Body composition in peri-menopausal Colombian women

According to WHO figures in 2016, more than half of the world's population over 18 years of age is overweight or obese (1). In Colombia the picture is similar, according to the National Nutrition Situation Survey of 2015, 56.5% of the adult population is overweight, especially women (59.6%) (2).
Overweight and obesity are important risk factors for high burden diseases in both Latin America and Colombia, such as cardiovascular diseases and cancer (3). Cardiovascular disease is associated with obesity through mechanisms such as endothelial dysfunction, subclinical inflammation and insulin resistance (4-6). Excess body fat is also associated with up to 12 types of cancer (7,8). Among the mechanisms proposed to explain this type of relationship are the stimulation of cell proliferation and the inhibition of apoptosis as a result of the activation of insulin-like growth factor in patients with high insulin concentrations (5,9). The high percentage of body fat, especially abdominal, has also been associated with an increase in estrogen and risk of tumors such as breast and ovarian (9,10).
Given the health implications not only of body mass index but especially of adiposity, in recent years attempts have been made to develop new methods for estimating the percentage of body fat, to detect patients at risk, to prioritize health promotion interventions and to monitor their evolution (11-13).
There are different methods for estimating the percentage of body fat. Plicometry is one of the best known methods. This method is based on measuring the thickness of body folds at certain points of the body, under the assumption that body fat is distributed equally.
Another way of estimating body composition is impedance measurement, which, through the conductive capacity of the different body structures, identifies the proportion in which the different structures make up the body (14). Impedance measurement equipment sends and receives electrical signals measuring tissue resistance and capacitance at various points. There are two-point equipment (e.g., hand-hand, foot-foot), or more emission and reception points to obtain more precise measurements (14,15). This method is safe, easy to use, relatively inexpensive, and once validated for a given population, valid and accurate in its measurements (14,16).
Several authors consider that currently dual X-ray absorptiometry (DXA) is the gold standard for determining the percentage of body fat(17,18). The DXA uses the transmission through the body of two different levels of energy, which are attenuated during the passage through the tissues according to their density and thickness. DXA has been used in multiple studies as a reference method for the validation of different methods for estimating body composition, demonstrating good correlation with equations based on impedance, plicometry, and anthropometric measurements, specific to each population type and age group (17-19).
The equations used to estimate the percentage of body fat should be population-specific, since the relationship between body measurements and body composition is modified by sex, age and ethnicity (20). Previous studies in Latin American and Colombian populations have shown that the equations commonly used in clinical practice, such as Durning-Womersly or Jackson/Pollock, are valid among Colombian women between 18 and 40 years of age. This is possibly due to the fact that there is a trend towards a greater central fat deposit in Hispanics, blacks and Native Americans than in Caucasians used for the development of the equations(21-23) .
In consideration of the above, it is necessary to propose and validate a method for measuring the percentage of total body fat through demographic data and simple anthropometric measurements such as body mass index, abdominal perimeter or plicometry that will allow adequate estimation of body composition in the Colombian population of interest due to the concomitance of risk factors for non-transmissible diseases of high burden in the population.
Currently, the Universidad del Rosario is leading the study "Determinants of Mammographic Density in Colombian Women - DDM-Colombia" financed by Colciencias through the Call for Projects 807-2018 Call for Science, Technology and Innovation in Health 2018, evaluates, in healthy women who attend breast cancer screening mammography at the Clínica Universitaria Colombia, in the city of Bogotá, the association between mammographic density and individual characteristics, such as: eating habits, lifestyles, anthropometric measurements, body mass index and body fat percentage. As of today (October 18, 2019), 315 women have been recruited and a total of 2,000 participants are expected to be recruited by August 31, 2020. For this reason, the DDM-Colombia study is the ideal platform to develop a model for estimating body fat percentage in our peri-menopausal female population.
References:
1. World Health Organization. Obesity and overweight - Key facts 2018. Disponible en: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
2. Ministerio de Salud y Protección Social. Encuesta Nacional de Situación Nutricional (ENSIN) 2015. Disponible en: https://www.minsalud.gov.co/salud/publica/epidemiologia/Paginas/encuesta-nacional-de-situacion-nutricional-ensin.aspx.
