Body Composition In Clinical Practice Research Articles

Ab. No. 118 Test-Retest Reliability of Commercially Available Bio-Electrical Impedance-Based Body Composition Analyzer in India

Introduction: The purpose of the study is to determine the consistency of body composition measures using a commercially available bioelectrical impedance-based body composition analyzer in India. Body composition assessment has application in several clinical populations including but not limited to those with obesity, cancer, renal failure, endocrine disorders. DEXA is considered gold standard but impractical to use in regular clinical practice. Bioelectrical impedance analysis (BIA) is emerging as a simpler alternative, especially in field settings and routine clinical practice. Its use is also recommended in current sarcopenia diagnostic guidelines. Many low-cost BIA devices are available but their reliability and validity information are seldom available. Such information can improve their relevance and utility in clinical settings. Methods: Forty apparently healthy adults (Age: 28±7.5 years; 78% women, BMI: 26.1±4.4). Following necessary approvals, body composition was assessed using four-point full body impedance analysis with Omron HBF-702T device on two occasions (1-4 days apart). The timing of measurement, food and fluid intake were not standardized to mimic clinical scenarios. Paired T-test determined significant difference between two assessments. Test-retest reliability was determined by ICC using two-way mixed methods model for consistency between measurements. Results: There was no clinically and statistically significant difference between two consecutive measurements (Mean difference of - Skeletal Muscle Percentage: 0.06%; Body Fat Percentage: 0.12%; RMR: 8.5 Kcal/day). All parameters exhibited excellent test-retest reliability (ICC & Cronbach’s Alpha: Skeletal Muscle Percentage – 0.97 & 0.98; Body Fat Percentage – 0.93 & 0.96; RMR – 0.94 & 0.97. Conclusion: The tested device exhibited excellent test-retest reliability for skeletal muscle, body fat percentage, and resting metabolic rate despite testing in non-standardized routine clinical setting. Implications: Bio-electrical impedance-based body composition analyzers could be a reliable way to measure body composition in clinical practice. However, each equipment’s reliability and validity needs to be established prior to clinical use.

Stochastic Resonance Whole Body Vibration (SR-WBV) Does Not Affect the Body Composition of Healthy Young Women: A Preliminary Controlled Before–After (CBA) Study

According to the WHO, overweight and obesity, defined as abnormal or excessive fat accumulation, are a major risk factor for many diseases. The bioelectrical impedance analysis (BIA) is a commonly used method of assessing body composition in clinical practice and medical research. When the BIA reveals abnormalities, the recommended therapeutic procedure is to modify the diet and implement physical activity. One method that can reinforce or support physical activity is whole-body vibration (WBV). Vibrating devices with stochastic resonance (SR) generate vibrations of variable amplitude and frequency. For people with unhealthy body composition who cannot undertake physical activity for various reasons, procedures with stochastic resonance seems to be a good solution. The aim of this study was to evaluate the impact of stochastic resonance whole-body vibration (SR-WBV) on the body composition of women. Measured BC parameters included fat mass (FM, kg), percent body fat (PBF, %), visceral fat area (VFA, cm2), soft lean mass (SLM, kg), fat-free mass (FFM, kg), skeletal muscle mass (SMM, kg), body cell mass (BCM, kg), protein (kg), minerals (kg), bone mineral contents (BMC, kg), intracellular water (IW, l), extracellular water (EW, l), total body water (TBW, l), extracellular water/total body water (EW/TBW). The study involved 240 healthy young women with normal body composition (BC) and low or moderate physical activity levels. Two groups were randomly formed from among all participants: the V group included 134 women participating in 12 SR-WBV procedure sessions over 6 weeks; the C group included 106 women not participating in SR-WBV procedure sessions over 6 weeks. The stochastic procedure consisted of 12 sessions over 6 weeks. One session lasted 15 min, consisting of nine active series of vibrations lasting 45 s each with 40 s breaks between series. The vibration frequency was 2–8 Hz and the amplitude ranged 0.5–3.5 mm. While observing the effect of SR-WBV vibrations on body composition in the group of women, no statistically significant changes were found. Hence, we conclude that the stochastic resonance vibration procedure cannot be recommended as a way to modify body composition in healthy young women characterized by normal body composition and low or moderate physical activity levels.

Role of Machine Learning-Based CT Body Composition in Risk Prediction and Prognostication: Current State and Future Directions.

