Body composition of healthy Spanish children

doi:10.4236/health.2011.34038

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Vol.3, No.4, 211-217 (2011) Health

doi:10.4236/health.2011.34038

Body composition of healthy Spanish children

Soledad Ag uado-Henc he*, Rosa R odríguez-To rres, Asunción Bosch-Martín, Luis Gómez-Pe llico

Human Anatomy and Embriology Department, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain;

*Corresponding Author: soledad.aguado@uah.es

Received 27 January 2011; revised 5 March 2011; accepted 23 March 2011.

ABSTRACT

This paper shows the distribution of the body

compartments, and the age and gender related

changes in Spanish children. Subjects and Me-

thods: A total of 231 healthy children from Ma-

drid (Spain) were recruited and divided into 3

groups according to age (birth-5, 6-10, 11-15y).

Body compartments (fat mass, lean mass and

bone mass) measures were obtained from dual

energy X-ray absorptiometry (DXA) scans. Total

and regional body compositions were evaluated.

Results: There were gender differences for

TBFM (total body fat mass) in 11 - 15 year age

group and for TLBM (total lean body mass) in all

age groups except for the 6 - 10 year age group.

TBMC (total bone mineral content) shows sig-

nificant gender differences form birth. Conclu-

sions: Contrary to boy s, girls showed from early

infancy a smaller proportion of muscle mass

and a higher proportion of body fat (from the

age of 10), with fat deposits being mostly pe-

ripheral. Bone mass and muscle mass values

were higher in boys.

Keywords: Body Composition; Dual Energy X-Ray

Absorptiometry; Children

1. INTRODUCTION

The assessment of the body composition provides in-

formation regarding the main constituents of the human

body and allows differentiation between genders and

ethnicities due to age, growth, physical activity, diet and

disease.

Obesity, type 2 diabetes mellitus (DM) and osteopo-

rosis are the most frequent metabolic disorders that have

strong associations with body composition. Although it’s

certainly clear that obesity, attributable to increased adi-

posity, can be considered a disorder of body composition,

a similar perspective applies to type 2 DM. The meta-

bolic perturbations of type 2 DM have been found to be

associated with certain patterns of adipose tissue and fat

distribution [1].

Moreover, the measurement of muscle in the human

body has been used mainly for the purpose of assessing

the nutritional status of the individual [2-4], as the mus-

cle mass constitutes the body’s principal reservoir of

proteins.

Many different techniques have been used since the

initiation of the first anthropometric studies. Analysis of

body composition is based on different types of body

partitioning, ranging from the traditional model, which

considers that there are two body compartments, through

multi-compartmental models. The first techniques used

and intended to measure body fat are fundamentally an-

thropometry and hydro densitometry. The possibility of

measuring the absorption of energy particles by tissues

has given way to absorptiometry techniques; Currently,

the advantages offered by dual energy X-ray absorpti-

ometry (DXA) make it the most appropriate and widely-

used technique, for measuring body composition in indi-

viduals of different ages and sexes [5].

This article shows in detail the three body compart-

ments (bone, fat and muscle mass) in the Spanish Cau-

casian population, in both sexes and for each group by

five-year age intervals from 0 to 15 years of age.

2. SUBJECTS AND METHODS

2.1. Subjects

For the purpose of this cross-sectional survey, we took

a sample of the urban population of the Madrid Auto-

nomous Region (Spain), comprised by 231 apparently

healthy children, all Caucasians with a medium socio-

economic background, which we divided into 3 groups

by five-year age intervals. Broken down by sex, there

were 120 boys and 111 girls. Age range of the subjects

was from 0 (birth) to 15 years. The study protocol was

approved by the Office for Protection from Research

Risks of Alcalá de Henares Medical School. The chil-

dren were randomly selected among the volunteers who

presented themselves for the study, who had previously

S. Aguado-Henche et al. / Health 3 (2011) 211-217

212

been advised of it in a variety of schools. The inclusion

criteria were the absence of any pathology (diabetes,

liver disease, kidney disease, endocrine disease) or

pharmacological treatment that could alter the metabo-

lism. The children performed the compulsory exercises

at their respective schools. The frequency of fitness-

oriented physical education classes was three times

every week for a 55-minute class period (older than 3

years of age). The subjects underwent a physical exami-

nation at time of the study to confirm a normal health

status. Consent was obtained from each subject’s parent

or guardian after ethics information. Weight was meas-

ured using a calibrated scale and height was measured

using a wall mounted stadiometer. Infants under 2 years

of age were measured in supine position. Table 1 pre-

sents mean values for height, weight and BMI values for

each age and gender group. None of the children was

obese according to the WHO criteria.

