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Body Fat% is Also a Potentially Poor Individual Measure for Health in Children Dr. Lee Hudson

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Consultant paediatrician, Great Ormond St Hospital, Research Fellow, UCL Institute of Child Health Published online: 14 Apr 2014.

Click for updates To cite this article: Dr. Lee Hudson (2014) Body Fat% is Also a Potentially Poor Individual Measure for Health in Children, Journal of the American College of Nutrition, 33:2, 91-91, DOI: 10.1080/07315724.2014.891906 To link to this article: http://dx.doi.org/10.1080/07315724.2014.891906

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Letter to the Editor

Body Fat% is Also a Potentially Poor Individual Measure for Health in Children

Downloaded by [University of Miami] at 15:19 27 December 2014

Dear Editor,

[5]. Indeed, when Ansel Keys and colleagues first published on the use of BMI for overweight in the 1970s, it was suggested that its usage be contained to population-based research rather than for individuals [6]. We should be careful that BMI it is not replaced with yet another measure such as%body fat, based on cross-sectional analysis alone, without linkage to outcomes. Furthermore, whilst access to DEXA (which incidentally includes exposure to radiation) remains limited, particularly in lower income countries, more multi-domain clinical approaches, including the BMI, will continue to be necessary.

Whilst it is important to validate such a widespread and conventional measure of nutritional status such as body mass index (BMI) against potentially more robust measures, it is important to also contextualize the validity of the ostensive “better” measure – in this case body fat. Although DEXA is the established “gold-standard” for measuring body fat composition, in their paper, Fusch et al fail to highlight the variability in healthy body fat% requirement between individual children thus limiting it as a reliable marker of health in children for comparison [1]. The authors also chose below the 10th centile of body fat% as a pragmatic definition of underweight. They do not highlight that by definition this will include 10% of a normal population (constituting many millions of normal children world wide). The World Health Organization has suggested using -2 SDS and 3SDS as cut-offs for thinness and severe thinness, and similar thinness scores have been developed using international groups of children by Cole et al. [2], however the authors do not examine the relationship between%body fat and this more extreme group, and this would have been of interest.

1. Fusch G, Raja P, Dung NQ, Karaolis-Danckert N, Barr R, Fusch C: Nutritional Status in Sick Children and Adolescents Is Not Accurately Reflected by BMI-SDS. J Am Coll Nutr 32(6):407–16, 2013. 2. Cole TJ, Flegal KM, Nicholls D, Jackson AA: Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335(7612):194, 2007. 3. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al.: Prospective Studies Collaboration: Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373(9669):1083–96, 2009. 4. Hudson LD, Court AJ: What paediatricians should know about eating disorders in children and young people. J Paediatr Child Health, Oct. 48(10):869–75, 2012. 5. Hudson L, Viner RM: Obesity in children and adolescents. BMJ 345: 2012. 6. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL: Indices of relative weight and obesity. Journal of Chronic Diseases 25(6): 329–43, 1972.

The aim of categorizing an individual child as underweight, healthy weight or overweight is to better understand an individual child’s risk associated with that weight status and to consider intervention and minimize harm. However in contrast to adults [3], there is a paucity of longitudinal data linking health outcomes to both body fat% and BMI in childhood. Clinically much variety is seen between children at the same “low” BMI and “low” body fat% in terms of growth, pubertal development and bone mineral density because what constitutes as “low” will be different for each child [4]; and it is likely that there will be variety in associated cardio-metabolic risk for different children at different greater extremes of the BMI, and fat% centile chart

Dr. Lee Hudson Consultant Paediatrician, Great Ormond St Hospital Research Fellow, UCL Institute of Child Health

Journal of the American College of Nutrition, Vol. 33, No. 2, 91 (2014) C American College of Nutrition Published by Taylor & Francis Group, LLC 91

Body fat% is also a potentially poor individual measure for health in children.

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