Gender differences in newborn subcutaneous fat distribution

The pattern and distribution of subcutaneous fat in term and preterm newborns has been assessed by skinfold thicknesses (ST), describing gender and gestational age variations. Weight, length and ST (triceps, biceps, subscapular and suprailiac) were measured in 4634 neonates (2445 males and 2189 females) aged from 32 to 41 gestational weeks. Central to total skinfold ratio (CTS), (suprailiac + subscapular)/sum of 4 ST, was calculated. Males were heavier and longer than females. The sum of 4 ST and CTS was higher in females at every gestational age (with significant differences from 35 weeks) and also the sum of 4 ST per kg body weight (P<0.05 from 32–33 weeks). Throughout the gestational period, ST increased significantly (P<0.0001) but CTS did not show variations, neither in males nor in females. Conclusion: term and preterm females have a more centralised pattern and more amount of subcutaneous fat than males. Central to total skinfold ratio must be considered as an index of centripetal fat store which is independant of gestational age.Abbreviations BS biceps skinfold thickness - CTS central to total skinfold ratio - DXA dual energy X-ray absorptiometry - FFM fat-free mass - FM fat mass - SBS subscapular skinfold thickness - SPS suprailiac skinfold thickness - ST skinfold thickness - ST the sum of the four skinfolds (biceps, triceps, subscapular and suprailiac) - TS triceps skinfold thickness     

Is term newborn body composition being achieved postnatally in preterm infants?

Background

The American Academy of Pediatrics (AAP) recommends that preterm infants' growth duplicates fetal growth rates and that body composition replicates in utero body composition.

Aims

To compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.

Study design

Prospective observational study.

Subjects

One hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.

Outcome measures

Growth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.

Results

Weight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P < 0.0001]. Fat mass was negatively correlated with gestational age (P < 0.001), and positively associated with weight increase (P < 0.05).

Conclusions

Our data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.     

Changes in fat mass,fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme

The purpose of this study was to describe changes in fat mass (FM), fat-free mass (FFM) and aerobic fitness in severely obese children and adolescents during residential treatment in the Medical Paediatric Centre Zeepreventorium. Treatment consisted of moderate dietary restriction, physical activity and psychological support. This study was a clinical observation of 20 severely obese children and adolescents (8 boys and 12 girls, aged 15.4+/-1.8 years) who completed the 10-month residential programme. Height, weight, FM, FFM and aerobic fitness was measured four times during the intervention: at baseline, 11 weeks, 24 weeks and at 33 weeks (at the end of the programme ). The mean decrease in level of overweight was 46% (P<0.001), with a mean loss of 8.9% FM (P<0.001). Submaximal performance (PWC150) improved from 123+/-35 Watt to 152+/-37 Watt (P<0.001). Maximal performance levels increased (performance time: from 14+/-2.9 min to 15.3+/-3.5 min, peak power: from 186+/-38 Watt to 205+/-45 Watt, P<0.01) without an improvement in absolute VO(2 peak). CONCLUSION: A moderate dietary restriction in combination with physical activity and psychological support in severely obese children and adolescents is effective in decreasing body fat and improving physical performance. Further research is needed to evaluate the longer-term effects of such a programme.     

Body composition measured by dual-energy X-ray absorptiometry half-body scans in obese children

Aim: To perform a methods comparison of a left or right half‐body scan versus whole‐body scan for measuring body composition in a sample of obese children. Methods: A group of obese children (n = 58; ≥95th BMI percentile; 8–18 years) were required to undergo a dual‐energy X‐ray absorptiometry (DXA) body composition measurement as part of an ongoing cohort study; 34 fit within the imaging field of the DXA scanner and were eligible for inclusion in the present analysis. Percent fat, total mass, fat mass, lean mass and bone mineral content (BMC) were estimated from half‐body scans and compared with the whole‐body results. Assessment was completed using GE enCORE 11.40 software. Results: In comparing left‐ and right‐side scans to whole‐body scans, there was significant correlation for all body composition variables (p ≤ 0.005, R² = 0.996–1.0). Bland Altman analyses also showed high levels of agreement between half‐body estimates and whole‐body measurements. Conclusion: This study supports using a half‐body scan methodology for percent fat, total mass, fat mass, lean mass, and BMC as a valid alternative to full‐body analysis in obese children and youth.     