2.2. Densitometric Measures

A total body scan was performed on each subject with

a Norland XR-26 densitometer, software version 2.3

(Norland Co., Fort Atkinson, Wisconsin, USA. Emsor

SA. Madrid). Each scan session was preceded by a cali-

bration routine using multiple quality control phantoms

that simulate bone and soft tissue. Scans were performed

3-4 hours post-pandrially. The children were placed in a

supine position, and correctly centered on the explora-

tion table. Infants were scanned when asleep. To begin

the scan, the starting point was placed 1 cm directly

above the centre of the patient’s head. A baseline point

was marked on the abdomen in an area of maximum soft

tissue thickness. We selected the various body zones

according to the equipment’s specific software: on the

body image, the upper axis of the thoracic cavity under

the chin, the side axes on the scapular-humeral union,

laterally adjusted between the upper limb and the trunk,

and the lower axis at the caudal limit of the thoracic cav-

ity. The upper axis of the pelvic cavity was placed on the

iliac crest, with the lower axis below the pubic symphy-

sis, ensuring that the lateral edges were over the femoral

neck. The exploration as defined was completed in an

average time of 15 minutes. Total radiation dose per in-

dividual always remained below 5 mrem.

Body compartments calculations were performed for

the following magnitudes:

STM = Soft Tissue Mass, in g.

BMC = Bone Mineral Content, in g.

TBM = Total Body Mass = TOTAL BMC + TOTAL

STM, in g.

TSTM = Total STM = in g.

LBM = Lean Body Mass = TSTM – FAT MASS, in g.,

where 90% its magnitude correspond to muscle mass.

FM (fat mass) = TBM – (BMC + LBM), in g.

% FAT = FAT MASS* 100/TBM.

For the fat mass the following variables were ana-

lyzed:

TBFM = Total body fat mass.

% FAT = Percentage body fat.

TrFM = Fat mass in trunk.

AFM = Fat mass in arms.

LFM = Fat mass in legs.

Ex FM = Fat mass in extremities = AFM + LFM.

Relation TrFM/ExFM

Relation TrFM/LFM

For the lean body mass the following variables were

analyzed:

TLBM = Total lean body mass.

TrLBM = Lean body mass in trunk.

ALBM = Lean body mass in arms

LLBM = Lean body mass in legs.

For the bone tissue the following variables were ana-

lyzed:

TBMC: Total bone mineral content.

TrBMC: Trunk bone mineral content.

ABMC: Bone mineral content in arms.

LBMC: Bone mineral content in legs.

TBMC/H: TBMC-to-height ratio.

Because of the fact that BMC is defined as the mass

of mineral contained in an entire bone or as the mass of

mineral per unit bone length, bone mineral content is

obviously a size-dependent parameter [6].

2.3. Statistical Methods

Statistical analyses were performed using the statisti-

cal and data management package SPSS for Windows,

Table 1. Anthropometric characteristics of the sample.

Males Females

Age groups (years) n Height (cm) Weight (Kg) BMI(Kg/m2) n Height (cm) Weight (Kg) BMI(Kg/m2)

1 (0-5) 19 101.7 (16.6) 17.0 (5.4) 16.0 (2.1) 1998.9 (25.7) 14.0 (4.6) 16.5 (3.3)

2 (6-10) 45 134.6 (12.2) 32.2 (8.8) 17.5 (2.7) 36134.7 (9.9) 31.2 (7.6) 16.9 (2.4)

3 (11-15) 56 162.6 (16.1) 52.4 (13.8) 19.4 (2.2) 56158.9 (10.3) 50.0 (10.5) 19.6 (2.8)

Values are means (standard deviation). BMI: Body mass index.

