Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2001 Jul;85(1):67–72. doi: 10.1136/adc.85.1.67

A critique of the expression of paediatric body composition data

J Wells 1
PMCID: PMC1718830  PMID: 11420208

Abstract

There is increasing interest in body composition in paediatric research, as distinct from growth and nutritional status, as almost all diseases have adverse effects on either fatness or the fat-free mass. However, the approaches used to assess growth and nutritional status are not appropriate for separate evaluations of body fatness and lean mass. Traditional measurements such as body mass index and skinfold thickness do not measure fat in accurate quantitative terms. Various techniques have been used in recent years which divide body weight into fat mass and fat-free mass; however, the data tend not to be appropriately expressed. Body fatness is generally expressed as a percentage of weight, while fat-free mass typically remains unadjusted for size. A more appropriate approach is to normalise both body fatness and fat-free mass for height. This recommendation is relevant both to studies comparing patients with controls and to the expression of new reference data on body composition which are needed to allow informative comparisons. The same approach is appropriate for the classification of childhood obesity.



Full Text

The Full Text of this article is available as a PDF (102.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asayama K., Hayashi K., Kawada Y., Nakane T., Uchida N., Hayashibe H., Kawasaki K., Nakazawa S. New age-adjusted measure of body fat distribution in children and adolescents: standardization of waist-hip ratio using multivariate analysis. Int J Obes Relat Metab Disord. 1997 Jul;21(7):594–599. doi: 10.1038/sj.ijo.0800447. [DOI] [PubMed] [Google Scholar]
  2. Chan Y. L., Leung S. S., Lam W. W., Peng X. H., Metreweli C. Body fat estimation in children by magnetic resonance imaging, bioelectrical impedance, skinfold and body mass index: a pilot study. J Paediatr Child Health. 1998 Feb;34(1):22–28. doi: 10.1046/j.1440-1754.1998.00147.x. [DOI] [PubMed] [Google Scholar]
  3. Cole T. J., Freeman J. V., Preece M. A. Body mass index reference curves for the UK, 1990. Arch Dis Child. 1995 Jul;73(1):25–29. doi: 10.1136/adc.73.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cole T. J., Henson G. L., Tremble J. M., Colley N. V. Birthweight for length: ponderal index, body mass index or Benn index? Ann Hum Biol. 1997 Jul-Aug;24(4):289–298. doi: 10.1080/03014469700005032. [DOI] [PubMed] [Google Scholar]
  5. Cole T. J. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990 Jan;44(1):45–60. [PubMed] [Google Scholar]
  6. Cole T. J. Weight/heightp compared to weight/height2 for assessing adiposity in childhood: influence of age and bone age on p during puberty. Ann Hum Biol. 1986 Sep-Oct;13(5):433–451. doi: 10.1080/03014468600008621. [DOI] [PubMed] [Google Scholar]
  7. Davies P. S. Body composition assessment. Arch Dis Child. 1993 Sep;69(3):337–338. doi: 10.1136/adc.69.3.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Davies P. S., Day J. M., Cole T. J. Converting Tanner-Whitehouse reference tricep and subscapular skinfold measurements to standard deviation scores. Eur J Clin Nutr. 1993 Aug;47(8):559–566. [PubMed] [Google Scholar]
  9. Davies P. S., Wells J. C. Calculation of total body water in infancy. Eur J Clin Nutr. 1994 Jul;48(7):490–495. [PubMed] [Google Scholar]
  10. Ellis K. J., Abrams S. A., Wong W. W. Monitoring childhood obesity: assessment of the weight/height index. Am J Epidemiol. 1999 Nov 1;150(9):939–946. doi: 10.1093/oxfordjournals.aje.a010102. [DOI] [PubMed] [Google Scholar]
  11. Ellis K. J. Measuring body fatness in children and young adults: comparison of bioelectric impedance analysis, total body electrical conductivity, and dual-energy X-ray absorptiometry. Int J Obes Relat Metab Disord. 1996 Sep;20(9):866–873. [PubMed] [Google Scholar]
  12. Fiorotto M. L., Cochran W. J., Klish W. J. Fat-free mass and total body water of infants estimated from total body electrical conductivity measurements. Pediatr Res. 1987 Oct;22(4):417–421. doi: 10.1203/00006450-198710000-00011. [DOI] [PubMed] [Google Scholar]
  13. Fomon S. J., Haschke F., Ziegler E. E., Nelson S. E. Body composition of reference children from birth to age 10 years. Am J Clin Nutr. 1982 May;35(5 Suppl):1169–1175. doi: 10.1093/ajcn/35.5.1169. [DOI] [PubMed] [Google Scholar]
  14. Freeman J. V., Cole T. J., Chinn S., Jones P. R., White E. M., Preece M. A. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child. 1995 Jul;73(1):17–24. doi: 10.1136/adc.73.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fuller N. J., Jebb S. A., Laskey M. A., Coward W. A., Elia M. Four-component model for the assessment of body composition in humans: comparison with alternative methods, and evaluation of the density and hydration of fat-free mass. Clin Sci (Lond) 1992 Jun;82(6):687–693. doi: 10.1042/cs0820687. [DOI] [PubMed] [Google Scholar]
  16. Gasser T., Ziegler P., Seifert B., Prader A., Molinari L., Largo R. Measures of body mass and of obesity from infancy to adulthood and their appropriate transformation. Ann Hum Biol. 1994 Mar-Apr;21(2):111–125. doi: 10.1080/03014469400003152. [DOI] [PubMed] [Google Scholar]