基于生物电阻抗法测量的体脂肪量对儿童血压和血糖代谢异常的预测价值

目的 探讨基于生物电阻抗法（BIA）测量的儿童体脂肪量对血压和血糖代谢异常的预测价值。方法 采用分层整群抽样的方法选取6~16岁学生进行问卷调查和体格测量,通过BIA仪器测量体脂肪量,计算体重指数（BMI）、体脂肪指数（FMI）和体脂肪率（FMP）,并检测空腹血糖水平。结果 纳入的14 293名儿童中男童占49.89%。在男女儿童中分别以FMI和FMP通过LMS法拟合的百分位数值（P₆₀、P₆₅、P₇₀、P₇₅、P₈₀、P₈₅、P₉₀、P₉₅）逐个作为切点,受试者工作特征曲线分析显示,对血压异常和血糖代谢异常预测价值较好的体脂过多切点为P₇₀值。控制FMI或FMP在P₇₀以下,可减少8.53%~43.24%的儿童发生血压和血糖代谢异常。结论 基于FMI和FMP评价肥胖状态对于儿童高血压和高血糖筛查具有一定的公共卫生价值,在今后儿童肥胖和相关慢性疾病防治工作中可进一步验证。     

Use of skin-fold thickness in Sri Lankan children: Comparison of several prediction equations

Objective  There are many prediction equations available in the literature for the assessment of body composition from skinfold thickness (SFT). This study aims to cross validate some of those prediction equations to determine the suitability of their use on Sri Lankan children. Methods  Height, weight and SFT of 5 different sites were measured. Total body water was assessed using the isotope dilution method (D₂O). Percentage Fat mass (%FM) was estimated from SFT using prediction equations described by five authors in the literature. Results  Five to 15 year old healthy, 282 Sri Lankan children were studied. The equation of Brook gave Ihe lowest bias but limits of agreement were high. Equations described by Deurenberg et al gave slightly higher bias but limits of agreement were narrowest and bias was not influence by extremes of body fat. Although prediction equations did not estimate %FM adequately, the association between %FM and SFT measures, were quite satisfactory. Conclusion  We conclude that SFT can be used effectively in the assessment of body composition in children. However, for the assessment of body composition using SFT, either prediction equations should be derived to suit the local populations or existing equations should be cross-validated to determine the suitability before its application.     

Skinfold measurements in children with cystic fibrosis: monitoring fat-free mass and exercise effects

Monitoring fat free mass (FFM), an indicator of nutritional status and a predictor of exercise performance in children, is particularly important in patients with cystic fibrosis (CF). We assessed validity of the skinfold method for measuring FFM, and its changes with exercise training, in children with CF. A total of 14 children with moderately severe symptoms of CF (age 10–18 years) were followed longitudinally and measured three times, before (at 0 and 6 months) and after exercise training (at 12 months). Separately, single measurements were conducted in 12 children with mild symptoms of CF and in 13 healthy controls. FFM was calculated from four skinfold measurements, and compared with estimations from total body water measured with deuterium dilution. The FFM calculated from skinfolds was 1.7% (P < 0.05) and 3.3% (P < 0.005) higher than that estimated with deuterium oxide dilution in patients with CF and controls, respectively. Limits of agreement were similar in patients with moderate and mild symptoms and in controls. The measurements in patients with moderate symptoms showed similar bias and limits of agreement at 6 and 12 months as compared to 0 months. Changes in FFM measured with both methods were significantly correlated before exercise (r = 0.82, P < 0.0005), and after exercise training (r = 0.60, P < 0.05). Conclusion In children with cystic fibrosis, skinfold measurements are applicable to monitor fat free mass irrespective of clinical severity of the disease, and repeated measurements at intervals of 6 months are applicable to monitor changes in fat free mass during exercise training. Received: 15 September 1998 / Accepted in revised form: 22 February 1999     