S. Aguado-Henche et al. / Health 3 (2011) 211-217

213

Version 10.0. The results were expressed as the mean

value (standard deviation) for each densitometric vari-

able by gender and age group. The data were stratified

by intervals of 5 years. Univariant variance analysis

(ANOVA) was used to check the effect of gender on the

densitometric variables considered. After calculating the

TBMC-to-height ratio and introducing the necessary

adjustments for weight gender differences of the mean

values in each age group were tested for significance by

means of Student’s t-test. Multiple comparisons were

made between the mean values of the variables for all

the age groups using the Bonferroni test. The level of

significance for all statistical tests of hypothesis was 0.05.

3. Results

Table 1 shows the anthropometric characteristics of

sample study and the differences in age- and gender-

specific mean values for these magnitudes.

Age- and gender- specific means and SDs for TBFM,

% FAT, TrFM/ExFM ratio and TrFM/LFM ratio are pro-

vided in Table 2.

In girls, %FAT followed an evolutional pattern similar

to that of TBFM. In boys, %FAT increased to the age of

10, decreased between the ages of 10 and 15. There were

significant gender differences in TBFM and % FAT from

the age of 11 to the age of 15, while the mean values

were always higher for girls. The TrFM/ExFM ratio

showed significant gender-related differences from birth

to the age of 10. Mean values were higher in boys.

Age- and gender- specific means and SDs for TLBM,

TrLBM, ALBM and LLBM are provided in Table 3.

There were gender differences for TLBM in all age

groups except for the 6-10 year age group. Values were

in all cases higher for boys, with a high degree of signi-

fication (p < 0.001), except for the 0 - 5 year age group

(p < 0.05).

Age- and gender- specific means and SDs for TBMC,

TrBMC, ABMC, LBMC and TBMC/H ratio are pro-

vided in Table 4. There is a significant TBMC increases,

coinciding with the period of maximum skeletal growth.

In all groups (0-15y), although TMBC values were higher

in boys, we did not find any statistically significant dif-

ferences between genders.

4. Discussion

Dual-energy X-ray absorptiometry scans is increas-

ingly available and easily performed on children of all

ages, making this method attractive for pediatric body

composition measurement [7].

Changes with age in body composition begin at the

moment of conception and ends only with the death; the

changes between different phases of life are subtle and

gradual. The age changes in human body composition

have three phases: growth and development, maturity

and senescence. The most important phase is growth and

development and the variation in body composition in

this period of life is a function of a complex interaction

between genes, environment and behavior [8].

Table 2. Fat Mass.

TBFM (Kg) % FAT TrFM/ExFM ratio TrFM/LFM ratio

Age groups (years)

Boys Girls Boys Girls Boys Girls Boys Girls

1 (0-5) 3.7 (2.5) 3.4 (1.9) 20.0 (8.9) 23.6 (6.6) 1.07 (0.14)0.95 (0.18)* 2.8 (1.3) 2.5 (1.3)

2 (6-10) 8.5 (5.6) 9.2 (4.7) 24.9 (11.2)29.1 (9.7) 0.91 (0.09)0.87 (0.06)* 1.5 (0.9) 1.4 (0.1)

3 (11-15) 10.6 (5.3) 17.2 (8.1)*** 21.1 (10.0)32.0 (9.3)*** 0.88 (0.07)0.86 (0.08) 1.3 (0.1) 1.3 (0.1)*

Values are means (standard deviation) *p ≤ 0.05 *** p ≤ 0.001. TBFM: Total body fat mass. % FAT = Percentage body fat. TrFM/ExFM ratio: Relation fat mass

in trunk/fat mass in extremities. TrFM/LFM ratio: Relation fat mass in trunk / fat mass in legs.

Table 3. Lean Body Mass (Kg).

