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Ashby-Thompson M, Heshka S, Rizkalla B, Zurlo R, Lemos T, Janumala I, Goodpaster B, DeLany J, Courcoulas A, Strain G, Pomp A, Kang P, Lin S, Thornton J, Gallagher D. Validity of dual-energy x-ray absorptiometry for estimation of visceral adipose tissue and visceral adipose tissue change after surgery-induced weight loss in women with severe obesity. Obesity (Silver Spring) 2022; 30:1057-1065. [PMID: 35384351 PMCID: PMC10001428 DOI: 10.1002/oby.23415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Reliable and simple methods to quantify visceral adipose tissue (VAT) and VAT changes are needed. This study investigated the validity of dual-energy x-ray absorptiometry (DXA) compared with magnetic resonance imaging (MRI) for estimating VAT cross sectionally and longitudinally after surgery-induced weight loss in women with severe obesity. METHODS Women with obesity (n = 36; mean age 43 [SD 10] years; 89% White) with DXA and MRI before bariatric surgery (T0) at 12 (T12) and 24 months (T24) post surgery were included. CoreScan (GE Healthcare, Chicago, Illinois) estimated VAT from 20% of the distance between the top of the iliac crest and the base of the skull. MRI VAT (total VAT) was measured from the base of the heart to the sacrum/coccyx on a whole-body scan. RESULTS Mean DXA VAT was 45% of MRI VAT at T0, 46% at T12, and 68% at T24. DXA underestimated change in MRI VAT between T0 and T12 by 26.1% (0.81 kg, p = 0.03) and by 71.7% (0.43 kg, p < 0.001) between T12 and T24. The relationship between DXA VAT and MRI VAT differed between T12 and T24 (p value for interaction = 0.03). CONCLUSIONS CoreScan lacks validity for comparing VAT across individuals or for estimating the size of changes within individuals; however, within the limits of measurement error, it may provide a useful indicator of whether some VAT change has occurred within an individual.
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Affiliation(s)
- Maxine Ashby-Thompson
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
- Division of Molecular Genetics, Deparent of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York, USA
| | - Stanley Heshka
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
| | - Bridgette Rizkalla
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
- Division of Endocrinology, Dept. of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rosalie Zurlo
- Division of Endocrinology, Dept. of Medicine, Columbia University Medical Center, New York, New York, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Thaisa Lemos
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
| | - Isaiah Janumala
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
| | - Bret Goodpaster
- AdventHealth Orlando, Translational Research Institute, Orlando, Florida, USA
| | - James DeLany
- AdventHealth Orlando, Translational Research Institute, Orlando, Florida, USA
| | - Anita Courcoulas
- Deparent of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gladys Strain
- Division of Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Alfons Pomp
- Deparent of Surgery, University of Montréal, Montréal Quebec, Canada
| | - Patrick Kang
- New York Radiology Partners, New York, New York, USA
| | - Susan Lin
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
- Center for Family and Community Medicine, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - John Thornton
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Columbia University Medical Center, New York, New York, USA
- Division of Endocrinology, Dept. of Medicine, Columbia University Medical Center, New York, New York, USA
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Davidson LE, Yu W, Goodpaster BH, DeLany JP, Widen E, Lemos T, Strain GW, Pomp A, Courcoulas AP, Lin S, Janumala I, Thornton JC, Gallagher D. Fat-Free Mass and Skeletal Muscle Mass Five Years After Bariatric Surgery. Obesity (Silver Spring) 2018; 26:1130-1136. [PMID: 29845744 PMCID: PMC6014876 DOI: 10.1002/oby.22190] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated changes in fat-free mass (FFM) and skeletal muscle 5 years after surgery in participants from the Longitudinal Assessment of Bariatric Surgery-2 trial. METHODS A three-compartment model assessed FFM, and whole-body magnetic resonance imaging (MRI) quantified skeletal muscle mass prior to surgery (T0) and 1 year (T1), 2 years (T2), and 5 years (T5) postoperatively in 93 patients (85% female; 68% Caucasian; age 44.2 ± 11.6 years) who underwent gastric bypass (RYGB), sleeve gastrectomy, or adjustable gastric band. Repeated-measures mixed models were used to analyze the data. RESULTS Significant weight loss occurred across all surgical groups in females from T0 to T1. FFM loss from T0 to T1 was greater after RYGB (mean ± SE: -6.9 ± 0.6 kg) than adjustable gastric band (-3.5 ± 1.4 kg; P < 0.05). Females with RYGB continued to lose FFM (-3.3 ± 0.7 kg; P < 0.001) from T1 to T5. A subset of males and females with RYGB and MRI-measured skeletal muscle showed similar initial FFM loss while maintaining FFM and skeletal muscle from T1 to T5. CONCLUSIONS Between 1 and 5 years following common bariatric procedures, FFM and skeletal muscle are maintained or decrease minimally. The changes observed in FFM and muscle during the follow-up phase may be consistent with aging.
