Evaluation of body composition in neonates and infants

doi:10.1016/j.siny.2006.10.011

Seminars in Fetal and Neonatal Medicine

Volume 12, Issue 1, February 2007, Pages 87-91

https://doi.org/10.1016/j.siny.2006.10.011 Get rights and content

Summary

A better understanding of the nutritional needs of both healthy and sick infants is important. Not only does too much or too little nutrition during early life have long-term effects on health, but periods of rapid growth during the first year of life also have long-term consequences. Knowledge of the changes in body composition in early life can help to better define nutritional needs at these ages. Several methods are available for measuring body composition of neonates and infants. Most focus on an assessment of either body fatness or bone mineralization; only a few can monitor the quality of the non-fat lean tissues. This paper provides an evaluation of the different approaches currently available to monitor infant body composition, identifying both their strengths and limitations.

Introduction

Both the quality and quantity of nutrient intake during early life can have long-term health consequences. Impaired or excess weight change, as well as periods of rapid ‘catch-up’ growth, have been associated with the increased risks for adult-onset diseases.1, 2 Monitoring changes in body weight, body length, and head circumference has become relatively routine for many pediatric practitioners. Plotting these changes on growth charts allows one to gauge an infant's progress compared with national or international standards.3, 4 Standardized weight-for-length indices are also available.⁵ In recent years, however, a number of non-invasive methods have emerged that can provide additional information about the composition of the body that may aid in the nutritional management of infants.6, 7

Section snippets

Body composition models

The simplest, and most frequently used, body composition model divides body weight (Wt) into two compartments: fat mass (FM) and fat-free mass (FFM). This model was originally derived specifically for the assessment of body fatness, defined as body fat expressed as a percentage of body weight; the FFM compartment was used only as part of the intermediate steps used in the calculation of the FM value. However, more advanced multiple-compartment models have divided FFM into its various components

Quality of the lean tissue mass

For the metabolic model (Fig. 1), the body cell mass (BCM) is defined as the oxygen-exchanging, potassium-rich, glucose-oxidizing, work-performing tissues of the body. Moore et al.³³ called the BCM the body's ‘engine’, which consists of the tissues that obtain, convert, and use chemical energy to perform chemical, mechanical, and thermal work. More than 98% of the potassium in the body is contained in these tissues. Hence a measurement of total body potassium (TBK) can be directly converted to

Body composition reference data for infants

Several studies provide contemporary references for infant body composition.13, 21, 22, 38, 39, 40 These data have been derived using one or more of the methods outline in previous sections. The longitudinal study of healthy infants by Butte et al.³⁸ provides the biological variability in FM, FFM, TBW, and BMC for each age group. The other studies have provided mainly age- and gender-specific cross-sectional values for each of the body composition compartments. The classic models by Ziegler⁴¹

Conclusion

In summary, although basic anthropometry will continue to be used to assess growth, there are now several non-invasive methods for the measurement of body composition that can be used in infants with minimal or no risk. Most of these methods are indirect, relying on assumed relationships between the measured parameter and body composition compartment. Care must be taken to see that the measurements are performed correctly, and that the findings are not over interpreted. The complexity of the

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Cited by (33)