北京市儿童青少年青春期发育与肥胖相关关系的研究

目的 分析北京市6~18岁儿童青少年青春期发育与超重肥胖的关系。方法 利用2004年北京市儿童青少年代谢综合征调查总样本中19 085名6~18岁儿童青少年的青春期发育、体重指数（BMI）和体脂含量百分比（FMP）等数据。采用女性乳房和男性睾丸容积Tanner分期指标衡量青春期发育，结合个体年龄将群体分为早、晚发育组；以BMI和生物电阻抗法所测FMP作为反映体脂含量的指标；7~18岁人群超重和肥胖的诊断采用中国肥胖问题工作组（WGOC）推荐的中国学龄儿童青少年超重、肥胖筛查BMI值分类标准进行，6岁组采用美国疾病预防与控制中心 2000年发布的儿童超重和肥胖BMI标准第P85和第P95分位值进行诊断；采用多元线形回归、Logistic回归分析早发育与体脂含量和超重、肥胖的相关联系。结果 早发育组的超重（合并肥胖）率和肥胖率均高于晚发育组，女性两组间差异大于男性；控制可能的混杂因素后，女性BMI和FMP与早发育呈正相关（BMI：β=2.25，P<0.001；FMP：β=4.55，P<0.001）；而男性BMI和FMP与早发育的联系相反，早发育组的BMI高于晚发育组，而FMP却低于晚发育组；以晚发育为参照组，控制年龄、城郊居住地等因素的影响后，早发育预测超重、肥胖的OR值（95%CI）：女性为3.39（2.94~3.92）和3.12（2.53~3.85），男性为1.12（0.96~1.31）和1.31（1.06~1.62）。结论 北京市儿童青少年青春期发育与肥胖密切相关，在评价超重、肥胖率及进行不同地区间肥胖流行状况的比较时，要注意青春期发育的效应修正作用。     

不同胎龄早产儿生后早期对脂肪乳的耐受性研究

目的分析不同出生胎龄早产儿生后早期对脂肪乳的耐受性。方法 98例早产儿分为超早产儿组(n=17)、早期早产儿组(n=48)和中晚期早产儿组(n=33),再根据脂肪乳剂量分为低剂量脂肪乳与高剂量两个亚组,留取脐血及生后前3 d的血干滤纸片,用串联质谱法检测短、中、长链酰基肉碱含量。结果超早产儿组与早期早产儿组脐血及生后前3 d长链酰基肉碱浓度均低于中晚期早产儿组(P0.05),且长链酰基肉碱浓度与胎龄呈正相关(P0.01)。超早产儿低剂量脂肪乳组生后第2天的短、中、长链酰基肉碱浓度均高于高剂量组(P0.05),而早期早产儿与中晚期早产儿不同剂量脂肪乳亚组的生后3 d短、中、长链酰基肉碱浓度差异均无统计学意义。结论超早产儿和早期早产儿生后前3 d对长链脂肪酸的代谢能力均低于中晚期早产儿;早期早产儿与中晚期早产儿生后早期可以耐受高剂量脂肪乳,但超早产儿生后早期对高剂量脂肪乳代谢能力可能不足。     

Weight/length ratio references and newborn body composition estimation at birth from a Brazilian cohort

ObjectivesThe objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st.MethodsSecondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models.ResultsAverage W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented.ConclusionsW/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.     

Fat-free mass hydration in newborns: assessment and implications for body composition studies

Aim: Equipment (Pea Pod) offering new possibilities to assess infant body composition has recently become available and has already been used in several studies. In the Pea Pod, body density is converted to body composition using one of two models (‘Fomon’ or ‘Butte’) with different water content in fat‐free mass (hydration factor, HF). In healthy full‐term infants, we assessed HF and its biological variability in 12 newborns and calculated body composition using the two models at 1 and 12 weeks in 108 infants. Body weight and volume were assessed in Pea Pod, and body water was assessed using isotope dilution. Results: Hydration factor was 80.9% with low biological variability (0.8% of average HF). Body fat (%) was significantly lower at 1 and 12 weeks when calculated using the ‘Butte’ model than when using the ‘Fomon’ model. The difference was more pronounced at one than at 12 weeks. Conclusion: Our HF value agrees with that in the ‘Fomon’ model, its low biological variability can be reconciled with the statement that Pea Pod is accurate in newborns and ‘Fomon’ is the best available model for studies in Pea Pod.     

