Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Evaluation of lean tissue density for use in air displacement plethysmography in obese children and adolescents

European Journal of Clinical Nutrition volume 65, pages 1094–1101 (2011)Cite this article

Subjects

Abstract

Background/Objectives:

Body composition techniques are required for monitoring response to treatment in individual obese children, and assessing the efficacy of weight loss programmes. Densitometry is readily undertaken, using air displacement plethysmography (ADP), but requires appropriate information on the density of lean tissue (DLT). The aims of this study were to develop predictive equations for DLT in obese children and adolescents, and to test the accuracy of ADP when using such predicted DLT values in an independent longitudinal sample using the four-component model as the reference method.

Subjects/Methods:

Equations for the prediction of DLT from age, gender and body mass index standard deviation score were developed in 105 children (39 boys). Accuracy of ADP, when incorporating predicted DLT values, was tested for baseline body composition and its change over time in a separate sample of 51 children (20 boys).

Results:

The predictive equation explained 33% of the variance in DLT. Fat mass obtained from ADP using such predicted values had a mean (s.d.) bias of 0.32 (1.39) kg, nonsignificant, whereas change in fat mass had an error of −0.25 (1.38) kg, nonsignificant. Hydration was strongly correlated with DLT.

Conclusions:

Use of ADP with predicted DLT values was associated with nonsignificant bias when estimating fat mass and its change over time. This study aids the application of ADP in childhood obesity research and clinical practise. The limits of agreement (±2.8 kg) relative to four-component values are moderately better than those for X-ray absorptiometry (±3.2 kg). Further improvement to accuracy would require assessment of lean tissue hydration by bioelectrical impedance.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  • Battistini N, Virgili F, Severi S, Brambilla P, Manzoni P, Beccaria L et al. (1995). Relative expansion of extracellular water in obese vs. normal children. J Appl Physiol 79, 94–96.

    Article  CAS  Google Scholar 

  • Bland JM, Altman DG (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1, 307–310.

    Article  CAS  Google Scholar 

  • Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 1240–1243.

    Article  CAS  Google Scholar 

  • Cole TJ, Freeman JV, Preece MA (1995). Body mass index reference curves for the UK, 1990. Arch Dis Child 73, 25–29.

    Article  CAS  Google Scholar 

  • Deurenberg P, Deurenberg-Yap M, Guricci S (2002). Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev 3, 141–146.

    Article  CAS  Google Scholar 

  • Deurenberg P, Yap M, van Staveren WA (1998). Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 22, 1164–1171.

    Article  CAS  Google Scholar 

  • Dewit O, Fuller NJ, Fewtrell MS, Elia M, Wells JC (2000). Whole body air displacement plethysmography compared with hydrodensitometry for body composition analysis. Arch Dis Child 82, 159–164.

    Article  CAS  Google Scholar 

  • Dietz WH (1998). Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 101 (3 Part 2), 518–525.

    CAS  Google Scholar 

  • Ehtisham S, Crabtree N, Clark P, Shaw N, Barrett T (2005). Ethnic differences in insulin resistance and body composition in United Kingdom adolescents. J Clin Endocrinol Metab 90, 3963–3969.

    Article  CAS  Google Scholar 

  • Fomon SJ, Haschke F, Ziegler EE, Nelson SE (1982). Body composition of reference children from birth to age 10 years. Am J Clin Nutr 35 (5 Suppl), 1169–1175.

    Article  CAS  Google Scholar 

  • Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA (1995). Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 73, 17–24.

    Article  CAS  Google Scholar 

  • Ginde SR, Geliebter A, Rubiano F, Silva AM, Wang J, Heshka S et al. (2005). Air displacement plethysmography: validation in overweight and obese subjects. Obes Res 13, 1232–1237.

    Article  Google Scholar 

  • Goulding A, Taylor RW, Jones IE, McAuley KA, Manning PJ, Williams SM (2000). Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord 24, 627–632.

    Article  CAS  Google Scholar 

  • Haines L, Wan KC, Lynn R, Barrett TG, Shield JP (2007). Rising incidence of type 2 diabetes in children in the UK. Diabetes Care 30, 1097–1101.

    Article  Google Scholar 

  • Haroun D, Wells JC, Williams JE, Fuller NJ, Fewtrell MS, Lawson MS (2005). Composition of the fat-free mass in obese and nonobese children: matched case-control analyses. Int J Obes (Lond) 29, 29–36.

    Article  CAS  Google Scholar 

  • Kiebzak GM, Leamy LJ, Pierson LM, Nord RH, Zhang ZY (2000). Measurement precision of body composition variables using the lunar DPX-L densitometer. J Clin Densitom 3, 35–41.

    Article  CAS  Google Scholar 

  • Leone PA, Gallagher D, Wang J, Heymsfield SB (2000). Relative overhydration of fat-free mass in postobese versus never-obese subjects. Ann NY Acad Sci 904, 514–519.

