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Body composition, energy expenditure and physical activity

Validation of surrogate limb analysis for body composition in children by dual energy X-ray absorptiometry (DXA)

Abstract

Background/Objectives:

Dual energy X-ray absorptiometry (DXA) is a recognized tool for measurement of body composition and provides benefits of low dose radiation, quick scan time and multiple measurement options. Challenges arise in scanning children, particularly with limb movement. We aimed to validate the use of surrogate limb substitutions compared with whole-body scans by DXA for measuring fat, lean and bone mass in children.

Subjects/Methods:

DXA scans were obtained from 3-year-old children who had normal positioning and no limb movement (n=246) or movement of a single limb (n=55). By replacing the measurements of one scanned limb with those of the opposite limb, we obtained an estimate value that was compared with the original whole-body scan measures for fat, lean and bone mass, percent whole-body fat and total mass for scans without or with movement.

Results:

Original normal scan analyses were highly correlated with estimates using substitution of the surrogate limb for all body compartments (R2=0.986–0.999, P<0.005). The Bland–Altman analysis demonstrated high levels of agreement between the estimates using surrogate limb and original whole-body measurements. Differences in estimate values and variance were greater with limb substitution in scans with movement compared to without movement.

Conclusions:

Use of limb surrogate methodology for fat mass, lean mass, bone mineral content, percent fat and total mass, is a valid alternative that minimizes variation in estimates of body composition from DXA scans in young children in which a single limb is affected by movement. This will allow inclusion of scans with movement artifact in a single limb for data analysis.

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Acknowledgements

The substudy was funded by Dairy Farmers of Canada and an Ontario Graduate Scholarship to DJR. The main FAMILY Study was funded by Canadian Institutes of Health Research and Heart and Stroke Foundation of Canada. We gratefully acknowledge the patience and cooperation of the young children and their families in the conduct of the DXA scans.

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Correspondence to S A Atkinson.

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The authors declare no conflict of interest.

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Contributors: DJR is a graduate student under the supervision of SAA. She assisted in the design of the study, conducted the scan analyses, analyzed the data, drafted the initial manuscript and approved the final manuscript as submitted. SAA is a primary investigator of the FAMILY birth cohort study; she conceptualized and designed this DXA validation study, supervised data collection and statistical analysis, contributed to interpretation of results and had primary responsibility for the final manuscript as submitted.

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Rodrigopulle, D., Atkinson, S. Validation of surrogate limb analysis for body composition in children by dual energy X-ray absorptiometry (DXA). Eur J Clin Nutr 68, 653–657 (2014). https://doi.org/10.1038/ejcn.2014.44

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