Comparative assessment of nutritional status and body composition of school children in Tororo district, Uganda

Abstract

Childhood malnutrition remains a critical public health issue in Uganda, with significant rates of stunting, wasting and underweight in rural districts like Tororo. Accurate assessment of nutrition status and body composition is essential for effective intervention. This study aimed to evaluate the accuracy of bioelectrical impedance analysis (BIA) as a non-invasive method for assessing the body composition of children aged 6 to 14 years against the deuterium dilution method (DDM) as a reference method in determining the nutritional status and body composition of school children aged 6 to 14 years in Tororo district Uganda. This was a cross-sectional study conducted among 152 school children aged 6 to 14 years from Rubongi Primary School, Tororo District, Bukedi sub-region selected through random sampling. BIA measurements of total body water (TBW), fat-free mass (FFM), fat mass (FM), and fat mass percentage (%FM) were carried out using the TANITA MC-780MA-N body composition analyser, and the results were compared to those obtained using the deuterium dilution method. Statistical analyses, including paired t-tests, correlation coefficients, and Bland-Altman analysis were used to assess the agreement between the two methods. The results indicated that 8.6%, 10.5% and 4.6% of the children were underweight, stunted and wasted, respectively; none of the children were overweight or obese. However, 2% of the children were severely stunted and wasted. BIA estimates of FFM and TBW were strong and positively correlated with the deuterium dilution method (r = 0.85, and r = 8.3) respectively (P<0.0001). However, a slight systematic bias was observed, with the BIA tending to overestimate %FM (20.01 + 2.56) in girls than boys (18.90 + 3.74). Despite these differences, the limits of agreement were within clinically acceptable ranges for most of the measurement variables. The Bland-Altman analysis showed no systematic bias between BIA and DDM values for FFM and TBW, with narrow limits of agreement between the two methods (TBW: bias of 0.8651kg [95% CI -4.19-5.92], and FFM: bias of 1.497kg [95% CI -6.040 to 9.035]. There was no significant difference between BIA and DDM in body composition measurement. Since BIA presents a more feasible method of body composition measurement, and this study has demonstrated its agreement with DDM, it can be used to assess body composition by researchers in the field and in clinics in resource constrained settings.