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Article

Association between Anthropometric Parameters and Physical Fitness in HIV-Diagnosed Children and Adolescents

by
João Antônio Chula de Castro
1,
Luiz Rodrigo Augustemak de Lima
2 and
Diego Augusto Santos Silva
1,*
1
Graduate Program of Physical Education, Sports Center, Federal University of Santa Catarina, P.O. Box 476, Florianopolis 88040-900, SC, Brazil
2
Institute of Physical Education and Sport, Federal University of Alagoas, Maceio 57072-900, AL, Brazil
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(20), 9217; https://doi.org/10.3390/app14209217
Submission received: 6 September 2024 / Revised: 2 October 2024 / Accepted: 5 October 2024 / Published: 10 October 2024
Versions Notes

Abstract

:
Background: Little is known regarding the association between physical fitness and anthropometric parameters in HIV-diagnosed children and adolescents. Therefore, this study aimed to investigate the association between anthropometric parameters and physical fitness in this population. Methods: A cross-sectional study was conducted with HIV-diagnosed children and adolescents (aged 5–15 years). Body composition was assessed by anthropometric measurements and dual-energy X-ray absorptiometry, cardiorespiratory fitness by peak oxygen consumption (VO2peak), muscle strength/endurance by handgrip strength, standing broad jump, abdominal and modified push-up tests, and flexibility using the sit-to reach test. Linear regression analyses (simple and multiple) were applied to investigate the association between anthropometric parameters and physical fitness. Results: In total, 86 children and adolescents (mean age: 11.44 ± 2.20 years) participated in the study. A significant association was observed between anthropometric parameters, whereby the sum of four skinfolds could explain 69% of the fat mass percentage and 30% of VO2peak; the sum of two bone diameters could explain 70% of fat-free mass, 55% of bone mineral content, and 43% of bone mineral density; calf skinfold and subscapular skinfold tests could explain the distance of standing broad jump, and the number of modified push-ups explained 16% of the standing broad jump and 19% of the modified push-up test results. Conclusions: Adding the measurements of four skinfolds and two bone diameters to a follow-up routine can provide relevant information regarding fat accumulation, bone development, cardiorespiratory fitness, and muscle strength/endurance status in HIV-diagnosed children and adolescents, supporting decision-making and measures for the adequate development of this population.

1. Introduction

Physical fitness investigations in children and adolescents have been led by the identification of alterations in body composition, such as bone development [1,2,3] and fat mass accumulation/distribution [4,5], and to a minor extent the identification of alterations in cardiorespiratory fitness, muscle strength/endurance, and flexibility [6]. As a result, studies that investigated physical fitness in HIV-diagnosed children and adolescents described alterations in fat distribution [4] and increases in body fat [5], low bone development [1,2,3], as well as low muscle strength/endurance, flexibility, and cardiorespiratory fitness when compared to healthy populations [7,8], which can be associated with higher body fat mass [7]. Considering that low physical fitness in childhood and adolescence is related to lower physical fitness and chronical health conditions and mortality in adulthood, there is a need to monitor physical fitness, especially in those who present chronic health conditions in childhood [9,10,11], such as HIV-diagnosed children and adolescents.
Despite the need for its investigation and the recommendations for developing physical fitness for this population [12], body mass and length/height are the primary measurements recommended for use in monitoring growth development and screening for thinness and overweight in HIV-diagnosed children and adolescents through indexes such as body mass index (BMI), weight-to-age ratio, and height-to-age ratio [13,14]. Considering the common use of anthropometric measurements and indexes in studies assessing physical fitness in this population [6], and their applicability for monitoring growth development and weight status [13,14], previous studies have also applied indexes, such as BMI, to investigate their possible association with cardiorespiratory fitness [15,16,17], muscle strength/endurance [17,18], and flexibility [17]. These studies relied on the assumption that BMI can identify increased fat mass in children and adolescents [13,19], and that these increases in fat mass can negatively impact cardiorespiratory fitness, muscle strength/endurance, and flexibility [20,21]. However, increases in BMI can also be positively associated with fat-free mass and muscle strength/endurance [17,22,23,24], given that BMI is not capable of distinguishing if an increase in body size is related to increases in fat mass and/or fat-free mass [22,25], thus limiting its applicability for monitoring muscle strength/endurance. Moreover, when observing the recommendations for monitoring HIV-diagnosed children and adolescents [26,27,28,29] and the results of previous studies that investigated physical fitness [6], there is a lack of standardization regarding which methods and protocols, such as reference values, should be applied for monitoring physical fitness in this population, limiting the comparison between studies and the direction of future research and guidelines [6,20,26,27,28,29].
Regarding the applicability of anthropometric parameters, previous studies showed that different anthropometric parameters, such as skinfolds [30,31] and body circumferences [31], can be used for estimating fat mass, and bone diameters and body circumferences can be used for monitoring the bone parameters [32] of HIV-diagnosed children and adolescents. Moreover, anthropometric parameters have been described as easy-to-use and accessible methods due to their low cost when compared to laboratory tests [33], and they are the main methods applied to investigate physical fitness in HIV-diagnosed children and adolescents [6]. Thus, the addition of anthropometric parameters to a follow-up routine, when it is not possible to carry out a complete assessment of physical fitness, could provide additional information regarding the physical fitness of HIV-diagnosed children and adolescents. However, according to a recent systematic review on the subject [6], little is known regarding the association between different anthropometric parameters and physical fitness indicators, such as muscle strength/endurance, cardiorespiratory fitness, and flexibility, in this population [6]. Thus, the aim of this study was to investigate the association between anthropometric parameters and physical fitness components in HIV-diagnosed children and adolescents.

