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Gutiérrez Marín, DesiréeAuthorEscribano, JoaquinAuthorClosa Monasterolo, RicardoAuthorFerre Pallas, NataliaAuthorMuñoz Hernando, JuditAuthorZaragoza Jordana, MartaAuthorGispert Llauradó, MarionaCorresponding AuthorRubio Torrents, María Del CarmenAuthorAlcazar Lopez, MireiaAuthorFeliu Rovira, AlbertAuthorLuque Moreno, VerònicaCorresponding Author

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Article

A novel approach to assess body composition in children with obesity from density of the fat-free mass

Publicated to:Clinical Nutrition. 40 (3): 1102-1107 - 2021-03-01 40(3), DOI: 10.1016/j.clnu.2020.07.011

Authors: Gutierrez-Marin, Desiree; Escribano, Joaquin; Closa-Monasterolo, Ricardo; Ferre, Natalia; Venables, Michelle; Singh, Priya; Wells, Jonathan C K; Munoz-Hernando, Judit; Zaragoza-Jordana, Marta; Gispert-Llaurado, Mariona; Rubio-Torrents, Carmen; Alcazar, Mireia; Nunez-Roig, Merce; Monne-Gelonch, Raquel; Feliu, Albert; Basora, Josep; Alejos, Ana M; Luque, Veronica

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Abstract

Background & aimsAssessment of Fat Mass (FM) and fat-free mass (FFM) using Air-displacement plethysmography (ADP) technique assumes constant density of FFM (DFFM) by age and sex. It has been recently shown that DFFM further varies according to body mass index (BMI), meaning that ADP body composition assessments of children with obesity could be biased if DFFM is assumed to be constant. The aim of this study was to validate the use of the calculations of DFFM (rather than constant density of the FFM) to improve accuracy of body composition assessment in children with obesity.Methodscross-sectional validation study in 66 children with obesity (aged 8-14 years) where ADP assessments of body composition assuming constant density (FFMBODPOD and FMBODPOD) were compared to those where DFFM was adjusted in relation to BMI (FFMadjusted and FMadjusted), and both compared to the gold standard reference, the 4-component model (FFM4C and FM4C).ResultsFFMBODPOD was overestimated by 1.50 kg (95%CI -0.68 kg, 3.63 kg) while FFMadjusted was 0.71 kg (-1.08 kg, 2.51 kg) (percentage differences compared to FFM4C were 4.9% (±2.9%) and 2.8% (±2.1%), respectively (p < 0.001)). Consistently, FM was underestimated by both methods, representing a mean difference between methods of 4.0% (±2.9%) and 6.8% (±3.8%), respectively, when compared to the reference method. The agreement and reliability of body composition assessments were improved when adjusted using calculations (adjusted models) rather than assuming constant DFFM.ConclusionsThe use of constant values for fat-free mass properties may increase bias when assessing body composition (FM and FFM) in children with obesity by two-component techniques such as ADP. Using adjusted corrections as proposed in the present work may reduce the bias by half.

Keywords

Adipose tissueAdolescentAgeAir displacement plethysmographyAnthropometryArticleBiasBody compositionBody massBody mass indexChildChildhood obesityChildrenClinical assessmentClinical featureCluster analysisComparative studyControlled studyCross-sectional studiesCross-sectional studyDensityDiagnostic imagingFat free massFemaleHumanHumansMaleMeasurement accuracyMeasurement precisionObesityPediatric obesityPlethysmographyProceduresRandomized controlled trial (topic)Randomized controlled trials as topicReproducibilityReproducibility of resultsSex differenceStatistical biasValidation study

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Clinical Nutrition due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 13/90, thus managing to position itself as a Q1 (Primer Cuartil), in the category Nutrition & Dietetics.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 1.11, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-07, the following number of citations:

  • WoS: 3
  • Scopus: 4
  • OpenCitations: 3

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-07:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 49.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 47 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 0.75.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
  • Assignment of a Handle/URN as an identifier within the deposit in the Institutional Repository: http://hdl.handle.net/20.500.11797/imarina9002318

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United Kingdom.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (GUTIÉRREZ MARÍN, DESIRÉE) and Last Author (Luque Moreno, Verònica).

the authors responsible for correspondence tasks have been Gispert Llauradó, Mariona and Luque Moreno, Verònica.