The validity of multifrequency bioelectrical impedance measures to detect changes in the hydration status of wrestlers during acute dehydration and rehydration

The objective of this study was to examine the validity of multifrequency direct segmental bioelectrical impedance analysis (DSM-BIA) measures to detect changes in the hydration status of wrestlers after they underwent 3% acute dehydration and a 2-hour rehydration period. Fifty-six National Collegiate Athletic Association wrestlers: (mean ± SEM); age 19.5 ± 0.2 years, height 1.73 ± 0.01 m, and body mass (BM) 82.5 ± 2.3 kg were tested in euhydrated, dehydrated (-3.5%), and 2-hour rehydration conditions using DSM-BIA to detect the changes in hydration status. The hydration status was quantified by measuring the changes in plasma osmolality (P(osm)), urine osmolality (Uosm), urine specific gravity (U(sg)), BM, and weighted segmental impedance at frequencies of 5, 20, 50, 100, and 500 kHz. Weighted segmental impedance significantly increased after a 3.5% reduction in the body weight for all the 5 frequencies evaluated, but it did not return to baseline at 2-hour rehydration. P(osm) (303 ± 0.6 mOsm·L(-1)), Uosm (617 ± 47 mOsm·L(-1)), and U(sg) (1.017 ± 0.001) all significantly increased at postdehydration and returned to baseline at 2-hour rehydration. Estimations of extracellular water were significantly different throughout the trial, but there were no significant changes in the estimations of the total body water or intracellular water. The results of this study demonstrate the potential use of DSM-BIA as a field measure to assess the hydration status of wrestlers for the purpose of minimal weight certification before the competitive season. When employing DSM-BIA to assess the hydration status, the results indicated that the changes in weighted segmental impedance at the frequencies evaluated (5, 20, 50, 100, and 500 kHz) are sensitive to acute changes in dehydration but lag behind changes in the standard physiological (plasma and urinary) markers of hydration status after a 2-hour rehydration period.     

Unreliable use of standard muscle hydration value in obesity

Intramuscular water content is assumed to be constant in humans independent of their anthropometric characteristics. To verify whether this assumption is correct, intramuscular water, proteins, glycogen, and both total and intramyocytic triglycerides were measured in 51 samples of rectus abdominis muscle obtained from 16 lean and 35 overweight and obese subjects (body mass index cutoff 24.9 kg/m2). Data (referred to as wet tissue) were analyzed by means of a composition model at the cellular level of the skeletal muscle (SM). The average SM water content was 76.3 +/- 3.3% in normal-weight individuals and 65.7 +/- 5.8% in obese subjects (P < 0.0001). Total triglycerides were 5.5 +/- 2.3% in controls and 19.0 +/- 7.0% in obese subjects (P < 0.0001). The intramyocytic triglyceride fraction was also increased in obese subjects. The composition model provides an explanation for the negative correlation between total triglycerides and intramuscular water, and some of the model parameters were determined from the experimental data. In conclusion, although the hydration of fat-free SM mass may be unchanged in obese subjects, the hydration of in toto muscle mass decreases as its lipid content increases.     

Body composition assessment of young tennis players by multi-frequency impedance measurements

Body composition was estimated in 169 young tennis players using the multi-frequency impedance method to predict their fatfree-mass, fat, extra-cellular water, and total body water. Bioelectrical impedances at 1, 5, 10, 50 and 100 kHz were determined. Ratios of impedance at low to high frequencies (Z1/Z100; Z5/Z100) were also used as indicators of body water distribution. This sample is characterized by a greater body mass — fat mass, above all-than other Italian sport participants. Sexual dimorphism in body composition is also evident in this sample. The parameters of body composition, predicted by impedance measurements were compared with parameters obtained through other methods (skinfolds and BMI) on the same subjects. Results varied considerably, in relation to the various equations or different techniques employed. Besides demonstrating the value of multifrequency impedance measurements in the assessment of body composition, our findings indicate the necessity of further methodological research to validate the method under controlled conditions.     

