Energy expenditure, body composition, and disease risk in children and adolescents.

Recent methodological advances have led to a tremendous improvement in our ability to measure energy expenditure, body composition and fat distribution in children. The availability of new and improved measurement techniques has greatly enhanced the scope of research studies in children. The key findings from the present review are as follows: total energy expenditure in young children is approximately 25% lower than current recommendations for energy intake and revised recommendations are necessary; reduced energy expenditure, however, does not necessarily explain the greater prevalence of obesity in the population as a whole or in sub-groups at greater risk of obesity; qualitative aspects of physical activity (e.g. time, intensity) may be more important than the energy expenditure of physical activity in the regulation of body composition; for body composition assessment, DXA is emerging as a technique which can substantially improve the accuracy and standardization in children; body fat begins to accumulate in the obese; waist:hip ratio or waist circumference are inadequate markers of intra-abdominal adipose tissue in children and adolescents; finally, the early accumulation of fat in the intra-abdominal region is significantly related to the development of adverse health effects, including dyslipidaemia and glucose intolerance.