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Title: Body composition among Sri Lankan infants by 18*O dilution method and the validity of anthropometric equations to predict body fat against 18*O dilution

Author
item BANDARA, THUSHARI - University Of Ruhuna
item HETTIARACHCHI, MANJULA - University Of Ruhuna
item LIYANAGE, CHANDRANI - University Of Ruhuna
item AMARASENA, SUJEEWA - University Of Ruhuna
item WONG, WILLIAM - Children'S Nutrition Research Center (CNRC)

Submitted to: BMC Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/27/2015
Publication Date: 5/6/2015
Citation: Bandara, T., Hettiarachchi, M., Liyanage, C., Amarasena, S., Wong, W.W. 2015. Body composition among Sri Lankan infants by 18*O dilution method and the validity of anthropometric equations to predict body fat against 18*O dilution. BMC Pediatrics. 15:52.

Interpretive Summary: To monitor growth among infants, particularly among infants in developing countries, it is important to know the amount of body fat in the infants. Most body fat was calculated using equations based on the thicknesses of the skinfolds around the upper arms or upper body. These equations have been widely used to monitor infant growth because the skinfold thickness measurements are simple to do and can be done anywhere. However, the usefulness of these equations to calculate body fat among Sri Lankan infants has not been tested. This study tested 16 skinfold thickness equations to measure body fat among 25 healthy, breast-fed Sri Lankan infants between 4 and 6 months of age. The body fat results were compared with the body fat values measured using a reference method, 18*O isotope dilution. Among the 16 skinfold thickness equations, only three equations yielded meaningful body fat values against the reference method. Therefore, the use of the skinfold thickness equations to measure body fat among Sri Lankan infants or infants in other developing countries must be used with caution.

Technical Abstract: Body composition indicators provide a better guidance for growth and nutritional status of the infants. This study was designed to (1) measure the body composition of the Sri Lankan infants using a reference method, the 18*O dilution method; (2) calculate the body fat content of the infants using published skinfold prediction equations; and (3) evaluate the applicability of the skinfold equations to predict body fat among Sri Lankan infants against the 18*O dilution method. Twenty five healthy, exclusively breast-fed infants were randomly recruited at well-baby clinics, for this cross-sectional study. Body composition was measured using 18*O dilution. Infant body weight, length, skinfold thicknesses and mid upper-arm circumference were measured using standard procedures. The Bland and Atlman pair-wise comparison method was used to evaluate the agreement of body fat generated using the anthropometric prediction equations against the 18*O dilution values as the reference. Mean (SD) body weight and length of the infants were 6.5 kg (0.9) and 64.7 cm (2.8) respectively. Mean total body water, fat free mass, fat mass and % fat mass as measured by 18*O dilution method were 58.8% (5.0), 4.6 kg (0.8), 1.9 (0.5) and 29.5% (6.1). Total body water and fat free mass were significantly higher in boys when compared to girls. With the exception of three prediction equations (Bandana et al., Goran et al. and Durnin and Wormsley), most of the other commonly used anthropometry-based prediction equations yielded a bias which was not constant but a function of the % fat mass. Body composition of Sri Lankan infants is comparable to the normative data available from the industrialized countries. Most of the commonly used anthropometric prediction equations generated a bias which varies with the size of the body fat. Only three prediction equations (Bandana, Goran, Durnin & Wormsley) yield a constant bias. The Durnin & Wormsely equation showed the smallest bias when compared to the 18*O dilution values with the narrowest limits of agreement. Accuracy of some of the prediction equations is a function of gender.