Comparison of Air-Displacement

Plethysmography, Hydrodensitometry, and

Dual X-ray Absorptiometry for Assessing Body
Composition of Children 10 to 18 Years of Age
D. W. LOCKNER,a V. H. HEYWARD,a R. N. BAUMGARTNER,c
AND K. A. JENKINSd
aCenter

for Exercise and Applied Human Physiology and cClinical Nutrition Program,
University of New Mexico, Albuquerque, New Mexico 87131, USA
dDepartment

of Human Performance, Leisure, and Sport,

New Mexico Highlands University, Las Vegas, New Mexico

ABSTRACT: Body density (Db) of 54 boys and girls 1018 years of age (13.9 2.4
years) was measured in an air-displacement plethysmograph, the BOD POD,
and compared to Db determined by hydrodensitometry (HW). Both Db values
were converted to percent body fat (%BF) using a two-component model conversion formula and compared to %BF determined by dual energy X-ray
absorptiometry (DXA). Body density estimated from the BOD POD (1.04657
0.01825 g/cc) was significantly higher than that estimated from HW (1.04032
0.01872 g/cc). The relative body fat calculated from the BOD POD (23.12 8.39
%BF) was highly correlated but, on average, 2.9% BF lower than %BF DXA.
Average %BF estimates from HW and DXA were not significantly different. Despite consistently underestimating the %BF of children, the strong relationship
between DXA and the BOD POD suggests that further investigation may improve the accuracy of the BOD POD for assessing body composition in children.

INTRODUCTION
Interest in assessing body composition in children is rising, due in part to the increasing incidence of childhood obesity. Because methods that are appropriate for
adults may not be valid for children, we must carefully evaluate new techniques to
determine their accuracy and reliability for that population by comparing results to
a reference method. For decades, hydrodensitometry (HW) has served as the reference method to assess body density (Db) of adults and children. However, the error
associated with HW may be large for children due to procedural difficulties in performing underwater weighing and assessing residual lung volume.1 Therefore, using
HW as a reference method for children may be inappropriate.

bAddress for correspondence: D. Lockner, Center for Exercise and Applied Human Physiology, Johnson Center, University of New Mexico, Albuquerque, NM 87131. Voice: 505-2773160; fax: 505-277-4362.
dlockner@unm.edu

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LOCKNER et al.: BODY COMPOSITION OF CHILDREN

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Dual energy X-ray absorptiometry (DXA) is widely used for body composition
assessment and is gaining support as a reference method.2 For children, DXA may
be even more appropriate than HW as a reference method because it requires little
active participation by the child and makes no assumptions about the composition of
the fat-free mass. Ellis3 suggests DXA as a criterion method for children when direct
chemical analysis is not possible.
Recent reports of the validity of air displacement plethysmography for determining body composition in adults4,5 prompted this investigation of its usefulness for
children. This device, the BOD POD, is readily accessible, rapid, has an easy testing protocol, and does not require submersion in water; thus, it is an attractive tool
for assessments of children. Lacking a singular reference standard, the purpose of
this study was to compare the BOD POD to HW and DXA for assessing body composition of children.
METHODS
Participants
Fifty-four healthy children (42 females, 12 males), aged 1018 years, were recruited from personal contacts in a large metropolitan area and surrounding towns.
The study was approved by the universitys Institutional Review Board, and written
informed consent was given by participants and parents prior to data collection.
Hydrostatic Weighing
The children were weighed underwater at residual lung volume using a load cell
system, which was calibrated before each test. As many trials were made as needed to
obtain three underwater weights within 50 grams. Residual lung volume (RV) was
measured while the children were seated, out of water, using the helium dilution technique,6 again with as many trials as needed to obtain two RV values within 100 milliliters. These data from the two trials were averaged and used to calculate body volume.
Air Displacement Plethysmography
Body volume was measured in the BOD POD (Life Measurement Instruments,
Concord, CA), an air displacement plethysmograph previously described.7 The
BOD POD was calibrated before each test following the manufacturers recommendations. Participants wore a tight-fitting swimsuit or biking shorts, and a swim cap,
and remained seated in the chamber during the measurement. The software-driven
automated test included measurement of volume of the thoracic gas. For this part of
the test, the children were prompted to puff gently against an occluded airway while
changes in body volume were recorded. If a valid measure was not obtained after
three trials, the volume of thoracic gas was predicted by the BOD POD software,
which also calculated body density at the conclusion of each test.
Dual Energy X-ray Absorptiometry
The bone mineral content and percent body fat (%BF) of each person were measured by dual energy X-ray absorptiometry (DXA) (Lunar DPX, Lunar Radiation