积极肠外营养支持方案在胎龄小于34周早产儿中的远期效果研究

目的 探讨应用积极肠外营养支持方案在胎龄小于34周早产儿肠外营养中的远期疗效。 方法 根据早期应用脂肪乳和氨基酸剂量的不同,将2019年5~12月收治的生后24 h内入院、胎龄小于34周的早产儿分为积极肠外营养组和常规肠外营养组,每组各50例,分别收集两组早产儿在随访6个月和13个月时的体格指标及Gesell发育量表测定值。 结果 6月龄时,积极肠外营养组早产儿（n=46）在大运动、精细运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=34）（P<0.05）;13月龄时,积极肠外营养组早产儿（n=25）在适应性行为、大运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=19）（P<0.05）。两组患儿在整个随访过程中的体重、身长、头围等体格发育指标差异均无统计学意义（P>0.05）。 结论 在生后24 h内给予胎龄小于34周早产儿含高剂量脂肪乳和氨基酸的积极肠外营养支持策略可显著改善其远期神经系统发育。     

单纯性肥胖儿童血小板聚集反应的变化及其机理研究

目的探讨肥胖儿童血小板聚集反应的变化及其机理。方法采用二磷酸腺苷（ＡＤＰ）诱发体外血小板聚集及胆固醇亚组份沉淀法观测２２例７～１２岁高脂血症肥胖儿童血小板聚集率及１５１例肥胖儿童血清胆固醇各组份含量和比值。结果单纯性肥胖儿童血清总胆固醇（ＴＣ）和低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）含量明显高于正常儿童（Ｐ＜００１）,而高密度脂蛋白胆固醇（ＨＤＬ２－Ｃ）含量和ＨＤＬ－Ｃ／ＴＣ、ＨＤＬ２－Ｃ／ＴＣ及ＨＤＬ２－Ｃ／ＨＤＬ－Ｃ比值显著低于正常儿童（Ｐ＜００５,Ｐ＜００１）。高脂血症肥胖儿童１秒与５秒时血小板聚集率较正常儿童和血脂不高的肥胖儿童显著升高（Ｐ＜００１）。结论高脂血症的肥胖儿童血小板聚集反应增强,似与其ＴＣ、ＬＤＬ－Ｃ增高及ＨＤＬ２－Ｃ含量下降有关     

Influence of dietary intervention on growth in children with hypercholesterolaemia

Aim: To determine whether a moderately reduced fat diet affects longitudinal growth in children with hypercholesterolaemia with a mean duration of 7.42 ± 1.93 y. Methods: Subjects with hypercholesterolaemia, total cholesterol above 5.18 mmol/L and LDL-cholesterol above 3.49 mmol/L (n = 144; 69 males and 75 females) from 2 to 13 y of age were studied. Patients were seen in our outpatient department for regular health check-ups. Weight and height were measured every year. At the same time, cholesterol, triglycerides, LDL-C, HDL-C, A-apoprotein and B-apoprotein levels were analysed. Furthermore, degrees of compliance at 1 mo, 6 mo and each year after starting the dietary treatment were determined. Results: No significant change in height or weight was found after fat restriction. In contrast, significant reductions in total cholesterol, LDL cholesterol and B-apoprotein levels of 19%, 24% and 14%, respectively, were detected. Finally, no significant differences were seen in HDL-cholesterol, A-apoprotein or triglycerides.

Conclusions: These data support the hypothesis that growth is not influenced by moderate fat restriction in healthy children who otherwise have normal nutrition.