Stable isotopes and body composition in children: History, fundamentals, and clinical applications
Wendell Costa Bila, Joel Alves Lamounier, André Everton de Freitas, Valmin Ramos Silva, Sylvia Dias Turani, José Eduardo Dutra de Oliveira
Faculty of Medicine, Federal University of S?o Jo?o Del Rei-West Campus Center, Divinópolis, Brazil.
Faculty of Medicine, School of Sciences of Santa Casa de Misericordia of Vitoria, Nossa Senhora da Glória Children’s Hospital, Vitória, Brazil.
Faculty of Medicine, University of S?o Paulo-Ribeir?o Preto, Brazil.
Graduate Program in Child and Teenager Health-Medicine School-UFMG Belo Horizonte, College of Health and Human Ecology-FASEH Vespasiano, Brazil.
Graduate Program in Health Sciences, Federal University of S?o Jo?o Del Rei-West Campus Center, Divinópolis, Brazil;.
DOI: 10.4236/health.2013.58A3009   PDF    HTML     4,920 Downloads   7,442 Views   Citations


The aim of this study was to gather information on the use of stable isotopes to measure total body water and body composition scan in children. We selected studies in the last 13 years, in addition to classical studies on the subject, indexed in the database PubMed, LILACS, BVS and SciELO. The body composition was characterized by the amount of bone tissue, muscle and adipose tissue, also including the organs as well as levels of body water. Your knowledge becomes increasingly important in light of the changes that occur in the nutritional status of various types of diseases in frameworks, such as diabetes mellitus, protein energy malnutrition, in cases of obesity and metabolic syndrome. The ability to accurately assess body fat mass especially in children is associated with the importance of effective strategies for prevention and treatment of childhood obesity. Historically, in addition to clinical applications, measurements of total body water were used to determine body composition in nutritional studies. To the knowledge of the body composition, the body water can be measured and used by the ingestion of a dose of labeled water. The measured isotope enrichment is a function of the amount of body water. The method of deuterium is particularly interesting for the assessment of body composition in children, due to its characteristics of collection and analysis.

Share and Cite:

Bila, W. , Lamounier, J. , Freitas, A. , Silva, V. , Turani, S. and de Oliveira, J. (2013) Stable isotopes and body composition in children: History, fundamentals, and clinical applications. Health, 5, 61-68. doi: 10.4236/health.2013.58A3009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Friend, A., Craig, L. and Turner, S. (2012) The prevalence of metabolic syndrome in children: A systematic review of the literature. Metabolic Syndrome and Related Disorders, 11, 71-80.
[2] Larsen, L.M., Hertel, N.T., Molgaard, C., Christensen, Rd., Husby, S. and Jarbol, D.E. (2012) Prevalence of overweight and obesity in Danish preschool children over a 10-year period: A study of two birth cohorts in general practice. Acta Paediatrica, 101, 201-207. doi:10.1111/j.1651-2227.2011.02551.x
[3] Gardner, K., Bird, J., Canning, P.M., Frizzell, L.M. and Smith, L.M. (2010) Prevalence of overweight, obesity and underweight among 5-year-old children in Saint Lucia by three methods of classification and a comparison with historical rates. Child: Care, Health and Development, 37, 143-149.
[4] Bishwalata, R., Singh, A.B., Singh, A.J., Devi, L.U. and Singh, R.K. (2010) Overweight and obesity among schoolchildren in Manipur, India. The National Medical Journal of India, 23, 263-266.
[5] Fuiano, N., Rapa, A., Monzani, A., Pietrobelli, A., Diddi, G., Limosani, A., et al. (2008) Prevalence and risk factors for overweight and obesity in a population of Italian schoolchildren: A longitudinal study. Journal of Endocrinological investigation, 31, 979-984.
[6] Amin, T.T., Al-Sultan, A.I. and Ali, A. (2008) Overweight and obesity and their relation to dietary habits and sociodemographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia. European Journal of Nutrition, 47, 310-318. doi:10.1007/s00394-008-0727-6
[7] Otero-González, M. and García-Fragoso, L. (2008) Prevalence of overweight and obesity in a group of children between the ages of 2 to 12 years old in Puerto Rico. Puerto Rico Health Sciences Journal, 27, 159-161.