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TABLE 1. Physical characteristics of the children (n = 54)

Variable
Age (year)
HT (cm)
BM (kg)
BSA (cm2)
Measured VTG (L) (n = 37)
Predicted VTG (L)
DbHW (g/cc)
DbBOD POD (g/cc)
%BFDXA
%BFHWa
%BFBODPODa
a

Mean SD
13.93 2.38
159.41 9.95
52.50 11.07
15236.60 1880.73
2.81 0.78
3.00 0.38
1.04032 0.01872
1.04657 0.01825
25.23 9.73
25.97 8.65
23.12 8.39

Range
1018
134.90180.10
30.5075.70
10843.3918357.07
1.474.85
1.773.95
0.992141.07369
0.99531.0707
9.1049.60
11.0348.92
12.3147.34

%BF calculated using two-component model conversion formula (Siri, 1961).

Corp., Madison, WI, Software Version 3.6Z). The densitometer was calibrated daily
according to the manufacturers recommendation, and all scans were performed by
a licensed radiological technician. Subjects lay supine with arms and legs at their
sides during the 15- to 20-minute scan.
Converting Body Density Values to Percent Body Fat
For comparison to %BF obtained from DXA, %BF was calculated from the twocomponent Siri equation.8 All hydrostatic weighing, BOD POD, and DXA measurements were taken on the same day within three hours. The order of testing was randomized for each person.
Statistical Analysis
A paired t test was used to compare DbHW and DbBP. The validity coefficient (r),
standard error of the estimate (SEE), and slope and intercept of the regression line
were calculated with linear regression. The average measured volume of thoracic gas
(Vtg) was compared to the average predicted Vtg using a paired t test. Paired t tests
were also used to compare %BF estimates from HW and BOD POD to %BF estimated by DXA. The relationship between %BFDXA and %BF, determined by each of the
two densitometric methods, was explored using linear regression.
An alpha value of .05 was set for testing significance. The Statistical Package for
the Social Sciences (SPSS, Version 7.5 for Windows) was used for all analyses.

RESULTS
The average age of the children was 13.9 2.4 years (range = 1018 years). Self-reported ethnicity was 59% Caucasian, 35% Hispanic, and 6% Native American. TABLE 1
summarizes their other characteristics.

LOCKNER et al.: BODY COMPOSITION OF CHILDREN

FIGURE 1. Relationship between DbBOD

line of identity.

POD

75

and DbHW. The dashed line indicates

There was a significant difference between average DbBOD POD (1.04657

0.01825 g/cc) and average DbHW (1.04032 0.01872 g/cc), p <0.0005; the validity
coefficient between them was r = 0.85, p <0.0005, and the SEE was 0.0100 g/cc. The
slope (0.869) of the regression line relating DbBOD POD to DbHW did not differ from 1.0
(p >0.05), and the intercept (0.131) was not significantly different from zero (p >0.05).
FIGURE 1 shows the relationship between DbHW and DbBOD POD. The bias of Db estimated by the BOD POD compared to HW was related to height (r = 0.33), body mass
(r = 0.40), and body surface area (r = 0.41), with the largest overprediction for the
smallest children.
Thirty-seven children (69%) achieved a valid measurement of thoracic gas volume (Vtg). Their Db was calculated using predicted Vtg (3.00 0.38 L), instead of
measured Vtg (2.81 0.78 L) and resulted in a significant mean difference of
0.0027 g/cc higher, p = 0.008.
When Db was converted to %BF for comparison to DXA values, %BFBOD POD (23.12
8.39 %BF) was significantly lower than %BFDXA (25.23 9.73 %BF), p <0.0005.
There was no significant difference between %BHW (25.97 8.65 %BF) and %BDXA.
Further analysis of this relationship, however, showed that the correlation between
%BFDXA and %BFBOD POD (r = 0.94) was greater than the correlation between
%BFDXA and %BFHW (r = 0.89), whereas the SEE was smaller for BOD POD (SEE
= 3.41 %BF) compared to HW (SEE = 4.55 %BF) (FIG. 2). Neither slopes of the lines
relating %BFBOD POD and %BFHW to %BFDXA differed from one, and the intercepts
did not differ from zero.

