Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

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ISSN: 2177-5281 (Online)

Vol. 15 nº 4 - Oct/Dec - 2018

Original Article Imprimir 

Páginas 82 a 91

Evaluation methods for predicting body composition used in adolescents with Down syndrome: a systematic review

Métodos de evaluación para predicción de la composición corporal utilizados en adolescentes con síndrome de Down: una revisión sistemática

Métodos de avaliação para predição da composição corporal utilizados em adolescentes com síndrome de Down: uma revisão sistemática

Autores: Geiziane Leite Rodrigues Melo1; Rafael dos Reis Vieira Olher2; Luiz Humberto Rodrigues Souza3; Rodrigo Vanerson Passos Neves4; Tânia Mara Vieira Sampaio5; Milton Rocha Moraes6

1. Bachelor and Degree in Phisical Education and Mastering student in Physical Education by the Catholic University of Brasilia (UCB). Brasilia, DF, Brazil
2. Master degree in Physical Education by the Catholic University of Brasilia (UCB). Doctoral student in Physical Education by the Post-Graduation Program in Physical Education by the UCB. Brasilia, DF, Brazil
3. Master degree in Physical Education and Doctoral student in Physical Education by the Post-Graduation Program in Physical Education by the Catholic University of Brasilia (UCB). Brasilia, DF, Brazil. Teacher of the course of Physical Education in the DEDC/XII of the State University of Bahia (UNEB). Guanambi, BA, Brazil
4. Doctoral student in Physical Education by the Post-Graduation Program in Physical Education by the Catholic University of Brasilia (UCB). Member del Strength Training in Health and Rehabilitation Studies Group at the UCB and the Study Group in Physical Education and Sports of the University Center Estácio Brasília. Brasilia, DF, Brazil
5. Post-Doctorate in Recreation Studies by the Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil. Teacher in the Federal Institute of Education, Science and Technology of Goiás (IFG) - Luziânia Campus. Member of the Editorial Board at IFG Editorial. Luziânia, GO, Brazil
6. Post-Doctorate concluded in the Immunology program at the São Paulo University (USP, and developed in the Institute of Biomedical Sciences-ICB-IV. São Paulo, SP, Brazil. Permanent Profesor of the Stricto Sensu Post-Graduation Program in Physical Education (CAPES nota 4) and the Physical Education course of the Catholic University of Brasilia (UCB). Brasilia, DF, Brazil

Geiziane Leite Rodrigues de Melo
Universidade Católica de Brasília
Brasília, DF, Brasil. CEP: 71966-700

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How to cite this article

Keywords: Anthropometry, obesity, intellectual disability, Down Syndrome.
Palabra Clave: Antropometría, obesidad, deficiencia intelectual, Síndrome de Down.
Descritores: Antropometria, obesidade, deficiência intelectual, Síndrome de Down.

OBJECTIVE: Analyze the methods of evaluation of body composition in children and adolescents with Down syndrome as a tool to predict obesity.
METHODOLOGY: Systematic review study using the following databases (Pubmed / MedLine, Scopus, Scielo and Lilacs). The search for the articles occurred through the following descriptors in Portuguese, English and Spanish: "Obesity" and "Down Syndrome". The inclusion criteria were: original article and sample of children and adolescents.
RESULT AND DISCUSSION: 21 articles contemplated the proposed criteria. The most commonly used methods of evaluation were skinfolds present in 8 studies, followed by dual energy radiological absorptiometry (DXA) with 5 studies. With respect to the equations used to predict the percentage of fat (% G) by means of the skinfolds, the most used was Slaughter et al. (1988) is a good predictor for obesity in adolescents with DS, and body mass index (BMI) present in all articles.
CONCLUSION: The BMI was less accurate in assessing body composition when compared to DC and DEXA. Regarding the intellectual disability, the revision shown that it influences adolescent obesity, so it suggests greater attention to this group regarding food and physical activity.