Comparison of DXA and CT in the Assessment of Body Composition in Premenopausal Women With Obesity and Anorexia Nervosa

Accurate methods for assessing body composition in subjects with obesity and anorexia nervosa (AN) are important for determination of metabolic and cardiovascular risk factors and to monitor therapeutic interventions. The purpose of our study was to assess the accuracy of dual‐energy X‐ray absorptiometry (DXA) for measuring abdominal and thigh fat, and thigh muscle mass in premenopausal women with obesity, AN, and normal weight compared to computed tomography (CT). In addition, we wanted to assess the impact of hydration on DXA‐derived measures of body composition by using bioelectrical impedance analysis (BIA). We studied a total of 91 premenopausal women (34 obese, 39 with AN, and 18 lean controls). Our results demonstrate strong correlations between DXA‐ and CT‐derived body composition measurements in AN, obese, and lean controls (r = 0.77–0.95, P < 0.0001). After controlling for total body water (TBW), the correlation coefficients were comparable. DXA trunk fat correlated with CT visceral fat (r = 0.51–0.70, P < 0.0001). DXA underestimated trunk and thigh fat and overestimated thigh muscle mass and this error increased with increasing weight. Our study showed that DXA is a useful method for assessing body composition in premenopausal women within the phenotypic spectrum ranging from obesity to AN. However, it is important to recognize that DXA may not accurately assess body composition in markedly obese women. The level of hydration does not significantly affect most DXA body composition measurements, with the exceptions of thigh fat.     

Comparison of proximal and distal placements of electrodes to assess body composition by bioelectrical impedance in obese adults

The purpose of this study was to compare the variability and accuracy of proximal and traditional distal electrode placement to estimate body composition in obese adults. Fifty-two obese men and women had a mean age of 37 years and an average body mass index (BMI) of 30.6 kg.m(-2). Body composition was measured using DEXA and an RJL bioelectric impedance analysis 101A bioelectric impedance analyzer. Impedance was measured using the traditional distal electrode placement (hand and foot) and a proximal electrode placement where the current detecting electrodes were placed in the antecubital and popliteal fossae. The distal resistance was 482.4 +/- 79 Omega, which was more than double the mean proximal values of 193.2 +/- 27 Omega. Multiple regression analysis derived the best-fitting equation to predict DEXA-derived fat-free mass. The combination of Ht(2)/R (height(2)/resistance) and mass were the only significant predictors for both the proximal and distal electrode placements. The resulting R(2) values were 0.86 and 0.88, whereas standard errors of the estimate (SEEs) were 4.0 and 3.6 kg for the distal and proximal placements, respectively. An independent sample of 40 obese women was used to cross-validate this new equation. Mean impedance predictions using the distal and proximal electrode placements (45.78 +/- 1.07 and 45.29 +/- 0.97 Omega, respectively) were similar to the reference values (45.29 +/- 0.64 Omega) determined by DEXA. Fat-free mass predicted with the distal and proximal electrode placements correlated significantly (p < 0.001) with the reference fat-free mass value (r = 0.72 and 0.75, respectively). These data suggest that using a proximal electrode placement and a fatness-specific equation helps to reduce the variability of the bioelectric impedance analysis technique in obese adults.     

Increased extracellular water compartment, relative to intracellular water compartment, after weight reduction.

The hydration of fat free mass (FFM) and extracellular (ECW) and intracellular water (ICW) compartments were studied in 30 obese premenopausal women before and after a 3-mo weight-reduction program and again after a 9-mo weight-maintenance program. Body fat was determined by a four-compartment model. Total body water and ECW were determined by deuterium dilution and bromide dilution, respectively. After the weight-reduction period, mean weight loss was 12.8 kg, and body fat was reduced on average by 10.9 kg. During weight maintenance, changes in body mass and body fat were not significant. Before weight reduction, mean ECW/ICW ratio was relatively high (0.78 +/- 0.10). During the the study, total body water and ICW did not change significantly. ECW did not change significantly after weight reduction, but 12 mo after the start ECW was significantly increased by 1 liter. The ECW/ICW ratio increased to 0.87 +/- 0.12 (month 12). The hydration of the FFM increased from 74 +/- 1 to 77 +/- 2% during the weight reduction and remained elevated during weight maintenance. In conclusion, the ECW/ICW ratio and the hydration of the FFM, did not normalize during weight reduction and weight maintenance.     

Single- and multifrequency models for bioelectrical impedance analysis of body water compartments.

