[Somatotype-specific anthropometry and eating disorders].
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We investigated body composition in older patients who had experienced a cerebrovascular accident (CVA) and were participating in a recovery program that included physical exercise. We studied 61 persons in two groups. One group consisted of 13 men and 12 women (mean age, 68 years) who were receiving day center care to recover from a CVA that had occurred from six months to one year previously. The second group (control) consisted of 20 men and 16 women (mean age, 68 years) in good health, residing in a retirement home. Most subjects in both groups were able to perform normal activities of daily living without help and showed a high degree of independence (> 60 on the Barthel scale). Bioelectric impedance and anthropometric methods were used to measure the magnitude of changes in fat-free mass and fat mass. Percentage total body fat measured with bioelectric impedance was higher in both groups than when measured anthropometrically. The anthropometric values and bioelectric impedance results in patients who participated in a physical exercise program were similar to the findings in control subjects. The anticipated loss in muscle mass and gain in body fat as a result of inactivity associated with illness was not seen, possibly because of the personalized program of continuous physical exercise. Our comparison of older people recovering from CVA and apparently healthy older people illustrates the benefits of physical exercise in compensating for changes in body composition as a result of immobility during convalescence.
Non-fasting plasma amino acids, proteins, anthropometric measurements, urea, and creatinine for 17 hemodialysis patients were compared with values in normal patients of similar age and sex. Values were characteristic for renal failure but with similarities to protein-energy malnutrition. Partial correlation coefficients, correcting for age and height, identified nutritional and non-nutritional factors. Plasma valine was the most correlated variable and was used to rank and group the patients. The group with valine less than 150 micrometers/liter had low values for 17 variables. Valine, isoleucine, leucine, threonine, asparagine, weight, and arm muscle circumference were interrelated and reflected malnutrition whereas fat correlated with calorie intake, and histidine and serine with protein intake. Taurine, aspartic acid, cystine, citrulline, urea, creatinine, prealbumin and retinol-binding protein were decreased in malnutrition but were higher than normal due to a loss of renal function. Fourteen variables, less affected by malnutrition, were changed by specific non-nutritional factors. Hemodialysis patients of long standing (1 to 11 years) apart from two patients with recurrent sepsis, were adequately nourished, but those on hemodialysis for less than 15 months, most of whom had previously received peritoneal dialysis, were malnourished. Malnutrition in dialysis patients was due to protein and energy deficiency enhanced by metabolic abnormalities of amino acids. Our study shows that plasma valine is interrelated with other nutritional variables and may be used to assess protein-energy malnutrition.
OBJECTIVE: To evaluate the performance of the body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting incident diabetes in Jamaica. RESEARCH METHODS AND PROCEDURES: A cohort of 728 nondiabetic adults (290 men and 438 women), ages 25 to 74 years and residents of Spanish Town, Jamaica, were followed for a mean of 4 years. Participants had fasting and 2-hour postchallenge glucose concentrations measured at baseline and follow-up. RESULTS: There were 51 cases of incident diabetes (17 men and 34 women). All indices were independent predictors of diabetes, and none was clearly superior. The area under the receiver operating characteristics curves (95% confidence interval) for BMI was 0.74 (0.59 to 0.88) for men and 0.62 (0.51 to 0.72) for women. For waist circumference, these values were 0.78 (0.65 to 0.91) in men and 0.61 (0.50 to 0.71) in women. Similar results were obtained for WHR and WHTR. "Optimal" cut-off points for BMI were 24.8 kg/m(2) (men) and 29.3 kg/m(2) (women). For waist circumference, these were 88 cm and 84.5 cm for men and women, respectively. Corresponding values for WHR were 0.87 and 0.80 and for WHTR were 0.51 and 0.54, respectively. DISCUSSION: Cut-off points for waist circumference and WHR were similar to those proposed in developed countries for women but lower in men. Waist circumference could be useful in health promotion as an alternative to BMI.
