Body Composition of Bangladeshi Children: Comparison and Development of Leg-to-Leg Bioelectrical Impedance Equation

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ABSTRACT

The aim of this study was to investigate the validity of the Tanita TBF 300A leg-to-leg bioimpedance analyzer for estimating fat-free mass (FFM) in Bangladeshi children aged 4-10 years and to develop novel prediction equations for use in this population, using deuterium dilution as the reference method. Two hundred Bangladeshi children were enrolled. The isotope dilution technique with deuterium oxide was used for estimation of total body water (TBW). FFM estimated by Tanita was compared with results of deuterium oxide dilution technique. Novel prediction equations were created for estimating FFM, using linear regression models, fitting child's height and impedance as predictors. There was a significant difference in FFM and percentage of body fat (BF%) between methods (p<0.01), Tanita underestimating TBW in boys (p=0.001) and underestimating BF% in girls (p<0.001). A basic linear regression model with height and impedance explained 83% of the variance in FFM estimated by deuterium oxide dilution technique. The best-fit equation to predict FFM from linear regression modelling was achieved by adding weight, sex, and age to the basic model, bringing the adjusted R2 to 89% (standard error=0.90, p<0.001). These data suggest Tanita analyzer may be a valid field-assessment technique in Bangladeshi children when using population- specific prediction equations, such as the ones developed here.

Key words: Bioelectrical impedance; Body composition; Children; Deuterium oxide dilution; Bangladesh

INTRODUCTION

Body composition measurement in children is important for assessing nutritional status for both health and disease (1). Determination of body fatness by measuring body composition in younger age-groups has been shown to be an important risk factor for later disease (2,3). A study undertaken by Yajnik (4) in India compared full-term babies born in India with those born in the UK and found that Indian babies were relatively lighter, shorter, and thinner. The thinness of the Indian babies is related to a paucity of lean softtissues, including abdominal viscera and skeletal muscle. The characteristic South Asian body phenotype, which comprises low muscle mass, high percentage of body fat, and tendency to central adiposity, is different from that in other populations (5,6). A better characterization of body proportions and composition during early life may be of relevance for improved understanding of the early origins of diseases in adulthood, and hence, the need for accurate assessment of body composition in children. Various established methods are used for body composition assessment, including air-displacement plethysmography (ADP), dual-energy x-ray absorptiometry (DXA), underwater weighing (densitometry), and magnetic resonance imaging (MRI) (7,8). However, these methods are expensive, not easily portable, time-consuming, and require highly-trained operators, which renders them unsuitable for most field settings.

In epidemiological and field studies, predictions of body fatness are often made from anthropo- metric measurements, including body mass index (BMI), waist-circumference, waist-hip ratio, and skinfold thickness. However, these techniques do not precisely characterize body fat or muscle mass, and there is a variation across age, sex, and ethnic groups (9,10). Further disadvantages of these techniques include a high degree of both intra- and inter- observer variation and acceptability of the measures in different populations (11).

Bioelectrical impedance analysis (BIA) is a popular and widely-used method of measuring body composition (12). BIA actually determines the electrical impedance of body tissues, which provides an estimate of total body water (TBW) that is converted to an estimate of fat-free mass (FFM), with assumed constant values for the hydration of lean tissue (13,14). BIA is a portable, non-invasive, rapid and relatively inexpensive method for assessing body composition, which lends itself to applications in epidemiological studies. …