2. Materials and Methods

2.1. Sample and Participants’ Characteristics

Data from HIV-diagnosed children and adolescent (aged 5–15 years) participants in two research protocols (previously described elsewhere [17]) were obtained to perform a cross-sectional study.
Participants’ age and sex were obtained through questionnaires. Pubertal stage was self-assessed by use of figures describing secondary sexual characteristics of development, as previously defined by Tanner [34]. Participants’ medical records were assessed to obtain the following HIV infection parameters: ART use and scheme, viral load, and CD4 and CD8 T lymphocyte counts. ART use and scheme were classified as: without ART, ART with a protease inhibitor, and ART without a protease inhibitor. Participants’ viral load and immunosuppression status were classified following the Center for Disease Control (CDC) parameters: (I) viral load ≤ 20 copies/mL or ≤40 copies/mL = target not detected or lower than detectable limit, and viral load > 40 to <1000 copies/mL = detectable and viral load > 1000 copies/mL = detectable > 1000; and (II) CD4 cell count > 500 cell mm−3 = %CD4 > 25% (non-immunosuppressed), CD4 cell count 200–499 cell mm−3 = %CD4 15 > 25% (moderate immunosuppression), and CD4 cell count < 200 cell mm−3 = %CD4 < 15% (severe immunosuppression) [35].
Considering that physical activity level could moderate the relationship between anthropometric parameters and different physical fitness components by promoting improvements in components such as body composition [20,21], the physical activity level was investigated by use of the Physical Activity Questionnaire for Older Children (PAQ-C) [36], Portuguese version [37]. The PAQ-C assesses physical activity through different items related to daily activities in the contexts of sport, leisure and school activities. The participants’ answers are scored, summed and averaged to obtain the final PAQ-C score and to estimate the participants’ physical activity level [36]. The method was previously described as presenting adequate reliability (inter-class correlation coefficients of 0.75 and 0.82 for male and female youth, respectively) [38] and has been previously validated for use in HIV-diagnosed children and adolescents [39].

2.2. Anthropometric Parameters

Height and body mass were assessed using a stadiometer with a resolution of 0.1 mm (AlturaExata®, Belo Horizonte, Brazil) and a digital scale with a resolution of 0.01 kg (Tanita® BF683W, Arlington Heights, IL, USA). Participants were instructed to wear light clothing and be barefoot during the test. BMI was calculated using a body mass and height ratio (BMI = body mass/height2) and z-scores were applied to investigate the participants’ weight status, their height-for-age and their weight-for-age. BMI was classified using the World Health Organization (WHO) growth charts [13,14].
The circumferences of the hip, waist and mid-upper arm were measured with an anthropometric tape of 0.1 cm resolution (Sanny®, Sao Paulo, Brazil). Hip and waist circumferences were used to calculate the waist-to-hip ratio (waist-to-hip ratio = waist circumference [cm]/hip circumference [cm]), and height and waist circumferences were used to calculate the waist-to-height ratio (waist-to-height ratio = waist circumference [cm]/height [cm]). The triceps and the subscapular, abdominal and calf skinfold were measured with a 0.01 mm-resolution caliper (Cescorf®, Porto Alegre, Brazil), and the sum of skinfolds was calculated using the values obtained for the four measured skinfolds (sum of four skinfolds = abdominal skinfold [mm] + triceps skinfold [mm] + subscapular skinfold [mm] + calf skinfold [mm]). Bone diameters, humeral and femoral, were measured with a 0.1 mm-resolution digital caliper (Digimess®, Sao Paulo, Brazil), and the sum of diameters was calculated using the two measured diameters (sum of diameters = humeral diameter [cm] + femoral diameter [cm]) (Supplementary Table S1). The choice of anthropometric parameters involved the consideration of previous studies that investigated the following: (1) the association between anthropometric parameters and health parameters in HIV-diagnosed children and adolescents [40,41,42,43] as well as their association with alterations in body composition [44,45]; (2) the validity of equations used for estimating body fat [30] and bone parameters [32] in this population. For quality control, all anthropometric evaluations were carried out in accordance with the recommendations of the International Society for the Advancement of Kinanthropometry (ISAK) [46] by ISAK-certified evaluators. Inter-evaluator and intra-evaluator technical errors of measurement were estimated at 0.33% and 0.23%, respectively. These estimates were calculated for waist circumference measurements in a population of a similar age range to that of the present study.

2.3. Physical Fitness Components

Physical fitness was investigated using the following: body composition components (fat mass, fat mass percentage, fat-free mass, bone mineral content [BMC] and bone mineral density [BMD])—assessed by dual energy X-ray absorptiometry (DXA), cardiorespiratory fitness (inferred from peak oxygen consumption [VO2peak])—assessed by breath-by-breath respiratory exchange evaluation in an incremental cycle ergometer test, muscle strength/endurance—assessed by handgrip strength, standing broad jump, abdominal endurance and a modified push-up test, and flexibility—assessed using the sit-to reach test. The equipment and protocols applied in this study to assess the physical fitness parameters have previously been described elsewhere [17], and detailed descriptions of them as well as the methods used [47,48,49] can be found in the Supplementary Materials (Supplementary Table S1).