OBJECTIVE: To develop prediction equations for total body fat specific to Latino children, using demographic and anthropometric measures. RESEARCH METHODS AND PROCEDURES: Ninety-six Latino children (7 to 13 years old) were studied. Two-thirds of the sample was randomized into the equation development group; the remainder served as the cross-validation group. Total body fat was measured by DXA. Measures included weight, height, waist and hip circumferences, and skinfolds (suprailiac, triceps, abdomen, subscapula, thigh, and calf). RESULTS: The previously published equation from Dezenberg et al. did not accurately predict total body fat in Latino children. However, newly developed equations with either body weight alone (intercept +/- SE = 1.78 +/- 1.53 kg, p > 0.05; slope +/- SE = 0.90 +/- 0.07, p > 0.05 against slope = 1.0; R(2) = 0.86), weight plus age and gender (intercept +/- SE = 2.28 +/- 1.20 kg, p > 0.05; slope +/- SE = 0.91 +/- 0.05, p > 0.05; against slope = 1.0; R(2) = 0.92), or weight plus height, gender, Tanner stage, and abdominal skinfold (intercept +/- SE = 1.47 +/- 1.01 kg, p > 0.05; slope +/- SE = 0.93 +/- 0.04, p > 0.05; against slope = 1.0, R(2) = 0.97) predicted total body fat without bias. DISCUSSION: Unique prediction equations of total body fat may be needed for Latino children. Weight, as the single most significant predictor, can be used easily to estimate total body fat in the absence of any additional measures. Including age and gender with weight produces an equally stable prediction equation with increasing precision. Using a combination of demographic and anthropometric measures, we were able to capture 97% of the variance in measured total body fat.
OBJECTIVE: The goal was to assess the ability of BMI to predict body fat (BF) among youths in four countries and identify the degree to which additional anthropometric measures improve this prediction. BMI is widely recommended as an indicator of overweight. However, whether BMI adequately estimates BF and has the same meaning in different ethnic groups and youths has been questioned. RESEARCH METHODS AND PROCEDURES: Data come from 456 Filipino, Chinese, Russian, and black South African youths, 6 to 16 years old. Percentage BF and fat mass index (FMI) were estimated by the deuterium dilution method. Skinfold thicknesses (triceps, subscapular, and suprailiac) and weight and height measures were collected. Percentage BF was regressed first on BMI and age and then with the addition of the skinfold measures. Linear models were run separately by country and sex. The models were repeated with FMI as the outcome. RESULTS: The R2 values from the percentage BF models ranged from 0.13 to 0.69 in the first models to 0.38 to 0.81 in the full models. The values were lowest among Russian males > or = 13 years and Russian females > or = 13 years of age in the reduced and full models, respectively, and were highest among Chinese females. Using FMI as the outcome did not meaningfully change the results. DISCUSSION: The ability of BMI to adequately predict BF and the additional predictivity of anthropometric measures varied widely across the samples, making its uniform use as a proxy for BF in youths from different countries questionable.
OBJECTIVES: To determine in non-obese pre-menarcheal girls if bioelectrical impedance (BIA) is a better predictor of body fatness than triceps skinfold (TSF) or body mass index (BMI) and to cross-validate published equations for determination of fat-free mass (FFM) from BIA in pre-menarcheal girls. DESIGN: Cross-sectional analysis of data from 132 non-obese pre-menarcheal girls. The relationship of percent body fat (%BF), derived from isotopic dilution of H2 18O to TSF, BMI, and %BF by BIA, calculated from measures of height, weight and resistance was examined by correlation analysis. SETTING: Massachusetts Institute of Technology (MIT) Clinical Research Center in Cambridge, MA, USA. SUBJECTS: Pre-menarcheal girls aged 8-12 y were recruited from local schools, MIT summer day camp and by word of mouth. RESULTS: TSF accounted for 68% of the explained variance (R2) in the prediction of %BF measured by H2 18O, compared to 38% for BMI and 70% for BIA. Prediction of FFM by comparison of published equations was evaluated in this population. The predictive ability differed by Tanner stage. Kushner's equation (Kushner et al, 1992), based solely on height2/resistance was the only equation that provided estimates that did not differ significantly from measured values among all Tanner stages. CONCLUSIONS: BIA appears to be a valid and reliable measure of FFM but is no better than TSF in predictions of body fat.
OBJECTIVES: This paper reports the effects of early supplementary feeding on body weight, length, head circumference and arm circumference among the children in the Pangalengan study. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementation was given for 12 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care centers. Twenty children that received S belonged to the 12- and 18-month cohorts. Inclusion criteria were: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: Length was measured with a portable measuring board; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight. Arm and head circumferences were measured using similar fiberglass tapes. RESULTS: Body weight showed effects on both cohorts at 2, 8 and 12 months; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort; and arm circumference showed effects across cohorts at 2, 8 and 12 months. In general the benefits are clearer for females and for the 12-month-old cohort.
