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Updated: Feb 18, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Body Composition in Children with Chronic Illness: Accuracy of Bedside Assessment Techniques
Enid E Martinez1, Craig D Smallwood2, Nicolle L Quinn3
1Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Insights
Bedside body composition methods like skinfold and bioelectrical impedance analysis (BIA) are not reliable for estimating fat mass and fat-free mass in children with chronic illnesses. New accurate, noninvasive methods are needed for this patient group.
Area of Science:
- Pediatric Medicine
- Body Composition Analysis
- Chronic Illness Management
Background:
- Accurate body composition assessment is crucial for managing pediatric chronic illnesses.
- Bedside methods like skinfold and bioelectrical impedance analysis (BIA) are commonly used but their accuracy in specific pediatric populations is often unverified.
- Children with conditions such as spinal muscular atrophy, intestinal failure, and post hematopoietic stem cell transplantation (HSCT) present unique physiological challenges that may affect body composition measurements.
Purpose of the Study:
- To evaluate the accuracy of bedside estimation methods for fat mass and fat-free mass in children with chronic illnesses.
- To compare the accuracy of skinfold and BIA equations against reference methods like dual-energy x-ray absorptiometry (DXA) and deuterium dilution.
- To determine if these bedside methods provide clinically acceptable agreement (within ±20%) with reference standards.
Main Methods:
- A cross-sectional study involving 56 patients (90 measurements) with chronic illnesses.
- Body composition was assessed using skinfold measurements, BIA, DXA, and deuterium dilution.
- Spearman's correlation and agreement analyses were conducted to compare estimated values with reference methods.
Main Results:
- High correlation coefficients were observed between estimated and reference methods (fat mass: 0.93-0.94 with DXA; fat-free mass: 0.92-0.97 with DXA, 0.87-0.91 with deuterium dilution).
- However, limits of agreement exceeded the clinically acceptable ±20% threshold for all skinfold and BIA equations compared to both DXA and deuterium dilution.
- This indicates significant discrepancies despite high correlations.
Conclusions:
- Current bedside estimation methods for body composition using skinfold and BIA are not reliable in children with chronic illnesses.
- The findings highlight a need for the development and validation of more accurate, noninvasive methods for assessing body composition in this vulnerable pediatric population.
- Clinical decisions regarding nutritional support and treatment based on these estimations may be inaccurate.
Objective:
To evaluate the accuracy of estimated fat mass and fat-free mass from bedside methods compared with reference methods in children with chronic illnesses.
Study Design:
Fat mass and fat-free mass values were obtained by skinfold, bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), and deuterium dilution method in children with spinal muscular atrophy, intestinal failure, and post hematopoietic stem cell transplantation (HSCT). Spearman's correlation and agreement analyses were performed between (1) fat mass values estimated by skinfold equations and by DXA and (2) fat-free mass values estimated by BIA equations and by DXA and deuterium dilution methods. Limits of agreement between estimating and reference methods within ±20% were deemed clinically acceptable.
Results:
Fat mass and fat-free mass values from 90 measurements in 56 patients, 55% male, and median age of 11.6 years were analyzed. Correlation coefficients between the skinfold-estimated fat mass values and DXA were 0.93-0.94 and between BIA-estimated fat-free mass values and DXA were 0.92-0.97. Limits of agreement between estimated and DXA values of fat mass and fat-free mass were greater than ±20% for all equations. Correlation coefficients between estimated fat-free mass values and deuterium dilution method in 35 encounters were 0.87-0.91, and limits of agreement were greater than ±20%.
Conclusion:
Estimated body composition values derived from skinfold and BIA may not be reliable in children with chronic illnesses. An accurate noninvasive method to estimate body composition in this cohort is desirable.
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