2.4. Statistical Analysis

In the descriptive analysis, mean and standard deviation have been used to present continuous variables, and frequencies and percentages have been used to present categorical variables. Histograms, scatter plots and the Shapiro–Wilk test were used to evaluate data distribution [50]. Sex-(female and male) and group (participants from study I and participants from study II)-related differences were investigated using the t-test for independent samples for normally distributed continuous data; the Mann–Whitney U Ranked Sum test was used for non-normally distributed continuous data, and the Pearson’s chi-squared test was used for categorical data.
The associations between anthropometric parameters (independent variables) and physical fitness (dependent variable) were investigated using the Spearman correlation tests, graphical analyses and linear regression analyses (simple and multiple). Considering the possible significant differences between participants from studies I and II, as well as the previously established direct associations between confounding variables (sex, age, pubertal stage and physical activity level) and anthropometric parameters and physical fitness components [6,14,19,20,21,25,51,52], the variables group (study I or II), sex, age, pubertal stage and physical activity level were included in the full models, and their significances were evaluated via model adjustments through backwards selection. To avoid multicollinearity and model overfitting, independent variables that were highly correlated with each other (correlation coefficient ≥ 0.75) were not included in the same model. Variables whose inclusion resulted in a Variance Inflation Factor (VIF) > 5 [53] were also not included. Furthermore, variables without statistical significance were removed from the models so as to preclude models without statistical significance [53]. To evaluate the selected models, values of significance (p-value < 0.05), standard errors of estimates, Akaike’s Inflation Criteria (AIC) and Bayesian Information Criterion (BIC), as well as a residual normality analysis (through Shapiro–Wilk test), were used. All the statistical analyses were performed using R© 4.2.1 software and the appropriate packages (The R Foundation for Statistical Computing, Vienna, Austria). Missing data were not included in the statistical analysis.
The software G*Power version 3.1.9.7 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) was used to calculate the power of our sample size using exact linear multiple regression (random model) and a posteriori parameters (1 for tails, 0 for H0 ρ2, 0.05 for “α err prob”), resulting in a power (1 − β err prob.) of 0.999 for the calculated H1 ρ2 of 0.31 (from an observed R2 of 0.31, 83 participants and 1 or 4 predictors) [54,55].

3. Results

3.1. Participants’ Characteristics

The sample consisted of a total of 86 children and adolescents (study I, n = 65; study II, n = 21) who met the inclusion criteria. Participants from study I, when compared to participants from study II, presented higher BMC, BMD and VO2peak values, while participants form study II presented higher values of BMI z-score, fat mass percentage, abdominal endurance, subscapular skinfold, abdominal skinfold and sum of four skinfolds, as well as a higher CD4/CD8 ratio. When compared to male participants, female participants presented higher fat mass values and higher fat mass percentages, higher values for triceps and subscapular, abdominal, calf and sum of four skinfolds, and a higher CD4/CD8 ratio, while male participants presented higher values for VO2peak, distance of standing broad jump, waist-to-hip ratio, physical activity level and CD8 cell count (Table 1 and Supplementary Table S2). Regarding the categorical variables, study I presented a higher number of participants with detectable viral load, as well as a higher number of participants treated with ART with protease inhibitors or not receiving ART. Comparing female and male participants, a higher number of participants in pubertal stage 3 was observed for females, whereas a higher number of participants in pubertal stage 4 was observed for males. For all other pubertal stages, numbers were similar between sexes (Supplementary Table S2).

3.2. Association between Anthropometric Parameters and Physical Fitness

Anthropometric parameters (body circumferences, ratios, skinfolds and bone diameters) were significantly correlated with body composition, cardiorespiratory fitness and muscle strength/endurance. However, there were no significant correlations between anthropometric parameters and flexibility or between anthropometric parameters and the distance values obtained in the standing broad jump test (Table 2).
In simple linear regression, significant associations were observed between fat mass percentage and VO2peak values and the following predictor variables: sum of four skinfolds, subscapular skinfold, waist circumference and waist-to-height ratio. Anthropometric parameters could explain 33% to 69% of the fat mass percentage and 7% to 30% of the VO2peak values, and these were associated with an increase in fat mass percentage and a decrease in VO2peak values. The associations observed in the simple linear regressions were sustained in the multilinear regression analysis in which the models were shown to explain 52% to 73% of fat mass percentage and 35% to 41% of VO2peak values (Table 3 and Table 4).
The results of simple linear regression also indicate that the diameters of the humeral and femoral bones, as well as the sum of diameters, could explain 66% to 70% of fat-free mass values, 53% to 55% of BMC, 41% to 43% of BMD, and 39% to 43% of handgrip strength values. Increases in the anthropometric parameters were associated with an increase in fat-free mass, BMC, BMD and handgrip strength. However, in the multilinear regression analysis, humeral diameter, femoral diameter, and the sum of diameters were only associated with fat-free mass values and BMC, with models explaining 81% to 87% of fat-free mass values and 73% to 79% of BMC. Humeral diameter and the sum of diameters also explained 63% to 67% of BMD variance, but there were no significant associations between the bone diameters and handgrip strength values (Table 3 and Table 4).
The results of simple linear regression also indicate that calf skinfold values could explain 16% of the distance values obtained in the stand broad jump test, with increases in calf skinfold values associated with a decrease in the distance values. This association was also observed in the multilinear regression analysis, in which the model could explain 50% of the distance value obtained in the standing broad jump test (Table 3 and Table 4).
Additionally, in the results of the simple linear regression, the sum of four skinfolds and the subscapular skinfold value explained 17% to 19% of the number of modified push-ups, with increases in the anthropometric parameters associated with a decrease in the number of modified push-ups. However, in the multilinear regression analysis, a significant association was only observed between subscapular skinfold value and the number of modified push-ups, with the model explaining 28% of the number of modified push-ups (Table 3 and Table 4). No significant associations were observed between anthropometric parameters and flexibility (Table 3 and Table 4).
All models were adjusted initially by group (study I and II), sex, age, pubertal stage and physical activity level. However, the pubertal stage was highly correlated with the variable sex (rho > 0.75), and the physical activity level did not present significance in any of the models. Thus, those variables were not included in the adjusted models in order to avoid overfitted models, as well as non-significant models.

