127 DXA, ADP & SFT in preterm infants 6 predictive value of SFT alone was generally low (16, 30). Moreover, these models were mostly only internally validated and looked at the prediction of absolute fat mass and not fat mass percentage (12, 13, 29). However, in our cohort it seems that the ∑SFT could also explain an important part of the variance in fat mass percentage. Even though the prediction model yielded a lower R² than the model for the prediction of fat mass, fat mass percentage may be a more generalizable factor and worth further exploration for external validation. Especially, in the light of resource poor settings, the ∑SFT might still be useful as an indicator of fat mass percentage. Our study was limited by the small sample size, which reduces the generalizability of the prediction models. Moreover, body composition was measured between 38 and 46 weeks postmenstrual age, a period in which body composition alters (31). In addition, the low number of successful DXA scans, with 1 in 4 scans not completed because of excess movement or too much agitation prior to the measurement, limited the assessment of agreement between different methods. Recent studies in term infants have shown that placing infants in a vacuum cushion limits movement artefacts and leads to more comparable results between DXA and ADP (32). This study has not been able to robustly show that skinfoldmeasurements qualify as a reliable, low-cost, point of care instrument. However, it remains desirable to find an easily accessible and reliable way of monitoring fat mass in light of possible adverse cardiometabolic outcomes in later life(1-3). Nevertheless, currently availablemethods for bedside assessment of body composition, such as bioelectrical impedance analysis and body proportionality measures, have a questionable accuracy and accurate, low-cost bedside methods are limited (30). To the best of our knowledge, other predictive equations including weight and length indices and easilymeasured clinical parameters are yet to be externally validated.(33-35) It would be of interest to further investigate the potential of these predictive equations. Taking previous findings into account, ADP seems to be more practical to assess body composition, in particular fat mass, in preterm infants in early life. Nevertheless, it remains to be elucidated whether or not a DXA without movement artifacts provides a more accurate assessment of whole body composition than ADP in preterm infants.
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