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Measurement of Body Composition in Burned Children: Is There a Gold Standard?
Author(s) -
Branski Ludwik K.,
Norbury William B.,
Herndon David N.,
Chinkes David L.,
Cochran Amalia,
Suman Oscar,
Benjamin Deb,
Jeschke Marc G.
Publication year - 2010
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607109336601
Subject(s) - lean body mass , medicine , total body surface area , body surface area , limits of agreement , body weight , body mass index , prospective cohort study , burn injury , nuclear medicine , surgery
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 long‐term therapeutic decisions. The aim of this study was to compare 2 measurement methods for body composition, whole‐body 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 ( R 2 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.