Vol.3, No.4, 211-217 (2011) Health
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
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.
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
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
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
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.
2.1. 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
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
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-
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
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-
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
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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).
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
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Table 4. Bone mineral content (g).
Age groups Boys Girls
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
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
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
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.
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-
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.
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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