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Affiliation(s)
- Lance E. Davidson
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Wen Yu
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - James P. DeLany
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX
| | - Thaisa Lemos
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Gladys W. Strain
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alfons Pomp
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Anita P. Courcoulas
- General Surgery, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University Medical Center, New York, New York, USA
| | - Isaiah Janumala
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | | | - Dympna Gallagher
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
- Institute of Human Nutrition, Columbia University, New York, New York, USA
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Moizé V, Pi-Sunyer X, Vidal J, Miner P, Boirie Y, Laferrère B. Effect on Nitrogen Balance, Thermogenesis, Body Composition, Satiety, and Circulating Branched Chain Amino Acid Levels up to One Year after Surgery: Protocol of a Randomized Controlled Trial on Dietary Protein During Surgical Weight Loss. JMIR Res Protoc 2016; 5:e220. [PMID: 27895003 PMCID: PMC5153533 DOI: 10.2196/resprot.6438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/16/2016] [Accepted: 09/17/2016] [Indexed: 12/26/2022] Open
Abstract
Background Bariatric surgery (BS), the most effective treatment for severe obesity, typically results in 40-50 kg weight loss in the year following the surgery. Beyond its action on protein metabolism, dietary protein intake (PI) affects satiety, thermogenesis, energy efficiency, and body composition (BC). However, the required amount of PI after surgical weight loss is not known. The current daily PI recommendation for diet-induced weight loss is 0.8 g/kg ideal body weight (IBW) per day, but whether this amount is sufficient to preserve fat-free mass during active surgical weight loss is unknown. Objective To evaluate the effect of a 3-month dietary protein supplementation (PS) on nitrogen balance (NB), BC, energy expenditure, and satiety in women undergoing either gastric bypass or vertical sleeve gastrectomy. Methods In this randomized prospective study, participants will be randomized to a high protein supplementation group (1.2 g/kg IBW per day) or standard protein supplementation group (0.8 g/kg IBW per day) based on current guidelines. Outcome measures including NB, BC, circulating branched chain amino acids, and satiety, which will be assessed presurgery, and at 3-months and 12-months postsurgery. Results To date, no studies have examined the effect of dietary PS after BS. Current guidelines for PI after surgery are based on weak evidence. Conclusions The results of this study will contribute to the development of evidence-based data regarding the safe and optimal dietary PI and supplementation after BS. Trial Registration Clinicaltrials.gov NCT02269410; http://clinicaltrials.gov/ct2/show/NCT02269410 (Archived by WebCite at http://www.webcitation.org/6m2f2QLeg).
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Affiliation(s)
- Violeta Moizé
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Pi-Sunyer
- Obesity Research Center, Department of Medicine, Columbia University, New York, NY, United States
| | - Josep Vidal
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Miner
- Queens College, City University of New York, New York, NY, United States
| | - Yves Boirie
- Unité de Nutrition Humaine, Clermont Universite, Université d'Auvergne, Clermont-Ferrand, France
| | - Blandine Laferrère
- Obesity Research Center, Department of Medicine, Columbia University, New York, NY, United States
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Bernhard AB, Scabim VM, Serafim MP, Gadducci AV, Santo MA, de Cleva R. Modified body adiposity index for body fat estimation in severe obesity. J Hum Nutr Diet 2016; 30:177-184. [PMID: 27524683 DOI: 10.1111/jhn.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity. METHODS A cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equation in this population. The new equation proposed was validated in another 158 patients with severe obesity (Group 2: G2). RESULTS There was a significant difference between BF determination by BIA and BAI (P = 0.039). The mean (SD) BF in G1 was 52.3% (6.1%) determined by BIA and 51.6% (8.1%) determined by BAI. Sex, waist-hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation (modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI% = 23.6 + 0.5 × (BAI); add 2.2 if body mass index ≥ 50 kg m-2 and 2.4 if WHR ≥ 1.05]. The new equation reduced the difference [1.2% (5.9%), P < 0.001 to 0.4% (4.12%), P = 0.315] and improved the correlation (0.6-0.7) between methods. CONCLUSIONS BAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.
