Challenges in body composition assessment using air-displacement plethysmography by BOD POD in pediatric and young adult patients.

Background & Aims: Air-Displacement-Plethysmography (ADP) by BOD POD is widely used for body fat assessment in children. Although validated in healthy subjects, studies about use in pediatric patients are lacking. We evaluated user experience and usability of ADP measurements with the BOD POD system in healthy children and pediatric and young adult patients.
Methods: Using the experiences of seven cohort studies, which included healthy children and patients aged 2-22 years, we retrospectively evaluated the user experience with the User Experience Questionnaire (UEQ) (n = 13) and interviews (n = 7). Technical performance was studied using the quality control data collected by the ADP-system.
Results: From 2016 to 2022, 1606 measurements were scheduled. BOD POD was mostly rated 'user-friendly', with a generally neutral evaluation on all scales of the UEQ. However, questionable reliability and validity of the results were frequently (86%) reported. We found a high technical failure-rate of the device, predominantly in stability (17%) and accuracy of the measurement (12%), especially in the 'pediatric option' for children aged <6 years. Measurement failure-rate was 38%, mostly due to subject's fear or device failure, especially in young and lean children, and in children with physical and/or intellectual disabilities.
Conclusion: We conclude that ADP by BOD POD in children and young adults is non-invasive and user-friendly. However, in specific pediatric populations, BOD POD has several limitations and high (technical) failure-rates, especially in young children with aberrant body composition. We recommend caution when interpreting body composition results of pediatric patients as assessed with BOD POD using the current default settings.
Competing Interests: Conflict of interest The Sophia Pluto study is an investigator-initiated cohort study, for which AHK received an independent research grant (number 120417) by Danone Nutricia Research. LEV's salary (TROMPET study) was supported by funding from the Stichting Vrienden van het Sophia (Erasmus MC Sophia Children’s Hospital, “Sporten voor Sophia” event, grant number B18-01). The ROSA study was supported by Stichting Vrienden van het Sophia (grant number B17-04A) and Stichting the Merel. The BRAVE study was supported by the Sophia Foundation for Scientific Research (SSWO) (Grant numbers: S15-13, S22-65) and an internal Erasmus MV grant of the department of Radiology and Nuclear Medicine of the Erasmus University Medical Center. The BRAVE study is also made possible by financial contribution of the Stichting Vogelgezang, which made it possible to complete the follow-up measurements. The other studies received no specific payments or services from a third party for this research. The sponsors had no role in the study design, collection, analysis or interpretation of the data, the writing of the manuscript or the decision to submit it for publication. The other research groups declare no conflict of interest.
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