Influence of the Basal Metabolic Profile on the Evolution of the Pediatric Patient with Obesity

Research Article

Austin J Obes & Metab Synd. 2021; 5(1): 1024.

Influence of the Basal Metabolic Profile on the Evolution of the Pediatric Patient with Obesity

Fernández Fernandez B, Sarasua Miranda, Lorente Blazquez I and Diez López ID*

Department of Pediatric Endocrinology, Araba University Hospital-Txagorritxu, Spain

*Corresponding author: Diez López ID, Department of Pediatric Endocrinology, Araba University Hospital- Txagorritxu, Bioaraba Health Research Institute, 01009 Vitoria-Gasteiz, Spain

Received: April 22, 2021; Accepted: May 19, 2021; Published: May 26, 2021


Purpose: To study how basal metabolism influences the somatometric evolution of the child and adolescent population with obesity in a pediatric endocrinology clinic.

Material and Methods: Study of the entire population diagnosed with childhood obesity in a tertiary hospital by means of a multichannel impedanceometry study, TANITA BF 430.

Results: 100 patients were selected by chance and studied from a database with 1400 records. Most of the patients who attend to these consultations for obesity are girls, between 8 and 11 years old. All the patients studied had a basal metabolism lower than the calculated theoretical ideal. The group of boys at the beginning of their follow-up showed a higher basal metabolism and more similar than the group of girls. Girls had a higher amount of fat mass compared to boys at the beginning of their follow up. After their first year of follow-up, both groups achieved a decrease in the percentage of fat mass, double in the case of boys compared to girls. After three years of the study, it was observed that 54% of the boys achieved a reduction in their FM compared to 36% of the girls.

In overall terms, weight reduction is not achieved in this pediatric population. However it is observed a decrease in fat content in the medium term (1-3 years). The reduction of this fat mass could be a protection factor against cardiovascular diseases in adults. Given the same adherence to nutritional programs, it is believed that physical exercise rates influence this reduction. It was also observed that the most relevant data in the evolution of obesity in these patients is the basal metabolism that they present at the beginning of their follow-up.

Discussion: Childhood obesity is a problem of increasing importance in our society. Understanding its characteristics would allow different strategies to be taken for a better treatment and diagnosis of these cases. Boys, in general, achieve a greater reduction in fat mass in the same follow-up time. Due to sexual dimorphism, or a higher rate of physical activity.

Bioelectrical impedanceometry measurement is a simple, cheap and easy to use method in clinical practice to evaluate the energy consumption and the body composition of the patient. In “healthy child” health programs and even in schools, an impedanceometry machine could be purchased to focus physical activity efforts on those boys and girls with a lower basal metabolism, adding a greater consumption factor such as physical exercise. Thus, it would be possible to increase the requirements and the basal metabolism of the patient would increase, favoring the loss of fat mass.

Regarding the use of conventional scales, in this type of patients, if we only look at the weight variable, a bias could be created since it would not be noticed that there has been a decrease in fat content at the cost of an increase in muscle mass.

Conclusion: We consider that it should be recommendable to supply with a multichannel impedanceometry every pediatric endocrine consultation room as it is a non-invasive, and easy-to-use test that can provide a great amount of information about the evolution of these patients, since we believe that focusing efforts on those boys and girls who have a worse basal metabolism could contribute to improving the efficiency and effectiveness of the scarce health resources that we have.

Keywords: Body mass index; TBW


Obesity, in adults and in childhood, is one of the most serious public health problems of the 21st century. The World Health Organization (WHO) describes it as an epidemic since it generally affects all countries.

In 2016, more than 41 million children under the age of five were overweight or obese [1]. That same year, according to UNICEF, the prevalence in children and adolescents between the ages of 5 and 19 was approximately 124 million with obesity and 216 million with overweight [2]. In pediatric age, obesity is already the chronic non-communicable disease and the most frequent nutritional and metabolic disorder [3].

The importance resides in the association of obesity with important health problems and the development of serious noncommunicable diseases, such as cardiovascular diseases, high blood pressure, type 2 diabetes mellitus and some types of cancer, which increases social and health costs considerably.

It is suspected that the presence of common causal factors could explain the global nature of this problem. Among other theories arises that of the Thrifty Genotype [4,5], whose hypothesis maintains that, due to the way of life of primitive man, the human genome developed a tendency to create energy reserve tissues for periods of famine based on fats since they provide more calories in less volume. This type of genes in a current way of life, characterized by food in abundance, cheap and with high fat contents, and the tendency to sedentary lifestyle of the population, would be responsible for the aforementioned global epidemic of the 21st century: obesity [6-8]. In developing countries, the prevalence of obesity and overweight in preschool children exceeds 30%, which represents a significant risk for them to become adults with metabolic syndrome and obesity [1].

Obesity is defined as an excess of body fat, the result of a positive energy balance persisting over a long period of time [9]. This situation in childhood develops different types of complications [10]. At first, problems such as flat feet, insulin resistance, increase in androgens, increase in cholesterol, LDL (Low-Density Lipoproteins) and triglycerides, as well as pulmonary, menstrual, type 2 diabetes and psychological disorders, such as deteriorated self-image.

After the first two or four years of the onset of obesity, obese children increase the risk of high blood pressure, hypercholesterolemia, increase in LDL, and decrease in HDL (High-Density Lipoprotein). If this situation persists, the presence of an increase in coronary diseases, vascular hypertension, vascular kidney disease, atherosclerosis, arthritis and certain neoplasias is added in adulthood, which are those that increase morbidity and explain mortality in adult life. Furthermore, obesity in pediatric age is related to other comorbidities such as: sleep apnea, nonalcoholic steatohepatitis, cholelithiasis, pseudotumor cerebri, gastrointestinal reflux and polycystic ovary syndrome [10].