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DISCUSSION
With the interest in the body composition of children, the validation of a rapid,
convenient method of assessment is needed. Although hydrodensitometry is often
used as a reference method for assessing body composition in children, its inconvenience and the difficulty of the protocol may lead to errors; DXA may be a more appropriate reference method due to its reduced error compared to HW. However, the
cost of DXA and the exposure to radiation during each scan may be problematic for
the pediatric population. Air-displacement plethysmography has the potential to
overcome these problems, but few validation studies with children have been conducted. Therefore, this study compared body composition results from the air-displacement plethysmograph, the BOD POD, to HW and DXA.
The testing protocol for HW, including measurement of residual lung volume, required approximately 75 minutes for each child. Some children required additional
coaching for underwater weighing, due to mild apprehension of submersion. By contrast, air displacement plethysmography was easily accomplished. All children in the
present study seemed comfortable with sitting in the BOD POD while breathing normally, and no training was needed for a successful Db trial, which took approximately 10 minutes. Although the measurement of thoracic gas volume in the BOD POD
was difficult for some children, this factor did not seem to significantly impact Db
measurement. Using predicted instead of measured volume of thoracic gas increased
the mean Db by 0.002 g/cc, similar to the results of Collins et al.,9 who reported a
lower measured Vtg compared to predicted Vtg in their study of collegiate football
players. The use of measured Vtg in calculating Db slightly overpredicted it in that
study, as well as for the children in this study.
The similarity of mean %BF estimated from HW and DXA could be misinterpreted as close agreement between these two methods. However, the large prediction error, (SEE >4.5 %BF) suggests that HW is not a good method for determining body
composition in children. Despite the significant mean difference in %BFBOD POD and
%BFDXA (with %BFBOD POD being 3.8% BF lower, on average), the SEE was smaller
(3.41% BF) than that for the relationship between %BFHW and % BFDXA (4.55%
BF). Although %BFBOD POD was underpredicted for 89% of the sample, there was
overall closer agreement between %BFBOD POD and %BFDXA than between %BFHW
and %BFDXA (FIG. 2).
The overestimation of Db compared to HW for children in this study contrasts
with previous studies using heterogeneous groups of adults4,5,10,11 where very close
agreement was reported. With more homogeneous subgroups, however, results have
been mixed. As in the present study, Iwaoka et al.12 reported an overestimation of
Db compared to HW (with an underestimation of %BF determined by the BOD POD
compared to DXA) in Japanese men of short stature, as did Collins et al.9 for collegiate football players. Nuez et al.10 found no significant difference for average Db
estimates from HW and the BOD POD for children 819 years of age; however, a
significant bias was noted. Explanation for these inconsistent results is lacking; as
with any new technology, additional observations are needed.
The strong correlation between %BFBOD POD and %BFDXA suggests additional
research may identify techniques to improve the usefulness of the BOD POD for
body composition measurement of children. Our results support the results and conclusion recently published by Nuez et al.10 that Db and derived %BF assessed by

LOCKNER et al.: BODY COMPOSITION OF CHILDREN

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FIGURE 2A. Relationship between %BF DXA and %BF HW. The dashed line indicates line of identity.

FIGURE 2B. Relationship between %BF DXA and %BF BOD POD. The dashed line
indicates line of identity.

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the BOD POD are highly correlated to values from HW and DXA. The bias in Db
measurement by the BOD POD related to body size indicates that a small correction
factor may improve the accuracy of the BOD POD measurements of children compared to DXA measurement. In addition, with our poor results in assessing body
composition of children using HW, the convenience of the BOD POD encourages
further investigations to improve its accuracy for such assessments.
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