CT body composition analysis has been shown to play an important role in predicting health and has the potential to improve patient outcomes if implemented clinically. Recent advances in artificial intelligence and machine learning have led to high speed and accuracy for extracting body composition metrics from CT scans. These may inform preoperative interventions and guide treatment planning. This review aims to discuss the clinical applications of CT body composition in clinical practice, as it moves towards widespread clinical implementation.

A comparative analysis of body composition assessment by BIA and DXA in children with type II and III spinal muscular atrophy.

Body composition analysis is a valuable tool for assessing and monitoring the nutritional status of children with spinal muscular atrophy (SMA). This study was designed to compare the consistency of bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), as the gold standard method for assessing body composition in clinical practice when treating children with type II and III SMA. From 2019 to 2021, we performed a retrospective analysis of body composition by DXA and BIA measurement methods in patients with type II and III SMA treated at a Chinese tertiary children's hospital. Fat mass (FM), muscle mass (MM), bone mineral content (BMC), and visceral fat area (VFA) were compared using paired sample t-tests. We calculated Lin's concordance correlation coefficient (CCC) and Spearman correlation coefficient to verify the correlation between DXA and BIA measurements. Bland-Altman analysis was used to assess the consistency of the two methods. Fifty-seven children with type II and III SMA were recruited. Compared with body composition measured by DXA, the average FM measured by BIA is significantly lower (P <0.001), whereas the average MM, BMC, and VFA measured by BIA are significantly higher (P < 0.001) in children with SMA. Overall, the difference between MM (Delta [BIA-DAX] = 1.6 kg) and FM (Delta [BIA-DAX] = -1.6 kg) measured by DXA and BIA was minor, whereas the difference of VFA (Delta [BIA-DAX] = -43.5 cm) was significantly large. Correlation analysis indicated a substantial correlation of MM (CCC = 0.96 [95% confidence interval (CI) = 0.93-0.98], r = 0.967 [P < 0.0001]) and FM (CCC = 0.95 [95% CI = 0.92-0.97], r = 0.953 [P < 0.0001]), and poor correlation of BMC (CCC = 0.61 [95% CI = 0.42-0.75], r = 0.612 [P < 0.0001]) and VFA (CCC = 0.54 [95% CI = 0.33-0.70], r = 0.689 [P < 0.0001]) measurements between the two methods. The Bland-Altman analysis suggests that the majority of participants were within LOA. In addition, differences in MM and VFA measurements between BIA and DAX increased according to patients' increasing height, whereas differences in FM and BMC did not differ with height. BIA overestimates MM and underestimates the FM, BMC, and VFA in children with SMA compared with DXA measurements. Overall, the non-invasive, easy-to-use, and repeatable BIA measurements were found to be in good agreement with DXA measurements, especially for FM and MM, which are essential parameters for the nutritional evaluation of children with SMA.

How reliable is BMI? Bioimpedance analysis of body composition in underweight, normal weight, overweight, and obese women

BackgroundThe human body consists of water, proteins, lipids, carbohydrates, and minerals that build cells, tissues, and organs. In healthy people, the content of these molecules remains nearly constant. The body mass index (BMI) is commonly used to classify abnormal body composition among adults. According to the WHO, a high BMI is a major risk factor for many diseases. Bioelectrical impedance analysis is a commonly used method for assessing body composition in clinical practice and medical research.AimsThe aim of this study was to identify the advantages and disadvantages of using BMI in diagnosis of underweight, overweight, and obesity, by comparing the value of the index with the values of body composition analysis parameters.MethodsA total of 267 healthy women 18 to 35 years of age participated in this study. Bioelectrical impedance analysis was performed on all participants at the beginning of the experiment with an InBodyS10 device.ResultsIn the BMI categories of overweight and obese, only women with excessive BFM were measured with BIA. The BMI category of normal body weight, apart from women with normal body composition, includes people with both deficient and excess body components, e.g., body fat or lean body mass. The BMI category of underweight includes women with different body compositions as well as people with excessive fat content.ConclusionsThe BMI is useful to provide a warning of excessive fat content in overweight and obese women, whereas among normal weight and underweight women, it may mask various types of body composition defects.