3. World Health Organization. Noncommunicable diseases country profiles 2018.Disponible en: https://www.who.int/nmh/publications/ncd-profiles-2018/en/.
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8. Barberio AM, Alareeki A, Viner B, Pader J, Vena JE, Arora P, et al. Central body fatness is a stronger predictor of cancer risk than overall body size. Nat Commun. 2019 22;10(1):383.
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10. Lennon H, Sperrin M, Badrick E, Renehan AG. The Obesity Paradox in Cancer: a Review. Curr Oncol Rep. 2016;18(9):56.
11. Andreoli A, Garaci F, Cafarelli FP, Guglielmi G. Body composition in clinical practice. Eur J Radiol. 2016 Aug;85(8):1461–8.
12. Thibault R, Genton L, Pichard C. Body composition: why, when and for who? Clin Nutr Edinb Scotl. 2012 Aug;31(4):435–47.
13. Mill-Ferreyra E, Cameno-Carrillo V, Saúl-Gordo H, Camí-Lavado MC. Estimación del porcentaje de grasa corporal en función del índice de masa corporal y perímetro abdominal: fórmula Palafolls. Med Fam SEMERGEN. 2019 Mar 1;45(2):101–8.
14. Kuriyan R. Body composition techniques. Indian J Med Res. 2018 Nov;148(5):648–58.
15. Gonzalez MC, Orlandi SP, Santos LP, Barros AJD. Body composition using bioelectrical impedance: Development and validation of a predictive equation for fat-free mass in a middle-income country. Clin Nutr Edinb Scotl. 2019 Oct;38(5):2175–9.
16. Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging Clin Exp Res. 2017 Aug;29(4):591–7.
17. Achamrah N, Colange G, Delay J, Rimbert A, Folope V, Petit A, et al. Comparison of body composition assessment by DXA and BIA according to the body mass index: A retrospective study on 3655 measures. PloS One. 2018;13(7):e0200465.
18. Grzegorczyk J, Woloszyn N, Perenc L. Comparison of selected body composition parameters in women using DXA and anthropometric method. J Res Med Sci Off J Isfahan Univ Med Sci. 2019;24:70.
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20. Deurenberg P, Deurenberg-Yap M. Validity of body composition methods across ethnic population groups. Forum Nutr. 2003;56:299–301.
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22. Rivera JCA, Calle MTR. Validez de la bioimpedancia para estimar la composición corporal de mujeres entre los 18 y 40 años. Perspect En Nutr Humana. 2014 Aug 11;16(1):51–60.
23. Silva DRP, Ribeiro AS, Pavão FH, Ronque ERV, Avelar A, Silva AM, et al. Validity of the methods to assess body fat in children and adolescents using multi-compartment models as the reference method: a systematic review. Rev Assoc Médica Bras. 2013 Oct;59(5):475–86.

The development of the present research protocol has contributed from its design to the strengthening of the knowledge and the research capacities of the members of the research seedbed such as the development of the research idea and the problem to be solved, the formulation of the research question, the setting of objectives leading to the resolution of the question and the design of an adequate methodology to reach the proposed objectives
Its execution will allow the development of research capacities from the process of learning to learn, since the students of the seedbed will be active and linked in different moments of the research process:
- Recruitment of research subjects based on defined inclusion criteria.
- Carrying out the informed consent process as a fundamental step for the execution of research processes with scientific integrity, with respect for the individual and his/her autonomy.
- Data collection for the project that implies the use of different measurement methods which must be subject to standardization processes for their reproducibility.
- Interdisciplinary work with students of rehabilitation sciences who will contribute to the standardization of methods for measuring skin folds.
- Analysis of the data that will require the use of statistical tools to describe the characteristics of the population studied, as well as comparing the data obtained to make inferences regarding them.
- Writing and publication of a research product where all the steps mentioned above will be integrated, articulated with the development of written communication skills for the transmission of scientific knowledge.
- Presentation of the research results in a national or international congress.