The 1994 National Institutes of Health Technology Conference on bioelectrical impedance analysis (BIA) did not support the use of BIA under conditions that alter the normal relationship between the extracellular (ECW) and intracellular water (ICW) compartments. To extend applications of BIA to these populations, we investigated the accuracy and precision of seven previously published BIA models for the measurement of change in body water compartmentalization among individuals infused with lactated Ringer solution or administered a diuretic agent. Results were compared with dilution by using deuterium oxide and bromide combined with short-term changes of body weight. BIA, with use of proximal, tetrapolar electrodes, was measured from 5 to 500 kHz, including 50 kHz. Single-frequency, 50-kHz models did not accurately predict change in total body water, but the 50-kHz parallel model did accurately measure changes in ICW. The only model that accurately predicted change in ECW, ICW, and total body water was the 0/infinity-kHz parallel (Cole-Cole) multifrequency model. Use of the Hanai correction for mixing was less accurate. We conclude that the multifrequency Cole-Cole model is superior under conditions in which body water compartmentalization is altered from the normal state.     

Three-compartment model: critical evaluation based on neutron activation analysis

There is renewed interest in Siri's classic three-compartment (3C) body composition model, requiring body volume (BV) and total body water (TBW) estimates, because dual-energy X-ray absorptiometry (DEXA) and in vivo neutron activation (IVNA) systems cannot accommodate subjects with severe obesity. However, the 3C model assumption of a constant ratio (alpha) of mineral (M) to total body protein (TBPro) and related residual mass density (D(RES)) based on cadaver analyses might not be valid across groups differing in sex, race, age, and weight. The aim of this study was to derive new 3C model coefficients in vivo and to compare these estimates to those derived by Siri. Healthy adults (n = 323) were evaluated with IVNA and DEXA and the measured components used to derive alpha and D(RES). For all subjects combined, values of alpha and D(RES) (means +/- SD, 0.351 +/- 0.043; 1.565 +/- 0.023 kg/l) were similar to Siri's proposed values of 0.35 and 1.565 kg/l, respectively. However, alpha and D(RES) varied significantly as a function of sex, race, weight, and age. Expected errors in percent body fat arising by application of Siri's model were illustrated in a second group of 264 adults, including some whose size exceeded DEXA limits but whose BV and TBW had been measured by hydrodensitometry and (2)H(2)O dilution, respectively. Extrapolation of predictions by newly developed models to very high weights allows percent fat error estimation when Siri's model is applied in morbidly obese subjects. The present study results provide a critical evaluation of potential errors in the classic 3C model and present new formulas for use in selected populations.     

Effect of subclinical hypothyroidism on body fluid compartments.

OBJECTIVE: The present study was aimed to assess the effects of subclinical hypothyroidism on body composition (BC). SUBJECTS: Thirty-one women (age: 37 +/- 9.9 years) with a wide range of body mass index (BMI) were studied. Subclinical hypothyroidism was defined by a basal TSH > or = 4 mU/L and/or TRH stimulated peak > or = 30 mU/L. MEASUREMENTS: For each subject, weight, height, BMI, multifrequency bioelectrical impedance spectroscopy (BIS) and D2O and NaBr dilution tests were performed to assessed total body water (TBW) and extracellular water (ECW). Thyroid function (basal and TRH stimulated TSH, free T3, and free T4) were determined from fasting blood samples for all subjects. Total body dual energy X-ray absorptiometry (DXA) were used to measure fat mass (FM) and lean mass (Lean). RESULTS: The results of BIS were compared with the TBW and ECW estimated by the dilution techniques on the same individuals. The correlation was R2 = 0.65 for impedance at 5 kHz and ECW by NaBr and R2 = 0.72 for impedance at 100 kHz and TBW by D2O. Intracellular water (ICW) was calculated as differences between TBW and ECW measured by dilution methods. Percent of ECW and ICW were related to BMI (ANOVA, p < 0.001). No difference in TBW, body water distribution and body composition related to thyroid function was demonstrated. CONCLUSIONS: In our patients affected with subclinical hypothyroidism, with or without obesity, only obesity appeared related to TBW, ECW and ICW; the subclinical hypothyroidism, on the contrary, had no effect on compartments of body fluids. Bioimpedance is a valid tool to assess body fluid distribution in subclinical hypothyroidism.     