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Affiliation(s)
- A B Bernhard
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - V M Scabim
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - M P Serafim
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A V Gadducci
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - M A Santo
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - R de Cleva
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg 2015; 24:847-54. [PMID: 24464517 DOI: 10.1007/s11695-014-1182-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies have validated bioelectrical impedance analysis (BIA) following bariatric surgery. METHODS We examined agreement of BIA (Tanita 310) measures of total body water (TBW) and percent body fat (%fat) before (T0) and 12 months (T12) after bariatric surgery, and change between T0 and T12 with reference measures: deuterium oxide dilution for TBW and three-compartment model (3C) for %fat in a subset of participants (n = 50) of the Longitudinal Assessment of Bariatric Surgery-2. RESULTS T0 to T12 median (IQR) change in deuterium TBW and 3C %fat was -6.4 L (6.4 L) and -14.8% (13.4%), respectively. There were no statistically significant differences between deuterium and BIA determined TBW [median (IQR) difference: T0 -0.1 L (7.1 L), p = 0.75; T12 0.2 L (5.7 L), p = 0.35; Δ 0.35 L(6.3 L), p = 1.0]. Compared with 3C, BIA underestimated %fat at T0 and T12 [T0 -3.3 (5.6), p < 0.001; T12 -1.7 (5.2), p = 0.04] but not change [0.7 (8.2), p = 0.38]. Except for %fat change, Bland-Altman plots indicated no proportional bias. However, 95% limits of agreement were wide (TBW 15-22 L, %fat 19-20%). CONCLUSIONS BIA may be appropriate for evaluating group level response among severely obese adults. However, clinically meaningful differences in the accuracy of BIA between individuals exist.
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Heymsfield SB, Ebbeling CB, Zheng J, Pietrobelli A, Strauss BJ, Silva AM, Ludwig DS. Multi-component molecular-level body composition reference methods: evolving concepts and future directions. Obes Rev 2015; 16:282-94. [PMID: 25645009 PMCID: PMC4464774 DOI: 10.1111/obr.12261] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/23/2014] [Accepted: 12/05/2014] [Indexed: 01/08/2023]
Abstract
Excess adiposity is the main phenotypic feature that defines human obesity and that plays a pathophysiological role in most chronic diseases. Measuring the amount of fat mass present is thus a central aspect of studying obesity at the individual and population levels. Nevertheless, a consensus is lacking among investigators on a single accepted 'reference' approach for quantifying fat mass in vivo. While the research community generally relies on the multi-component body volume class of 'reference' models for quantifying fat mass, no definable guide discerns among different applied equations for partitioning the four (fat, water, protein and mineral mass) or more quantified components, standardizes 'adjustment' or measurement system approaches for model-required labelled water dilution volumes and bone mineral mass estimates, or firmly establishes the body temperature at which model physical properties are assumed. The resulting differing reference strategies for quantifying body composition in vivo leads to small, but under some circumstances, important differences in the amount of measured body fat. Recent technological advances highlight opportunities to expand model applications to new subject groups and measured components such as total body protein. The current report reviews the historical evolution of multi-component body volume-based methods in the context of prevailing uncertainties and future potential.
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Affiliation(s)
| | - Cara B. Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jolene Zheng
- Pennington Biomedical Research Center, LSU System, Baton Rouge, LA, USA
| | | | - Boyd J. Strauss
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, United Kingdom
| | - Analiza M. Silva
- Exercise and Health Laboratory, CIPER, Fac Motricidade Humana, Univ Tecn Lisboa, Cruz-Quebrada, Portugal
| | - David S. Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, Massachusetts, USA
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Gallagher D, DeLegge M. Body composition (sarcopenia) in obese patients: implications for care in the intensive care unit. JPEN J Parenter Enteral Nutr 2011; 35:21S-8S. [PMID: 21807929 DOI: 10.1177/0148607111413773] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study of body composition is a rapidly evolving science. In today's environment, there is a great deal of interest in assessing body composition, especially in the obese subject, as a guide to clinical and nutrition interventions. There are some strikingly different compartments of body composition between the obese and the lean patient. We do have the ability to measure body composition accurately, although these techniques can be labor intensive and expensive. The recognition of patients with sarcopenic obesity has identified a potential high-risk patient population. These body composition abnormalities may have even greater importance in the intensive care patient.
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Affiliation(s)
- Dympna Gallagher
- Department of Medicine and Institute of Human Nutrition, Columbia University and St. Luke's-Roosevelt Hospital New York, New York, USA.
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Levitt DG, Beckman LM, Mager JR, Valentine B, Sibley SD, Beckman TR, Kellogg TA, Ikramuddin S, Earthman CP. Comparison of DXA and water measurements of body fat following gastric bypass surgery and a physiological model of body water, fat, and muscle composition. J Appl Physiol (1985) 2010; 109:786-95. [PMID: 20558754 DOI: 10.1152/japplphysiol.00278.2010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Measurement of body composition changes following bariatric surgery is complicated because of the difficulty of measuring body fat in highly obese individuals that have increased photon absorption and are too large for the standard dual-energy X-ray absorptiometry (DXA) table. We reproducibly measured body composition from half-body DXA scans and compared the values of total body fat estimated from total body water (TBW) and DXA measurements before and after Roux-en-Y gastric bypass surgery (RYGB). DXA, TBW (deuterium dilution), extracellular water (ECW; bromide dilution), and intracellular water (ICW) measurement (by subtraction) were made before surgery and at 2 wk, 6 wk, 6 mo, and 12 mo after surgery. Twenty individuals completed baseline and at least four follow-up visits. DXA appeared to underestimate the fat and bone mass in extreme obesity (before surgery), whereas at 6 and 12 mo after surgery, the DXA and TBW fat measurements were similar. The ECW-to-ICW ratio was increased in obese individuals and increased slightly more after surgery. We describe a new model that explains this abnormal water composition in terms of the normal physiological changes that occur in body composition in obesity and weight loss. This model is also used to predict the muscle mass loss following RYGB.
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Affiliation(s)
- David G Levitt
- Department of Integrative Biology and Physiology, University of Minnesota Twin Cities, 225 Food Science & Nutrition, 1334 Eckles Ave., St. Paul, MN 55108-6099, USA
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Levitt DG, Heymsfield SB, Pierson RN, Shapses SA, Kral JG. Physiological models of body composition and human obesity. Nutr Metab (Lond) 2007; 4:19. [PMID: 17883858 PMCID: PMC2082278 DOI: 10.1186/1743-7075-4-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 09/20/2007] [Indexed: 02/06/2023] Open
Abstract
Background The body mass index (BMI) is the standard parameter for predicting body fat fraction and for classifying degrees of obesity. Currently available regression equations between BMI and fat are based on 2 or 3 parameter empirical fits and have not been validated for highly obese subjects. We attempt to develop regression relations that are based on realistic models of body composition changes in obesity. These models, if valid, can then be extrapolated to the high fat fraction of the morbidly obese. Methods The analysis was applied to 3 compartment (density and total body water) measurements of body fat. The data was collected at the New York Obesity Research Center, Body Composition Unit, as part of ongoing studies. A total of 1356 subjects were included, with a BMI range of 17 to 50 for males and 17 to 65 for females. The body composition model assumes that obese subjects can be represented by the sum of a standard lean reference subject plus an extra weight that has a constant adipose, bone and muscle fraction. Results There is marked age and sex dependence in the relationship between BMI and fat fraction. There was no significant difference among Caucasians, Blacks and Hispanics while Asians had significantly greater fat fraction for the same BMI. A linear relationship between BMI and fat fraction provides a good description for men but overestimates the fat fraction in morbidly obese women for whom a non-linear regression should be used. New regression relations for predicting body fat just from experimental measurements of body density are described that are more accurate then those currently used. From the fits to the experimental BMI and density data, a quantitative description of the bone, adipose and muscle body composition of lean and obese subjects is derived. Conclusion Physiologically realistic models of body composition provide both accurate regression relations and new insights about changes in body composition in obesity.
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Affiliation(s)
- David G Levitt
- Department of Integrative Biology and Physiology, University of Minnesota, 321 Church St. S.E., Minneapolis, MN 55455, USA
| | - Steven B Heymsfield
- Merck & Co, 126 E. Lincoln Avenue, PO Box 2000, RY34-A238, Rahway, NJ 07065-0900, USA
| | - Richard N Pierson
- St. Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, NY Body Composition Unit, 114Street and Amsterdam Ave, NY, NY 10025, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, 96 Lipman Drive, New Brunswick, NJ 08901, USA
| | - John G Kral
- Department of Surgery, SUNY Downstate Medical Center, Box 40, 450 Clarkson Ave, Brooklyn, NY 11203, USA
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Alvarez VP, Dixon JB, Strauss BJG, Laurie CP, Chaston TB, O'Brien PE. Single frequency bioelectrical impedance is a poor method for determining fat mass in moderately obese women. Obes Surg 2007; 17:211-21. [PMID: 17476875 DOI: 10.1007/s11695-007-9032-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The primary aim of weight loss intervention in obesity is the loss of fat mass (FM). Hence, determinations of changes in FM and fat free mass (FFM) during weight loss are of clinical value. The authors compared the clinical utility of SkinFold Thickness (SKF), tetrapolar bioelectrical impedance analysis (BIA) and a body mass index (BMI) based calculation, in determining changes in percentage of fat mass (delta%FM). METHODS Using dual X-ray absorptiometry (DEXA) measurements of %FM as a standard, BIA, SKF and BMI were compared in 41 moderately obese women (BMI 30-35) before and after significant weight loss (-13.9 +/- 5.8 kg). RESULTS When measuring fat mass loss, SKF was precise and accurate with a bias of +0.86 +/- 6.16 %, while the BMI-based estimation had a systematic bias of +6.36 +/- 6.04 % (r2 = 0.791, P < 0.001). BIA using the Lukaski formula had a bias of +5.22 % and limits of agreement that approached the magnitude of the measurement (+/- 20.82 %), thus providing no information. In contrast, BIA using the Segal formula had a systematic bias of +7.81% (r2 = 0.636, P < 0.001) and gave narrower limits of agreement (+/- 8.34 %). CONCLUSION For measuring changes in %FM with weight loss, BIA has no clinical value using the Lukaski formula, and using the Segal formula BIA provided no additional information to that given by BMI. We show that BIA instrument variables confound the estimates of %FM achieved by the BMI component of the Lukaski and Segal formulas.
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Affiliation(s)
- Veronica P Alvarez
- Australian Centre for Obesity Research and Education, Monash University Medical School, The Alfred Hospital, Melbourne, VIC, Australia
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Abstract
PURPOSE OF REVIEW Severe obesity is accompanied by large increases in fat mass and alterations in the composition of fat free mass, in particular total body water and its extracellular compartment. The physical size limitations imposed by severe obesity, and variations in body composition from that of normal weight, pose tremendous challenges to the measurement of body composition. This review focuses on some of the methodological and practical issues associated with the use of common body composition methods, and identifies available published information on feasible methods for use in the severely obese. RECENT FINDINGS There is little published research regarding what body composition methods can be used with confidence in the severely obese populations. A simple three-compartment model combining measurements of body density by air displacement plethysmography and total body water by bio-electrical impedance can provide measurements of percentage body fat in the severely obese that are comparable with a traditional, highly technical three-compartment model requiring facilities such as isotope ratio mass spectrometry along with a substantial technical expertise. SUMMARY This review highlights some of the basic challenges faced by researchers and clinicians when conducting body composition assessments in severely obese patients. A simple three-compartment model that is accurate and easy to perform appears to be promising for use in this population. Further research is needed, however, on this and other feasible methods of body composition assessment in a diverse group of severely obese people.
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Affiliation(s)
- Sai Krupa Das
- Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111, USA.
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