Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Body composition, energy expenditure and physical activity

Longitudinal body composition assessment in healthy term-born infants until 2 years of age using ADP and DXA with vacuum cushion

European Journal of Clinical Nutrition volume 74, pages 642–650 (2020)Cite this article

Subjects

Abstract

Objectives

Accelerated gain in fat mass (FM) in early life increases the risk for adult diseases. Longitudinal data on infant body composition are crucial for clinical and research use, but very difficult to obtain due to limited measurement tools and unsuccessful measurements between age 6–24 months. We compared FM% by dual-energy X-ray absorptiometry (DXA), with cushion to reduce movement artifacts, with FM% by air-displacement plethysmography (ADP) and evaluated the reliability of this cushion during DXA by comparing FM% with and without cushion. Subsequently, we constructed sex-specific longitudinal body composition charts from 1–24 months.

Methods

In 692 healthy, term-born infants (Sophia Pluto Cohort), FM% was measured by ADP from 1–6 months and DXA with cushion from 6–24 months. At 6 months, FM% was measured in triplicate by ADP and DXA with and without cushion(n = 278), later on in smaller numbers.

Results

At 6 months, mean FM% by DXA with cushion was 24.1 and by ADP 25.0, mean difference of 0.9% (Bland–Altman p = 0.321, no proportional bias). Mean FM% by DXA without cushion was 12.5% higher compared to ADP (Bland–Altman p < 0.001). DXA without cushion showed higher mean FM% compared to DXA with cushion (+11.6%, p < 0.001) at 6 months. Longitudinally, FM% increased between 1–6 months and decreased from 6–24 months(both p < 0.001).

Conclusions

In infants, DXA scan with cushion limits movement artifacts and shows reliable FM%, comparable to ADP. This allowed us to construct longitudinal body composition charts until 24 months. Our study shows that FM% increases from 1–6 months and gradually declines until 24 months.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: ADP versus DXA at 6 months of age.
Fig. 2: Bland–Altman analyses between ADP and DXA at 6 months of age, n = 278.
Fig. 3: Longitudinal values of FM%, FM, FMI, FFM, and FFMI for male and female.

Similar content being viewed by others

References

  1. Pietrobelli A, Agosti M, MeNu G. Nutrition in the first 1000 days: ten practices to minimize obesity emerging from published science. Int J Environ Res Public Health. 2017;14:1491. https://doi.org/10.3390/ijerph14121491.

    Article  CAS  PubMed Central  Google Scholar 

  2. Roy SM, Spivack JG, Faith MS, Chesi A, Mitchell JA, Kelly A et al. Infant BMI or weight-for-length and obesity risk in early childhood. Pediatrics 2016;137.

  3. Leunissen RW, Kerkhof GF, Stijnen T, Hokken-Koelega A. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. JAMA. 2009;301:2234–42. https://doi.org/10.1001/jama.2009.761.

    Article  CAS  PubMed  Google Scholar 

  4. Odegaard AO, Choh AC, Nahhas RW, Towne B, Czerwinski SA, Demerath EW. Systematic examination of infant size and growth metrics as risk factors for overweight in young adulthood. PLoS ONE. 2013;8:e66994.

    Article  CAS  Google Scholar 

  5. Ay L, Hokken-Koelega ACS, Mook-Kanamori DO, Hofman A, Moll HA, Mackenbach JP. et al. Tracking and determinants of subcutaneous fat mass in early childhood: the Generation R Study. Int J Obes. 2008;32:1050. https://doi.org/10.1038/ijo.2008.76.

    Article  CAS  Google Scholar 

  6. Wells JCK. Body composition in infants: evidence for developmental programming and techniques for measurement. Rev Endocr Metab Disord. 2012;13:93–101. https://doi.org/10.1007/s11154-012-9213-9.

    Article  PubMed  Google Scholar 

  7. Breij LM, Steegers-Theunissen RPM, Briceno D, Hokken-Koelega ACS. Maternal and fetal determinants of neonatal body composition. Horm Res Paediatr.2015;84:388–95. https://doi.org/10.1159/000441298.

    Article  CAS  PubMed  Google Scholar 

  8. Demerath EW, Fields DA. Body composition assessment in the infant. Am J Hum Biol. 2014;26:291–304.

    Article  Google Scholar 

  9. Butte NF, Hopkinson JM, Wong WW, Smith EO, Ellis KJ. Body composition during the first 2 years of life: an updated reference. Pediatr Res. 2000;47:578–85.

    Article  CAS  Google Scholar 

  10. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr. 1982;35(5 Suppl):1169–75.

    Article  CAS  Google Scholar 

  11. Harrington TA, Thomas EL, Frost G, Modi N, Bell JD. Distribution of adipose tissue in the newborn. Pediatr Res. 2004;55:437–41.

