Elsevier

Clinical Nutrition

Volume 34, Issue 3, June 2015, Pages 523-528
Clinical Nutrition

Original article
Anthropometric indices to assess body-fat changes during a multidisciplinary obesity treatment in adolescents: EVASYON Study

https://doi.org/10.1016/j.clnu.2014.06.004Get rights and content

Summary

Background & aims

The main objectives of weight loss interventions in children and adolescents are to decrease fat mass while maintaining fat-free mass. Several methods are available to assess childhood and adolescence obesity, such as weight and height, bioelectrical impedance, skin-fold thickness measurements and other laboratory methods. The aim was to assess simple anthropometric indices as predictors of body-fat changes, using dual-energy X-ray absorptiometry measurements as reference method.

Methods

Multi-intervention approach (diet, physical activity and psychological support in a family-group-based treatment) was implemented with a one-year follow-up in 13-to-16-year-old overweight or obese Spanish adolescents. A total of 83 adolescents were recruited from Granada and Zaragoza, males (n = 43) (31.6 kg/m2) and females (n = 40) (32.0 kg/m2). We measured body composition with anthropometry and dual-energy X-ray absorptiometry. All measurements were made at baseline, and after 2 and 13 months. Random coefficient regression model was used to calculate the proportion of body composition changes during follow-up that would be explained by simple body composition indices based on anthropometric measures.

Results

After controlling for age and Tanner stage, body mass index explained 76.5% of body composition changes in males and 90.1% in females, while fat mass index (assessed by skin-folds) explained 78.9% of body composition changes in males and 84.0% of body composition changes in females.

Conclusions

In conclusion, we found that BMI was a good indicator of body fat composition changes in children and adolescents, although FMI assessed by anthropometry was also a good indicator.

Introduction

Obesity is a complex and multi-factorial disease that often develops during childhood and adolescence. In obese children and adolescents the main objectives of weight loss interventions are to decrease fat mass (FM) while maintaining fat-free mass (FFM) [1], [2]. Therefore, monitoring changes in body composition during weight loss programmes is important. Several methods are available to assess childhood and adolescence obesity, but the most widely used in clinical and epidemiological settings consist of measuring weight and height and, from which, body mass index (BMI) is calculated [3]. Currently, methods to examine changes in children's body fat composition include relatively simple field methods [4], such as bioelectrical impedance and skin-fold thickness measurements [5]. Other laboratory methods, such as hydrodensitometry, isotope dilution or dual-energy X-ray absorptiometry (DXA), are more accurate and precise but can be inconvenient and difficult to use in standard clinical practice because they are expensive and invasive, and require training of operators in measurement procedures. Also, subjects are required to be positioned correctly and children are exposed to irradiation; albeit minor [6]. DXA is a useful tool for assessing obesity because it accurately evaluates total mass, as well as distinguishes between regional lean body mass and adipose tissues [7]. DXA appears to be effective in measuring changes in body composition in obese subjects participating in weight reduction interventions [8], [9]. However, there is a dearth of data on effectiveness of simple anthropometric methods in detecting body fat changes in the paediatric and adolescent populations during treatment.

The aim of this study was to derive adolescents specific body composition indices based on anthropometric measures, and to assess the value of these indices as predictors of body fat changes.

Section snippets

Subjects and methods

The study has been termed ‘Development, implementation and evaluation of the efficiency of a therapeutic programme for overweight and obese adolescents: a comprehensive education programme of nutrition and physical activity [Desarrollo, aplicación y evaluación de la eficacia de un programa terapéutico para adolescentes con sobrepeso y obesidad: educación integral nutricional y de actividad física], the EVASYON Study’. The original programme was implemented in adolescents from five Spanish

Results

Baseline characteristics of 83 participants (43 males and 40 females) from Granada (n = 41) and Zaragoza (n = 42) participating in the EVASYON Study are shown in Table 1. Compared with males, females had higher fat mass percentage measured by anthropometry and DXA (both p < 0.001) and FMI (by anthropometry and DXA; both p < 0.001). For Tanner status, males were more frequently at the third stage (34.1%) while 41% of females were at the fourth stage.

The FMI assessed by DXA (FMI-DXA) during the

Discussion

The outcomes of the present study show BMI in females and FMI assessed by skin-folds in males as being the best predictors of changes in fat mass as measured by FMI, with the use of DXA measurements as the reference standard. Comparison of simple, low-cost indices to assess body fat changes during obesity management in children and adolescents is of practical importance for routine clinical evaluation of body composition.

Increasingly, DXA is being used as the criterion, or reference, for

Sources of funding

The study was supported by: the Ministry of Health, Social Services and Equality; the Spanish Government (Carlos III Institute of Health. FIS. Grant PI051080, PI051579); European Regional Development Fund (MICINN-FEDER).

Statement of authorship

LM, JM-G and PM-E conceived and designed this study. LM, AM, CC, JM-G and AsM conceived and designed the EVASYON Study. JS and PM-E analysed and interpreted data. PM-E, MM-M and MJP carried out measurements. All authors were involved in writing the paper and had final approval of the submitted and published versions. EVASYON Study Group provided technical and general support during the EVASYON Study.

Conflict of interest

The authors do not declare conflict of interest.

Acknowledgements

We gratefully acknowledge the enthusiasm and commitment of all the participating adolescents and their families.

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    1

    The members of the “EVASYON Study Group” are listed in Appendix section.

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