4. Discussion

This study aimed to investigate the association between anthropometric and physical fitness parameters, and its main finding was the evidence of a direct association of anthropometric parameters with our physical fitness parameters (body composition, cardiorespiratory fitness, and muscle strength/resistance) in HIV-diagnosed children and adolescents.
Previous studies that investigated the association between anthropometric parameters and fat mass in HIV-diagnosed children and adolescents described significant associations between skinfolds, body circumferences, indexes such as BMI, and body fat parameters such as fat mass percentage [17,30,31]. Additionally, those studies described the utility of skinfolds, body circumferences and indexes to discriminate fat mass in this population [17,30,31]. Thus, significant associations between anthropometric parameters and fat mass percentage were expected. Considering the utility of anthropometric parameters to discriminate fat mass, and given that high fat mass can negatively impact physical fitness parameters such as cardiorespiratory fitness [20,21], we hypothesized that anthropometric parameters that were significantly associated with fat mass would be negatively associated with cardiorespiratory fitness. The results of the present study corroborate this hypothesis, indicating that increases in the sum of four skinfolds, subscapular skinfold, waist circumference and waist-to-height ratio are significantly associated with increased fat mass percentage, and significantly associated with decreased VO2peak, thus showing that anthropometric parameters can be applied for monitoring fat mass and cardiorespiratory fitness in HIV-diagnosed children and adolescents. Furthermore, considering that HIV-diagnosed children and adolescents can present alterations in fat mass distribution/accumulation [4,5] as well as a low cardiorespiratory fitness [7,8], and that there is a need to monitor physical fitness in this population, including the measurement of four skinfolds and waist circumference in a follow-up routine can provide relevant information for monitoring fat mass percentage and cardiorespiratory fitness in this population.
The investigation of the association between anthropometric parameters and fat-free mass, BMC and BMD was based on the results of a previous study that investigated the usability of anthropometric parameters, such as bone diameters, for monitoring bone parameters in HIV-diagnosed children and adolescents [32]. It was also based on the assumption that there is an association between bone development and fat-free mass, considering that improvements in bone structure through the recruitment of mineral cells are related to the mechanical load applied to bones, which in turn depends on the capacity of muscle force production [56]. Considering this relationship between muscle force production and bone development [56], it was hypothesized that bone diameters could also be associated with muscle strength/endurance. However, while humeral diameter, femoral diameter and the sum of diameters were significantly associated with fat-free mass, BMC and BMD, a significant association with handgrip strength was only observed in the simple linear regression, and was not sustained in the multilinear regression analysis. Thus, the results from the present study only support the assumption that bone diameters can be used in monitoring fat-free mass, BMC and BMD in HIV-diagnosed children and adolescents.
Regarding muscle strength/endurance, a previous study with HIV-diagnosed children and adolescents investigated the relationship between BMI and muscle strength/endurance, reporting that BMI was significantly associated with handgrip strength but not significantly associated with values from the standing broad jump test, abdominal endurance, or the number of modified push-ups [17]. The authors argued that BMI was associated with handgrip strength because increases in BMI can be related to increases in fat-free mass [22,25] positively affecting isometric tests [23,24], and suggested that variables such as age, sex and fat mass percentage could be more useful than BMI in investigating muscle strength/endurance [17]. In addition, previous studies described how fat mass could negatively affect muscle strength/endurance, which is often measured using tests that involve body movement, such as the standing broad jump, the abdominal endurance, and the modified push-ups test [23,24]. Thus, we hypothesized that anthropometric parameters that were significantly associated with fat mass could negatively affect the standing broad jump, abdominal endurance, and modified push-ups results. The results from the present study corroborate this hypothesis, indicating that increased values for calf skinfold were associated with decreased distance values in the standing broad jump test. Additionally, increased values for subscapular skinfold were associated with a decreased number of modified push-ups, suggesting that anthropometric parameters can be applied for monitoring muscle strength/endurance in HIV-diagnosed children and adolescents, specifically for parameters involving body movement.
Concerning flexibility, little is known regarding its associations with anthropometric parameters in HIV-diagnosed children and adolescents due to a lack of studies [6]. Previous studies comparing HIV-diagnosed children and adolescents with their healthy peers described low flexibility for HIV-diagnosed children and adolescents, but did not investigate the associations between flexibility and anthropometric parameters [7,8,42]. Flexibility has been described as the range of motion of muscle and connective tissues at a joint or at a group of joints, which, given its complexity, should be investigated in combination with other musculoskeletal variables [57]. Some studies indicate that increased fat mass, specially central body fat mass, can negatively impact flexibility [20,21]. Thus, we hypothesized that anthropometric parameters that were significantly associated with fat mass accumulation could also be significantly associated with flexibility in HIV-diagnosed children and adolescents. However, no significant associations were observed between anthropometric parameters and flexibility in the present study. These results suggest that central body fat accumulation did not significantly affect flexibility in this population. However, considering a previous study that described a significant positive association between flexibility and distance values in the standing broad jump test [17], the low flexibility for HIV-diagnosed children and adolescents when compared to their healthy peers, and the lack of studies that investigated the associations between flexibility and anthropometric parameters in this population, there is a need to investigate and monitor flexibility in HIV-diagnosed children and adolescents.
Despite the relevant results discussed above, some limitations of this study should be considered, such as the cross-sectional design of the study, which limits the possibility of making causal inferences from the results, and the sample heterogeneity in relation to the viral load and immunosuppression status, where 82.7% of the sample were non-immunosuppressed participants and 74.4% presented undetectable viral loads. Furthermore, there was no significant association between the physical activity level and physical fitness parameters, an expected association considering that physical activity could promote improvements in physical fitness [20,21]. These results suggest that the physical activity level of this population could be insufficient to result in significant improvements in physical fitness, thus not acting as a moderator variable for the associations between anthropometric parameters and physical fitness [20,21].