OBJECTIVE: To examine the effect of zinc supplementation to HIV-1-infected pregnant women on viral load, early mother-to-child transmission of HIV (MTCT), and wasting. DESIGN: Double-blind placebo-controlled randomized clinical trial. SETTING: Antenatal clinic in Dar es Salaam, Tanzania. SUBJECTS: Four hundred HIV-1-infected pregnant women. METHODS: Women 12-27 weeks of gestation were randomly assigned to receive a daily oral dose of 25 mg zinc or placebo from the day of the first prenatal visit until 6 weeks postdelivery. Weight and mid-upper arm circumference (MUAC) were measured monthly. HIV status of the babies was assessed at birth and at 6 weeks postpartum. Viral load was assessed in a random sample of 100 women at baseline and at the end of the study. RESULTS: Zinc had no effects on maternal viral load or early MTCT. Supplementation was related to a significant threefold increase in the risk of wasting (reaching a MUAC value <22 cm) during an average 22 weeks of observation (RR=2.7, 95%CI=1.1, 6.4, P=0.03), and to a 4 mm decline in MUAC during the second trimester (P=0.02). CONCLUSIONS: Zinc supplementation to HIV-infected pregnant women offers no benefits on viral load or MTCT. The clinical relevance of an apparent decrease in MUAC associated with zinc supplementation is yet to be ascertained. These findings together with the lack of effect on fetal outcomes (reported previously) do not provide support for the addition of zinc supplements to the standard of prenatal care among HIV-infected women.
OBJECTIVE: To evaluate the validity of the Durnin-Womersley equations and to derive our local predictive equations for body fat from upper limb skinfold thicknesses in older Chinese people in Hong Kong. To evaluate the validity of mid-arm circumference and corrected arm muscle area in predicting lean tissue mass in the same population. DESIGN: Comparison of fat percentages predicted by Durnin-Womersley (D-W) equations with those estimated by Dual energy X ray absorptiometry (DXA). Predictive equations derived from regression between upper limb skinfold thicknesses and fat percentages estimated by DXA were similarly evaluated in internal and external validation groups. Mid-arm circumference (MAC) and corrected arm muscle area (CAMA) were correlated with the limb lean tissue mass, body lean tissue mass and fat percentage. SUBJECTS: 354 female and 263 male, apparently well, community dwelling subjects, aged 69-82 y; of which 40 subjects of each sex were randomly selected from the study population for internal validation of the local predictive equations; 60 female and 33 male hospital medical outpatients, aged 61-87 y, were recruited for external validation. MEASUREMENTS: Triceps and biceps skinfold thicknesses, mid-arm circumference, body mass index, fat percentages, limb and whole body lean tissue masses estimated by Hologic QDR-2000 bone densitometer. RESULTS: Fat percentages calculated by D-W equations were significantly different from those estimated by DXA (average difference -2.4 (s.d. 4.8)% and +2.1 (5.2)% in females and males respectively). The corresponding differences for our local predictive equations were not significant (-0.9 (4.7)% and -0.5 (5.0)% in females and males respectively). There was a trend of under-estimation of body fat with increasing fatness. In the hospital medical outpatients, there was a significant difference between fat percentages predicted by our equation and those by DXA in female (-2.9(5.3)%), but not in male (+0.3(4.3)%) subjects. In males, MAC correlated with limb and body lean tissue masses as well as with fat percentage (r = 0.60, 0.68, 0.65 respectively). CAMA correlated similarly well with lean tissue masses but was more independent of fat percentage (r = 0.61, 0.65, 0.44 respectively). In females, both MAC and CAMA correlated poorly with limb and body lean tissue masses. Moreover, MAC correlated well with fat percentage (r = 0.80). CONCLUSION: Upper limb skinfold thicknesses measurement is a valid means of predicting body fat in older Chinese people. Local predictive equations were more reliable that D-W equations. They were, however, subject to errors at the extreme ends of body fatness and in the presence of disease. In older females, MAC and CAMA were not reliable in predicting lean tissue mass, but MAC could be used to predict fat percentages. In older males, CAMA was more reliable than MAC in predicting lean tissue mass.
