The body adiposity index (BAI) and relative fat mass (RFM) are anthropometric measures developed to estimate body composition (%Fat). There is limited research validating these methods of body composition assessment in adults with Down syndrome (DS). The aim of this study was to examine the accuracy of the BAI and RFM in a sample of adults with- and without DS. We hypothesize that the RFM would provide greater accuracy than the BAI when estimating %Fat.
BAI and RFM were assessed in a sample of adults (n = 235, 50.2% female, 20.0% DS, 23.1 ± 6.7 years). %Fat assessed using dual-energy X-ray absorptiometry served as the criterion method of body composition. Between-group differences were assessed using a two-way (SEX × DS) analysis of variance.
BAI overestimated %Fat in men without DS, but underestimated %Fat in women without DS (4.1 ± 4.5%Fat vs. −3.5 ± 4.6%Fat, respectively, p < 0.001). BAI overestimated %Fat in men and women with DS (4.7 ± 7.8%Fat vs. 0.8 ± 7.5%Fat, respectively, p = 0.090). RFM slightly overestimated %Fat in male and female participants without DS, and did not vary by sex (0.9 ± 4.0%Fat vs. 0.2 ± 4.2%Fat, respectively, p = 0.248). RFM underestimated %Fat in men and women with DS, with no differences observed between sexes (−2.1 ± 5.3%Fat vs. −2.2 ± 6.9%Fat, respectively, p = 0.953).
The BAI and RFM can be used to estimate body composition in individuals with- and without DS, however, the RFM yields greater accuracy and is recommended when more advanced methods of body composition assessment are unavailable or create unwanted participant burden.
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Presson AP, Partyka G, Jensen KM, Devine OJ, Rasmussen SA, McCabe LL, et al. Current estimate of Down Syndrome population prevalence in the United States. J Pediatr. 2013;163:1163–8.
Rimmer JH, Wang E. Obesity prevalence among a group of Chicago residents with disabilities. Arch Phys Med Rehabil. 2005;86:1461–64.
Rowland M, Peterson-Besse J, Dobbertin K, Walsh ES, Horner-Johnson W, Andresen E, et al. Health outcome disparities among subgroups of people with disabilities: a scoping review. Disabil Health J. 2014;7:136–50.
Maatta T, Tervo-Maatta T, Taanila A, Kaski M, Iivanainen M. Mental health, behaviour and intellectual abilities of people with Down syndrome. Downs Syndr Res Pract. 2006;11:37–43.
Woolcott OO, Bergman RN. Relative fat mass (RFM) as a new estimator of whole-body fat percentage - a cross-sectional study in American adult individuals. Sci Rep. 2018;8:10980.
Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, et al. A better index of body adiposity. Obesity (Silver Spring, MD) 2011;19:1083–9.
Gonzalez-Aguero A, Ara I, Moreno LA, Vicente-Rodriguez G, Casajus JA. Fat and lean masses in youths with Down syndrome: gender differences. Res Dev Disabil. 2011;32:1685–93.
Karastergiou K, Smith SR, Greenberg AS, Fried SK. Sex differences in human adipose tissues–the biology of pear shape. Biol Sex Differ. 2012;3:13.
Myrelid Å, Gustafsson J, Ollars B, Annerén G. Growth charts for Downs syndrome from birth to 18 years of age. Arch Dis Child. 2002;87:97.
Nickerson BS, Esco MR, Bicard SC, Russell AR, Williford HN, Schaefer G. Validity of the body adiposity index in adults with Down syndrome. Res Dev Disabil. 2015;38:92–6.
Esco MR. The accuracy of the body adiposity index for predicting body fat percentage in collegiate female athletes. J Strength Cond Res. 2013;27:1679–83.
Casey AF. Measuring body composition in individuals with intellectual disability: a scoping review. J Obes. 2013;2013:628428.
Fedewa MV, Nickerson BS, Esco MR. Associations of body adiposity index, waist circumference, and body mass index in young adults. Clin Nutr. 2018. pii: S0261-5614(18)30126-2. https://doi.org/10.1016/j.clnu.2018.03.014.
Cerqueira MS, Santos CAD, Silva DAS, Amorim P, Marins JCB, Franceschini S. Validity of the body adiposity index in predicting body fat in adults: a systematic review. Adv Nutr. 2018;9:617–24.
Rossato M, Dellagrana RA, de S ouza Bezerra E, da Costa RM, dos Santos JOL, Silva DAS, et al. Comparison of body adiposity index (BAI) and air displacement plethysmograph with estimations of % body fat in adults with Down’s syndrome. Eur J Clin Nutr. 2017;71:1341.
Baptista F, Varela A, Sardinha LB. Bone mineral mass in males and females with and without Down syndrome. Osteoporos Int. 2005;16:380–88.
Wagner DR, Heyward VH. Measures of body composition in blacks and whites: a comparative review. Am J Clin Nutr. 2000;71:1392–402.
Jackson AS, Stanforth PR, Gagnon J, Rankinen T, Leon AS, Rao DC, et al. The effect of sex, age and race on estimating percentage body fat from body mass index: the Heritage Family Study. Int J Obes Relat Metab Disord. 2002;26:789–96.
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Fedewa, M.V., Russell, A.R., Nickerson, B.S. et al. Relative accuracy of body adiposity index and relative fat mass in participants with and without down syndrome. Eur J Clin Nutr 73, 1117–1121 (2019). https://doi.org/10.1038/s41430-018-0351-3