5. Conclusions

The construction of the present study was based on the hypothesis that anthropometric parameters could be applied for monitoring the physical fitness in HIV-diagnosed children and adolescents. The study results support this hypothesis, showing that anthropometric parameters can be used to monitor body composition (fat mass percentage, fat-free mass, BMC and BMD), cardiorespiratory fitness and muscle strength/endurance. Particularly, adding the measurement of four skinfolds (subscapular, abdominal, triceps and calf skinfold) and two bone diameters (humeral and femoral diameter) to a follow-up routine can provide relevant information regarding fat accumulation, bone development, cardiorespiratory fitness and muscle strength/endurance status in HIV-diagnosed children and adolescents, supporting decision-making and initiatives for the adequate development of this population.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app14209217/s1, Table S1: Investigated anthropometric parameters and physical fitness components; Table S2: Study participants’ characteristics.

Author Contributions

Conceptualization, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; methodology, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; formal analysis, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; writing—original draft preparation, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; writing—review and editing, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; visualization, J.A.C.d.C., L.R.A.d.L. and D.A.S.S.; supervision, D.A.S.S. All authors have read and agreed to the published version of the manuscript.

Funding

D.A.S.S. is supported by the National Council for Scientific and Technological—CNPq, Brazil (442747/2019-5) and was financed by the Coordination of Superior Level Staff Improvement—Brazil (CAPES)—Finance Code 001.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the CEPSH/UFSC (protocol 42602921.5.0000.0121, 12 November 2015, and protocol 49691815.0.0000.0121, 13 April 2021).

Informed Consent Statement

Written informed consent was obtained from all participants and caregivers involved in the study prior to enrollment.