  17. Gerver W. J., de Bruin R. Body composition in children based on anthropometric data. A presentation of normal values. Eur J Pediatr. 1996 Oct;155(10):870–876. doi: 10.1007/BF02282836. [DOI] [PubMed] [Google Scholar]
  18. Goran M. I., Driscoll P., Johnson R., Nagy T. R., Hunter G. Cross-calibration of body-composition techniques against dual-energy X-ray absorptiometry in young children. Am J Clin Nutr. 1996 Mar;63(3):299–305. doi: 10.1093/ajcn/63.3.299. [DOI] [PubMed] [Google Scholar]
  19. Hewitt M. J., Going S. B., Williams D. P., Lohman T. G. Hydration of the fat-free body mass in children and adults: implications for body composition assessment. Am J Physiol. 1993 Jul;265(1 Pt 1):E88–E95. doi: 10.1152/ajpendo.1993.265.1.E88. [DOI] [PubMed] [Google Scholar]
  20. Hill P., Taylor E. An auditable protocol for treating attention deficit/hyperactivity disorder. Arch Dis Child. 2001 May;84(5):404–409. doi: 10.1136/adc.84.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hulton S. A. Evaluation of urinary tract calculi in children. Arch Dis Child. 2001 Apr;84(4):320–323. doi: 10.1136/adc.84.4.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hutton J. L., Colver A. F., Mackie P. C. Effect of severity of disability on survival in north east England cerebral palsy cohort. Arch Dis Child. 2000 Dec;83(6):468–474. doi: 10.1136/adc.83.6.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Iwata K., Satou Y., Iwata F., Hara M., Fuchigami S., Kin H., Fuchigami T., Okada T., Harada K., Ohkuni M. Assessment of body composition measured by bioelectrical impedance in children. Acta Paediatr Jpn. 1993 Oct;35(5):369–372. doi: 10.1111/j.1442-200x.1993.tb03074.x. [DOI] [PubMed] [Google Scholar]
  24. Moreno L. A., Fleta J., Mur L., Feja C., Sarría A., Bueno M. Indices of body fat distribution in Spanish children aged 4.0 to 14.9 years. J Pediatr Gastroenterol Nutr. 1997 Aug;25(2):175–181. doi: 10.1097/00005176-199708000-00008. [DOI] [PubMed] [Google Scholar]
  25. Paul A. A., Cole T. J., Ahmed E. A., Whitehead R. G. The need for revised standards for skinfold thickness in infancy. Arch Dis Child. 1998 Apr;78(4):354–358. doi: 10.1136/adc.78.4.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pearson G. A., Stickley J., Shann F. Calibration of the paediatric index of mortality in UK paediatric intensive care units. Arch Dis Child. 2001 Feb;84(2):125–128. doi: 10.1136/adc.84.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Pietrobelli A., Faith M. S., Allison D. B., Gallagher D., Chiumello G., Heymsfield S. B. Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr. 1998 Feb;132(2):204–210. doi: 10.1016/s0022-3476(98)70433-0. [DOI] [PubMed] [Google Scholar]
  28. Reilly J. J., Dorosty A. R., Emmett P. M. Prevalence of overweight and obesity in British children: cohort study. BMJ. 1999 Oct 16;319(7216):1039–1039. doi: 10.1136/bmj.319.7216.1039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Reilly J. J., Wilson J., Durnin J. V. Determination of body composition from skinfold thickness: a validation study. Arch Dis Child. 1995 Oct;73(4):305–310. doi: 10.1136/adc.73.4.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Riordan M. Investigation and treatment of facial paralysis. Arch Dis Child. 2001 Apr;84(4):286–288. doi: 10.1136/adc.84.4.286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Ruxton C. H., Reilly J. J., Kirk T. R. Body composition of healthy 7-and 8-year-old children and a comparison with the 'reference child'. Int J Obes Relat Metab Disord. 1999 Dec;23(12):1276–1281. doi: 10.1038/sj.ijo.0801067. [DOI] [PubMed] [Google Scholar]
  32. Schaefer F., Georgi M., Wühl E., Schärer K. Body mass index and percentage fat mass in healthy German schoolchildren and adolescents. Int J Obes Relat Metab Disord. 1998 May;22(5):461–469. doi: 10.1038/sj.ijo.0800608. [DOI] [PubMed] [Google Scholar]
  33. Tanner J. M., Whitehouse R. H. Revised standards for triceps and subscapular skinfolds in British children. Arch Dis Child. 1975 Feb;50(2):142–145. doi: 10.1136/adc.50.2.142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Torun B., Viteri F. E. Influence of exercise on linear growth. Eur J Clin Nutr. 1994 Feb;48 (Suppl 1):S186–S189. [PubMed] [Google Scholar]
  35. VanItallie T. B., Yang M. U., Heymsfield S. B., Funk R. C., Boileau R. A. Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Clin Nutr. 1990 Dec;52(6):953–959. doi: 10.1093/ajcn/52.6.953. [DOI] [PubMed] [Google Scholar]
  36. Wells J. C. A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord. 2000 Mar;24(3):325–329. doi: 10.1038/sj.ijo.0801132. [DOI] [PubMed] [Google Scholar]
  37. Wells J. C., Fuller N. J., Dewit O., Fewtrell M. S., Elia M., Cole T. J. Four-component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models. Am J Clin Nutr. 1999 May;69(5):904–912. doi: 10.1093/ajcn/69.5.904. [DOI] [PubMed] [Google Scholar]
  38. de Bruin N. C., van Velthoven K. A., de Ridder M., Stijnen T., Juttmann R. E., Degenhart H. J., Visser H. K. Standards for total body fat and fat-free mass in infants. Arch Dis Child. 1996 May;74(5):386–399. doi: 10.1136/adc.74.5.386. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES