions:
This clinical method of handling BIA reveals important variations in nutritional status that would not be detected using anthropometry alone. BIA used in this way would allow more accurate assessment of energy sufficiency in children with neurodisability and may provide a more valid identification of children at risk of underweight or obesity in field and clinical settings.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fsj.ejcn.1602714/MediaObjects/41430_2008_Article_BF1602714_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fsj.ejcn.1602714/MediaObjects/41430_2008_Article_BF1602714_Fig2_HTML.gif)
Similar content being viewed by others
References
Azcue MP, Zello GA, Levy LD, Pencharz PB (1996). Energy expenditure and body composition in children with spastic quadriplegic cerebral palsy. J Pediatr 129, 870–876.
Bland J, Altman D (1995). Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 346, 1085–1087.
Chad KE, McKay HA, Zello GA, Bailey DA, Faulkner RA, Snyder RE (2000). Body composition in nutritionally adequate ambulatory and non-ambulatory children with cerebral palsy and a healthy reference group. Dev Med Child Neurol 42, 334–339.
Davies PS, Preece MA, Hicks CJ, Halliday D (1988). The prediction of total body water using bioelectrical impedance in children and adolescents. Ann Hum Biol 15, 237–240.
Deurenberg P, Smit HE, Kusters CS (1989). Is the bioelectrical impedance method suitable for epidemiological field studies? Eur J Clin Nutr 43, 647–654.
Fomon S, Haschke F, Ziegler E, Nelson S (1982). Body composition of refercne children from birth to age 10 years. Am J Clin Nutr 35, 1169–1175.
Foster KR, Lukaski HC (1996). Whole-body impedance – what does it measure? Am J Clin Nutr 64, 388S–396S.
Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM, Preece MA (1995). Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 73, 17–24.
Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC et al. (2002). Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc 102, 361–373.
Golding J, Pembrey M, Jones R, ALSPAC study team (2001). The Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatr Perinat Epidemiol 15, 74–87.
Goran MI, Shewchuk R, Gower BA, Nagy TR, Carpenter WH, Johnson RK (1998). Longitudinal changes in fatness in white children: no effect of childhood energy expenditure. Am J Clin Nutr 67, 309–316.
Houtkooper LB, Lohman TG, Going SB, Howell WH (1996). Why bioelectrical impedance analysis should be used for estimating adiposity. Am J Clin Nutr 64, 436S–448S.
Jebb SA, Cole TJ, Doman D, Murgatroyd PR, Prentice AM (2000). Evaluation of the novel Tanita body-fat analyser to measure body composition by comparison with a four-compartment model. Br J Nutr 83, 115–122.
Kushner RF, Schoeller DA, Fjeld CR, Danford L (1992). Is the impedance index (ht2/R) significant in predicting total body water? Am J Clin Nutr 56, 835–839.
Liu LF, Roberts R, Moyer-Mileur L, Samson-Fang L (2005). Determination of body composition in children with cerebral palsy: bioelectrical impedance analysis and anthropometry vs dual-energy x-ray absorptiometry. J Am Diet Assoc 105, 794–797.
Lohman TG (1989). Assessment of body composition in children. Paediatr Exerc Sci 1, 21.
Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM (2001). Childhood body composition in relation to body mass index. Pediatrics 107, 344–350.
Parker L, Reilly JJ, Slater C, Wells JC, Pitsiladis Y (2003). Validity of six field and laboratory methods for measurement of body composition in boys. Obes Res 11, 852–858.
Reilly J, Wilson J, McColl J, Carmichael M, Durnin J (1996). Ability of biolectric impedance to predict fat-free mass in prepubertal children. Pediatr Res 39, 176–179.
Rennie KL, Livingstone MB, Wells JC, McGloin A, Coward WA, Prentice AM et al. (2005). Association of physical activity with body-composition indexes in children aged 6–8 y at varied risk of obesity. Am J Clin Nutr 82, 13–20.
Schaefer F, Georgi M, Zieger A, Scharer K (1994). Usefulness of bioelectic impedance and skinfold measurements in predicting fat-free mass derived from total body potassium in children. Pediatric Research 35, 617–624.
Smye S, Sutcliffe J, Pitt E (1993). A comparison of four commercial systems used to measure whole-body electrical impedance. Physiol Meas 14, 473–478.
Stallings VA, Cronk CE, Zemel BS, Charney EB (1995). Body composition in children with spastic quadriplegic cerebral palsy. J Pediatr 126, 833–839.
Sullivan PB, Alder N, Bachlet AM, Grant H, Juszczak E, Henry J et al. (2006). Gastrostomy feeding in cerebral palsy: too much of a good thing? Dev Med Child Neurol 48, 877–882.
Wells JC, Cole TJ (2002). Adjustment of fat-free mass and fat mass for height in children aged 8 y. Int J Obes Relat Metab Disord 26, 947–952.
Wells JC, Fuller NJ, Dewit O, Fewtrell MS, Elia M, Cole TJ (1999). Four-component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models. Am J Clin Nutr 69, 904–912.
Wells JC (2003). Body composition in childhood: effects of normal growth and disease. Proc Nutr Soc 62, 521–528.
Acknowledgements
The authors are grateful to all the mothers who took part in the ALSPAC study and to the midwives for their cooperation and help in recruitment and to Pauline Emmett and Imogen Rogers for recognizing the value of including BIA in the assessment protocol. The whole ALSPAC study team comprises interviewers, computer technicians, laboratory technicians, clerical workers, research scientists, volunteers and managers who continue to make the study possible. The authors are also grateful to the special schools for their support of the proof of concept study and to Sarah Rosser who collected the repeatability data. This analysis was supported by funding from British Heart Foundation. The main ALSPAC study was funded by the Wellcome Trust, the Medical Research Council, the University of Bristol, the Department of Health, the Department of the Environment and various other funders. British Heart Foundation, The Wellcome Trust, the Medical Research Council, the University of Bristol, the Department of Health, the Department of the Environment, and other funders.
Author information
Authors and Affiliations
Corresponding author
Additional information
Guarantor: CM Wright.
Appendix 1
Appendix 1
Rights and permissions
About this article
Cite this article
Wright, C., Sherriff, A., Ward, S. et al. Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood. Eur J Clin Nutr 62, 210–217 (2008). https://doi.org/10.1038/sj.ejcn.1602714
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ejcn.1602714
Keywords
This article is cited by
-
A cross-sectional study of the impact of school neighbourhood on children obesity and body composition
European Journal of Pediatrics (2021)
-
Prevalence of under and over weight in children with neurodisability, using body composition measures
European Journal of Clinical Nutrition (2018)
-
Application of receiver operating characteristic curve in the assessment of the value of body mass index, waist circumference and percentage of body fat in the Diagnosis of Polycystic Ovary Syndrome in childbearing women
Journal of Ovarian Research (2016)
-
The Coordination and Activity Tracking in CHildren (CATCH) study: rationale and design
BMC Public Health (2015)
-
Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls
European Journal of Clinical Nutrition (2014)