[8] Padula, G. and Salceda, S.A. (2008) Comparison between references of the overweight and obesity prevalence, through the body mass index, in Argentinean children. Archivos latinoamericanos de Nutrición, 58, 330-335.
[9] Khang, Y.H. and Park, M.J. (2011) Trends in obesity among Korean children using four different criteria. International Journal of Pediatric Obesity, 6, 206-214. doi:10.3109/17477166.2010.490270
[10] Lazarou, C., Panagiotakos, D.B., Panayiotou, G. and Malatas, A.L. (2007) Overweight and obesity in preadolescent children and their parents in Cyprus: Prevalence and associated socio-demographic factors—The CYKIDS study. Obesity Reviews, 9, 185-193. doi:10.1111/j.1467-789X.2007.00461.x
[11] Abrantes, M.M., Lamounier, J.A. and Colosimo, E.A. (2003) Prevalência de sobrepeso e obesidade nas regioes Nordeste e Sudeste do brasil. Revista da Associacao Médica Brasileira, 49, 162-166. doi:10.1590/S0104-42302003000200034
[12] Sopher, A.B., Thornton, J.C., Wang, J., Person, R.N., Heymsfield, S.B. and Horlice, M. (2004) Measurement of percentage of body fat in 411 children and adolescents: A comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics, 113, 1285-1290. doi:10.1542/peds.113.5.1285
[13] Robothan, D.R., Schoeller, D.A., Mercado, A.B., Mirch, M.C., Theim, K.R., Reynolds, J.C., et al. (2006) Estimates of body fat in children by hologic QDR-2000 and QDR 4500A dual-energy X-ray absorptiometers compared with deuterium dilution. Journal of Pediatric Gastroenterology and Nutrition, 42, 331-335. doi:10.1097/01.mpg.0000189373.31697.15
[14] Wells, J.C.K. and Fewtrell, M. S. (2006) Measuring body composition. Archive of Diseases of Childhood, 91, 612-617. doi:10.1136/adc.2005.085522
[15] IAEA. (1996) Targeting malnutrition: Isotopic tools for evaluating nutrition worldwide. International Atomic Energy Agency, Viena.
[16] Schloerb, P.R., Friis-Hansen, B.J., Edelman, I.S., Solomon, A.K. and Moore, F.D. (1950) The Measurement of total Body water in the human subject by deuterium oxide diluition: With a consideration of the dynamics of deuterium distribution. The Journal of Clinical Investigation, 20, 1296-1310. doi:10.1172/JCI102366
[17] Moore, F.D. (1946) Determination of total body water and solids with isotopes. Science, 104, 157-160. doi:10.1126/science.104.2694.157
[18] Jennings, G., Bluck, L., Wright, A. and Eilia, M. (1999) The use of infrared spectrophotometry for measuring body water spaces. Clinical Chemistry, 45, 1077-1081.
[19] Wells, J.C., Fuller, N.J., Dewit, O., Fewtrell, M.S., Elia, M. and Cole, T.J. (1999) Four-component model of body composition in children: Density and hydration of fat free mass and comparison with simpler models. American Journal of Clinical Nutrition, 69, 904-912.
[20] Fuller, N.J., Jebb, S.A., Laskey, M.A., Coward, W.A. and Elia, M. (1992) Four component model for the assessment of body composition in humans: Comparison with alternative methods and evaluation of the density and hydration of fat-free mass. Clinical Science, 82, 687-693.
[21] Fusch, C. and Moeller, H. (1988) Measurement of D2O concentrations at tracer levels in small samples obtained from paediatric patients. Journal of clinical chemistry and clinical biochemistry, 26, 715-721.
