Body composition measurements in paediatrics – a review. Part 2

Abstract

With the increasing recognition of overweight, obesity, and metabolic diseases in paediatrics, there is a need to apply more precise diagnostic methods to individualise the procedures and improve their monitoring. Advanced methods of evaluating body composition are a valuable addition to body weighing because they provide more precise data than screening methods such as anthropometry and bioelectrical impedance analysis (BIA). However, they require expensive equipment and highly trained staff. The availability of methods used in paediatrics is increasing. The article discusses the technical assumptions and summarises data from literature concerning the accuracy of chosen methods. From those, dual-energy X-ray absorptiometry (DXA) is distinguished as being widely accepted. Not only does it serve to evaluate bone density, but also to assess fat mass, making it a crucial element of multicomponent models (3C, 4C), which is often used separately as a reference method for other techniques. Methods based on body volume measurement are also of great importance. Traditionally they include hydrodensitometry (HW), which is being displaced by air displacement plethysmography (ADP), which is more acceptable among young patients. Numerous publications indicate that ADP may become a valuable alternative for widely used DXA. Isotope dilution methods are less popular in paediatrics, due to their cost and limited credibility, but are more commonly used among adults. The last group comprises imaging methods rarely used in the discussed indication. With the knowledge of available techniques and current clinical situation one can, for the patient's benefit, decide between screening and advanced techniques of body composition measurement.

Diagnostic Methods in Childhood Obesity

“…Computed tomography (CT) is the gold standard method for the determination of visceral abdominal fat (VAF), due to its ability to differentiate between subcutaneous and visceral adiposity [44]. CT has the advantage of not depending on the operator's ability to identify structures during the examination and not be influenced by ultrasound transducer pressure on the abdomen during measurements.…”

“…CT has the advantage of not depending on the operator's ability to identify structures during the examination and not be influenced by ultrasound transducer pressure on the abdomen during measurements. However, CT is an expensive method and submits patients to ionizing radiation, which limits its use mainly in epidemiological studies [31,44].…”

“…Magnetic resonance imaging (MRI) has also developed criteria for assessing visceral fat, with good accuracy [29,44]; it is a method with which it is possible to assess the distribution of adipose tissue in children [10]. This test has the advantage of not emitting ionizing radiation [36] and the ability to quantify the fraction of fat [10]; however, it is more subject to artifacts than CT [29].…”

“…Ultrasonography, in recent years, has been proposed as a noninvasive technique for the assessment of intra-abdominal fat [43], as it is a useful method for the Diagnostic Methods in Childhood Obesity DOI: http://dx.doi.org/10.5772/intechopen.92880 determination of visceral adipose tissue [28,44]. The possibility of measuring visceral fat attributes to US an important role in the assessment of MS [29].…”

Generación de recursos audiovisuales para la realización de medidas antropométricas en sujetos diagnosticados con obesidad

“…El IMC ha sido por excelencia el parámetro más utilizado para valorar la obesidad (OMS 2017;Osayande et al 2018), pero presenta limitaciones al no informar de la distribución de la masa grasa (MG) y no discriminar entre MG y masa magra o libre de grasa (MLG). Por ello, no resulta fiable su empleo como único indicador de la obesidad en el diagnóstico clínico (Cieśluk et al 2018;Trifu et al 2018) Otra alternativa para valorar sobrepeso y obesidad ha sido estimar la masa grasa (MG) de un sujeto, considerando que existe un exceso cuando el porcentaje de grasa corporal total (%GCT) es superior al 25% del peso corporal total en un hombre o un 33-35% en una mujer (Martínez Sanz et al 2019;Trifu et al 2018). Además, esta evaluación permite no solamente el diagnóstico sino el seguimiento de la obesidad mostrando los cambios de volumen y distribución de la MG corporal en función de la planificación dietética pautada (Martínez Sanz et al, 2019;Rosales Ricardo 2012).…”