22 Zemel Stallingsficult to distinguish whether children with a high
body mass index have excess adiposity, skinfold
assessment can be used to make this distinction.
However, skinfold measurements by less experi-
enced anthropometrists are subject to measure-
ment error, and DXA assessments are more accu-
rate. As DXA-based cutoff points are established
for the level of body fat associated with the health
risks of obesity, DXA could become a commonly
used tool in the diagnosis and treatment of obesity.
Other Techniques for Assessing Body
Composition
Other body composition measurement tech-
niques include air displacement plethysmogra-
phy (Bod Pod and Pea Pod) and bioelectrical
methods such as bioelectrical impedance analyz-
ers (BIA). Bod Pod, Pea Pod and BIA are current-
ly not used in the clinical care of individual pa-
tients who have illnesses that influence body
composition and hydration. However, these
methods are used in research settings to describe
important changes in body composition in groups
of subjects. With further research experience and
the necessary healthy infant and child reference
data, body composition assessment will likely
move into the clinical care setting.
More advanced imaging technologies (CT and
MRI) are particularly useful for measuring the
composition of specific body compartments such
as visceral adipose as well as intramuscular, in-
tramyocellular and brown adipose tissue [2].
However, their radiation risk (CT only), availabil-
ity and cost do not make them useful in clinical
practice. Peripheral quantitative CT measures
cross-sectional areas for fat and muscle as well as
muscle density in addition to volumetric BMD of
cortical and trabecular bones. However, periph-
eral quantitative CT generally is not available for
clinical purposes.ConclusionsTechnical measures in nutritional assessment in
the clinical setting:- include indirect calorimetry to directly mea-
sure REE; the REE is used to estimate total en-
ergy needs in order to achieve weight mainte-
nance or gain in children; - include DXA to measure bone mass and den-
sity in children at risk of bone disease and
body composition for the diagnosis and treat-
ment of obesity in some settings; - do not include Bod Pod, BIA, CT and MRI, as
these are primarily research tools
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