[22] Koletzko, B., Demmelmaira, H., Hartlb, W., Kindermann, A., Koletzko, S., Sauerwald, T., et al. (1998) The use of stable isotope techniques for nutritional and metabolic research in paediatrics. Early Human Development, 53, S77-S97. doi:10.1016/S0378-3782(98)00067-X
[23] Gigante, D.P., Santos, I.S., Coitinho, D.C., Valle, N.C.J., Haisma, H. and Valente, G.C.M. (2002) Avaliacao do impacto do Programa Nacional do Leite em Alagoas, através de métodos isotópicos: Aspectos metodológicos e resultados preliminares. Revista Brasileira de Epidemiologia, 5, 63-70.
[24] Barbour, H.G. (1937) The basis of the Pharmacological action of heavy water in mammals. Yale Journal of Biology and Medicine, 9, 551-565.
[25] Schoeller, D.A., Van Santen, E., Peterson, D.W., Dietz, W., Jaspan, J. and Klein, P.D. (1980) Total body water measurement in humans with 180 and 2H labeled water. The American Journal of Clinical Nutrition, 33, 2686-2693.
[26] Klein, P.D. and Klein, E.R. (1986) Stable isotopes: Origins and safety. The Journal of Clinical pharmacology, 26, 378-382. doi:10.1002/j.1552-4604.1986.tb03544.x
[27] Trabulsi, J., Troiano, R.P., Subar, A.F., Sharbaugh, C., Kipnis, V., Schattzkin, A., et al. (2003) Precision of the doubly labeled water method in a large-scale application: Evaluation of a streamlined-dosing protocol in the observing protein and energy nutrition (OPEN) study. European Journal of Clinical Nutrition, 57, 1370-1377. doi:10.1038/sj.ejcn.1601698
[28] Amarose, A.P. and Czajka, D.M. (1962) Cytopathic effects of deuterium oxide on the male gonads of the mouse and dog. Experimental Cell Research, 26, 43-61. doi:10.1016/0014-4827(62)90201-X
[29] Hughes, A.M., Bennet, E.L. and Calvin, M. (1959) Production of sterility in mice by deuterium oxide. Proceedings of the National Academy of sciences of the United States of America, 45, 581-586. doi:10.1073/pnas.45.4.581
[30] Oakberg, E.F. and Hughes, A.M. (1968) Deuterium oxide effect on spermatogenesis in the mouse. Experimental Cell Research, 50, 306-314. doi:10.1016/0014-4827(68)90449-7
[31] Murphy, J., Desaive, C., Giaretti, W., Kendall, F. and Nicoline, C. (1977) Experimental results on mammalian cells growing in vitro in deuterated medium for neutronscattering studies. Journal of Cell Science, 25, 87-94.
[32] Jones, P.J. and Leatherdale, S.T. (1991) Stable isotopes in clinical research: Safety reaffirmed. Clinical Science, 80, 277-280.
[33] Culebras, J.M. and Moore, F.D. (1977) Total body water and the exchangeable hydrogen. Theoretical calculation of nonaqueous exchangeable hydrogen in man. American Journal of Physiology, 232, R54-R59.
[34] Anbar, M. and Lewitus, Z. (1958) Rate of body-water distribution studied with triple labelled water. Nature, 181, 344. doi:10.1038/181344a0
[35] Schoeller, D.A. (1983) Energy expenditure from doubly labeled water: some fundamental considerations in humans. The American Journal of Clinical Nutrition, 38, 999-1005.
[36] Schoeller, D.A., Taylor, P. and Shay, K. (1995) Analytical requirements for the doubly labeled water method. Obesity Research, 3, 14-20.
[37] Roberts, S.B., Dietz, W., Sharp, T., Dallal, G.E and Hill, J.O. (1995) Mulitple laboratory comparison of the doubly labeled water technique. Obesity Research, 3, 3-13.
[38] Ritz, P., Johnson, P.G. and Coward, W.A. (1994) Measurements of 2H and 18O in body water: Analytical considerations and physiological implications. British Journal of Nutrition, 72, 3-12. doi:10.1079/BJN19940004
[39] Barbosa-Cortéz, L., Tapia-Rojas, M., López-Aguilar, E., Mejía-Aranguré, J.M. and Rivera-Márquez, H. (2007) Body composition by dilution of deuterium oxide in Mexican children with lymphoma and solid tumors. Nutrition, 23, 739-744. doi:10.1016/j.nut.2007.07.001
[40] Schoeller, D.A., Dietz, W., Van Santen, E. and Klein, D. (1982) Validation of saliva sampling for total body water determination by H218O dilution. The American Journal of Clinical Nutrition, 35, 591-594.