Dapagliflozin Add-On Therapy Improves Body Composition and Metabolic Parameters in Overweight Type 2 Diabetic Patients: A Pilot Study

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) inhibit renal glucose reabsorption in the proximal tubules, and reduce plasma glucose, body weight and cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). The data on the effect of SGLT-2i on body composition are conflicting: in some reports, they reduce fat mass, while in other reports, they determine reduction of extra- and intra-cellular fluids. The aim of our pilot study was to investigate the body compartments changes and the effects on glycemia and plasma lipids of add-on SGLT2-i dapagliflozin therapy in poorly controlled overweight/obese T2DM patients. Methods: Fifty-six overweight (body mass index (BMI) > 25) uncontrolled (HbA1c > 53 mmol/mol; 7%) T2DM outpatients were recruited. They were treated with metformin and basal insulin (group A) or metformin (group B). Weight, BMI, waist circumference (WC), fasting blood glucose (FPG), HbA1c, plasma lipids, bioelectric parameters and derived body compartments (phase angle (pA), total body water (TBW), fat free mass (FFM) and fat mass (FM)) were assessed at baseline (T0) and after 16 weeks (T1) of dapagliflozin 10 mg add-on treatment. Student’s t -test and one-way analysis of variance (ANOVA) were used to compare the T0 and T1 data. Results: After 16 weeks, all the patients had weight loss (-3.0 ± 0.6 kg, P < 0.0001) and reduced WC (-2.5 ± 0.6 cm, P < 0.0001). Weight reduction was significant in both groups separately (group A: -2.5 ± 0.3 kg, P <= 0.001; group B: -3.4 ± 0.4 kg, P <= 0.001) and was higher in group B. FFM was not impaired in group A (from 60.2 ± 5.2 to 59.5 ± 8.1 kg; ns) and in group B (from 60.4 ± 6.2 to 59.3 ± 6.6 kg; ns). FM decreased in all the patients (29.9 ± 6.84 kg vs. 26.30 ± 7.4 kg, P < 0.000); a higher reduction was found in group B (-3.6 ± 1.2 kg, P < 0.001) vs. group A (-2.3 ± 1.3 kg, P < 0.001). Metabolic control improved in all the patients: FPG 172 ± 49.4 mg/dL vs. 137 ± 36.8 mg/dL at T1, P < 0.0001; HbA1c 69 ± 9.3 mmol/mol (8.5±1.5%) vs. 60 ± 8.7 mmol/mol (7.6±1.4%), P = 0.000. In group A, insulin dose was reduced by 9.3%. Cholesterol and triglycerides (TG) levels decreased in overall population (181.8 ± 48.8 mg/dL vs. 170.7 ± 40.7, P = 0.003; 172 ± 93 mg/dL vs. 143.2 ± 87.8, P = 0.000). Conclusions: Dapagliflozin add-on therapy induced weight loss and metabolic improvement in overweight and obese T2DM patients. Also insulin-treated patients had weight loss (2.5 kg). Bioelectric impedance analysis (BIA) demonstrated FM loss without FFM impairment and was confirmed to be a simple and effective method to assess body composition in clinical practice. J Endocrinol Metab. 2019;9(4):90-94 doi: https://doi.org/10.14740/jem564

Body composition of women 20-49 years old as a predictor for noncommunicable diseases: a community-based study.

Obesity increases a person's risk of developing a number of noncommunicable diseases (NCDs), including, type 2 diabetes, coronary heart disease, hypertension, and certain cancers. The bioelectrical impedance analysis (BIA) has been considered as a safe, noninvasive, simple, and least expensive portable method for the evaluation of body composition in clinical practice. However, there is not enough information about its use in community-based surveys to detect the optimal cutoff point for the body fat percent (BF%) that could predict NCDs. To identify the cutoff point for the BF%, at which NCD risk could be predicted compared with BMI and waist circumference (WC). A community-based study was conducted in a randomly selected cluster located within the catchment area of Cairo University Hospitals. All ever-married women 20-49 years old and not currently pregnant (n=373) in the selected cluster were included in the study. A questionnaire was used for recoding data during the household survey. Portable equipment that estimates body composition (water, fat, protein, and bone) through BIA was used. Receiver operating characteristic curve analysis showed cutoff point for BF% of 37.5% (P=0.02) at the time of reporting hypertension, with 78% sensitivity and 40% specificity. For diagnosed diabetes, cutoff point for the BF% was 38.5% (P=0.005), with 71% sensitivity and 46% specificity. For diagnosed cardiovascular diseases, cutoff point for BF% was 38.5% (P=0.001) with 86% sensitivity and 47% specificity. For diagnosed joint diseases, cutoff point for BF% was 38.5% (P=0.005), with 67% sensitivity and 48% specificity. BIA was effective in predicting and suggesting the cutoff points for the BF% associated with four types of NCDs (hypertension, cardiovascular, diabetes, and joint diseases). The use of BIA for women before the age of 20 years could guide strategies for reducing body fat and its risk of NCDs.