Infant body composition assessment in the neonatal intensive care unit (NICU) using air displacement plethysmography: Strategies for implementation into clinical workflow
2021, Clinical Nutrition ESPEN
Citation Excerpt :
TBW is the main constituent of FFM. TBW constitutes approximately 95% of total body weight early in fetal life, it subsequently decreases during pregnancy to reach approximately 75% by birth in the term infant [29], and continues to decline continuously throughout healthy infancy [30]. Having said that, availability of normative age- and sex-specific term and preterm infant body composition curves that were generated using ADP in infants up to 6 months of age overcomes the issue of FFM hydration and enables assessment of ADP body composition data [20,31].
Nutritional management is integral to infant care in the neonatal intensive care unit (NICU). Recent research on body composition that specifically evaluated fat and fat-free mass has improved our understanding of infant growth and nutritional requirements. The need for body composition monitoring in infants is increasingly recognized as changes in fat mass and fat-free mass associated with early growth can impact clinical outcomes. With the availability of air displacement plethysmography (ADP) as a noninvasive method for assessing infant body composition and published normative gestational age- and sex-specific body composition curves, it is justifiable to integrate this innovation into routine clinical care. Here we describe our experiences in implementing body composition measurement using ADP in routine clinical care in different NICU settings.
Measuring body composition in the preterm infant: Evidence base and practicalities
2019, Clinical Nutrition
Preterm birth and body composition have demonstrable effects on growth and later health outcomes. Preterm infants reach term equivalent age with a lower proportion of lean mass and higher body fat percentage than their term equivalent counterparts. Weight and length do not give an accurate assessment of body composition. Tracking body composition rather than just weight is a fundamental part of improving nutritional outcomes. This is important given the ongoing controversies regarding the nutritional needs of preterm infants, as well as establishing suitable targets for their growth.
In this review we describe current methodologies used in the measurement of body composition of the preterm infant and the review the recent published evidence for their accuracy and utility.
Current measurement techniques employed include air displacement plethysmography, bioelectrical impedance analysis, isotope dilution techniques, MRI and a combination of manual measurements including skinfold thickness, body mass index and mid upper arm/mid-thigh circumference. These measures allow for the estimation of fat mass, fat-free mass and regional assessment of adiposity.
Some methods, such as dual-energy X-ray absorptiometry and air displacement plethysmography do allow for comparison of change in body composition over time in cohorts of preterm infants that may be studied over a longer period of time and into adult life. However, none of the currently described methods give an accurate and practically achievable method of obtaining body composition measures in preterm infants in day to day routine clinical practise, although this remains a key priority when decisions are being made about how best to feed.
Factors affecting body composition in preterm infants: Assessment techniques and nutritional interventions
2019, Pediatrics and Neonatology
Citation Excerpt :
Specialized equipment, such as the common Dual-energy X-ray Absorptiometry (DEXA)19 and gold standard Air Displacement Plethysmography (ADP),14 is expensive to use to assess body composition in preterm infants. These assessments can be challenging to perform on preterm infants as the DEXA method requires the infant to be removed from the NICU and minimal movement from the infant is required for accurate results.16,18,22,43 The ADP method, on the other hand, requires the infant to be removed from the incubator and placed in the PEA POD® machine for an average of 2 min.18,44
Limited research has been conducted that elucidates the growth and body composition of preterm infants. It is known that these infants do not necessarily achieve extra-utero growth rates and body composition similar to those of their term counterparts. Preterm infants, who have difficulty in achieving these growth rates, could suffer from growth failure. These infants display an increased intra-abdominal adiposity and abnormal body composition when they achieve catch-up growth. These factors affect the quality of weight gain, as these infants are not only shorter and lighter than term infants, they also have more fat mass (FM) and less fat-free mass (FFM), resulting in a higher total fat percentage. This could cause metabolic syndrome and cardiovascular problems to develop later in a preterm infant's life. The methods used to determine body composition in preterm infants should be simple, quick, non-invasive and inexpensive. Available literature was reviewed and the Dauncey anthropometric model, which includes skinfold thickness at two primary sites and nine body dimensions, is considered in this review the best method to accurately determine body composition in preterm infants, especially in resource-poor countries. It is imperative to accurately assess the quality of growth and body composition of this fragile population in order to determine whether currently prescribed nutritional interventions are beneficial to the overall nutritional status and quality of life—in the short- and long-term—of the preterm infant, and to enable timely implementation of appropriate interventions, if required.