TLBM TrLBM ALBM LLBM

Age groups

(years) Boys Girls Boys Girls Boys Girls Boys Girls

1 (0-5) 12.8 (3.4) 10.3 (2.9)* 5.4 (1.5) 4.1 (1.4)* 2.8 (0.9) 2.3 (0.6) 2.3 (1.3) 1.9 (1.1)

2 (6-10) 22.1 (4.4) 20.2 (4.1) 9.2 (1.8) 8.2 (1.8)* 3.8 (0.9) 3.4 (0.8) 6.2 (1.9) 5.7 (1.5)***

3 (11-15) 39.2 (13.1) 31.1 (5.1)*** 16.9 (6.1)13.1 (2.5)*** 6.4 (2.5) 4.8 (0.9)*** 12.2 (4.6) 9.8 (1.9)***

Values are means (standard deviation) * p ≤ 0.05 *** p ≤ 0.001. TLBM: Total lean body mass. TrLBM: Lean body mass in trunk. ALBM: Lean body

mass in arms. LLBM: Lean body mass in legs.

S. Aguado-Henche et al. / Health 3 (2011) 211-217

214

Table 4. Bone mineral content (g).

Age groups Boys Girls

(years) TBMC TrBMCABMC LBMCTBMC/H ratio TBMC TrBMC ABMC LBMC TBMC/H ratio

1 (0-5) 579.59 190.46 86.14 77.17 5.49 456.03 149.95 68.41 65.34 4.56

(214.5) (79.1) (46.2) (67.7) (1.48) (220.1)(78.0) (42.8) (60.2) (1.72)

2 (6-10) 1245.11 421.47 150.62 347.999.16 1214.27410.49 137.26 366.47 8.92

(385.0) (154.1)(62.1) (159.2)(2.09) (313.8)(130.3) (43.0) (132.7) (1.78)

3 (11-15) 2202.19 773.42 293.09 732.2213.28 2261.71839.54 274.65 744.09 14.08

(719.1) (284.6)(148.4) (280.4)(3.07) (607.7)(271.0) (88.6) (220.4) (3.16)

Values are means (standard deviation). TBMC: Total bone mineral content. TrBMC: Trunk bone mineral content. ABMC: Bone mineral content in

arms. LBMC: Bone mineral content in legs. TBMC/H: TBMC-to-height ratio.

4.1. Fat Mass

Fat mass is the most variable component of body

composition, and between-individual variability ranges

from approximately 6% to 60% of total body weight [9].

Many studies suggest there are three critical periods for

the development of obesity and its complications. These

include gestation and early infancy, the period of adipos-

ity rebound that occurs between the ages of 5 and 7, and

adolescence. The obesity that begins at these periods

appears to increase the risk of persistent obesity and its

complications. [10].

Our study of prepubertal children (ages 0 to 10) showed

no gender-related differences in age-adjusted weight,

height or BMI. Both %FAT and the absolute mean val-

ues of total and regional fat mass increased progressively

in both genders. Although no statistically significant

gender-related differences were found, the values were

usually higher in girls. In addition, girls had a signifi-

cantly higher proportion of fat mass than of lean mass,

and larger peripheral (extremities) fat deposits. The dis-

tribution of fat is an accepted criterion in the prediction

of cardiovascular risk for both children and adults.

Koo et al. [11] found an increase in fat mass in girls

was accompanied by a similar decrease in lean mass,

which is consistent with our findings.

Subsequent studies to assess TBFM and muscle ac-

cumulation in prepubertal children using DXA yielded

conflicting results. Some investigators observed no gen-

der-related differences in body composition [12]. Others

reported that girls had more fat and similar muscle mass

[13-15]. Still others suggested that, compared with boys,

girls had more fat but less muscle [16,17]. Our study

showed that between the ages of 10 and 15, boys ex-

perienced an increase in the proportion of muscle mass

paired with a decrease in % fat. The divergences in these

results are perhaps due to the effects of the different

samples studied (age, geographical location, ethnicity,

hormonal status, physical activity, lifestyle and so on).

4.2. Lean Body Mass

Henche et al [18] observed that the increase in lean

mass of females is until age 15, from which age onwards

it stabilises till 80 years of age. Apparently the muscular

body component in females is subject to minimal varia-

tions during lifetime. Lean mass in males increases pro-

gressively until age 20, then remains stable until age 55,

after which it starts to decrease.

For TrLBM, there are differences by sex at all ages,

which are, however, more pronounced from age 11 years

onwards. The significant differences in regional lean

mass occur at earlier age in legs than in arms.