The objectives of this paper were to: a) evaluate the accuracy and precision of previously published pediatric body composition prediction equations and b) develop additional prediction equations from a large, heterogeneous group of Caucasian (n = 133) and African-American (n = 69) children. The combined cohort of 202 children included a wide range of ages (4.0-10.9 y), weights (14.0-70.8 kg), fat mass (FM: 1.2-28.5 kg) and percent body fat (% body fat: 6.2-49.6%). Skinfold measurements were obtained using a Lange caliper and body fat was measured with a Lunar DPX-L densitometer. The previously published equations of Slaughter et al and Goran et al did not accurately predict body fat. The entire cohort was randomly divided into two sub-groups for purposes of deriving and cross-validating a new prediction equation. In stepwise regression analysis in the development group (n = 135), weight, triceps skinfold, gender, ethnicity and abdominal skinfold estimated FM measured by dual energy x-ray absorptiometry (DEXA) with a model R2 of 0.95. The new prediction equation was cross-validated in the control group (n = 67) and each ethnic and gender subgroup. We conclude that a) the equations of Slaughter et al and Goran et al did not accurately predict FM in a heterogeneous group of children and b) a new anthropometric prediction equation is proposed that may provide accurate estimates of FM in both Caucasian and African-American children aged 4-10 y with a wide range of FM and body composition.
OBJECTIVE: To investigate whether the dual-energy X-ray absorptiometry (DEXA) was a better predictor of abdominal fat, measured by magnetic resonance imaging (MRI) at the level of L2-L3, than anthropometric measurements in non-obese men and non-obese women. DESIGN: Observational, cross sectional study. SUBJECTS: 34 healthy subjects (17 men and 17 women) aged 20-53 y with a body mass index (BMI) < 30 kg/m2. MEASUREMENTS: Fat distribution parameters including waist circumference and waist-to-hip ratio (WHR); intra abdominal fat (IAF) by MRI; and central abdominal fat (CAF) by DEXA. RESULTS: Measurement of IAF by MRI, was highly correlated to the CAF measured by DEXA. In men, both waist circumference and WHR had similar correlation to IAF as DEXA. In women, waist circumference was less well correlated with IAF than DEXA, and the WHR had a weaker non significant correlation with IAF. CONCLUSIONS: In non-obese men; DEXA, waist circumference and WHR can predict IAF equally well, while in non-obese women, DEXA is superior to waist circumference and much better than WHR.
OBJECTIVE: To evaluate the merit of body mass index (BMI), % body fat, waist circumference and waist-to-hip ratio as predictors of abdominal visceral fat (AVF) level. DESIGN: Cross-sectional measurements obtained from 458 female and 331 male subjects of French Canadian descent with an age range from 18-72 y. MEASUREMENTS: AVF level was assessed by computed tomography. BMI was calculated as weight (in kg) divided by stature2 (in m), body density was derived from underwater weighing and % body fat was computed from the estimate of body density with the Siri equation. Waist-to-hip ratio was calculated as waist circumference divided by hip circumference. Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off points. RESULTS: In younger women (< 40 y, n = 258), waist-to-hip ratio was the poorest predictor of AVF level with areas under the ROC curves (Az) ranging from 0.684-0.716, sensitivity (Sen) from 63.3-68.8% and specificity (Spe) from 64.0-67.5%, whereas the Az, Sen and Spe for other predictors ranged from 0.924-0.983, 87.0-96.8, and 83.4-92.7, respectively. The same trend was observed in older (> or = 40 y, n = 200) women, although differences between waist-to-hip ratio and other predictors were less pronounced. In older men, waist circumference was the best overall predictor (Az from 0.88-0.92), whereas BMI showed the lowest Az values (0.831-0.875, P < or = 0.001 vs waist circumference). In younger men, BMI had the smallest Az (P < 0.007 vs others) with the lowest AVF cut-off point (100 cm2). However, with higher AVF cut-offs the differences were not significant. CONCLUSION: Waist circumference is the best overall predictor of abdominal visceral obesity, whereas in women waist-to-hip ratio is a poor indicator of AVF and its use as a surrogate measure of visceral fat should be avoided.
