title: Measurement of body composition in burned children: is there a gold standard?
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 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.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, Texas, and Shriners Hospitals for Children, Galveston, Texas 77550, USA.
authors.forename: Ludwik K
authors.initials: LK
authors.lastname: Branski
authors.forename: William B
authors.initials: WB
authors.lastname: Norbury
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: David L
authors.initials: DL
authors.lastname: Chinkes
authors.forename: Amalia
authors.initials: A
authors.lastname: Cochran
authors.forename: Oscar
authors.initials: O
authors.lastname: Suman
authors.forename: Deb
authors.initials: D
authors.lastname: Benjamin
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000293:Adolescent; D000367:Age Factors; D001823:Body Composition; D001825:Body Fluid Compartments; D001835:Body Weight; D002056:Burns / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011188:Potassium / Q000032:analysis*; D012044:Regression Analysis
chemical_list: D011188:Potassium