Body composition in clinical practice

Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice.

Non-alcoholic fatty liver disease severity, central fat mass and adinopectin: a close relationship.

AimNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the general population. Overweight is a common condition in patients with NAFLD, and body composition (BC) assessment is useful to evaluate nutritional status and the efficacy of nutritional strategies. A valid tool for assessing BC is dual-energy X-ray absorptiometry (DXA). Adiponectin has been shown to be relevant to the pathogenesis of NAFLD. The aim of this observational study is to define the relationship between the severity of NAFLD, the central fat mass evaluated by DXA, and the circulating levels of adiponectin.MethodsThe study was carried out in 31 overweight patients. The degree of liver steatosis was evaluated by ultrasound (US) examination. Anthropometric parameters were measured according to standard methods. Fasting glucose and insulin level were used also to calculate insulin resistance (IR), according to the homeostasis model assessment-insulin resistance (HOMA-IR). The enzyme-linked immunosorbent assay technique was performed to dose fasting serum levels of adiponectin.ResultsNAFLD progression was significantly associated with increased central fat (p<0.05). Using DXA, we quantified the regional distribution of adipose tissue and found the expected association between central fat and the US severity of NAFLD. Serum levels of adiponectin, were inversely related to NAFLD progression (p<0.05).ConclusionBC evaluated by anthropometry and DXA, may be used as indicator of NAFLD severity in overweight patients. The evaluation of BC in clinical practice, can improve the nutritional strategies and follow-up. In the clinical setting adiponectin may represent a potential marker for the staging of NAFLD.

A 360-degree overview of body composition in healthy people: Relationships among anthropometry, ultrasonography, and dual-energy x-ray absorptiometry

ObjectiveThe aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in clinical practice. MethodsThe study was carried out in Italian blood donor volunteers belonging to five different age groups (18–70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat–lean mass balance, central–peripheral fat distribution, central or visceral fat, and subcutaneous fat. ResultsAnthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women (P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography (P < 0.025). ConclusionsBoth anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.

La bioimpedancia como valoración del peso seco y del estado de hidratación

Several studies confirm that continuous overhydration is associated with morbidity and mortality in dialysis patients. To determine hydration status in these patients, clinical parameters such as interdialytic weight gain, the presence of hypertension and episodes of intradialytic hypotension are generally used. Many techniques for assessing body composition in clinical practice have been described, but most are invasive, costly and difficult to apply in daily clinical practice. Electrical bioimpedance (BIA) is a noninvasive, inexpensive and easy to use technique that is being incorporated in nephrology to analyze body composition and hydration status objectively, complementing clinical evaluation and helping to identify patients with fluid overload. In this review, we specify the different methods for estimating dry weight by focusing on the techniques that can objectively help us to identify patients with fluid overload and increased risk of morbidity and mortality.

Development and validation of two equations estimating body composition for overweight and obese postmenopausal women

Objective The aim of this study was to develop and validate two equations that best predict body composition of overweight and obese postmenopausal women. Methods Bioelectrical impedance analyses (BIAs) and anthropometric data such as circumferences and skinfolds were incorporated in the development of these two equations, respectively, while dual energy X-ray absorptiometry (DXA) was used as the reference method. A total number of 196 overweight and obese Greek postmenopausal women were used (131 subjects to develop the equations, and 65 to validate them). Results The BIA equation was: (FFM) = 38.475 + 0.207 × Wt − 0.092 × Rz/Ht 2 + 0.291 × Xc/Ht 2 ( R 2 = 0.800, p < 0.0001) and the anthropometry equation was FM = −31.913 + 0.333 × GC + 0.840 × body mass index (BMI) + 0.064 × (biceps + triceps skinfold) ( R 2 = 0.835, p < 0.0001). Both equations were found to result in unbiased estimates. Regarding reliability, BIA equation was found to be more reliable compared to existing ones when applied to this population. Additionally, BIA equation was more reliable compared to the anthropometric equation (±3.12642 kg vs. ±5.2342 kg limits of agreement, respectively). Conclusion These conclude that the equations developed in the current study are more reliable than the existing ones in the literature, and could be applied for assessing body composition in clinical practice and research.