    Article  CAS  Google Scholar 

  • Lloyd LJ, Langley-Evans SC, McMullen S (2010). Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond) 34, 18–28.

    Article  CAS  Google Scholar 

  • Lohman TG (1986). Assessment of body composition in children. Pediatr Exerc Sci 1, 19–30.

    Article  Google Scholar 

  • Marken Lichtenbelt WD, Fogelholm M (1999). Increased extracellular water compartment, relative to intracellular water compartment, after weight reduction. J Appl Physiol 87, 294–298.

    Article  CAS  Google Scholar 

  • Mazess RB, Cameron JR, Sorenson JA (1970). Determining body composition by radiation absorption spectrometry. Nature 228, 771–772.

    Article  CAS  Google Scholar 

  • Nunez C, Kovera AJ, Pietrobelli A, Heshka S, Horlick M, Kehayias JJ et al. (1999). Body composition in children and adults by air displacement plethysmography. Eur J Clin Nutr 53, 382–387.

    Article  CAS  Google Scholar 

  • Petroni ML, Bertoli S, Maggioni M, Morini P, Battezzati A, Tagliaferri MA et al. (2003). Feasibility of air plethysmography (BOD POD) in morbid obesity: a pilot study. Acta Diabetol 40 (Suppl 1), S59–S62.

    Article  Google Scholar 

  • Piccoli A (2004). Bioelectric impedance vector distribution in peritoneal dialysis patients with different hydration status. Kidney Int 65, 1050–1063.

    Article  Google Scholar 

  • Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L et al. (2003). Health consequences of obesity. Arch Dis Child 88, 748–752.

    Article  CAS  Google Scholar 

  • Schoeller DA (1996). Human body composition. In: Roche AF, Heymsfield SB and Lohman TG (eds). Hydrometry. Human Kinetics: Champaign, IL, pp 25–43.

    Google Scholar 

  • Siri WE (1961). Body composition from fluid space and density. In: Brozek J and Henschel A (eds). Techniques for Measuring Body Composition. National Academy of Sciences: Washington DC, pp 223–244.

    Google Scholar 

  • Sopher AB, Thornton JC, Wang J, Pierson Jr RN, Heymsfield SB, Horlick M (2004). Measurement of percentage of body fat in 411 children and adolescents: a comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics 113, 1285–1290.

    Article  Google Scholar 

  • Wells JC (2000). A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 24, 325–329.

    Article  CAS  Google Scholar 

  • Wells JC, Chomtho S, Fewtrell MS (2007). Programming of body composition by early growth and nutrition. Proc Nutr Soc 66, 423–434.

    Article  Google Scholar 

  • Wells JC, Fewtrell MS (2008). Is body composition important for paediatricians? Arch Dis Child 93, 168–172.

    Article  Google Scholar 

  • Wells JC, Fewtrell MS, Williams JE, Haroun D, Lawson MS, Cole TJ (2006). Body composition in normal weight, overweight and obese children: matched case-control analyses of total and regional tissue masses, and body composition trends in relation to relative weight. Int J Obes (Lond) 30, 1506–1513.

    Article  CAS  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Wells JC, Haroun D, Williams JE, Wilson C, Darch T, Viner RM et al. (2010a). Evaluation of DXA against the four-component model of body composition in obese children and adolescents aged 5–21 years. Int J Obes (Lond) 34, 649–655.

    Article  CAS  Google Scholar 

  • Wells JC, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, Kennedy K et al. (2010b). Pediatric reference data for lean tissue properties: density and hydration from age 5 to 20 y. Am J Clin Nutr 91, 610–618.

    Article  CAS  Google Scholar 

  • Williams JE, Wells JC, Wilson CM, Haroun D, Lucas A, Fewtrell MS (2006). 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. Am J Clin Nutr 83, 1047–1054.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was designed and analysed by JCKW. The subjects were recruited by DH, JEW and RMV, and measured by DH and JEW under the supervision of JCKW and MSF. The mass spectrometric analyses were conducted by TD and SE. The body composition modelling was undertaken by DH and JEW under the supervision of JCKW and MSF. All authors critically appraised the manuscript. This study used core funding from the UK Medical Research Council. DH was funded by the Child Growth Foundation and the British Heart Foundation.

Author information

Authors and Affiliations

  1. Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK

    J C K Wells, D Haroun, J E Williams, T Darch & M S Fewtrell

  2. Department of Surgery, UCL Institute of Child Health, London, UK

    S Eaton

  3. General and Adolescent Paediatrics Unit, UCL Institute of Child Health, London, UK

    R Viner

Authors
  1. J C K Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Haroun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J E Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Darch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Eaton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Viner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M S Fewtrell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J C K Wells.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wells, J., Haroun, D., Williams, J. et al. Evaluation of lean tissue density for use in air displacement plethysmography in obese children and adolescents. Eur J Clin Nutr 65, 1094–1101 (2011). https://doi.org/10.1038/ejcn.2011.76

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2011.76

Keywords

This article is cited by

Search

Advanced search

Quick links