Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models

Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients

OBJECTIVE

Increased body mass index (BMI) is associated with reduced all-cause and cardiovascular (CV) mortality in hemodialysis (HD) patients, whereas CV risk increases with BMI in the general population. In the general population, obesity is associated with inflammation, decreased high-density lipoprotein (HDL) cholesterol, increased low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs), all risk factors for CV disease. Low-density lipoprotein cholesterol does not predict CV risk in HD, whereas increased C-reactive protein and interleukin-6 (IL-6), low HDL and apolipoprotein (apo) AI, and increased fasting TGs do predict risk. Renal failure is associated with dyslipidemia and inflammation in normal-weight patients. We hypothesized that the effects of obesity may be obscured by renal failure in HD.

METHODS

We explored the relationship between adipose tissue pools and distribution, i.e., subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) (measured by magnetic resonance imaging) and measures of inflammation (C-reactive protein, IL-6, ceruloplasmin, and alpha1 acid glycoprotein), HDL and LDL cholesterol, total TGs, apo AI, apo B, apo CII (an activator of lipoprotein lipase), apo CIII (an inhibitor of lipoprotein lipase), and the adipokines, leptin and adiponectin, in 48 patients with prevalent HD.

RESULTS AND CONCLUSIONS

Total TG concentrations were positively correlated with VAT controlled for age, sex, and weight. Both apo CII and apo CIII were correlated only with VAT. Adiponectin was inversely correlated with VAT, and leptin was positively associated with SAT. C-reactive protein and alpha1 acid glycoprotein were weakly associated with SAT, whereas ceruloplasmin was strongly associated with VAT according to multiple regression analysis. In contrast, apo B, LDL, apo AI, HDL, and IL-6 were not correlated with any measure of body composition, potentially mitigating the effects of obesity in HD.

Body mass and circumference of upper arm are associated with race performance in ultraendurance runners in a multistage race--the Isarrun 2006

In the present study, we investigated the association of anthropometric parameters with race performance in ultraendurance runners in a multistage ultraendurance run, in which athletes had to run 338 km within 5 consectitive days. In 17 male successful finishers, calculations of body mass, body height, skinfold thicknesses, extremity circumference, skeletal muscle mass (SM), and percentage body fat (%BF) were performed before the race to correlate anthropometric parameters with race performance. A positive association was shown between total running time and both body mass (r2 = .29, p < .05) and upper arm circumference (r = .23, p < .05). In contrast, body height, skinfold thicknesses, extremity circumference, SM, and %BF showed no association with race performance (p > .05). We concluded that in a multistage ultraendurance run, body mass and upper arm circumference were nega tively associated with race performance in well experienced ultraendurance runners. In contrast, body height, skinfold thicknesses, circumferences of the other extremities, SM, and %BF showed no association with race performance.

No change of body mass, fat mass, and skeletal muscle mass in ultraendurance swimmers after 12 hours of swimming

We evaluated whether ultraendurance swimmers suffer a change of body mass, fat mass, skeletal muscle mass, total body water and specific gravity of urine during a 12-hr swim in 12 male Caucasian ultraswimmers. Proton nuclear magnetic resonance of urine samples before and after the race was performed to detect alanine, lactate, and 3-hydroxybutyrate. The 12 swimmers achieved an average distance of 29.4 km (SD = 5.1). No statistically significant changes in body mass, fat mass, skeletal muscle mass, and total body water could be determined (p > .05), but urine gravity decreased significantly (p < .001). Two participants showed increased signals of ketone bodies after the race. In these samples, the hydroxybutyrate-creatinine ratio increased more than tenfold.

Derivation of a new equation for estimating creatinine clearance by using fat-free mass and serum creatinine concentration in Korean patients with type 2 diabetes mellitus

AIMS

Equations to predict creatinine clearance (Ccr) or glomerular filtration rate have limitations in applying to a wide range of ethnicities with different fat-free mass (FFM). We aimed to determine the serum creatinine (Scr) concentrations that indicate renal insufficiency and formulate a new equation to estimate Ccr by a function of FFM in Korean type 2 diabetic patients.

METHODS

Ccr was measured in 283 type 2 diabetic patients by 24-h urine collection. Receiver operating characteristic (ROC) curve was used to determine the Scr concentration corresponding to a Ccr of 60 mL min(-1) x 1.73 m(-2). A new equation to predict Ccr was derived by using Scr and FFM.

RESULTS

The Scr concentration corresponding to a Ccr of 60 mL min(-1) x 1.73 m(-2) was 1.15 mg/dL in men and 0.95 mg/dL in women. The regression equation estimating the Ccr was expressed as (1.72 x FFM-0.23 x age)/Scr, and it showed a good correlation with the measured Ccr (r=0.718, P<0.001).

CONCLUSIONS

Scr concentrations indicating renal insufficiency in the Korean patients were considerably lower than those in Caucasians. The equation derived in this study would be more useful in Korean or other Asian type 2 diabetic patients.

Human organ/tissue growth algorithms that include obese individuals and black/white population organ weight similarities from autopsy data

Physiologically based pharmacokinetic (PBPK) models need the correct organ/tissue weights to match various total body weights in order to be applied to children and the obese individual. Baseline data from Reference Man for the growth of human organs (adrenals, brain, heart, kidneys, liver, lungs, pancreas, spleen, thymus, and thyroid) were augmented with autopsy data to extend the describing polynomials to include the morbidly obese individual (up to 250 kg). Additional literature data similarly extends the growth curves for blood volume, muscle, skin, and adipose tissue. Collectively these polynomials were used to calculate blood/organ/tissue weights for males and females from birth to 250 kg, which can be directly used to help parameterize PBPK models. In contrast to other black/white anthropomorphic measurements, the data demonstrated no observable or statistical difference in weights for any organ/tissue between individuals identified as black or white in the autopsy reports.

The effects of running 1,200 km within 17 days on body composition in a female ultrarunner-Deutschlandlauf 2007

We describe the changes of body composition in the female overall winner of the Deutschlandlauf 2007 over 17 stages from the northeast to the southwest of Germany with average daily running stages of 70.9 km to cover the total distance of 1,200 km. Determined by bioelectrical impedance analysis, body mass (BM) increased, percent body fat (% BF) decreased, and percent body water as well as lean body mass (LBM) increased. Skeletal muscle mass and % BF as determined by an anthropometric method showed no changes. This data show, that this female runner achieved an excellent performance and that it is possible for a woman to beat all the men. This type of analysis provides a unique opportunity to gain insight into the physiological changes during multiday running in ultraendurance athletes.

Validação de equações antropométricas para a estimativa da massa muscular por meio de absortometria radiológica de dupla energia em universitários do sexo masculino

Diferentes equações antropométricas têm sido desenvolvidas e validadas para uso em populações distintas, a partir de modelos multicompartimentais. A absortometria radiológica de dupla energia (DEXA) é uma alternativa multicompartimental de avaliação da composição corporal, ainda pouco utilizada no Brasil para validação e desenvolvimento de equações antropométricas, sobretudo para predição da massa muscular (MM). Assim, o objetivo deste estudo foi validar equações antropométricas para estimativa da MM a partir da DEXA, em universitários brasileiros do sexo masculino. Para tanto, 131 adultos entre 18 e 36 anos (73,9 ± 9,7kg; 177,6 ± 6,4cm; MM = 32,1 ± 3,6kg) foram avaliados por meio da DEXA e de medidas antropométricas (massa corporal, estatura, circunferências e espessura de dobras cutâneas), e analisados mediante utilização de quatro equações preditivas da MM. Foram utilizadas as seguintes análises: estatística descritiva, procedimentos de validação cruzada e análise de concordância (CCI e Bland e Altman). A equação 3 [MM (kg) = E.(0,00744.CBrC² + 0,00088.CCxC² + 0,00441.CPantC²) + 2,4.S - 0,048.Id + R + 7,8] de Lee et al. (Am J Clin Nutr 2000;72:796-803) apresentou validade concorrente, para a avaliação da MM (t = 1,13; r = 0,83; EPE = 2,08; diferença média [d] = 0,21). Além desta, a equação 4, dos mesmos autores [MM (kg) = 0,244.MC + 7,8.E + 6,6.S - 0,098.Id + R - 3,3], com baixos valores de EPE (2,20), erro constante (- 0,72), erro total (2,72) e d (- 0,77) e boas concordâncias (moderada a alta) foi sugerida para utilização na amostra estudada. Novos estudos de validação são sugeridos em amostras diferentes, mediante o uso de DEXA como método de referência. Da mesma forma, sugere-se maior utilização de equações antropométricas para avaliação da MM, sobretudo para o monitoramento das alterações na massa muscular em relação aos processos de crescimento, desenvolvimento e envelhecimento e na avaliação do treinamento físico e esportivo.

Rheumatoid cachexia: a clinical perspective

Rheumatoid cachexia is under-recognized in clinical practice. The loss of lean body tissue, which characterizes cachexia, is often compensated for by gain in body fat-so called 'cachectic obesity'-so that 85% or more RA patients have a normal BMI. Severe cachexia with loss of weight leads to increased morbidity and premature mortality but loss of muscle bulk with a normal BMI also associates with poor clinical outcomes. Increasing BMI, even into the obese range, is associated with less joint damage and reduced mortality. Measurement of body composition using DXA and other techniques is feasible but the results must be interpreted with care. Newer techniques such as whole-body MRI will help define with more confidence the mass and distribution of fat and muscle and help elucidate the relationships between body composition and outcomes. Cachexia shows little response to diet alone but progressive resistance training and anti-TNF therapies show promise in tackling this potentially disabling extra-articular feature of RA.

Upper arm circumference is associated with race performance in ultra-endurance runners

OBJECTIVE

To investigate the association of anthropometric parameters to race performance in ultra-endurance runners in a multistage ultra-endurance run.

DESIGN

Descriptive field study.

SETTING

The Deutschlandlauf 2006 race in Germany, where athletes had to run 1200 km within 17 consecutive days. There were no interventions.

SUBJECTS

In total, there were 19 male Caucasian ultra-endurance runners (mean (SD) 46.2 (9.6) years, 71.8 (5.2) kg, 179 (6) cm, BMI 22.5 (1.9) kg/m(2)).

MAIN OUTCOME MEASUREMENTS

Determination of body mass, body height, length of lower limbs, skin-fold thicknesses, circumference of limbs, body mass index (BMI), percentage skeletal muscle mass (%SM), and percentage body fat (%BF) in 19 successful finishers in order to correlate anthropometric parameters with running performance.

RESULTS

A significant association of upper arm circumference with the total running time was found (p<0.05, r2 = 0.26). No significant association was found with the directly measured anthropometric properties body height, body mass, average skin-fold thickness and the circumference of thigh and calf (p>0.05). Furthermore, no significant association was observed between the running time and the calculated parameters BMI, %BF, and %SM (p>0.05).

CONCLUSIONS

In an ultra-endurance run over 1200 km within 17 consecutive days, circumference of the upper arm was the only factor associated with performance in well-experienced ultra-endurance runners. Body mass, BMI, body height, length of limbs, skin-fold thicknesses, circumference of limbs and the calculated percentage body composition of skeletal muscle mass and body fat showed no association with running performance.

Increased thermoregulation in cold-exposed transgenic mice overexpressing lipoprotein lipase in skeletal muscle: an avian phenotype?

LPL is an enzyme involved in the breakdown and uptake of lipoprotein triglycerides. In the present study, we examined how the transgenic (Tg) overexpression of human LPL in mouse skeletal muscle affected tolerance to cold temperatures, cold-induced thermogenesis, and fuel utilization during this response. Tg mice and their nontransgenic controls were placed in an environmental chamber and housed in metabolic chambers that monitored oxygen consumption and carbon dioxide production with calorimetry. When exposed to 4 degrees C, an attenuation in the decline in body temperature in Tg mice was accompanied by an increased metabolic rate (15%; P < 0.001) and a reduction in respiratory quotient (P < 0.05). Activity levels, the expression of uncoupling proteins in brown fat and muscle, and lean mass failed to explain the enhanced cold tolerance and thermogenesis in Tg mice. The more oxidative type IIa fibers were favored over the more glycolytic type IIb fibers (P < 0.001) in the gastrocnemius and quadriceps muscles of Tg mice. These data suggest that Tg overexpression of LPL in skeletal muscle increases cold tolerance by enhancing the capacity for fat oxidation, producing an avian-like phenotype in which skeletal muscle contributes significantly to the thermogenic response to cold temperatures.

Anthropometric dimensions of male powerlifters of varying body mass

In this study, we examined the anthropometric dimensions of powerlifters across various body mass (competitive bodyweight) categories. Fifty-four male Oceania competitive powerlifters (9 lightweight, 30 middleweight, and 15 heavyweight) were recruited from one international and two national powerlifting competitions held in New Zealand. Powerlifters were assessed for 37 anthropometric dimensions by ISAK (International Society for the Advancement of Kinanthropometry) level II and III accredited anthropometrists. The powerlifters were highly mesomorphic and had large girths and bony breadths, both in absolute units and when expressed as Z(p)-scores compared through the Phantom (Ross & Wilson, 1974). These anthropometric characteristics were more pronounced in heavyweights, who were significantly heavier, had greater muscle and fat mass, were more endo-mesomorphic, and had larger girths and bony breadths than the lighter lifters. Although middleweight and heavyweight lifters typically had longer segment lengths than the lightweights, all three groups had similar Zp-scores for the segment lengths, indicating similar segment length proportions. While population comparisons would be required to identify any connection between specific anthropometric dimensions that confer a competitive advantage to the expression of maximal strength, anthropometric profiling may prove useful for talent identification and for the assessment of training progression in powerlifting.

Influence of anthropometry on race performance in extreme endurance triathletes: World Challenge Deca Iron Triathlon 2006

OBJECTIVE

To investigate the influence of anthropometric variables on race performance in ultra-endurance triathletes in an ultra-triathlon.

DESIGN

Descriptive field study.

SETTING

The "World Challenge Deca Iron Triathlon 2006" in Monterrey, Mexico, in which everyday for 10 consecutive days athletes had to perform the distance of one Ironman triathlon of 3.8 km swimming, 180 km cycling and 42.195 km running.

SUBJECTS

Eight male ultra-endurance athletes (mean (SD) age 40.6 (10.7) years, weight 76.4 (8.4) kg, height 175 (4) cm and body mass index (BMI) 24.7 (2.2) kg/m2).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Direct measurement of body mass, height, leg length, skinfold thicknesses, limb circumference and calculation of BMI, skeletal muscle mass (SM), percentage SM (%SM) and percentage body fat (%BF) in order to correlate measured and calculated anthropometric variables with race performance.

RESULTS

Race time was not significantly (p>0.05) influenced by the directly measured variables, height, leg length, body mass, average skinfold thicknesses, or circumference of thigh, calf or upper arm. Furthermore, no significant (p>0.05) correlation was observed between race time and the calculated variables, BMI, %SM and %BF.

CONCLUSIONS

In a multistage ultra-triathlon over 10 Ironman triathlon distances in 10 consecutive days, there was no effect of body mass, height, leg length, skinfold thicknesses, limb circumference, BMI, %SM or %BF on race performance in the only eight finishers.

Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease

BACKGROUND

Accurate estimation of the glomerular filtration rate (GFR) is crucial for the detection of chronic kidney disease (CKD). In clinical practice, GFR is estimated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) study equation or the Cockcroft-Gault (CG) equation instead of the time-consuming method of measured clearance for exogenous markers such as inulin. In the present study, the equations originally developed for a Caucasian population were tested in Japanese CKD patients, and modified with the Japanese coefficient determined by the data.

METHODS

The abbreviated MDRD study and CG equations were tested in 248 Japanese CKD patients and compared with measured inulin clearance (Cin) and estimated GFR (eGFR). The Japanese coefficient was determined by minimizing the sum of squared errors between eGFR and Cin. Serum creatinine values of the enzyme method in the present study were calibrated to values of the noncompensated Jaffé method by adding 0.207 mg/dl, because the original MDRD study equation was determined by the data for serum creatinine values measured by the noncompensated Jaffé method. The abbreviated MDRD study equation modified with the Japanese coefficient was validated in another set of 269 CKD patients.

RESULTS

There was a significant discrepancy between measured Cin and eGFR by the 1.0xMDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881xMDRD) determined for Japanese CKD patients yielded lower mean difference and higher accuracy for GFR estimation. In particular, in Cin 30-59 ml/min per 1.73 m(2), the mean difference was significantly smaller with the 0.881xMDRD equation than that with the 1.0xMDRD study equation (1.9 vs 7.9 ml/min per 1.73 m(2); P < 0.01), and the accuracy was significantly higher, with 60% vs 39% of the points deviating within 15%, and 97% vs 87% of points within 50%, respectively (both P < 0.01). Validation with the different data set showed the correlation between eGFR and Cin was better with the 0.881xMDRD equation than with the 1.0xMDRD study equation. In Cin less than 60 ml/min per 1.73 m(2), the accuracy was significantly higher, with 85% vs 69% of the points deviating within 50% (P < 0.01), respectively. The mean difference was also significantly smaller (P < 0.01). However, GFR values calculated by the 0.881xMDRD equation were still underestimated in the range of Cin over 60 ml/min per 1.73 m(2).

CONCLUSIONS

Although the Japanese coefficient improves the accuracy of GFR estimation of the original MDRD study equation, a new equation is needed for more accurate estimation of GFR in Japanese patients with CKD stages 3 and 4.

Anthropometry and body composition of south Indian babies at birth

OBJECTIVES

To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition.

DESIGN

Prospective observational study.

SETTING

Bangalore City, India.

SUBJECTS

A total of 712 women were recruited at 12.5+/-3.1 weeks of gestation (mean+/-standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital.

RESULTS

The mean+/-SD birth weight of all newborns was 2.80+/-0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the baby's length at birth.

CONCLUSIONS

Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the baby's skinfold thicknesses and maternal fat-free mass (P<0.02).

Laboratory and field measurements of body composition

Objective

This background paper was prepared in response to a request to review the concepts related to measurement of body composition, to discuss laboratory and field methods of assessing body composition and to discuss the practical applications of the methods – how they might be used singly or in combination to provide data for a selected population.

Design

The common laboratory and field methods are described and discussed, with particular attention to the assumptions involved and the applicability of the methods to the different population groups. Most measurements of body composition are made in the field, at the bedside or clinic as opposed to in the laboratory. The laboratory methods have a role to play in their own right, in research into new concepts, models and methods. However, they are particularly important in establishing the accuracy of the field methods.

Setting

Field, bedside and laboratory studies.

Subjects

Children, adults, the elderly, ethnic groups.

Results

Laboratory estimates of body compositions are best performed by multi-component methods or by 2-component methods adjusted for to the populations under investigation. There is a scarcity of data for most of the populations in the world.

Conclusions

Energy requirements based on body weight are an approximation since they do not take into account differences in body composition, which will better determine the true requirements. The measurement of body composition occurs in many branches of biology and medicine. It is used in the assessment of nutritional and growth status and in disease states and their treatment. Energy stores, skeletal muscle and protein content can be determined and changes monitored. In human energetics, body composition is widely used for the standardisation of other variables, such as basal metabolic rate (BMR), in the assessments of ethnic and environmental differences and of variability and adaptation to different levels of nutrition. Choosing a method is very problematic. Users want simple, inexpensive, rapid, safe accurate methods to measure body composition but speed and simplicity come at the expense of accuracy. Recommendations are made for age, sex, and in some cases, fatness and ethnic specific methods.

Total-body skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in children and adolescents

BACKGROUND

Skeletal muscle (SM) is an important compartment but is difficult to quantify in children and adolescents.

OBJECTIVE

We investigated the potential of dual-energy X-ray absorptiometry (DXA) for measuring total-body SM in pediatric subjects.

DESIGN

A previously published adult DXA SM prediction formula was evaluated in children and adolescents aged 5-17 y (n = 99) who varied in pubertal maturation stage. SM estimated by whole-body magnetic resonance imaging (MRI) was used as the reference. The adult SM model was not accurate for subjects below Tanner stage 5 (n = 65; aged 5-14 y). New pediatric SM prediction models were therefore developed and validated in a separate group (n = 18).

RESULTS

The adult DXA SM prediction model was valid in subjects at Tanner stage 5 but significantly (P < 0.001) overestimated SM in subjects below Tanner stage 5. New SM prediction formulas were developed with appendicular lean soft tissue (ALST) estimates by DXA as the main predictor variable (eg, model 1, ALST alone: R(2) = 0.982, SEE = 0.565 kg, P < 0.001). The new models were validated by the leave-one-out method and were cross-validated in a separate validation group.

CONCLUSIONS

A previously reported adult DXA SM prediction model is applicable in children and adolescents late in pubertal development (Tanner stage 5). A new DXA SM prediction model was developed for prepubertal and pubertal subjects (Tanner stage </=4) aged >/=5 y. DXA thus provides an important opportunity for quantifying total-body SM mass across most of the human life span.

Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD

STUDY OBJECTIVES

Low body weight in COPD patients is associated with worsening dyspnea, reduced leg strength, and poor prognosis. Classical rehabilitation strategies are then limited by reduced exercise tolerance. Thus, we proposed to evaluate whether electrostimulation (ES) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation.

DESIGN

Randomized, controlled study.

SETTING

Pulmonary rehabilitation center.

PATIENTS

Seventeen patients with severe COPD (mean [ +/- SD] FEV(1), 30 +/- 3% predicted) and low body mass index (BMI) [18 +/- 2.5 kg/m(2)].

METHODS

Patients were randomly assigned either to usual rehabilitation (UR) alone or to a UR-plus-ES program for 4 weeks. Quadriceps muscle strength, total muscle mass (MM), exercise capacity, and health-related quality of life were measured before and after rehabilitation.

RESULTS

The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97 +/- 71 vs 36 +/- 34 contractions, respectively; p = 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure questionnaire, -1.7 +/- 1.0 vs -0.2 +/- 1.2 points, respectively; p = 0.05). There was also a significant increase in walking distance (63 +/- 40 m; p = 0.01) and BMI (0.6 +/- 0.5 kg/m(2); p = 0.02) after training in the ES + UR group. A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group (r = 0.94; p = 0.03).

CONCLUSIONS

The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation.

Validation of a skinfold based index for tracking proportional changes in lean mass

BACKGROUND

The lean mass index (LMI) is a new empirical measure that tracks within-subject proportional changes in body mass adjusted for changes in skinfold thickness.

OBJECTIVE

To compare the ability of the LMI and other skinfold derived measures of lean mass to monitor changes in lean mass.

METHODS

20 elite rugby union players undertook full anthropometric profiles on two occasions 10 weeks apart to calculate the LMI and five skinfold based measures of lean mass. Hydrodensitometry, deuterium dilution, and dual energy x ray absorptiometry provided a criterion choice, four compartment (4C) measure of lean mass for validation purposes. Regression based measures of validity, derived for within-subject proportional changes through log transformation, included correlation coefficients and standard errors of the estimate.

RESULTS

The correlation between change scores for the LMI and 4C lean mass was moderate (0.37, 90% confidence interval -0.01 to 0.66) and similar to the correlations for the other practical measures of lean mass (range 0.26 to 0.42). Standard errors of the estimate for the practical measures were in the range of 2.8-2.9%. The LMI correctly identified the direction of change in 4C lean mass for 14 of the 20 athletes, compared with 11 to 13 for the other practical measures of lean mass.

CONCLUSIONS

The LMI is probably as good as other skinfold based measures for tracking lean mass and is theoretically more appropriate. Given the impracticality of the 4C criterion measure for routine field use, the LMI may offer a convenient alternative for monitoring physique changes, provided its utility is established under various conditions.

Growth of Estonian seventeen-year-old boys during the last two centuries

Between 1811 and 2003, the mean height of 17-year-old Estonian boys increased 18.4 cm (0.97 cm per decade). The increase was 5.2 cm (0.7 cm per decade) between 1811 and 1886, 12.3 cm (2.2 cm per decade) between 1922 and 1978, and 0.5 cm per decade between 1978 and 2003. Between 1922 and 2003, mean height increased 8.2% and mean weight increased 27.2%. Between 1956 and 2003, biacromial (shoulder) breadth increased more than bicristal (hip) breadth; relative chest depth diminished; chest circumference and upper thigh circumference both increased. A multidimensional body structure model is constructed from 1998 to 2003 data.

Analysis of factors that influence rates of carbon monoxide uptake, distribution, and washout from blood and extravascular tissues using a multicompartment model

To better understand factors that influence carbon monoxide (CO) washout rates, we utilized a multicompartment mathematical model to predict rates of CO uptake, distribution in vascular and extravascular (muscle vs. other soft tissue) compartments, and washout over a range of exposure and washout conditions with varied subject-specific parameters. We fitted this model to experimental data from 15 human subjects, for whom subject-specific parameters were known, multiple washout carboxyhemoglobin (COHb) levels were available, and CO exposure conditions were identical, to investigate the contributions of exposure conditions and individual variability to CO washout from blood. We found that CO washout from venous blood was biphasic and that postexposure times at which COHb samples were obtained significantly influenced the calculated CO half times (P < 0.0001). The first, more rapid, phase of CO washout from the blood reflected the loss of CO to the expired air and to a slow uptake by the muscle compartment, whereas the second, slower washout phase was attributable to CO flow from the muscle compartment back to the blood and removal from blood via the expired air. When the model was used to predict the effects of varying exposure conditions for these subjects, the CO exposure duration, concentration, peak COHb levels, and subject-specific parameters each influenced washout half times. Blood volume divided by ventilation correlated better with half-time predictions than did cardiac output, muscle mass, or ventilation, but it explained only approximately 50% of half-time variability. Thus exposure conditions, COHb sampling times, and individual parameters should be considered when estimating CO washout rates for poisoning victims.

Predicting in Vivo Soft Tissue Masses of the Lower Extremity Using Segment Anthropometric Measures and DXA

The purpose of this study was to derive and validate regression equations for the prediction of fat mass (FM), lean mass (LM), wobbling mass (WM), and bone mineral content (BMC) of the thigh, leg, and leg + foot segments of living people from easily measured segmental anthropometric measures. The segment masses of 68 university-age participants (26 M, 42 F) were obtained from full-body dual photon x-ray absorptiometry (DXA) scans, and were used as the criterion values against which predicted masses were compared. Comprehensive anthropometric measures (6 lengths, 6 circumferences, 8 breadths, 4 skinfolds) were taken bilaterally for the thigh and leg for each person. Stepwise multiple linear regression was used to derive a prediction equation for each mass type and segment. Prediction equations exhibited high adjustedR2values in general (0.673 to 0.925), with higher correlations evident for the LM and WM equations than for FM and BMC. Predicted (equations) and measured (DXA) segment LM and WM were also found to be highly correlated (R2= 0.85 to 0.96), and FM and BMC to a lesser extent (R2= 0.49 to 0.78). Relative errors between predicted and measured masses ranged between 0.7% and –11.3% for all those in the validation sample (n= 16). These results on university-age men and women are encouraging and suggest that in vivo estimates of the soft tissue masses of the lower extremity can be made fairly accurately from simple segmental anthropometric measures.

Estimation of total-body and limb muscle mass in hemodialysis patients by using multifrequency bioimpedance spectroscopy

BACKGROUND

Skeletal muscle mass can be measured noninvasively with magnetic resonance imaging (MRI), but this is time-consuming and expensive.

OBJECTIVE

We evaluated the use of multifrequency bioimpedance spectroscopy (BIS) measurements of intracellular volume (ICV) to model total-body skeletal muscle mass (TBMM) and limb skeletal muscle mass in hemodialysis patients.

DESIGN

TBMM was measured by MRI in 20 male and 18 female hemodialysis patients with a median (range) age of 54 y (33-73 y), weight of 78.9 kg (43.2-120 kg), and body mass index (BMI; in kg/m2) of 27.3 (19.4-46.6). We measured total body water (TBW) by using D2O dilution, extracellular volume (ECV) as bromide space, and ICV as TBW minus bromide space. Total body potassium (TBK) measured as 40K was used as an independent model of TBMM. BIS was used to measure whole-body TBW (ankle to wrist) and TBW in the arms and legs. BIS-estimated ICV was used to construct models to calculate limb muscle mass and TBMM. The latter was compared with models derived from isotopic methods.

RESULTS

BIS yielded a model for TBMM [TBMM = 9.52 + 0.331 x ICV + 2.77 (male) + 0.180 x weight (kg) - 0.133 x age] (R2 = 0.937, P < 0.0001) as precise as TBK-measured TBMM [TBMM = 1.29 + 0.00453 x TBK (mEq) + 1.46 (male) + 0.144 x weight (kg) - 0.0565 x age] (R2 = 0.930, P < 0.0001) or isotopic methods. BIS models were also developed for measuring leg and arm muscle mass.

CONCLUSION

BIS provides an estimate of TBMM that correlates well with isotopic methods in approximating values obtained by MRI and can be used to estimate limb muscle mass.

Prediction and validation of total and regional skeletal muscle mass by ultrasound in Japanese adults

The present study was performed to develop regression-based prediction equations for skeletal muscle (SM) mass by ultrasound and to investigate the validity of these equations in Japanese adults. Seventy-two Japanese men (n=38) and women (n=34) aged 18-61 years participated in this study and were randomly separated into two groups: the model development group (n=48) and the validation group (n=24). The total and regional SM mass were measured using magnetic resonance imaging (MRI) 1.5 T-scanners with spin-echo sequence. Contiguous transverse images (about 150 slices) with a slice thickness of 1 cm were obtained from the first cervical vertebra to the ankle joints. The volume of SM was calculated from the summation of digitized cross-sectional area. The SM volume was converted into mass units (kg) by an assumed SM density of 1.04 kg l(-1). The muscle thickness (MTH) was measured by B-mode ultrasound (5 MHz scanning head) at nine sites on the anatomical SM belly. Strong correlations were observed between the site-matched SM mass (total, arm, trunk body, thigh, and lower leg) by MRI measurement and the MTH x height (in m) in the model development group (r=0.83-0.96 in men, r=0.53-0.91 in women, P<0.05). When the SM mass prediction equations were applied to the validation group, significant correlations were also observed between the MRI-measured and predicted SM mass (P<0.05). The predicted total SM mass for the validation group was 19.6 (6.5) kg and was not significantly different from the MRI-measured SM mass of 20.2 (6.5) kg. Bland-Altman analysis did not indicate a bias in prediction of the total SM mass for the validation group (r=0.00, NS). These results suggested that ultrasound-derived prediction equations are a valid method to predict SM mass and an alternative to MRI measurement in healthy Japanese adults.

The optimised CO-rebreathing method: a new tool to determine total haemoglobin mass routinely

A routine method to determine total haemoglobin mass (tHb) in clinical practice and sports medicine is non-existent. Radioactive tracers or other dilution procedures like the common CO-rebreathing method (Proc(com)) are impractical, the latter in particular because of the relatively long time of respiration. According to the multicompartment model of Bruce and Bruce (J Appl Physiol 95:1235-1247, 2003) the respiration time can be considerably reduced by inhaling a CO-bolus instead of the commonly used gas mixture. The aim of this study was to evaluate this theoretical concept in practice. The kinetics of the HbCO formation were compared in arterialised blood sampled from an hyperaemic earlobe after inhaling a CO-bolus (Proc(new)) for 2 min and a CO-O(2) mixture (Proc(com)) for approximately 10 min. The reliability of Proc(new) was checked in three consecutive tests, and phlebotomy was used to determine the validity. VO(2max) was determined with and without previous application of Proc(new) and the half-time of HbCO was registered also in arterialised blood after resting quietly and after the VO(2max) test. Proc(new) yielded virtual identical tHb values compared to Proc(com) when HbCO determined 5 min after starting CO-rebreathing was used for calculation. The typical error of Proc(new) was 1.7%, corresponding to a limit of agreement (95%) of 3.3%. The loss of 95 g (19) haemoglobin was detected with an accuracy of 9 g (12). After application of Proc(new) VO(2max) was reduced by 3.0% (3.7) (P=0.022) and half-time was lowered from 132 min (77) to 89 min (23) after the VO(2max) test. Inhaling a CO-bolus markedly simplifies the CO-rebreathing method without reducing validity and reliability and can be used for routine determination of tHb for various indications.

Anabolic Responses to Resistance Training in Older Men and Women: A Brief Review

Resistance training has been shown to be the most effective exercise mode to induce anabolic adaptations in older men and women. Advances in imaging techniques and histochemistry have increased the ability to detect such changes, confirming the high level of adaptability that remains in aging skeletal muscle. This brief review presents a summary of the resistance-training studies that directly compare chronic anabolic responses to training in older (>60 years) men and women. Sixteen studies are summarized, most of which indicate similar relative anabolic responses between older men and women after resistance training. Relatively small sample sizes in most of the interventions limited their ability to detect significant sex differences and should be considered when interpreting these studies. Future research should incorporate larger sample sizes with multiple measurement time points for anabolic responses.

Urinary mercury concentrations associated with dental restorations in adult women aged 16-49 years: United States, 1999-2000

BACKGROUND

Mercury amalgam dental restorations have been used by dentists since the mid 19th century and issues on safety continue to be periodically debated within the scientific and public health communities. Previous studies have reported a positive association between urine mercury levels and the number of dental amalgams, but this relation has never been described in a nationally representative sample in the United States.

AIMS AND METHODS

Using household interview, dietary interview, dental examination, and laboratory data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES), the association between mercury concentrations and dental restorations was examined in US women of reproductive age.

RESULTS

In women of childbearing age, approximately 13% of all posterior dental surfaces were restored with amalgams and the average urinary mercury level in women was low (1.34 microg/l). It is estimated that an increase of 1.8 microg/l in the log transformed values for mercury in urine would occur for each 10 dental surfaces restored with amalgam.

CONCLUSIONS

Although the findings do not address the important issues of adverse health effects at low thresholds of mercury exposure, they do provide important reference data that should contribute significantly to the ongoing scientific and public health policy debate on the use of dental amalgams in the USA.

Dietary treatment of rheumatoid cachexia with β-hydroxy-β-methylbutyrate, glutamine and arginine: A randomised controlled trial

BACKGROUND & AIMS

Rheumatoid arthritis (RA) is complicated by cytokine-driven alterations in protein and energy metabolism and consequent muscle wasting (cachexia). The aim of this randomised controlled trial was to investigate the efficacy of a mixture of beta-hydroxy-beta-methylbutyrate, glutamine and arginine (HMB/GLN/ARG) as nutritional treatment for rheumatoid cachexia.

METHODS

Forty RA patients supplemented their diet with either HMB/GLN/ARG or a nitrogen (7.19 g/day) and calorie (180 kcal/day) balanced mixture of alanine, glutamic acid, glycine, and serine (placebo) for 12 weeks. Body composition and other outcomes were assessed at baseline and follow-up, and analysed by mixed ANOVA.

RESULTS

Dietary supplementation with HMB/GLN/ARG was not superior to placebo in the treatment of rheumatoid cachexia (groupxtime interactions P>0.05 for all outcomes). Both amino acid mixtures significantly increased (main effect of time) fat-free mass (727+/-1186 g, P<0.01), total body protein (719+/-1703 g, P=0.02), arms (112+/-183 g, P<0.01) and legs (283+/-534 g, P<0.01) lean mass, and some measures of physical function. No significant adverse event occurred during the study, but patients in the HMB/GLN/ARG group reported fewer gastrointestinal complaints compared to placebo.

CONCLUSIONS

Dietary supplementation with HMB/GLN/ARG is better tolerated but not more effective in reversing cachexia in RA patients compared to the mixture of other non-essential amino acids used as placebo. Further controlled studies are necessary to confirm the beneficial anabolic and functional effects of increased nitrogen intake in this population.

Serum creatinine as marker of kidney function in South Asians: a study of reduced GFR in adults in Pakistan

Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged > or = 40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of <60 ml/min per 1.73 m2. Creatinine excretion was compared with age- and gender-matched white individuals by comparison of observed versus expected results on the basis of a formula using t test. The agreement among Cockcroft Gault (CG) Ccr and Modification of Diet in Renal Disease (MDRD) Study GFR equations was assessed by regression analyses, and the degree of accuracy of estimated versus measured GFR was determined. Mean (95% confidence interval) creatinine excretion was 1.7 (1.0 to 2.4) mg/kg per d lower than expected for age- and gender-matched white individuals (P < 0.001). The coefficient of determination for measured Ccr on the logarithmic scale was 66.7 and 55.6% for the CG and MDRD Study equations, respectively. The proportion of estimates within 20, 30, and 50% of measured Ccr values was 47.7 versus 32.8% (P < 0.001), 64.9 versus 49.6% (P < 0.001), and 79.4 versus 72.9 (P = 0.07) for CG versus MDRD Study equations, respectively. Lower mean creatinine excretion in these individuals may explain, in part, suboptimal agreement between estimated versus measured GFR. Inclusion of terms for ethnic and racial groups other than white and black might improve the performance of GFR estimating equations.

The Effects of 10 Weeks of Reforestation Work on Body Composition☆

OBJECTIVE

To document changes in body composition and body mass in male and female tree planters.

METHODS

Height, mass, skin-fold thickness, and limb girths were measured in 17 male and 5 female tree planters before and after 10 weeks of work.

RESULTS

Significant decreases were found in body mass (80.6 +/- 10.7 kg vs 76.8 +/- 8.5 kg) and body fat (13.3% +/- 5.5% vs. 10.4% +/- 5.0%) in the men (P < .05). No changes in skin-fold-corrected limb girths were found in the men or women. Initial body mass was significantly (P < .05) correlated with mass loss in men (r2 = .46) and women (r2 = .67). Estimated daily energy consumption was 20680.1 +/- 2204.5 kJ for men and 14516.6 +/- 2077.3 kJ for women, and estimated daily fat consumption was 194.2 +/- 30.1 g for men and 132.3 +/- 35.6 g for women.

CONCLUSIONS

Ten weeks of tree planting leads to significant decreases in body mass and body fat in men while maintaining skin-fold-corrected limb girths.

Estimation of Total-Body Skeletal Muscle Mass in Children and Adolescents

PURPOSE

The estimation of total-body skeletal muscle mass (SMM) has been predicted in healthy adults using anthropometric measurements and urine creatinine excretion. SMM measurement is compulsory to evaluate exercise performance and the influence of physical training on muscle mass. However, there is a lack of information on children and adolescents when quantifying appendicular skeletal muscle mass.

METHODS

Thirty-nine Caucasian children and adolescents (male and female, 7-16 yr old) and 20 adults (men and women, 20-24 yr old) were tested for total-body SMM using dual-energy x-ray absorptiometry measurement (DEXA), anthropometric measurements (ANTHR), and urine creatinine (UCrn) determination. Skinfold thickness and circumference were measured at mid-arm (CAG), mid-thigh (CTG), and mid-calf (CCG) and the skin-corrected circumferences (cm), together with height (Ht; m), age (yr), and sex (0 for female, 1 for male). The UCrn excretion (g.24 h(-1)) was also determined in all subjects. The ANTHR and UCrn measurements were then compared with DEXA as reference value.

RESULTS

The multiple linear regression from anthropometric measurements gave the following equation to evaluate the total-body skeletal muscle mass (SMM) in children and adolescents: SMM (kg) = Ht x [(0.0064 x CAG) + (0.0032 x CTG) + (0.0015 x CCG)(2)] + (2.56 x sex) + (0.136 x age). The prediction of SMM from a 24-h urine collection was obtained with the following equation: SMM (kg) = (10.62 x Crn) + 6.63. The correlation coefficient (r(2)) was 0.966 and 0.710 for the anthropometric and creatinine methods, respectively (P < 0.001).

CONCLUSION

Besides DEXA technique, the determination of total-body skeletal muscle mass in children and adolescents can be highly validated with satisfactory confidence by simple anthropometric measurements or 24-h urine creatinine excretion.

Changes in quadriceps twitch tension in response to resistance training in healthy sedentary subjects

Magnetic stimulation of the femoral nerve has been shown to evoke maximal quadriceps twitch contraction (TwQ(max)). Its measurement as a nonvolitional index of muscle strength has been proposed as a means to follow the disability of patients with neuromuscular disorders or peripheral muscle weakness. The aim of the present study was to investigate TwQ(max) sensitivity to interventions known to develop peripheral muscle strength. We thus measured changes in TwQ(max) after a short-duration resistance training program, examining its reproducibility and comparing its changes with other indices of muscle strength, such as maximal voluntary contraction (MVC) and one-repetition maximum (1-RM). In 23 subjects, TwQ(max)was measured on two occasions. High within- and between-session intraclass coefficients of correlation were observed (r > 0.99). Within-session and between-session differences in TwQ(max)were low (2.2 +/- 1% and 5.4 +/- 2%, respectively). Eight subjects subsequently participated in a resistance training program of the knee extensors, 3 days per week for 8 weeks. TwQ(max) and 1-RM increased significantly after training (10.9 +/- 3.7 vs. 12.3 +/- 4.4 kg, P < 0.04; and 45 +/- 13 vs. 55 +/- 12 kg, P < 0.001, respectively), whereas the MVC increase did not reach significance (41.9 +/- 16 kg vs. 42.3 +/- 15 kg, P = 0.25). Responses to magnetic stimulation of the femoral nerve are highly reproducible and sensitive enough to detect improvement in muscle contractile mechanisms after resistance training in healthy subjects. Patient cooperation is not required, which may be an advantage in clinical situations.

B-6 vitamers and 4-pyridoxic acid in the plasma, erythrocytes, and urine of postmenopausal women

BACKGROUND

Although many studies have reported reduced vitamin B-6 status with aging, little information is available about the specific effects of menopause.

OBJECTIVE

We aimed to examine vitamin B-6 metabolism in premenopausal and early postmenopausal women.

DESIGN

We examined dietary intake and vitamin B-6 metabolites in the plasma, erythrocytes, and urine of 30 premenopausal women (x +/- SD age: 41.9 +/- 4.8 y) and 30 women (aged 54.0 +/- 3.8 y) who were 4.0 +/- 1.4 y past menopause.

RESULTS

Vitamin B-6 intake in the postmenopausal group (1.97 +/- 0.40 mg/d) was significantly greater than that in the premenopausal group (1.63 +/- 0.50 mg/d). Plasma pyridoxal phosphate (PLP) and pyridoxal concentrations and erythrocyte PLP, pyridoxal, and pyridoxamine phosphate concentrations were in the normal range in both groups and did not differ significantly between the 2 groups. Plasma and erythrocyte 4-pyridoxic acid (4-PA) concentrations were significantly higher in the postmenopausal group than in the premenopausal group, which may have been due at least partly to the slightly higher vitamin B-6 intake of the former group. Erythrocyte 4-PA was correlated (r = -0.37, P < 0.01) with serum estradiol in both groups. Urinary 4-PA did not differ significantly between the 2 groups. The serum phosphate concentration was higher in the postmenopausal group than in the premenopausal group, and it was correlated (r = 0.40, P < 0.01) with plasma PLP. Inhibition of alkaline phosphatase by the increased phosphate may help to increase plasma PLP.

CONCLUSION

Menopause may not necessarily be associated with a decrease in vitamin B-6 status.

Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults

Skeletal muscle (SM) is a large and physiologically important compartment. Adipose tissue is found interspersed between and within SM groups and is referred to as intermuscular adipose tissue (IMAT). The study objective was to develop prediction models linking appendicular lean soft tissue (ALST) estimates by dual-energy X-ray absorptiometry (DXA) with whole body IMAT-free SM quantified by magnetic resonance imaging. ALST and total-body IMAT-free SM were evaluated in 270 healthy adults [body mass index (BMI) of <35 kg/m2]. The SM prediction models were then validated by the leave-one-out method and by application in a new group of subjects who varied in SM mass [anorexia nervosa (AN), n = 23; recreational athletes, n = 16; patients with acromegaly, n = 7]. ALST alone was highly correlated with whole body IMAT-free SM [ model 1: R2 = 0.96, standard error (SE) = 1.46 kg, P < 0.001]; age ( model 2: R2 = 0.97, SE = 1.38 kg, P < 0.001) and sex and race ( model 3: R2 = 0.97, SE = 1.06 kg, both P < 0.001) added significantly to the prediction models. All three models validated in the athletes and patients with acromegaly but significantly ( P < 0.01–0.001) over-predicted SM in the AN group as a whole. However, model 1 was validated in AN patients with BMIs in the model-development group range ( n = 11; BMI of >16 kg/m2) but not in those with a BMI of <16 kg/m2 ( n = 12). The DXA-based models are accurate for predicting IMAT-free SM in selected populations and thus provide a new opportunity for quantifying SM in physiological and epidemiological investigations.

Anthropometric assessment of 10-y changes in body composition in the elderly

BACKGROUND

An increased central distribution of fat with advancing age is associated with chronic metabolic and cardiovascular abnormalities. Little is known about the magnitude or pattern of fat distribution and its association with healthy aging.

OBJECTIVE

This study describes approximately 10-y changes in body composition at 11 anthropometric sites in elderly persons and the metabolic and physical activity factors associated with these changes.

DESIGN

Skinfold thicknesses, girths, body fat by hydrodensitometry, physical activity by questionnaire, and metabolic variables were examined twice, 9.4 +/- 1.4 y apart, in 54 men and 75 women aged 60.4 +/- 7.8 y at baseline.

RESULTS

Subcutaneous fat declined (-17.2%; P < 0.001), whereas total fat mass increased (7.2%; P < 0.05). Waist and hip circumference changes were the best anthropometric predictors of total fat mass change (r(2) = 0.40-0.65, P < 0.0001). Thigh girth change was more strongly associated with fat-free mass change (r(2) = 0.22, P < 0.01) than with fat mass change (r(2) = 0.07, P < 0.05) in women. An increase in physical activity was associated with an attenuation of thigh girth decline in men and women (F ratio = 5.13, P < 0.007). Traditional metabolic markers of visceral adiposity (triacylglycerol, glucose, and total cholesterol) were not significantly related to the change in waist circumference.

CONCLUSIONS

Skinfold thicknesses cannot be used to assess changes in body fat mass because of age-related fat redistribution. Higher levels of physical activity can attenuate the decline in appendicular lean tissue expected over 10 y. Waist and thigh girths, rather than skinfold thicknesses, should be considered for use in longitudinal studies in the elderly because the changes in these girths capture increased abdominal adiposity and sarcopenia, respectively.

Control of the Size of the Human Muscle Mass

This review is divided into two parts, the first dealing with the cell and molecular biology of muscle in terms of growth and wasting and the second being an account of current knowledge of physiological mechanisms involved in the alteration of size of the human muscle mass. Wherever possible, attempts have been made to interrelate the information in each part and to provide the most likely explanation for phenomena that are currently only partially understood. The review should be of interest to cell and molecular biologists who know little of human muscle physiology and to physicians, physiotherapists, and kinesiologists who may be familiar with the gross behavior of human muscle but wish to understand more about the underlying mechanisms of change.

Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM)

RATIONALE

Appendicular skeletal muscle mass (ASMM) is useful in the evaluation of nutritional status because it reflects the body muscle protein mass. The purpose of this study was to validate, against dual-energy X-ray absorptiometry (DEXA), a BIA equation to predict ASMM to be used in volunteers and patients.

METHOD

Healthy men (n = 246 men, BMI 25.3+/-2.9 kg/m(2)) and women (n =198, 24.1+/-3.6 kg/m(2)), and heart, lung and liver transplant patients (213 men, BMI of 24.6+/-4.4 kg/m(2); 113 women, BMI 23.0+/-5.2 kg/m(2)) were measured by BIA (Xitron Technologies) and DEXA (Hologic QDR 4500). A BIA equation to predict ASMM (kg) that included height(2)/resistance, weight, gender, age and reactance, was developed by means of multiple regressions. [table: see text] Mean difference (Bland-Altman) for volunteers was 0.1+/-1.1 kg, r =0.95, SEE 1.12 kg and for patients -0.4+/-1.5 kg, r =0.91, SEE 1.5 kg. Best fitted multiple regression equation was -4.211 + (0.267 x height2 / resistance) + (0.095 x weight)+(1.909 x sex (men = 1, women = 0)) + (-0.012 x age) + (0.058 x reactance).

CONCLUSIONS

BIA permits the prediction of ASMM in healthy volunteers and patients between 22 and 94 years of age. A slightly larger, though clinically not significant, error was noted in patients.

Maximum rate of oxygen consumption related to succinate dehydrogenase activity in skeletal muscle fibres of chronic heart failure patients and controls

Previous studies indicate that the low maximum rate of oxygen consumption (VO2max) of chronic heart failure (CHF) patients is not because of impaired pump function of the heart. We hypothesize that VO2 during maximum exercise is determined by the total oxidative capacity of skeletal muscle. VO2max of six controls and 14 CHF patients, New York Heart Association class I-III, was determined using an incremental bicycle ergometer test. Cryostat sections of a biopsy from the quadriceps femoris muscle were incubated for succinate dehydrogenase (SDH) using quantitative histochemistry. VO2max (range: 29 ml O2 kg muscle(-1) min(-1) in a class III patient to 118 ml O2 kg muscle(-1) min(-1) in a control subject) correlates with the mean SDH activity of skeletal muscle fibres (r=0.79 or r=0.81, including or excluding oxygen uptake at rest, respectively; P<0.001). The relationship between VO2max and SDH activity is similar to that determined previously using isolated single muscle fibres and myocardial trabeculae under hyperoxic conditions. From the product of SDH activity and the cross-sectional area of the fibre (i.e. spatially integrated SDH activity), it is possible to calculate the maximum oxygen uptake rate per unit muscle fibre length. This uptake rate is linearly related to the number of capillaries per fibre (r=0.76, P<0.001) in all subjects, suggesting that oxidative capacity of skeletal muscle fibres in CHF patients decreases in proportion to the oxygen supply capacity of the microcirculation.

Anthropometrically estimated total body water volumes are larger than modeled urea volume in chronic hemodialysis patients: effects of age, race, and gender

BACKGROUND

The modeled volume of urea distribution (Vm) in intermittently hemodialyzed patients is often compared with total body water (TBW) volume predicted from population studies of patient anthropometrics (Vant).

METHODS

Using data from the HEMO Study, we compared Vm determined by both blood-side and dialysate-side urea kinetic models with Vant as calculated by the Watson, Hume-Weyers, and Chertow anthropometric equations.

RESULTS

Median levels of dialysate-based Vm and blood-based Vm agreed (43% and 44% of body weight, respectively). These volumes were lower than anthropometric estimates of TBW, which had median values of 52% to 55% of body weight for the three formulas evaluated. The difference between the Watson equation for TBW and modeled urea volume was greater in Caucasians (19%) than in African Americans (13%). Correlations between Vm and Vant determined by each of the three anthropometric estimation equations were similar; but Vant derived from the Watson formula had a slightly higher correlation with Vm. The difference between Vm and the anthropometric formulas was greatest with the Chertow equation, less with the Hume-Weyers formula, and least with the Watson estimate. The age term in the Watson equation for men that adjusts Vant downward with increasing age reduced an age effect on the difference between Vant and Vm in men.

CONCLUSION

The findings show that kinetically derived values for V from blood-side and dialysate-side modeling are similar, and that these modeled urea volumes are lower by a substantial amount than anthropometric estimates of TBW. The higher values for anthropometry-derived TBW in hemodialyzed patients could be due to measurement errors. However, the possibility exists that TBW space is contracted in patients with end-stage renal disease (ESRD) or that the TBW space and the urea distribution space are not identical.

A multicompartment model of carboxyhemoglobin and carboxymyoglobin responses to inhalation of carbon monoxide

We have developed a model that predicts the distribution of carbon monoxide (CO) in the body resulting from acute inhalation exposures to CO. The model includes a lung compartment, arterial and venous blood compartments, and muscle and nonmuscle soft tissues with both vascular and nonvascular subcompartments. In the model, CO is allowed to diffuse between the vascular and nonvascular subcompartments of the tissues and to combine with myoglobin in the nonvascular subcompartment of muscle tissue. The oxyhemoglobin dissociation curve is represented by a modified Hill equation whose parameters are functions of the carboxyhemoglobin (HbCO) level. Values for skeletal muscle mass and cardiac output are calculated from prediction formulas based on age, weight, and height of individual subjects. We demonstrate that the model fits data from CO rebreathing studies when diffusion of CO into the muscle compartment is considered. The model also fits responses of HbCO to single or multiple exposures to CO lasting for a few minutes each. In addition, the model reproduces reported differences between arterial and venous HbCO levels and replicates predictions from the Coburn-Forster-Kane equation for CO exposures of a 1- to 83-h duration. In contrast to approaches based on the Coburn-Forster-Kane equation, the present model predicts uptake and distribution of CO in both vascular and tissue compartments during inhalation of either constant or variable levels of CO.

Evaluation of body composition: practical guidelines

The measurement of body composition in the truest sense allows for the estimation of body tissues, organs, and their distributions in living persons without inflicting harm. It is important to recognize that there is no single measurement method that is error-free. Furthermore, bias can be introduced if a measurement method makes assumptions related to body composition proportions and characteristics that are inaccurate across different populations. Some methodologic concerns include hydration of fat-free body mass changes with age and differences across ethnic groups [73]; the density of fat-free body mass changes with age and differences between men and women [74, 75]; total body potassium decreases with age [73] and fatness [76] and differences between African Americans and Caucasians [77]; the mass of skeletal muscle differences across race group [63]; and VAT differences across sex [78] and race [67, 79, 80] groups, independent of total adiposity. These between-group differences influence the absolute accuracy of methods for estimating fatness or FFM that involve the two-compartment model approach. The clinical significance of the body compartment to be measured should be determined before a measurement method is selected, because the more advanced techniques are less accessible and more costly.

Whole-body skeletal muscle mass: development and validation of total-body potassium prediction models

BACKGROUND

A substantial proportion of total body potassium (TBK) in humans is found in skeletal muscle (SM), thus affording a means of predicting total-body SM from whole-body counter-measured (40)K. There are now > 30 whole-body counters worldwide that have large cross-sectional and longitudinal TBK databases.

OBJECTIVE

We explored 2 SM prediction approaches, one based on the assumption that the ratio of TBK to SM is stable in healthy adults and the other on a multiple regression TBK-SM prediction equation.

DESIGN

Healthy subjects aged >or= 20 y were recruited for body-composition evaluation. TBK and SM were measured by whole-body (40)K counting and multislice magnetic resonance imaging, respectively. A conceptual model with empirically derived data was developed to link TBK and adipose tissue-free SM as the ratio of TBK to SM.

RESULTS

A total of 300 subjects (139 men and 161 women) of various ethnicities with a mean (+/- SD) body mass index (in kg/m(2)) of 25.1 +/- 5.4 met the study entry criteria. The mean conceptual model-derived TBK-SM ratio was 122 mmol/kg, which was comparable to the measurement-derived TBK-SM ratios in men and women (119.9 +/- 6.7 and 118.7 +/- 8.4 mmol/kg, respectively), although the ratio tended to be lower in subjects aged >or= 70 y. A strong linear correlation was observed between TBK and SM (r = 0.98, P < 0.001), with sex, race, and age as small but significant prediction model covariates.

CONCLUSIONS

Two different types of prediction models were developed that provide validated approaches for estimating SM mass from (40)K measurements by whole-body counting. These methods afford an opportunity to predict SM mass from TBK data collected in healthy adults.

Assessment by bioimpedance of forearm cell mass: a new approach to calibration

OBJECTIVE

Changes in skeletal muscle mass are involved in several important clinical disorders including sarcopenia and obesity. Unlike body fat, skeletal muscle is difficult to quantify in vivo, particularly without highly specialized equipment. The present study had a two-fold aim: to develop a regional (40)K counter for non-invasively estimating cell mass in the arm, mainly skeletal muscle cell mass, without radiation exposure; and to test the hypothesis that cell mass in the arm is highly correlated with electrical impedance after adjusting for the arm's length.

METHODS

Forearm cell mass was estimated using a rectangular lead-shielded (40)K counter with 4-NaI crystals; impedance of the arm was measured at multiple frequencies using a segmental bioimpedance analysis (BIA) system. The system's within- and between-day coefficient of variation (CV) for (40)K-derived elemental potassium averaged 1.8+/-1.3 and 5.8+/-1.2%, respectively. The corresponding BIA system's CVs were 1.0+/-0.4 and 2.1+/-1.0%, respectively.

SUBJECTS AND RESULTS

Participants in the study were 15 healthy adults (eight females, seven males; age 39+/-2.8 y, BMI 22.9+/-4.5 kg/m(2)). The right arm's K (5.2+/-1.7 g) was highly correlated with length-adjusted impedance (r(2)=0.81, 0.82, and 0.83 for 5, 50 and 300 kHz, respectively; all P<0.001); multiple regression analysis showed no additional improvement by adding age or sex to the prediction models.

CONCLUSION

These results demonstrate the feasibility of calibrating BIA-measured electrical properties of the arm against estimates of arm cell mass, mainly of skeletal muscle, obtained by regional (40)K counting. This simple and practical approach should facilitate the development of BIA-based regional cell mass prediction formulas