Article Commentary: Application of Bioelectrical Impedance to Clinical Assessment of Body Composition in Peritoneal Dialysis

Patients on peritoneal dialysis (PD) develop complex changes in body composition. These changes reflect hydration, nutrition, and body fat, all important elements reflecting patient well-being and efficacy of therapy that should be assessed and monitored as guides to patient management. They are all notoriously difficult to accurately measure in clinical practice and simultaneous abnormalities may obscure detection, as in the malnourished fluid-overloaded patient where body weight is misleadingly stable. Malnutrition is a serious complication in PD that carries an adverse prognosis. Assessment of hydration in PD is important in determining "dry weight" to allow adjustment of dialysis prescription to optimize fluid balance. A number of techniques have been investigated to measure body composition in clinical practice. Of these, bioelectrical impedance analysis (BIA) has attracted most interest and seems to be of greatest promise. Cases illustrating different aspects of the use of BIA in PD patients are described, and the background, possible uses, and limitations of BIA in PD patients are discussed. To be of clinical value, BIA must be used to distinguish between extracellular water (which reflects hydration) and body cell mass, or intracellular water (which declines in wasting and malnutrition). The high precision of BIA is ideally suited to detecting changes in body composition and its main role may be in longitudinal monitoring. However, inaccuracy of absolute measurements and variability of normal values in the general population make precise diagnosis of the degree of normality of body composition in an individual subject a more difficult task for body composition analysis.

Body composition analysis by dual X‐ray absorptiometry: in vivo and in vitro comparison of three different fan‐beam instruments

Background. Dual X‐ray absorptiometry (DXA) is the preferred method for measuring body composition in clinical practice, but interchange between devices may pose problems with the interpretation of results. Objective. To establish conversion equations for body composition variables between three fan‐beam DXA systems. Methods. Body composition was assessed in 21 subjects using Lunar Expert (Expert), Lunar Prodigy (Prodigy) and Hologic Delphi W (Delphi). Weekly measurements of Hologic whole body phantom 164 were performed. Results. There were no significant differences between DXA‐measured means of body weight, fat mass and lean body mass. Bland‐Altman analysis revealed that Lunar Expert increasingly overestimated fat mass with increasing total mass (p<0.001) relative to Delphi and Prodigy, while Delphi produced a constant underestimation of fat mass. Correlations between scale weights and DXA‐measured body weights, and between DXA‐measured body weights and the sum of fat masses, lean body masses and bone mineral contents (BMC) between the three instruments, were excellent (Rsqr 0.998–0.910; p<0.001). Conversion factors to Prodigy for Expert and Delphi were respectively 1.003 and 1.011 for total body mass, 0.954 and 1.079 for fat mass, 1.018 and 0.967 for lean body mass and 1.049 and 1.136 for BMC (Rsqr 0.999–0.991; p<0.001). Standard error of estimate (SEE) for the slopes ranged from 0.20% to 2.10%. Phantom studies revealed stable instrument function with CV% commonly<2%, except for lean mass for Delphi (5.5%). Conclusions. Despite the significant differences in measurement of body composition between DXA fan‐beam instruments, clinically relevant conversion factors can be established.

Consensus in clinical nutrition

List of contributors Preface 1. Measurement of body composition in clinical practice S. A. Jebb and M. Ella 2. Assessment of energy requirements J. H. Green 3. Amino acid requirements in health and disease P. J. Garlick, M. A. McNurlan and M. F. Fuller 4. Mineral and vitamin metabolism A. Shenkin 5. Nutritional immunology A. Animashaun and R. V. Heatley 6. Physiology of nutrient absorption: a decade of advance in formulation of enteral diets G. K. Grimble 7. Enteral and parenteral nutrition C. R. Pennington 8. Is nutritional support worthwhile? R. L. Koretz 9. Enteral feeding and food intolerance in paediatrics A. MacDonald 10. Neonatal intravenous feeding I. W. Booth 11. Nutrition and the surgical patient N. Everitt and M. McMahon 12. Perioperative feeding M. M. Meguid and A. C. L. Campos 13. How I feed the starving patient S. P. Allison 14. Intensive care management I. T. Campbell and R. A. Little 15. The role of the liver in nutrition M. S. Losowsky and P. N. Bramley 16. Nutritional deficiencies in inflammatory bowel disease P. Duane and R. V. Heatley 17. Short bowel syndrome J. E. Lennard-Jones 18. Nutrition in cystic fibrosis J. M. Littlewood and S. P. Wolfe 19. Diet, lipids and lipoproteins J. P. Miller and A. Naylor 20. Diet and book pressure J. D. Swales 21. Obesity J. Garrow 22. Eating disorders L. F. Pieri and A. C. P. Sims Index.