Data Availability Statement

All the data presented in this study are available upon request from the corresponding authors due to ethical restrictions.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Study participants’ characteristics, continuous variables.
Table 1. Study participants’ characteristics, continuous variables.
VariablesStudy IStudy IIFemalesMalesTotal
(n = 65)(n = 21)(n = 46)(n = 40)(n = 86)
Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)
Age (years)11.7 (2.1)10.6 (2.4)11.7 (2.1)11.2 (2.3)11.4 (2.2)
Height (cm)147.3 (13.1)143.2 (13.3)146.9 (12.6)145.7 (13.9)146.3 (13.2)
Body mass (kg)39.8 (11.4)40.0 (13.8)41.2 (11.2)38.4 (12.6)39.9 (11.9)
BMI (kg/m2)17.9 (2.7)19.0 (4.1)18.7 (2.9)17.7 (3.2)18.2 (3.1)
Fat mass (kg)6.9 (4.3)9.2 (7.0)9.1 (5.2) * 5.5 (4.5)7.5 (5.8)
Fat mass (%)16.7 (7.2)20.7 (9.8) ‡ 20.9 (7.2) ‡ 13.9 (7.4)17.7 (8.1)
Fat-free mass (kg)32.9 (9.3)30.9 (8.4)32.1 (7.3)32.9 (10.9)32.4 (9.1)
BMC (g)1182.9 (445.7) ‡ 938.0 (337.6)1152.4 (384.5)1058.5 (477.6)1109.5 (428.9)
BMD (g/cm2)0.8 (0.1) ‡ 0.7 (0.1)0.8 (0.1)0.8 (0.2)0.8 (0.1)
VO2peak (mL·kg−1.min−1)39.1 (6.9) ‡ 33.9 (8.9)34.6 (6.3)41.8 (7.2) ‡ 37.8 (7.6)
Handgrip strength (kg)39.9 (19.1)31.6 (14.2)36.9 (16.8)39.0 (20.1)37.9 (18.3)
Abdominal endurance (reps/min)17.6 (14.7)27.2 (10.7) * 17.1 (9.6)23.3 (17.9)19.9 (14.4)
Stand Broad Jump (cm)-116.9 (31.1)103.1 (16.5)132.1 (36.8) ‡ -
Modified Push-ups (reps/min)-24.6 (10.0)20.6 (9.2)29.0 (9.4)-
Flexibility (cm)-23.0 (5.2)22.7 (5.7)23.3 (4.9)-
Mid-upper arm circumference (cm)21.3 (3.1)22.5 (3.5)22.0 (3.1)21.1 (3.4)21.6 (3.2)
Waist circumference (cm)63.1 (6.5)63.9 (9.7)63.4 (7.2)63.1 (7.6)63.3 (7.4)
Hip circumference (cm)77.1 (10.4)79.7 (11.2)79.5 (10.7)75.7 (10.1)77.8 (10.6)
Waist-to-hip ratio0.8 (0.1)0.8 (0.1)0.8 (0.1)0.8 (0.1) * 0.8 (0.1)
Waist-to-height ratio0.4 (0.0)0.4 (0.1)0.4 (0.0)0.4 (0.0)0.4 (0.0)
Triceps skinfold (mm)9.6 (3.3)11.8 (5.7)11.1 (3.8) * 9.0 (4.2)10.1 (4.1)
Subscapular skinfold (mm)7.3 (3.4)10.6 (6.7) * 9.2 (4.5) * 6.8 (4.4)8.1 (4.6)
Abdominal skinfold (mm)10.3 (4.5)17.3 (10.3) * 13.8 (6.9) * 10.0 (6.7)12.0 (7.0)
Calf skinfold (mm)10.4 (3.6)12.0 (5.4)11.7 (4.1) * 9.7 (3.9)10.8 (4.1)
Sum of four skinfolds a37.6 (13.6)51.7 (26.2) * 45.8 (17.2) * 35.5 (18.3)41.0 (18.4)
Humeral diameter (cm)-5.9 (0.5)5.9 (0.5)5.9 (0.6)-
Femoral diameter (cm)-8.4 (0.7)8.3 (0.7)8.5 (0.8)-
Sum of diameters (cm) b-14.3 (1.2)14.2 (1.1)14.3 (1.3)-
SD: standard deviation. BMI: body mass index. BMC: bone mineral content. BMD: bone mineral density. VO2peak: peak oxygen consumption. a Sum of four skinfolds: sum of triceps, subscapular, abdominal and calf skinfolds. b Sum of diameters: sum of humeral and femoral diameters. ‡ independent variables t-test p-value < 0.05. * Wilcoxon signed-rank test p-value < 0.05. Significant differences are in bold.
Table 2. Spearman rank correlation between anthropometric parameters and physical fitness components.
Table 2. Spearman rank correlation between anthropometric parameters and physical fitness components.
FM%FFMBMCBMDVO2peakHGSAbESBJMPUFlexibility
MUAC (cm)0.791 ***0.796 ***0.794 ***0.747 **−0.517 *0.557 *−0.171−0.022−0.284−0.292
Waist circumference (cm)0.746 **0.816 ***0.769 **0.720 **−0.583 *0.491 *−0.3120.007−0.368−0.195
Hip circumference (cm)0.690 **0.880 ***0.837 ***0.799 ***−0.4590.664 **−0.0530.048−0.147−0.271
Waist-to-hip ratio0.134−0.298−0.262−0.246−0.337−0.411−0.691 **−0.109−0.470 *−0.049
Waist-to-height ratio0.848 ***0.1800.2420.187−0.515 *0.038−0.600 **−0.335−0.657 **−0.214
Triceps skinfold (mm)0.855 ***0.3150.3660.272−0.3440.133−0.392−0.325−0.487 *−0.418
Subscapular skinfold (mm)0.926 ***0.558 *0.628 **0.547 *−0.635 **0.268−0.524 *−0.391−0.628 **−0.332
Abdominal skinfold (mm)0.860 ***0.581 *0.620 **0.553 *−0.651 **0.215−0.458−0.344−0.586 *−0.295
Calf skinfold (mm)0.775 **0.2470.1780.093−0.300−0.023−0.401−0.420−0.437−0.376
Sum of four skinfolds (mm) a0.930 ***0.531 *0.581 *0.493 *−0.587 *0.213−0.482 *−0.389−0.601 **−0.379
Humeral diameter (cm)0.483 *0.815 ***0.691 **0.651 **−0.4480.573 **−0.0630.0700.012−0.320
Femoral diameter (cm)0.4130.800 ***0.708 **0.666 **−0.477 *0.572 **−0.0610.1080.065−0.295
Sum of diameters (cm) b0.478 *0.810 ***0.701 **0.653 **−0.4660.567 *−0.0660.0460.015−0.336