Validation of BIA in Obese Children and Adolescents and Re‐evaluation in a Longitudinal Study

Decrease in fat mass (FM) is a one of the aims of pediatric obesity treatment; however, measurement techniques suitable for routine clinical assessment are lacking. The objective of this study was to validate whole‐body bioelectrical impedance analysis (BIA; TANITA BC‐418MA) against the three‐component (3C) model of body composition in obese children and adolescents, and to test the accuracy of our new equations in an independent sample studied longitudinally. A total of 77 white obese subjects (30 males) aged 5–22 years, BMI‐standard deviation score (SDS) 1.6–3.9, had measurements of weight, height (HT), body volume, total body water (TBW), and impedance (Z). FM and fat‐free mass (FFM) were calculated using the 3C model or predicted from TANITA. FFM was predicted from HT²/Z. This equation was then evaluated in 17 other obese children (5 males) aged 9–13 years. Compared to the 3C model, TANITA manufacturer's equations overestimated FFM by 2.7 kg (P < 0.001). We derived a new equation: FFM = ?2.211 + 1.115 (HT²/Z), with r² of 0.96, standard error of the estimate 2.3 kg. Use of this equation in the independent sample showed no significant bias in FM or FFM (mean bias 0.5 ± 2.4 kg; P = 0.4), and no significant bias in change in FM or FFM (mean bias 0.2 ± 1.8 kg; P = 0.7), accounting for 58% (P < 0.001) and 55% (P = 0.001) of the change in FM and FFM, respectively. Our derived BIA equation, shown to be reliable for longitudinal assessment in white obese children, will aid routine clinical monitoring of body composition in this population.     

Simplified Resting Metabolic Rate—Predicting Formulas for Normal‐Sized and Obese Individuals

Objective: Resting metabolic rate (RMR) is known to be proportional to body weight and to follow allometric scaling principles. We hypothesized that RMR can be predicted from an allometric formula with weight alone as an independent variable. Research Methods and Procedures: An allometric, power‐law scaling model was fit to RMR measurements obtained from a cohort of patients being treated for weight loss. This, as well as many of the commonly used RMR‐predicting formulas, was tested for RMR prediction ability against a large publicly available RMR database. Bland‐Altman analysis was used to determine the efficacy of the various RMR‐predicting formulas in obese and non‐obese subjects. Results: Power law modeling of the RMR—body weight relationship yielded the following RMR‐predicting equations: RMR_Women = 248 × Weight^0.4356 ? (5.09 × Age) and RMR_Men = 293 × Weight^0.4330 ? (5.92 × Age). Partial correlation analysis revealed that age significantly contributed to RMR variance and was necessary to include in RMR prediction formulas. The James, allometric, and Harris‐Benedict formulas all yielded reasonable RMR predictions for normal sized and obese subjects. Discussion: A simple power formula relating RMR to body weight can be a reasonable RMR estimator for normal‐sized and obese individuals but still requires an age term and separate formulas for men and women for the best possible RMR estimates. The apparent performance of RMR‐predicting formulas is highly dependent on the methodology employed to compare the various formulas.     

Estimation of human body composition by electrical impedance methods: a comparative study

This study 1) further validated the relationship between total body electrical conductivity (TOBEC) and densitometrically determined lean body mass (LBMd) and 2) compared with existing body composition techniques (densitometry, total body water, total body potassium, and anthropometry) two new electrical methods for the estimation of LBM: TOBEC, a uniform current induction method, and bioelectrical impedance analysis (BIA), a localized current injection method. In a sample of 75 male and female subjects ranging from 4.9 to 54.9% body fat the correlation between LBMd and LBM predicted from TOBEC by use of a previously developed regression equation was extremely strong (r = 0.962), thus confirming the validity of the TOBEC method. LBM predicted from BIA by use of prediction equations provided with the instrument also correlated with LBMd (r = 0.912) but overestimated LBM compared with LBMd in obese subjects. However, no such systematic error was apparent when new prediction equations derived from this heterogeneous sample of subjects were applied. Thus the TOBEC and BIA methods, which are based on the differing electrical properties of lean tissue and fat and which are convenient, rapid, and safe, correlate well with more cumbersome human body composition techniques.     