OBJETIVO: Analizar los métodos de evaluación de la composición corporal en niños y adolescentes con síndrome de Down como herramienta de predicción a la obesidad. Metodología: estudio de revisión sistemática utilizando las siguientes bases de datos (PubMed/Medline, Scopus, SciELO y Lilacs). La búsqueda de artículos se llevó a cabo a través de las siguientes palabras clave en portugués, inglés y español: "Obesidad" y "Síndrome de Down". Los criterios de inclusión fueron: ser artículo original y muestra de niños y adolescentes.
RESULTADO Y DISCUSIÓN: 21 artículos contemplaron los criterios propuestos. Los métodos de evaluación utilizados fueron los pliegues cutáneos (DC) presentes en ocho estudios, seguido por la absorciometría radiológica de doble energía (DEXA) con 5 estudios. Con respecto a las ecuaciones utilizadas para predecir el porcentaje de grasa (% G) por medio de la DC, el más utilizado fue Slaughter et al. (1988), que se considera un buen predictivo para determinar la obesidad en adolescentes con SD, e índice de masa corporal (IMC) presente en todos los artículos.
CONCLUSIÓN: El IMC fue menos preciso en la evaluación de la composición corporal en comparación con la DC y el DEXA. Con relación a la deficiencia intelectual, la revisión mostró que ella influye en la obesidad de adolescentes, de modo que sugiere mayor atención a ese grupo en cuanto a la alimentación y actividad física.

OBJETIVO: Analisar os métodos de avaliação da composição corporal em crianças e adolescentes com síndrome de Down como ferramenta de predição a obesidade.
METODOLOGIA: Estudo de revisão sistemática utilizando as seguintes bases de dados (Pubmed/MedLine, Scopus, Scielo e Lilacs). A busca dos artigos ocorreu por meio dos seguintes descritores em português, inglês e espanhol: "Obesidade" e "Síndrome de Down". Os critérios de inclusão foram: ser artigo original e amostra de crianças e adolescentes.
RESULTADO E DISCUSSÃO: 21 artigos contemplaram aos critérios propostos. Os métodos de avaliação mais utilizados foram dobras cutâneas (DC) presentes em 8 estudos, seguida pelo absortometria radiológica de dupla energia (DEXA) com 5 estudos. Com relação às equações utilizadas para predizer a percentagem de gordura (%G) por meio da DC, a mais utilizada foi Slaughter et al. (1988) que foi considerada uma boa preditora para determinar obesidade em adolescentes com SD, e o índice de massa corporal (IMC) presente em todos artigos.
CONCLUSÃO: O IMC foi menos preciso na avaliação da composição corporal quando comparado a DC e ao DEXA. Com relação à deficiência intelectual, a revisão mostrou que ela influencia na obesidade de adolescentes, de modo que sugere maior atenção a esse grupo quanto à alimentação e atividade física.


The incidence of obesity has increased considerably worldwide1 and it is characterized by the excessive accumulation of fat that has also affected children and adolescents with Down Syndrome (DS)2. The prevalence in this people may be caused by the increase of sedentary lifestyle, excess intake of calories and nutrients4, muscle hypotonia, lower basal metabolic rate3, and secondary diseases such as hypothyroidism and sleep apnea4.

In children and adults with Down Syndrome, pictures high obesity have been recorded since the 80s to the present, so there is likely to be obese adults hese1. According Rimmer et al.4, the incidence has increased in individuals with Down Syndrome before reaching 20 years.

From this marked increase, it is reasonable infer that this growing obesity framework may contribute to increased health risks3 and risk of comorbidities, being essential to avoid this situation young people with SD5. As a result, methods for evaluating body composition are used to control the body's growth and development, and also to evaluate the body composition of children and adolescents with DS6.

However, today there are few methods that estimate fat in children and adolescents compared to adults3. On the other hand, uncertainty6 coexists about its use and there is a hiatus in literature when it comes to people with Down Syndrome. For Casey6, there are few studies that reliably and accurately determine the validity of body composition assessment methods for people with intellectual disabilities.

Another factor to consider are the disadvantages applied to indirect methods, such as plethysmography by air displacement (ADP); double energy radiological absorptiometry (DEXA) and bioelectrical impedance (BIA). Although they are more accurate and reliable when compared to doubly indirect methods, for example, skin folds (DC) and the circumference of the body, have a high financial cost to estimate body fat in population studios. In contrast, doubly indirect methods are inexpensive and can be applied in a research of the population's study7.