FM%: fat mass percentage. FFM: fat-free mass. BMC: bone mineral content. BMD: bone mineral density. VO2peak: peak oxygen consumption. HGS: handgrip strength. SBJ: standing broad jump. AbE: abdominal endurance. MPU: modified push-ups. MUAC: mid-upper arm circumference. a Sum of four skinfolds: sum of triceps, subscapular, abdominal and calf skinfolds. b Sum of diameters: sum of humeral and femoral diameters. * p < 0.05; ** p < 0.01; *** p < 0.001.
Table 3. Associations between anthropometric parameters and physical fitness components based on simple linear regression analysis.
Table 3. Associations between anthropometric parameters and physical fitness components based on simple linear regression analysis.
β (95% CI)β p-Valueβ stR2 AdjustedRMSEF
Fat mass (%)
      Sum of four skinfolds (mm) a0.36 (0.31; 0.42)<0.0010.830.694.47188.9
      Subscapular skinfold (mm)1.31 (1.1; 1.6)<0.0010.750.565.31110.1
      Waist circumference (cm)0.60 (0.40; 0.80)<0.0010.550.296.7636.1
      Waist-to-height ratio114.7 (79.6; 149.7)<0.0010.580.336.5942.3
Fat-free mass (kg)
      Humeral diameter (cm)14.0 (9.6; 18.4)<0.0010.770.684.7444.1
      Femoral diameter (cm)9.76 (6.5; 13.0)<0.0010.760.664.8940.1
      Sum of diameters (cm) b5.95 (4.1; 7.8)<0.0010.780.704.6446.8
Bone mineral content (g)
      Humeral diameter (cm)499.4 (284.5; 714.3)<0.0010.590.53231.123.7
      Femoral diameter (cm)354.3 (202.4; 506.3)<0.0010.590.53230.723.8
      Sum of diameters (cm) b214.6 (126.1; 303.1)<0.0010.600.55225.725.7
Bone mineral density (g/cm2)
      Humeral diameter (cm)0.18 (0.08; 0.28)0.0010.700.410.1115.1
      Femoral diameter (cm)0.13 (0.06; 0.20)0.0010.710.420.1115.4
      Sum of diameters (cm) b0.08 (0.04; 0.12)0.0010.720.430.1016.3
VO2peak (mL·kg−1.min−1)
      Sum of four skinfolds (mm) a−0.23 (−0.30; −0.15)<0.001−0.550.306.3536.5
      Subscapular skinfold (mm)−0.90 (−1.20; −0.60)<0.001−0.550.306.3635.9
      Waist circumference (cm)−0.34 (−0.56; −0.13)0.002−0.330.107.2110.1
      Waist-to-height ratio−51.7 (−91.2; −12;2)0.011−0.280.077.346.77
Handgrip strength (kg)
      Humeral diameter (cm)18.4 (8.1; 28.6)0.0010.500.3911.014.0
      Femoral diameter (cm)13.4 (6.4; 20.5)0.0010.520.4210.815.7
      Sum of diameters (cm) b8.0 (3.8; 12.3)0.0010.520.4310.716.0
Abdominal endurance (reps/min)
      Waist-to-hip ratio−24.2 (−66.2; 17.8)0.256<0.01<0.0114.31.3
      Waist-to-height ratio−37.0 (−112.9; 38.9)0.335<0.01<−0.0114.40.94
      Subscapular skinfold (mm)−0.13 (−0.80; 0.55)0.705<0.01−0.0114.40.14
Stand Broad Jump (cm)
      Calf skinfold (mm)−2.62 (−5.1; −0.14)0.040−0.350.1628.44.88
      Subscapular skinfold (mm)−1.32 (−3.5; 0.81)0.210−0.200.0330.61.69
      Sum of four skinfolds (mm) a−0.47 (−0.99; 0.05)0.074−0.280.1129.23.59
Modified Push-ups (reps/min)
      Sum of four skinfolds (mm) a−0.18 (−0.34; −0.01)0.034−0.330.179.145.19
      Subscapular skinfold (mm)−0.71 (−1.34; −0.08)0.029−0.330.199.065.59
      Waist-to-height ratio−72.6 (−160.5; 15.2)0.100−0.290.099.582.99
Flexibility (cm)
      Triceps skinfold (mm)−0.39 (−0.79; 0.01)0.053−0.310.144.824.26
      Sum of four skinfolds (mm) a−0.07 (−0.16; 0.02)0.105−0.260.094.972.90
      Subscapular skinfold (mm)−0.16 (−0.35; 0.03)0.091−0.260.104.943.17
β: unstandardized regression coefficient. CI: confidence interval. β st: standard regression coefficient. R2 Adjusted: adjusted coefficient of determination. RMSE: root mean square error of estimate. F: F statistic. VIF: variance inflation factor. a Sum of four skinfolds: sum of triceps, subscapular, abdominal and calf skinfolds. b Sum of diameters: sum of humeral and femoral diameters. VO2peak: peak oxygen consumption. Bold: p-value < 0.05.
Table 4. Associations between anthropometric parameters and physical fitness components based on multilinear regression analysis.
Table 4. Associations between anthropometric parameters and physical fitness components based on multilinear regression analysis.
β (95% CI)β p-Valueβ stR2 Adjustedp-ValueRMSEFVIF
Fat mass (%)
      Sum of four skinfolds (mm) a0.36 (0.30; 0.42)<0.0010.850.73<0.0014.1758.11.42
      Subscapular skinfold (mm)1.21 (0.94; 1.48)<0.0010.760.61<0.0015.0134.21.32
      Waist circumference (cm)0.70 (0.51; 0.90)<0.0010.670.52<0.0015.5524.11.55