A simple tool to assess this problem is the Body Mass Index (BMI), which represents both fat mass and fat-free mass, so it is an indicator of weight and not of adiposity as such. It is independent of height, allowing the comparison of the body weights of individuals of different heights [10].

Body composition is made up of two major components: Body Fat Mass (BFM) and Lean Body Mass (LBM). Fat mass refers to the fat tissue, lipids that the human body has, while lean mass in turn is divided into three main components: Total Body Water (TBW), mineral content, mainly bones, and protein content like muscles.

In the first year of life there is a significant increase in body fat content, followed by a period of decline that ends between the 4 to 6 years of age, increasing later until the end of adolescence, known as adipose rebound. The earlier the rebound begins, the greater the risk of later obesity [11]. Childhood overweight is established above the 85th percentile of BMI, and obesity above the 95th percentile of BMI [12]. Due to the physiological differences between boys and girls, graphics and percentiles are created for each sex [10,13,14].

In Spain, the ALADINO study has evaluated the prevalence of childhood overweight and obesity every 4 years since 2011. In 2019, a downward trend is observed since 2011 and stable compared to 2015 [15]. Currently in Spain overweight in the child population is 23.3% and obesity 17.3% [15]. Poor eating habits, low physical activity and low socioeconomic status of the family influence these results. A significant percentage of parents mistakenly perceive their children’s overweight or obesity as normal.

The child population with overweight oro bese has, in general, greater weight at birth than thin or normal weight children. By sex, overweight is more prevalent in girls and obesity in boys. In children, the frequency of overweight is higher in those of 9 years and regarding obesity in those of 7, 8 and 9, compared to younger age groups. In girls, there are no age differences in overweight, while obesity increases from 6 to 8 years old [15].

Being thin does not necessarily mean having a lower percentage of body fat than people who are thinner, since the latter can be more muscular. A high percentage of fat tissue increases the risk of developing cardiovascular diseases, diabetes, hypertension and certain types of cancer [16,17]. Accurately assessing the weight of a person is to know the body composition, that is, the amount of lean body mass and fat body mass in their organism. There are different measurement methods, each of them with advantages and disadvantages: [16]

• Octopolar multi-frequency impedance measurement: An electrical current of very low intensity runs through the body, interacts with body water, which has a constant proportion of muscle mass. This data, together with the sex, age and height of the patient, calculates the body muscle mass. Fat mass does not conduct electricity, so it is not directly measured.

• Dual X-ray Absorption (DXA): “Gold standard”. It determines the corresponding weights and percentages of fat, bone and muscle tissue. It allows assessing the specific location of an excess of fat or muscle tissue. It evaluates the distribution of android and gynoid fat and these two data are two of the best predictors of health risks.

• Anthropometry: It consists of measuring skin folds using a “caliper”, different perimeters and diameters. It needs to be measured by an expert. Applying a series of formulas subsequently, the body composition and the somatotype are determined. It reports the magnitude and distribution of subcutaneous fat. However, it only provides regional body fat data, not the deep fat. Also, it is not useful for measuring folds in obese people.

• Image morphological study: it observes subtle changes in body silhouette, volumes and postural habits.

Metabolism represents energy expenditure at a baseline situation without stress. And it is primarily determined by age, sex, size, and body composition. The most used technique for its determination is indirect open-circuit calorimetry; its value can also be estimated using predictive equations. The most used in the pediatric population are those of Schofield and those of the WHO [18].

In 2017, a study led by the Imperial College London and the WHO concluded that the number of children and adolescents (between the ages of 5 and 19) with obesity has multiplied by 10 in the world in the last four decades. It is also indicated that in 2022 there will be more children and adolescents with obesity than children with low weight.

Two articles on body composition in the adolescent [19] and adult [20] population have been found in the literature, but not in the child population. Both highlight the fact that the female population has a higher percentage of body fat mass; and that in overall; the obese population has a lower basal metabolism than estimated, higher in men than in women. In general, in terms of intake, this population falls within the normal limits of the FAO/WHO recommendations; at the same time that they present insufficient total energy expenditure.

Detecting excess weight early and preventing it during childhood is essential to achieve a greater impact on health.

With the aim of finding another explanation for excess weight in childhood, apart from those already mentioned, this work will focus on finding a causal relationship between basal metabolism and excess weight in the child population.


Given the importance of the knowledge and management of obesity due to its relationship with certain comorbidities in the child population, it seems necessary to know if children who attend hospital consultation for childhood obesity referred from primary care have a basal metabolism or caloric intake below what is expected for their age and sex. Assuming that this fact is an associated risk factor for obesity or, on the other hand, its usual treatment is more difficult than usual.


To study how basal metabolism influences the somatometric evolution of the child and adolescent population with obesity in a pediatric endocrinology consultation.

Material and Methods

An anonymized and coded database of a pediatric endocrine clinic in a tertiary hospital was used, which records the body composition of patients by means of impedance measurement at different consultations, up to 3 years of follow-up.

Finally, a sample of 100 people was selected from the database that had 1,400 patients.

Inclusion criteria

• Patients referred from primary care, less than 14 years of age at the time of referral, who present a lack of weight control.

• Minimum age 6 years, due to impedance measurement limitation.

• Minimum longitudinal follow-up 12 months (at least 2 visits).

Deferral criteria

• Patients with syndromic or similar diseases that could justify their overweight or obesity.


The type of patient who mainly attends these consultations is 11-years-old girls (Figure 1 and 2).