Which alternative method to dual-energy X-ray absorptiometry for assessing body composition in overweight and obese adolescents?

CONTEXT: Professionals in charge of overweight and obese children and adolescents need a simple, reliable and precise method for assessing body composition. OBJECTIVES: To compare body composition as assessed by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and the skinfold thickness (SFT) method in overweight and obese adolescents, and to establish and validate new predictive equations of body composition from BIA measurements using DXA as standard method. SUBJECTS AND METHODS: Body composition was assessed in 143 obese adolescents (Z-score = 3.2 +/- 1.4) aged 12 to 17 years by DXA, BIA (RJL System, Analycor and Analycor XF models) and SFT (Siri and Slaughter's equations). New prediction equations of fat mass (FM) as assessed by DXA were computed from BIA measurements in a calibration group, and validated in an homologous group of subjects. Results. - The Bland-Altman test showed that compared to DXA, BIA underestimated FM by 2.8 +/- 2.0 kg and 2.3 +/- 2.1 kg using the RJL System and Analycor impedancemeter, respectively (P < 0.001). With the Analycor XF model, FM was underestimated by 3.3 +/-2.6 kg in boys, and over-valued by 0.6 +/- 2.4 kg in girls. On the contrary, the predictive equation of Wabitsch et al. overvalued FM by 6.2 +/- 2.9 kg. The SFT method overvalued FM by 2.1 +/- 5.0 kg in boys and underestimated FM by 2.3 +/- 3.5 kg in girls using Slaughter et al. equation, while Siri's equation underestimated FM by 4.0 +/- 2.9 kg (P < 0.001). The alternative to the DXA method to assess FM was BIA with new prediction equations including gender, body weight, height(2)/resistance and reactance. CONCLUSION: DXA, BIA and the SFT method were not directly interchangeable. The SFT method was inadequate to assess body composition in overweight and obese adolescents. BIA and new prediction equations could be an alternative to the DXA method in overweight and obese adolescents.