133 Body composition measurement methods in preterm infants 7 Introduction It is becoming more evident that preterm birth increases the incidence of risk factors for cardiovascular disease in early as well as later life. Preterm birth is associated with a higher percentage of body fat, higher blood pressure, and an increased risk of dysglycemia from infancy into adulthood.1-6 Furthermore, preterm birth has been associated with an increased risk of ischemic heart disease in adulthood.7 Therefore, it is of utmost importance to identify proper screening tools to identify risk factors for cardiovascular disease at an early age and implement preventive measures accordingly. As body fat percentage and fat mass index have been shown to positively correlate with the occurrence of metabolic syndrome components 8,9, monitoring body composition during early life could help to implement timely preventive measures. To gain more insight into which methods should be used to monitor body composition in early life in preterm infants, this systematic review will assess validation studies in preterm infants from birth up to 6 months corrected age. Several methods to assess body composition are available - ranging from inexpensive, bedside techniques, such as skinfold thickness (SFT) measurement to expensive and bulky equipment, like air displacement plethysmography (ADP). 10,11 Currently, ADP and dual energy x-ray absorptiometry (DXA) are frequently used in research settings and are considered as reliable methods. 12 Nevertheless, these methods are not widely implemented in clinical practice. Furthermore, there is no consensus on which method should preferentially be used to assess body composition in preterm infants. This systematic review aims to determine the validity of different methods used to measure body composition in preterm infants and to show whether validated methods yield comparable results. Methods This systematic review primarily assessed the accuracy of various methods used to measure or estimate body composition in infants born preterm. A systematic literature reviewwas conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-statement (www. prisma-statement.org). The review was registered and the protocol was published on PROSPERO International prospective register of systematic reviews under ID CRD42018107821. Searches were performed in PubMed, Embase.com, and Wiley/ Cochrane Library from inception (1809) up to 29 September 2020 by D.F.J.Y. and J.C.F.K. The search included keywords and free-text terms for ‘premature’ and ‘body composition’ or ‘adiposity’ or ‘lean’. Animal studies, conference papers and editorial letters were excluded. No language or publication date restrictions were applied. The full search strategies can be found in table 1.
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