Pediatric reference charts of dual-energy X-ray absorptiometry body composition measures

Abstract Objective Dual-Energy X-Ray Absorptiometry (DXA) is a fast, relatively safe and efficient modality to estimate body composition, which may aid in assessing adiposity and cardio-metabolic health. European pediatric references for these measures are scarce. We aimed to create age-based reference charts and height-based distribution charts for DXA-derived body composition measures in a diverse population for ages 5-20 years. Design Population-based cohort study, including 6102 singleton-born children in Rotterdam with DXA data from one or more visits between 5 and 20 years. Methods Assessments included total-body-less-head (TBLH)-bone mineral density (BMD) and content (TBLH-BMC), fat mass percentage (FM%) and index (FMI), lean soft tissue mass percentage (LST%) and index (LMI), and appendicular LMI (ALMI). Reference charts were calculated with General Additive Modeling and adjusted using inverse probability weighting. Results In our study sample, 60.5% had DXA data at 3 or more time-points. Sex differences were most pronounced for fat and lean soft tissue mass. Girls had higher and increasing median FMI, which was relatively stable in boys from 5 to 20 years. Conversely, median LST% only increased in girls from between the ages of 10-14 years, whilst this increase was higher and continued from 10 to 18 years in boys. Compared with children from European descent, we observed higher FMI and differences in LMI in children of Cape Verdean, Dutch Antillean, Moroccan, Surinamese-Hindustani and Turkish descent. Comparison with North American and Swiss cohorts showed current BMD centiles were similar, but our FMI and LMI average references values were lower. Conclusions We created age-based reference charts and height-based distribution charts for DXA-derived body composition measures for a Europe-based, diverse pediatric population. These charts can be useful for European populations and clinical studies.