    Article  Google Scholar 

  12. Mazahery H, von Hurst PR, McKinlay CJD, Cormack BE, Conlon CA. Air displacement plethysmography (pea pod) in full-term and pre-term infants: a comprehensive review of accuracy, reproducibility, and practical challenges. Matern Health Neonatol Perinatol. 2018;4:12.

    Article  Google Scholar 

  13. Breij Laura M, Kerkhof Gerthe F, De Lucia Rolfe E, Ong Ken K, Abrahamse‐Berkeveld M, Acton D. et al. Longitudinal fat mass and visceral fat during the first 6 months after birth in healthy infants: support for a critical window for adiposity in early life. Pediatr Obes. 2017;12:286–94. https://doi.org/10.1111/ijpo.12139.

    Article  CAS  PubMed  Google Scholar 

  14. Breij LM, Abrahamse-Berkeveld M, Acton D, De Lucia Rolfe E, Ong KK, Hokken-Koelega ACS. Impact of early infant growth, duration of breastfeeding and maternal factors on total body fat mass and visceral fat at 3 and 6 months of age. Ann Nutr Metab. 2017;71:203–10.

    Article  CAS  Google Scholar 

  15. Zanini RdV, Santos IS, Chrestani MAD, Gigante DP. Body fat in children measured by DXA, air-displacement plethysmography, TBW and multicomponent models: a systematic review. Matern Child Health J. 2015;19:1567–73. https://doi.org/10.1007/s10995-015-1666-5.

    Article  PubMed  Google Scholar 

  16. COSMED. Bod Pod Brochure ENGLISH. https://www.cosmed.com/hires/Bod_Pod_Brochure_EN_C03837-02-93_A4_print.pdf.

  17. Fields DA, Gunatilake R, Kalaitzoglou E. Air displacement plethysmography: cradle to grave. Nutr Clin Pr. 2015;30:219–26.

    Article  Google Scholar 

  18. Godang K, Qvigstad E, Voldner N, Isaksen GA, Frøslie KF, Nøtthellen J. et al. Assessing body composition in healthy newborn infants: reliability of dual-energy X-ray absorptiometry. J Clin Densitom. 2010;13:151–60. https://doi.org/10.1016/j.jocd.2010.01.121.

    Article  PubMed  Google Scholar 

  19. de Knegt VE, Carlsen EM, Bech Jensen JE, Lade Rasmussen AM, Pryds O. DXA performance in a pediatric population: precision of body composition measurements in healthy term-born infants using dual-energy X-ray absorptiometry. J Clin Densitom. 2015;18:117–23.

    Article  Google Scholar 

  20. Koo WW, Walters JC, Hockman EM. Body composition in human infants at birth and postnatally. J Nutr. 2000;130:2188–94.

    Article  CAS  Google Scholar 

  21. van der Sluis IM, de Ridder MA, Boot AM, Krenning EP, de Muinck, Keizer-Schrama SM. Reference data for bone density and body composition measured with dual energy x ray absorptiometry in white children and young adults. Arch Dis Child. 2002;87:341–7.

    Article  Google Scholar 

  22. IAEA. Body composition assessment from birth to two years of age. In: International Atomic Energy Agency. Human Health Series. Vienna, Austria; 2013; 22.

  23. Fields David A, Demerath Ellen W, Pietrobelli A, Chandler‐Laney Paula C. Body composition at 6 months of life: comparison of air displacement plethysmography and dual‐energy X‐ray absorptiometry. Obesity. 2012;20:2302–6. https://doi.org/10.1038/oby.2012.102.

    Article  CAS  PubMed  Google Scholar 

  24. Shepherd JA, Sommer MJ, Fan B, Powers C, Stranix-Chibanda L, Zadzilka A, et al. Advanced analysis techniques improve infant bone and body composition measures by dual-energy X-ray absorptiometry. J Pediatr. 2017;181:248–253 e243.

    Article  Google Scholar 

  25. Wrottesley SV, Pisa PT, Micklesfield LK, Pettifor JM, Norris SA. A comparison of body composition estimates using dual-energy X-ray absorptiometry and air-displacement plethysmography in South African neonates. Eur J Clin Nutr. 2016;70:1254. https://doi.org/10.1038/ejcn.2016.91.

    Article  CAS  PubMed  Google Scholar 

  26. COSMED. PEA POD Infant body composition system operator’s manual. 2015: 205.

  27. Healthcare GE Frequently asked questions; advanced body composition application overview. 2012.

  28. Rigby RA, Stasinopoulos DM. Generalized additive models for location, scale and shape. J R Stat Soc: Ser C (Appl Stat). 2005;54:507–54. https://doi.org/10.1111/j.1467-9876.2005.00510.x.