OBJECTIVE: To get accurate measurements of visceral adipose tissue (VAT) using dual energy X-ray absorptiometry (DXA). DESIGN: DXA and anthropometric data and their combinations were compared to the VAT area calculated from a computed tomography (CT) single scan. SUBJECTS: 71 overweight subjects (44 women, 27 men), age: 16-70 y, BMI: 27-52 kg/m2. MEASUREMENTS: Total body and segmental tissue composition, and new parameters obtained from DXA, in addition to waist and hip circumferences and abdominal sagittal diameter measurements. RESULTS: The ratio measured at the umbilical level (sagittal diameter - subcutaneous fat width) x (transverse internal diameter)/(height) was closely related to VAT (r=0.94 for women and 0.88 for men). It gave the most predictive equation for VAT: y = 79.6x (s.e. 3.9) - 149 cm2 for the whole population (r2=0.86, P<0.0001, root mean square error=38.2 cm2. An independent relationship between lean mass or its index (r=0.52 and 0.72, P<0.001) and VAT was also found in women. CONCLUSION: This study demonstrates the potential usefulness of DXA to supply accurate measurements of VAT in addition to total body composition determination in obese subjects.
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OBJECTIVE: To examine the impact of childhood body mass index (BMI) on timing of puberty, adult stature and obesity. DESIGN: A retrospective school-based cohort follow-up study. SUBJECTS: A total of 1520 men born between 1927 and 1956 with serial height and weight measurements from the age of 9 to 18, followed up in adulthood at a mean age of 63 years. MEASUREMENTS: Prepubertal (child) BMI; age at peak height velocity (APHV); adult leg length, waist and hip circumference (self-reported), and height and weight (measured). RESULTS: Boys with a higher childhood BMI tended to have an earlier puberty (per s.d. increase in child BMI: -0.31 years, 95% confidence interval (CI): -0.23 to -0.39, P < 0.001). Childhood BMI correlated strongly and positively with adult adiposity, as measured by BMI (1.24 kg/m(2), 95% CI: 1.04-1.45, P < 0.001), waist (1.94 cm, 95% CI: 1.50-2.37, P < 0.001) and hip (1.91 cm, 95% CI: 1.55-2.28, P < 0.001). It correlated inversely with leg length (-0.40 cm, 95% CI: -0.68 to -0.12, P = 0.005), but not significantly with height or trunk length. Boys with a later puberty tended to be taller (per s.d. increase in APHV: 0.57 cm, 95% CI: 0.17-0.97, P = 0.006) and less adipose as adults (-0.55 kg/m(2), 95% CI: -0.33 to -0.77, P < 0.001). CONCLUSION: The long-term consequences of childhood obesity into adulthood are well known, but the potential impact on early pubertal maturation is less well appreciated. The factors that contribute to the onset and persistence of childhood obesity require more public health focus.
OBJECTIVE: To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country. DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods. SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK. MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight. RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m(2)) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m(2)). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: -2.38; 95% CI: -2.48 to -2.29) and mid-arm circumference (s.d. score: -1.82; 95% CI: -1.89 to -1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: -0.53; 95% CI: -0.61 to -0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations. CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.
OBJECTIVE: To determine the cut-off points of indices of obesity for detecting hypertension, dyslipidemia and diabetes mellitus in Japanese individuals. DESIGN: Cross-sectional study. SUBJECTS: A total of 2728 Japanese individuals (768 males and 1960 females, aged 20-79 y) who attended the Fukuoka Health Promotion Center, Japan for health check-up. MEASUREMENTS: Body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) were measured. Percentage fat mass (%FM), trunk fat mass (FM(trunk)) and trunk fat mass-leg fat mass ratio (FM(trunk)/FM(legs)) were obtained by dual-energy X-ray absorptiometry (DXA). Cardiovascular risk factors were determined by blood pressure, serum lipids, fasting blood glucose and hemoglobin A(1C). RESULTS: The cut-off points of BMI, WC and WHR were around 23.5 kg/m(2), 84 cm and 0.9 for males, and 22.5 kg/m(2), 72 cm and 0.8 for females. The cut-off points of %FM, FM(trunk) and FM(trunk)/FM(legs) were around 24%, 8 kg and 1.6 for males, and 35%, 9 kg and 1.4 for females. WHR and FM(trunk)/FM(legs) most accurately detected the risk factors. CONCLUSIONS: For Japanese individuals, the cut-off points for detecting cardiovascular risk factors are lower than the criteria by the World Health Organization. Indices of fat distribution detected the cardiovascular risk factors more accurately than those of overall adiposity. The accuracy of detecting the risk factors was comparable between the anthropometric indices and indices obtained by DXA.