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Body composition, energy expenditure and physical activity

Changes in body composition by age and obesity status in preschool-aged children: the STEPS study



Obesity in early childhood is associated with increased risk of chronic diseases, but studies of body composition at preschool ages are sparse. Therefore, we examined differences in body composition by sex and obesity status in Finnish preschool-aged children and within-individual changes in body composition in normal and overweight children.


Body composition was measured using segmental multifrequency bioimpedance analysis (BIA) in 476 children and in 781 children at age 3 and 5 years, respectively. Of those, 308 had repeated BIA measurements at both ages. BMI-SDS was used for classification of normal weight and overweight children.


Sex difference in the amount of lean mass (LM) was already seen at 3 years of age (boys 11.7 kg, girls 11.3 kg; p < 0.001). At 5 years of age, boys had lower fat mass (FM; 3.6 kg vs. 3.9 kg, p < 0.001), lower percent fat mass (%FM; 17.2% vs. 19.1%; p < 0.001), and higher LM (16.0 kg vs. 15.2 kg; p < 0.001) than girls. Overweight children had higher values in FM, %FM, and LM compared with normal weight peers at both ages. Among normal weight children, the increase of LM by age was associated with only minor changes in FM, whereas children who were or became overweight both LM and FM was substantially increased between 3 and 5 years of age.


BIA-assessed body composition differs by sex and obesity status already at age of 3 years. For children who are or become overweight at very young age, the patterns for the changes in LM and FM by age are different than for normal weight children.

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Fig. 1
Fig. 2: Change of percent fat mass (%FM), fat mass (FM), lean mass (LM), and visceral fat area (VFA) from 3 to 5 years of under and normal weight and overweight including obese separately of boys (left column) and girls (right column) as means ± quartiles.
Fig. 3: Change of body composition in four weight status groups.
Fig. 4: Change of ∆LM/∆FM in four weight status groups.


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The authors are grateful to all the families who took part in this study, the midwives for their help in recruiting them and the whole STEPS Study research team and the whole STEPS study team for enabling the collaboration. We thank study nurse Anne-Mari Pieniniemi for conduction the clinical study visits. This study was financially supported by the Academy of Finland (HL, grant number 121569), Juho Vainio Foundation, Yrjö Jahnsson Foundation, and also Päivikki and Sakari Sohlberg Foundation and Kuopio University Hospital State Research Funding.

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AME, TL, and HL conceptualized the study in accordance with all other authors (TT, AS, JM, and HN) and drafted the initial manuscript for submission. All authors were involved in literature search. HO was responsible for statistical analysis. All authors reviewed, revised, and approved the submission of this manuscript for peer review.

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Correspondence to Hanna Lagström.

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Leskinen, T., Eloranta, AM., Tompuri, T. et al. Changes in body composition by age and obesity status in preschool-aged children: the STEPS study. Eur J Clin Nutr 75, 57–65 (2021).

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