Densitometry Versus Bioimpedance for Modeling Vitamin D-Endocrine and Metabolic Associations in Pediatric Obesity: A Cross-Sectional Parallel-Modality Analysis.

Background/

Objectives

It has been previously shown that bioimpedance assessment (BIA) systematically underestimates adiposity compared to densitometry analysis (DXA), though the methods correlate strongly. However, whether DXA outperforms BIA for physiology modeling-using vitamin D as a sentinel signal-remains uncertain. We compared DXA and BIA side-by-side to model (i) adiposity-25(OH)D associations, (ii) mediation-style links with metabolic outcomes, and the vitamin D-PTH-calcium axis.

Methods

We performed a cross-sectional analysis of 165 children with simple obesity and no vitamin D prophylaxis collected between July 2022 and July 2025. We measured adiposity through DXA and BIA methods, laboratory 25(OH)D, and associated biochemical and clinical parameters: PTH, calcium, phosphate, glucose/insulin/HOMA-IR, lipids. Information on age, sex, and season was recorded and used to adjust for potential covariates. Parallel analyses included partial correlations, linear regression, mediation models, and Bland-Altman analysis for DXA-BIA agreement.

Results

The cohort median age was 13 years; median 25(OH)D level was 21.9 ng/mL. DXA fat % exceeded BIA (46.6% vs. 36.7%). Univariately, 25(OH)D correlated inversely with adiposity (DXA rho = -0.16, BIA rho = -0.19), but adiposity was not a significant determinant of 25(OH)D after season/age adjustment with either modality. No mediation of vitamin D to metabolic associations via adiposity were detected. The vitamin D-PTH-calcium axis was robust across modalities.

Conclusions

In children with established obesity, seasonal and age factors dominate 25(OH)D variability, while the adiposity contributes little within-group. Vitamin D shows endocrine but not metabolic associations, and within this homogenous pediatric obesity cohort, DXA does not outperform BIA for physiologic modeling.