In addition, studies indicate a fall s in the application of methods for assessing body composition in both the population without DS, especially in relation to body mass index (BMI)5. In this regard, it is recognized that although BMI s ea a parameter for predicting obesity worldwide Accept or it should be noted its fragility as an instrument, taking into account the possibility of correlating the total body weight within an absolute estimate, not differentiating Body mass weight6 thin.

Thus, it´s important to find out through a systematic review, different methods of body composition analysis most widely used in children and adolescents with DS for to determine the degree of obesity.


The search was carried out in newspapers indexed in the electronic databases MEDLINE / PUBMED, LILACS, SCIELO and SCOPUS, on the methods of evaluation of body composition most used in children and adolescents with DS to predict obesity. The descriptors used for the electronic search in the databases have been identified in consultation with the Descriptors in Health Sciences (DeCS), through the portal of the Virtual Health Library (VHL). The search was conducted from October 2014 to September 2017, using the following key words: Down Syndrome or Mongolism and obesity, in combination with the operator and both the languages english, spanish and portuguese.

The inclusion criteria of the studies for 1analysis were: articles of primary quantitative studies that have investigated obesity in children and adolescents with Down Syndrome; as a primary or secondary study objective; studies published between 2005 and 2017; studies published in portuguese, english and spanish and samples of children and adolescents.

The following requirements were used as exclusion criteria: review articles; repeated items; a sample formed by an age group of 0 to 2 years, adults and the elderly; research done with animals; articles that treat diseases such as sleep disorders for breathing, sleep apnea, asthma, tonsillectomy, adenoidectomy, adenotonsillectomy, Alzheimer . Works of monographs, dissertations and theses were also excluded.


Figure 1 shows the flow diagram that contains the stages of the search and selection process of the articles included in the present review. From keywords were initially identified 1.171 potential articles, being that combinations carried out in each database and they were: Down Syndrome and obesity ( SciELO and LILACS); Down Syndrome and obesity (SCOPUS and PubMed) and Mongolism and obesity (MEDLINE), being that the second term, mongolism, was used according to MeSH as synonymous, because the MEDLINE database has as that term indexes do. In this stage, 914 were identified in the SCOPUS database, 142 articles in MEDLINE, 72 in PUBMED, 34 in LILACS, and nine in SCIELO and, from that, 21 items were considered eligible for the study.

Figure 1. Identification and selection of the articles included in the review.

It was observed that the countries that published most on the subject of obesity for public with DS were Spain and the United States of America, five and six respectively, being that Brazil contributes with three studies. The age group varies between 2 to 20 years of age, with samples between 22 and 333 individuals. Table 1 describes the methods used to evaluate the body composition of most of the studies reviewed, which were: DC were present in 11 studies, followed by DEXA in six studies and other methods (ADP and BIA) in two jobs. With respect to the equations used to predict the percentage of fat (%G) per DC, the most used were Slaughter et al.14 in every eight jobs, followed by Durnin et al.15 and Brook et al16 . Other equations were present in two other studies: Johnston et al.17; Durnin and Rahman18; Weststrate and Deurenberg19. An important aspect to note is that all studies take on BMI for predicting obesity in this population.

Tables 2 and 3 show the results of BMI and % G for both male and female sexes and / or together. From the distribution of the BMI values, it was observed that the girls showed BMI and % G greater than children20. In addition, in seven studies that contained a sample of both with and without DS, it was observed that individuals with DS have a higher BMI with respect to individuals without DS. In the same way, in four other studies it was observed that individuals with DS have greater %G in relation to individuals without DS.


It was observed in Table 1 that the most commonly used methods to predict obesity were DC, with 52.3% of the studies reviewed, which was possibly the most widely used because it is an easy to use method and relatively low cost, besides estimating total body fat in field and clinical situations6. ADP and BIA together were little used (13.4%) including being easy methods, fast and precise for to determine the %G in comparison, respectively, by DC and DEXA2 ,7. However, for Loverday2 the BIA is valid for measuring the % G in people with DS, which can be derivative of present a proper body composition. Another highlight is that the ADP was used by 38,09% of the studies, and the DEXA was used by 28,5 of the sample, using as a parameter assessment in children and adolescents accurately7.