Evaluation of muscular tissue with DXA is clearly

supported in medical literature [19,20]. The study of

body compartments in healthy subjects is extremely im-

portant, since the relationship between other body parts

and muscle has been proven. For example the influence

of muscular mass and fat mass on bone mass has been

the focus of many research projects concluding that pa-

tients with smaller amounts of muscular and adipose

tissues also have a smaller bone mass, bone mineral

content and bone mineral density [21,22], as has been

clearly evidenced in boys and girls during growing

stages [23,24].

The proportion of lean mass to total body mass is in-

fluenced by physical exercise or sports activity [25].

Additionally, constant physical activity increases the

proportion of lean body mass and reduces the fat com-

partment, even without changes in body weight. In addi-

tion, in 11 years old children the positive influence of

physical activity on bone size seems to be opposed by

the tendency of physical activity to reduce fat mass. There-

fore, exercise programs may be more effective at en-

hancing skeletal development in childhood when the ex-

ercise associate with a minimal reduction in fat mass [26].

S. Aguado-Henche et al. / Health 3 (2011) 211-217

215

Some investigators point that the age for gender dif-

ferences for TLBM becomes evident at 7.5 years old

only [27], others at age 10 [13] or 14 years of age.[28].

However, as reported in other studies, boys are generally

more muscular than girls in all age groups [13]. In girls,

the increase in lean mass we have shown occurs only

until 15 years of age according to other authors [29].

4.3. Bone Mass

There is no evidence for gender differences in bone

mass of either the axial or appendicular skeleton at birth.

This absence of a substantial gender difference in bone

mass is maintained until the onset of puberty [30], al-

though there was some divergence in prepubescent boys

between 6 and 11 [31].

TBMC does not present statistically significant dif-

ferences between genders up to the age of 16, as con-

firmed by other studies [32-34].

One study of healthy white Mediterranean Spanish

children and adolescents, who were grouped according

to age and gender in 1-y age groups, shows that L2-L4

bone mineral content values progressively increase from

infancy to adulthood and mean values are similar in both

genders until the age of 9-10 y, occurring with height.

Thereafter, and corresponding to the more rapid height

growth rate observed in girls because of earlier pubertal

development, bone mineral content values are higher in

girls than in boys until the age of 14-15 y [35]. These

gender differences in this group of age may be hidden in

our study because we have grouped the subjects per

quinquennium of age, and the regions that we have stud-

ied have been different.

The marked increase demonstrated in bone mineral

content in Caucasian children overlaps with that of Asians

[36].

Several authors demonstrate that body composition in

children can be improved by modifications of the school

physical education curriculum, and consequently im-

proving cardiovascular health [37]. Also, low bone min-

eral density, low physical activity and overweight in

children of 3-10 years of age are potential risk factors for

fracture of the distal forearm [38]. In the other hand, it is

probable that children who experience a fracture are likely

to be the children who do more physical activity and

contact sports [39].

The reference data we present, can be used in clinical

practice and in further research about children who prac-

tice some extracurricular sport or associated sport since

some researchers have reported positive effects of physi-

cal activity on the bone mineral content of whole body

[40], lumbar spine [41], and hip [42-44] in growing

children, even though other authors are in disagree [45].

Some limitations of this study are the cross-sectional

nature of the data and the inability to generalize the find-

ings to other populations since the sample is restricted to

an urban Spanish setting. On the other hand, our data are

primarily based on chronological age, and thus do not

account for the degree of sexual development.

5. CONCLUSIONS

Contrary to boys, girls showed from early infancy a

smaller proportion of muscle mass and a higher propor-

tion of body fat (from the age of 10), with fat deposits

being mostly peripheral. There is no evidence for gender

differences in bone mineral content in Caucasian chil-

dren.

Therefore, the normal densitometric values presented

offer useful information as a reference for comparison of

populations of different genetic makeup and environ-

mental influences. Similarly, densitometric values have

proved to be useful for revealing the state of the skeleton

during growth.

Dual-energy X-ray absorptiometry (DXA) makes it

possible to detect differences in body compartments dur-

ing the life cycle, as well as it shows clear differences

between boys and girls.

6. ACKNOWLEDGEMENTS

We would like to thank for their time all the children and their fami-

lies as well as all the teachers who took part in this study.

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