    Article  Google Scholar 

  29. Rigby RA, Stasinopoulos DM. Smooth centile curves for skew and kurtotic data modelled using the Box–Cox power exponential distribution. Stat Med. 2004;23:3053–76. https://doi.org/10.1002/sim.1861.

    Article  PubMed  Google Scholar 

  30. Ma G, Yao M, Liu Y, Lin A, Zou H, Urlando A. et al. Validation of a new pediatric air-displacement plethysmograph for assessing body composition in infants. Am J Clin Nutr. 2004;79:653–60.

    Article  CAS  Google Scholar 

  31. Carberry AE, Colditz PB, Lingwood BE. Body composition from birth to 4.5 months in infants born to non-obese women. Pediatr Res. 2010;68:84. https://doi.org/10.1203/PDR.0b013e3181df5421.

    Article  PubMed  Google Scholar 

  32. Fields DA, Gilchrist JM, Catalano PM, Gianni ML, Roggero PM, Mosca F. Longitudinal body composition data in exclusively breast-fed infants: a multicenter study. Obes (Silver Spring). 2011;19:1887–91. https://doi.org/10.1038/oby.2011.11.

    Article  Google Scholar 

  33. Andersen GS, Girma T, Wells JC, Kaestel P, Leventi M, Hother AL, et al. Body composition from birth to 6 mo of age in Ethiopian infants: reference data obtained by air-displacement plethysmography. Am J Clin Nutr. 2013;98:885–94.

    Article  CAS  Google Scholar 

  34. Sauder KA, Kaar JL, Starling AP, Ringham BM, Glueck DH, Dabelea D. Predictors of infant body composition at 5 months of age: The Healthy Start Study. J pediatrics. 2017;183:94–99.e91. https://doi.org/10.1016/j.jpeds.2017.01.014.

    Article  Google Scholar 

  35. Fields DA, Krishnan S, Wisniewski AB. Sex differences in body composition early in life. Gend Med. 2009;6:369–75.

    Article  Google Scholar 

  36. Hawkes CP, Hourihane JO, Kenny LC, Irvine AD, Kiely M, Murray DM. Gender- and gestational age-specific body fat percentage at birth. Pediatrics. 2011;128:e645–651. https://doi.org/10.1542/peds.2010-3856.

    Article  PubMed  Google Scholar 

  37. Ay L, Van Houten VA, Steegers EA, Hofman A, Witteman JC, Jaddoe VW. et al. Fetal and postnatal growth and body composition at 6 months of age. J Clin Endocrinol Metab. 2009;94:2023–30. https://doi.org/10.1210/jc.2008-2045.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all infants and their parents for participating in the Sophia Pluto Study. Furthermore, we greatly acknowledge Mrs. J. van Nieuwkasteele, Mrs. M. Huibregtse-Schouten, Mrs. C. Bruinings-Vroombout, Mrs. E. Lems, Ms. N. Khieroe, Mrs. S. Besteman-Voortman, Mrs. J. Bontenbal-van de Wege, research nurses, for their assistance with data collection.

Funding

A.C.S.H.-K. received an independent research grant by Danone Nutricia Research.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam, The Netherlands

    Kirsten S. de Fluiter, Inge A.L.P. van Beijsterveldt, Wesley J. Goedegebuure, Laura M. Breij & Anita C. S. Hokken-Koelega

  2. Dutch Growth Research Foundation, Rotterdam, The Netherlands

    Alexander M. J. Spaans & Anita C. S. Hokken-Koelega

  3. Danone Nutricia Research, Utrecht, The Netherlands

    Dennis Acton

Authors
  1. Kirsten S. de Fluiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inge A.L.P. van Beijsterveldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wesley J. Goedegebuure
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura M. Breij
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexander M. J. Spaans
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dennis Acton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anita C. S. Hokken-Koelega
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

L.M.B., D.A. and A.C.S.H.-K. designed research; K.S.dF., I.A.L.P.vB., L.M.B. and A.C.S.H.-K. conducted research; AS provided essential materials; K.S.dF. analyzed the data; K.S.dF., I.A.L.P.vB., W.J.G, D.A. and A.C.S.H.-K. wrote the paper; K.S.dF. had primary responsibility for final content. All authors were involved in writing the manuscript and approved the submitted version.

Corresponding author

Correspondence to Kirsten S. de Fluiter.

Ethics declarations

Conflict of interest

The Sophia Pluto Study is an investigator-initiated study. D.A. is an employee of Danone Nutricia Research.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Online Trial Registry: NTR, NL7833.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Fluiter, K.S., van Beijsterveldt, I.A., Goedegebuure, W.J. et al. Longitudinal body composition assessment in healthy term-born infants until 2 years of age using ADP and DXA with vacuum cushion. Eur J Clin Nutr 74, 642–650 (2020). https://doi.org/10.1038/s41430-020-0578-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-020-0578-7

This article is cited by

Search

Advanced search

Quick links