[41] Wabitsch, M., Braun, U., Heinze, E., Muche, R., Mayer, H., Teller, W., et al. (1996) Body composition in 5-18-year-old obese children and adolescents before and after weight reduction as assessed by deuterium dilution and bioelectrical impedance analysis. The American Journal of Clinical Nutrition, 64, 1-6.
[42] Schoeller, D.A., Kushner, R.F. and Taylor, P. (1985) Measurement of total body water: Isotope dilution techniques. In: Roche, A.F., Ed., Body Composition Assessments in Youth and Adult Sixth Ross Conference on Medical Research, Ross Laboratories, Columbus, 124-129.
[43] Racette, S.B., Schoeller, D.A., Luke, A.H., Shay, K., Hnilicka, J. and Kushner, R.F. (1994) Relative dilution spaces of 2H-and 18O-labeled water in humans. American Journal of Physiology, 267, E585-E590.
[44] Hewitt, M.J., Going, S.B., Williams, D.P. and Lohman, T.G. (1993) Hydration of the fat-free body mass in children and adults: Implications for body composition assessment. American Journal of Physiology, 265, E88-E95.
[45] Speakman, J.R. (1995) Estimation of the precision in DLW studies using the two-point methodology. Obesity Research, 3, S31-S40.
[46] Schoeller, D.A. (1999) Recent Advances from Application of Doubly Labeled Water to Measurement of Human Energy Expenditure. The Journal of Nutrition, 129, 1765-1768.
[47] Diouf, A., Gartner, A., Dossou, N.I., Sanon, D.A., Bluck, L., Wright, A., et al. (2009) Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients. The British Journal of Nutrition, 101, 1369-1377. doi:10.1017/S0007114508067640
[48] Chan, C., Mclntyre, C., Smith, D., Spanel, P. and Davies, S.J. (2009) Combining near-subject absolute and relative measures of longitudinal hydration in hemodialysis. Clinical Journal of the American Society of Nephrology, 4, 1791-1798. doi:10.2215/CJN.02510409
[49] Arkouche, W., Fouque, D., Pachiaudi, C., Normand, S., Laville, M., Delawari, E., et al. (1997) Total body water and body composition in chronic peritoneal dialysis patients. Journal of the American Society of Nephrology, 8, 1906-1914.
[50] Chan, C., Smith, D., Spanel, P., McIntyre, C.W. and Davies, S.J. (2008) A non-invasive, on-line deuterium dilution technique for the measurement of total body water in haemodialysis patients. Nephrology, Dialysis, Tranplantation, 23, 2064-2070. doi:10.1093/ndt/gfn045
[51] Strauss, B.J., Gibson, P.R., Stroud, D.B., Borovnicar, D.J., Xiong, D.W. and Keogh, J. (2000) Total body dual X-ray absorptiometry is a good measure of both fat mass and fat-free mass in liver cirrhosis compared to “gold-standard” techniques. Melbourne Liver Group. Annals of the New York Academy of Sciences, 904, 55-62. doi:10.1111/j.1749-6632.2000.tb06421.x
[52] Bedogni, G., Polito, C., Severi, S., Strano, C.G., Manzieri, A.M., Alessio, M., et al. (1996) Altered body water distribution in subjects with juvenile rheumatoid arthritis and its effects on the measurement of water compartments from bioelectric impedance. European Journal of Clinical Nutrition, 50, 335-339.
[53] Medoua, G.N., Sajo Nana, E.C., Ndzana, A.C., Makamto, C.S., Etame, L.S., Rikong, H.A., et al. (2012) Breastfeeding practices of Cameroonian mothers determined by dietary recall since birth and the dose-to-the-mother deuterium-oxide turnover technique. Meternal and Child Nutrition, 8, 330-339.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.