Reference Ranges for Body Composition Indices by Dual Energy X-ray Absorptiometry from the Bone Mineral Density in Childhood Study Cohort.

Aug 21, 2023

Experts: Babette S Zemel,John A Shepherd,Struan F A Grant,Joan M Lappe,Sharon E Oberfield,Jonathan A Mitchell,Karen K Winer,Andrea Kelly,Heidi J Kalkwarf

Body composition assessment aids evaluation of energy stores and the impact of diseases and interventions on child growth. Current U.S. pediatric reference ranges from the National Health and Nutrition Examination Survey (NHANES) include 20% of children with obesity, BMI ≥95 percentile.
To develop dual energy x-ray absorptiometry (DXA) based reference ranges in a diverse cohort with low obesity prevalence from the Bone Mineral Density in Childhood Study (BMDCS).
This is a secondary analysis of a longitudinal, prospective, observational cohort. Healthy children (height and BMI within 3 to 97 percentiles, ages 5-19y at enrollment), from 5 U.S. centers were measured annually for up to 7 visits. Whole body scans were acquired using Hologic scanners. A subsample underwent repeat measurements to determine precision. We generated reference ranges for appendicular and total lean soft-tissue mass index (LSTM Index), fat mass index (FMI), and other body composition measures. Resulting curves were compared to NHANES and across subgroups. Sex and age-specific equations were developed to adjust body composition Z-scores for height Z-score.
We obtained 9,846 scans on 2011 participants (51% female, 22% Black, 17% Hispanic, 48% White, 7% Asian/Pacific Islander, 6% with obesity). Precision (percent coefficient of variation) ranged from 0.7 to 1.96%. Median and -2SD curves for BMDCS and NHANES were similar, but NHANES +2SD LSTM Index and FMI curves were distinctly greater than the respective BMDCS curves. Subgroup differences were more extreme for appendicular LSTM Index-Z (mean±sd: Asian -0.52±0.93 vs Black 0.77±0.87) than for FMI-Z (Hispanic 0.29±0.98 vs Black -0.14±1.1) and were smaller for Z-scores adjusted for height Z-score.
These reference ranges add to sparse normative data regarding body composition in children and adolescents, and are based on a cohort with an obesity prevalence similar to current BMI charts. Awareness of subgroup differences aid in interpreting results.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Babette S Zemel,John A Shepherd,Struan F A Grant,Joan M Lappe,Sharon E Oberfield,Jonathan A Mitchell,Karen K Winer,Andrea Kelly,Heidi J Kalkwarf

Babette S Zemel

Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: zemel@chop.edu.

John A Shepherd

Cancer Center, University of Hawaii, Honolulu, HI, USA.

Struan F A Grant

Division of Human Genetics, The Children’s Hospital of Philadelphia, Department of Pediatrics, and Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Joan M Lappe

Department of Medicine, Creighton University, Omaha, NB, USA.

Sharon E Oberfield

Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.

Jonathan A Mitchell

Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Karen K Winer

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.

Andrea Kelly

Division of Pediatric Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Heidi J Kalkwarf

Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, USA.