Mechanical-tactile stimulation (MTS) during neonatal stress prevents hyperinsulinemia despite stress-induced adiposity in weanling rat pups
2011, Early Human Development
Citation Excerpt :
Body mass is comprised of lean and fat tissue as well as extracellular and intracellular fluid compartment. Weight gain or loss reflects changes in body composition in any of these four areas [29]. Thus body weight or weight gain trajectory alone is an insufficient indicator of growth quality.
Stress in early life negatively influences growth quality through perturbations in body composition including increased fat mass. At term (40 weeks) preterm infants have greater fat mass and abdominal visceral adipose tissue than term-born infants. Mechanical-tactile stimulation (MTS) attenuates the stress response in preterm infants and rodents. We tested the hypothesis that MTS, administered during an established model of neonatal stress, would decrease stress-driven adiposity and prevent associated metabolic imbalances in rat pups. Pups received one of three treatments from postnatal days 5 to P9: Neonatal Stress (Stress; n = 20) = painful stimulus and hypoxic/hyperoxic challenge during 60 min of maternal separation; MTS (n = 20) = neonatal stress + 10 min of MTS; or Control (n = 20). Body weight, DXA whole body fat mass (g), MRI subcutaneous and visceral adipose tissue, and fasting adiponectin, leptin, glucose, insulin, and corticosterone were measured at weaning (P21). Stress and MTS weight gain (g/d) were accelerated following neonatal stress with greater fat mass, abdominal subcutaneous adipose tissue, serum adiponectin, leptin, and fasting glucose at weaning (P21). Male Stress and MTS pups had greater visceral adipose tissue depot. Male and female Stress pups were hyperinsulinemic. In summary, neonatal stress compromised body composition by increasing fat mass and abdominal subcutaneous adipose tissue depot, and in males, visceral adipose tissue depot. Importantly, MTS prevented hyperinsulinemia despite of stress-induced adiposity. We conclude that MTS during neonatal stress has the potential to minimize metabolic consequences associated with stress-driven perturbations in fat mass and abdominal adipose depots.
Normative Data for Lean Mass and Fat Mass in Healthy Predominantly Breast-Fed Term Infants From 1 Month to 1 Year of Age
2020, Journal of Clinical Densitometry
Citation Excerpt :
Limitations, however, include the masking of alterations in body composition as children could have normal BMI despite a higher fat mass (FM) and a lower lean mass (LM) (11). Few reference data on body composition in infants exist and most of the existing studies used air-displacement plethysmography (ADP) to assess FM and fat free mass (FFM) (12,13), which is not designed for infants who are 6–12 months (mo) of age (14). In recent years, dual-energy X-ray absorptiometry (DXA) has provided further clarity on body composition in older pediatric populations (15,16).
Background: A leaner body phenotype in infancy plays an important role in the early life prevention of obesity. However, there is a dearth of reference data for body composition in infancy. This study aimed to create a normative reference dataset for lean (LM) and fat (FM) mass and accretion rates in healthy infants. Methods: Healthy term-born infants (35 boys; 35 girls) were studied at ≤ 1, 3, 6, 9, and 12 mo of age for growth and compared to World Health Organization standards. LM (g) and FM (g) were measured using DXA (APEX version 13.3:3, Hologic 4500A) in infant whole-body mode. Sex specific reference curves were generated using the LMS method (LMSchartmaker, Medical Research Council, UK). Results: Infants were predominantly white (82.9%), breastfed (98.4% ≥ 3 mo), and grew in length and weight within World Health Organization Z-score ranges for normal growth across infancy. LM accretion was 327.4 ± 12.5 g/mo representing 95% increment in LM. Boys had more LM compared to girls at 12 mo (7807.4 ± 1114.0 vs 6817.4 ± 1016.1 g; p = 0.008). FM accretion was 114.3 ± 12.0 g/mo representing 114% increment in FM with no difference between the sexes. Conclusions: This data, which is based on a healthy sample of infants, characterizes LM and FM accretion during the first year of life and will aid in the interpretation of body composition.
D<inf>3</inf>-creatine dilution for the noninvasive measurement of skeletal muscle mass in premature infants
2021, Pediatric Research

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Evaluation of body composition in neonates and infants

Summary

Introduction

Section snippets

Body composition models

Quality of the lean tissue mass

Body composition reference data for infants

Conclusion

Semin Fetal Neonat Med

Am J Clin Nutr

Am J Clin Nutr

Nutrition

J Clin Nutr

Nutrition

Am J Clin Nutr

Am J Clin Nutr

Semin Neonatol

J Nutr

J Clin Densitom

J Clin Densitom

J Nutr

Am J Clin Nutr

2000 CDC Growth Charts for the United States: methods and development

Vital Health Stat 11

Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth

Pediatrics

Growth assessment in infants and toddlers using three different reference charts

J Pediatr Gastroenterol Nutr

Human body composition: in vivo methods

Physiol Rev

Methods of measuring body composition

Total body electrical conductivity measurements: an evaluation of current instrumentation for infants

Pediatr Res

Standards for total body fat and fat-free mass in infants

Arch Dis Child

A new air displacement plethysmograph for the measurement of body composition in infants

Pediatr Res