In relation to the equations most commonly used to predict the %G, the test indicated that the method with DC most used was that of Slaughter et al.14 present in 72,7% of articles3,5,7,22 -26. González-Agüero et al.7 investigate the precision of the equations for to estimate the %G through comparing the DC with ADP in children  and adolescents with DS, so that the result found was the  equation of Slaughter et al.14 that presented approximate results of ADP. The equation of Slaughter et al.14 is used in research of clinical ethics and the population, which considered the level of maturity, race and sex. In this way, the multicomponent boarding of the body composition and the chemical immaturity of the children must be considered14.

In the González studio Omen et al.27 comparing the regional and global distribution of fat and light mass among children and adolescents with and without DS, it was observed that the BMI values were lower for people with and without DS, compared to the methods of ADP and indirect DEXA. The fact that it is worth mentioning is that in all the studies the body mass index was adopted to predict obesity, even with discussions and different interpretations of its use in the general population5, so the BMI can vary according to age, chronological, biological, ethnic and gender5 . In contrast, high BMI in adolescence is an indicator of risk of chronic non communicable diseases related to obesity in adulthood1. However, Freireet al.5 they found a strong correlation between the BMI and % G by means of DC, so to know the ideal weight is not recommended using only the height, but consider the somatotype, that is, the physical type of each person and the % G associated with other measures of body composition more reliable. On the other hand, sexual dimorphism27, physiological, environmental and genetic differences7, physical activity and the bad diet22 must be considered.

In this way, it has been found in studies of Izquierdo-Gomes23, Hill8 , Izquierdo-Gomes24 , Galli9 , Wee28 and Izquierdo-Gomes26 that the body mass index of the subjects of both sexes with DS was higher than without DS, and the same happened for the %G for that group. This was due to environmental, biological and social factors that can influence obesity through the culture in which this population is inserted23, as the level of regular physical activity in young people with DS is low27.29. Some impossibilities to the practice of physical activity would be n flatfoot, the laxity of the ligaments and muscle hypotonia, reflecting mobility and can perform changes in postural control, discouraging participant with SD30. Regarding physiological aspects, the increase of leptin levels, resting energy expenditure model and food intake may also influence the increased incidence of obesity in this population8 21,22,23.

Studios Bandini13 , Loveday2, Bertapelli3 and Freire Samur -San Martin12 showed a marked difference when comparing body mass index and %G in individuals with Down syndrome compared to sex, where girls had BMI and G% higher than boys. According to González-Agüero27 and Bertapelli27, that It occurs due to sexual dimorphism and the distribution of fat mass, which have an incompatibility in relation to the sexual difference increasingly evident in the transition of puberty. And it´s at this stage that there is a change in the significant body composition between the boy and the girl. This distribution of fat has a relationship with hormonal regulation disorders that can result in sexual development and, therefore, influence body composition25.

Regarding the distribution of body fat, in the studies of Bertapelli3 and Grammatikopoulou2, it is observed that children have the highest %G before puberty, which is around 12 years. On the other hand, %G of girls was more accentual or after 12 years. The same phenomenon occurs in the population without DS, which during adulthood softens this sexual dimorphism in body composition1.2.

Regarding the degree of intellectual disability (ID), according to to Jankowinz et al.20 found that women have higher body mass index and the %G higher when intellectual disability is to temper and also have a greater tendency to gain total body weight. The mild and moderate ID of the women remained similar in comparison with the men. Therefore, women present a greater risk to develop obesity when it is related to the degree of ID of this population with DS. The same was found in the study of Wee28 that showed that participants who have DI of both sexes had higher BMI in the general population, so that the DI influence on obesity.


The most used methods in the studies analyzed were DC and DEXA. The BMI, although it is the subject of discussion about its effectiveness, is present in all the studies. On the other hand, it can be seen that the results found of BMI are out of compared to indirect (DEXA) and doubly indirect (DC) methods. Therefore, the use of other parameters to evaluate body composition to determine obesity in individuals with DS should be used. In addition, it was observed that ID influences obesity in adolescent girls, in comparison with children, so that this study suggests greater attention to that group in relation to care with food and physical activity. Then they suggested new searches with different descriptors to delve into the subject of methods of body composition in children and adolescents with DS.


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