Measurement of body composition in burned children: Is there a gold standard?

Ludwik Branski, William Norbury, David Herndon, David L. Chinkes, Amalia Cochran, Oscar Suman, Deb Benjamin, Marc G. Jeschke

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Maintaining lean body mass (LBM) after a severe burn is an essential goal of modern burn treatment. An accurate determination of LBM is necessary for short-and longterm therapeutic decisions. The aim of this study was to compare 2 measurement methods for body composition, wholebody potassium counting (K count) and dual x-ray absorptiometry (DEXA), in a large prospective clinical trial in severely burned pediatric patients. Methods: Two-hundred seventy-nine patients admitted with burns covering 40% of total body surface area (TBSA) were enrolled in the study. Patients enrolled were controls or received long-term treatment with recombinant human growth hormone (rhGH). Near-simultaneous measurements of LBM with DEXA and fat-free mass (FFM) with K count were performed at hospital discharge and at 6, 9, 12, 18, and 24 months post injury. Results were correlated using Pearson's regression analysis. Agreement between the 2 methods was analyzed with the Bland-Altman method. Results: Age, gender distribution, weight, burn size, and admission time from injury were not significantly different between control and treatment groups. rhGH and control patients at all time points postburn showed a good correlation between LBM and FFM measurements (R2 between 0.9 and 0.95). Bland-Altman revealed that the mean bias and 95% limits of agreement depended only on patient weight and not on treatment or time postburn. The 95% limits ranged from 0.1 ± 2.9 kg for LBM or FFM in 7-to 18-kg patients to 16.3 ± 17.8 kg for LBM or FFM in patients >60 kg. Conclusions: DEXA can provide a sufficiently accurate determination of LBM and changes in body composition, but a correction factor must be included for older children and adolescents with more LBM. DEXA scans are easier, cheaper, and less stressful for the patient, and this method should be used rather than the K count.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalJournal of Parenteral and Enteral Nutrition
Volume34
Issue number1
DOIs
StatePublished - 2010

Fingerprint

Body Composition
Fats
Human Growth Hormone
Growth Hormone
Therapeutics
Weights and Measures
Body Surface Area
Age Distribution
Photon Absorptiometry
Wounds and Injuries
Burns
Potassium
Regression Analysis
X-Rays
Clinical Trials
Pediatrics
Control Groups

Keywords

  • Absorptiometry/bone densitometry
  • Body composition
  • Burns
  • Pediatrics
  • Whole-body counting

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Measurement of body composition in burned children : Is there a gold standard? / Branski, Ludwik; Norbury, William; Herndon, David; Chinkes, David L.; Cochran, Amalia; Suman, Oscar; Benjamin, Deb; Jeschke, Marc G.

In: Journal of Parenteral and Enteral Nutrition, Vol. 34, No. 1, 2010, p. 55-63.

Research output: Contribution to journalArticle

Branski, Ludwik ; Norbury, William ; Herndon, David ; Chinkes, David L. ; Cochran, Amalia ; Suman, Oscar ; Benjamin, Deb ; Jeschke, Marc G. / Measurement of body composition in burned children : Is there a gold standard?. In: Journal of Parenteral and Enteral Nutrition. 2010 ; Vol. 34, No. 1. pp. 55-63.
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abstract = "Background: Maintaining lean body mass (LBM) after a severe burn is an essential goal of modern burn treatment. An accurate determination of LBM is necessary for short-and longterm therapeutic decisions. The aim of this study was to compare 2 measurement methods for body composition, wholebody potassium counting (K count) and dual x-ray absorptiometry (DEXA), in a large prospective clinical trial in severely burned pediatric patients. Methods: Two-hundred seventy-nine patients admitted with burns covering 40{\%} of total body surface area (TBSA) were enrolled in the study. Patients enrolled were controls or received long-term treatment with recombinant human growth hormone (rhGH). Near-simultaneous measurements of LBM with DEXA and fat-free mass (FFM) with K count were performed at hospital discharge and at 6, 9, 12, 18, and 24 months post injury. Results were correlated using Pearson's regression analysis. Agreement between the 2 methods was analyzed with the Bland-Altman method. Results: Age, gender distribution, weight, burn size, and admission time from injury were not significantly different between control and treatment groups. rhGH and control patients at all time points postburn showed a good correlation between LBM and FFM measurements (R2 between 0.9 and 0.95). Bland-Altman revealed that the mean bias and 95{\%} limits of agreement depended only on patient weight and not on treatment or time postburn. The 95{\%} limits ranged from 0.1 ± 2.9 kg for LBM or FFM in 7-to 18-kg patients to 16.3 ± 17.8 kg for LBM or FFM in patients >60 kg. Conclusions: DEXA can provide a sufficiently accurate determination of LBM and changes in body composition, but a correction factor must be included for older children and adolescents with more LBM. DEXA scans are easier, cheaper, and less stressful for the patient, and this method should be used rather than the K count.",
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AU - Branski, Ludwik

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AU - Herndon, David

AU - Chinkes, David L.

AU - Cochran, Amalia

AU - Suman, Oscar

AU - Benjamin, Deb

AU - Jeschke, Marc G.

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KW - Pediatrics

KW - Whole-body counting

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