      Waist-to-height ratio115.74 (86.9; 144.6)<0.0010.620.57<0.0015.2828.71.07
Fat-free mass (kg)
      Humeral diameter (cm)8.83 (4.12; 13.5)0.0010.480.81<0.0013.6230.42.24
      Femoral diameter (cm)6.88 (3.73; 10.0)<0.0010.470.84<0.0013.3436.52.30
      Sum of diameters (cm) b4.11 (2.23; 6.0)<0.0010.490.87<0.0013.3436.52.35
Bone mineral content (g)
      Humeral diameter (cm)300.34 (70.9; 529.8)0.0130.300.73<0.001176.318.82.24
      Femoral diameter (cm)267.30 (121.7; 412.9)0.0010.320.79<0.001154.726.12.30
      Sum of diameters (cm) b151.74 (61.0; 242.5)0.0030.320.77<0.001161.223.62.35
Bone mineral density (g/cm2)
      Humeral diameter (cm)0.09 (−0.02; 0.20)0.1150.270.63<0.0010.0812.22.24
      Femoral diameter (cm)0.08 (0.01; 0.16)0.0310.320.67<0.0010.0814.82.30
      Sum of diameters (cm) b0.05 (0.00; 0.09)0.0480.310.66<0.0010.0813.82.35
VO2peak (mL·kg−1.min−1)
      Sum of four skinfolds (mm) a−0.16 (−0.24; −0.08)<0.001−0.560.41<0.0015.8515.11.47
      Subscapular skinfold (mm)−0.64 (−0.96; −0.32)<0.001−0.550.41<0.0015.8115.51.36
      Waist circumference (cm)−0.32 (−0.54; −0.11)0.004−0.380.37<0.0016.0512.81.52
      Waist-to-height ratio−43.81 (−78.2; −9.5)0.013−0.310.35<0.0016.1312.01.09
Handgrip strength (kg)
      Humeral diameter (cm)8.27 (−4.6; 21.2)0.1940.240.510.0029.917.992.24
      Femoral diameter (cm)7.74 (−1.25; 16.7)0.0870.290.550.0019.549.062.30
      Sum of diameters (cm) b4.31 (−1.13; 9.8)0.1130.280.540.0019.678.692.35
Abdominal endurance (reps/min)
      Waist-to-hip ratio−0.75 (−44.1; 42.6)0.973<0.010.19<0.00112.96.141.32
      Waist-to-height ratio−42.27 (−111.4; 26.9)0.227<0.010.21<0.00112.86.621.07
      Subscapular skinfold (mm)−0.66 (−1.33; 0.02)0.057<0.010.23<0.00112.67.361.31
Standing broad jump (cm)
      Calf skinfold (mm)−2.40 (−4.40; −0.40)0.021−0.390.500.00221.97.741.20
      Subscapular skinfold (mm)−1.40 (−3.23; 0.43)0.125−0.290.410.00823.95.561.25
      Sum of four skinfolds (mm) a−0.50 (−0.93; −0.07)0.026−0.380.490.00222.17.471.24
Modified Push-ups (reps/min)
      Sum of four skinfolds (mm) a−0.17 (−0.34; 0.00)0.051−0.370.260.0448.643.341.24
      Subscapular skinfold (mm)−0.69 (−1.35; −0.04)0.038−0.370.280.0358.513.621.25
      Waist-to-height ratio−73.92 (−155.4; 7.6)0.073−0.300.230.0588.803.031.17
Flexibility (cm)
      Triceps skinfold (mm)−0.42 (−0.84; −0.00)0.049−0.340.110.1854.911.801.18
      Sum of four skinfolds (mm) a−0.09 (−0.18; 0.00)0.063−0.330.080.2234.981.611.24
      Subscapular skinfold (mm)−0.19 (−0.04; 0.01)0.065−0.290.080.2304.991.581.21
Models adjusted by age (months), sex, group, pubertal stage and physical activity. β: unstandardized regression coefficient. CI: confidence interval. β st: standard regression coefficient. R2 Adjusted: adjusted coefficient of determination. RMSE: root mean square error of estimate. F: F statistic. VIF: variance inflation factor. a Sum of four skinfolds: sum of triceps, subscapular, abdominal and calf skinfolds. b Sum of diameters: sum of humeral and femoral diameters. VO2peak: peak oxygen consumption. Bold: p-value < 0.05.
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de Castro, J.A.C.; de Lima, L.R.A.; Silva, D.A.S. Association between Anthropometric Parameters and Physical Fitness in HIV-Diagnosed Children and Adolescents. Appl. Sci. 2024, 14, 9217. https://doi.org/10.3390/app14209217

AMA Style

de Castro JAC, de Lima LRA, Silva DAS. Association between Anthropometric Parameters and Physical Fitness in HIV-Diagnosed Children and Adolescents. Applied Sciences. 2024; 14(20):9217. https://doi.org/10.3390/app14209217

Chicago/Turabian Style

de Castro, João Antônio Chula, Luiz Rodrigo Augustemak de Lima, and Diego Augusto Santos Silva. 2024. "Association between Anthropometric Parameters and Physical Fitness in HIV-Diagnosed Children and Adolescents" Applied Sciences 14, no. 20: 9217. https://doi.org/10.3390/app14209217

APA Style

de Castro, J. A. C., de Lima, L. R. A., & Silva, D. A. S. (2024). Association between Anthropometric Parameters and Physical Fitness in HIV-Diagnosed Children and Adolescents. Applied Sciences, 14(20), 9217. https://doi.org/10.3390/app14209217

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