Beneficial effects of ketogenic diet in obese diabetic subjects

Objective Obesity is closely linked to the incidence of type II diabetes. It is found that effective management of body weight and changes to nutritional habits especially with regard to the carbohydrate content and glycemic index of the diet have beneficial effects in obese subjects with glucose intolerance. Previously we have shown that ketogenic diet is quite effective in reducing body weight. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. In this study the effect of ketogenic diet in obese subjects with high blood glucose level is compared to those with normal blood glucose level for a period of 56 weeks. Materials and methods A total of 64 healthy obese subjects with body mass index (BMI) greater than 30, having high blood glucose level and those subjects with normal blood glucose level were selected in this study. The body weight, body mass index, blood glucose level, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, urea and creatinine were determined before and at 8, 16, 24, 48, and 56 weeks after the administration of the ketogenic diet. Results The body weight, body mass index, the level of blood glucose, total cholesterol, LDL-cholesterol, triglycerides, and urea showed a significant decrease from week 1 to week 56 (P < 0.0001), whereas the level of HDL-cholesterol increased significantly (P < 0.0001). Interestingly these changes were more significant in subjects with high blood glucose level as compared to those with normal blood glucose level. The changes in the level of creatinine were not statistically significant. Conclusion This study shows the beneficial effects of ketogenic diet in obese diabetic subjects following its long-term administration. Furthermore, it demonstrates that in addition to its therapeutic value, low carbohydrate diet is safe to use for a longer period of time in obese diabetic subjects.     

Assessment of body cell mass at bedside in critically ill patients

Critical illness affects body composition profoundly, especially body cell mass (BCM). BCM loss reflects lean tissue wasting and could be a nutritional marker in critically ill patients. However, BCM assessment with usual isotopic or tracer methods is impractical in intensive care units (ICUs). We aimed to modelize the BCM of critically ill patients using variables available at bedside. Fat-free mass (FFM), bone mineral (Mo), and extracellular water (ECW) of 49 critically ill patients were measured prospectively by dual-energy X-ray absorptiometry and multifrequency bioimpedance. BCM was estimated according to the four-compartment cellular level: BCM = FFM - (ECW/0.98) - (0.73 × Mo). Variables that might influence the BCM were assessed, and multivariable analysis using fractional polynomials was conducted to determine the relations between BCM and these data. Bootstrap resampling was then used to estimate the most stable model predicting BCM. BCM was 22.7 ± 5.4 kg. The most frequent model included height (cm), leg circumference (cm), weight shift (Δ) between ICU admission and body composition assessment (kg), and trunk length (cm) as a linear function: BCM (kg) = 0.266 × height + 0.287 × leg circumference + 0.305 × Δweight - 0.406 × trunk length - 13.52. The fraction of variance explained by this model (adjusted r(2)) was 46%. Including bioelectrical impedance analysis variables in the model did not improve BCM prediction. In summary, our results suggest that BCM can be estimated at bedside, with an error lower than ±20% in 90% subjects, on the basis of static (height, trunk length), less stable (leg circumference), and dynamic biometric variables (Δweight) for critically ill patients.     

Bioelectrical parameters of the whole human body obtained through bioelectrical impedance analysis

Knowledge of electrical properties of body tissues across the frequency spectrum is useful for tissue characterization. The bioelectric impedance analysis method, operating from 1 to 250 kHz (multi-frequency), was used in 23 normal male human subjects between the ages of 21 and 52 years, for estimation of their bioelectrical parameters. Amplitude of the output current was set to 800 microA(RMS). The experimental data showed that bioelectric parameters were highly dependent on frequency and the presence of a threshold frequency around 4 kHz. In order to explain the unusual features observed in our experimental data, the human body was simulated through the Cole-Fricke-Cole model (RC circuit) and the Extended Cole-Fricke-Cole model (RLC circuit). The simulated data showed that the Extended Cole-Fricke-Cole model had a higher accuracy than the traditional Cole-Fricke-Cole model. These results suggest that the unusual features could be due to the possible existence of inductive effects in biological cells and body tissues and that the inductive parameter and the threshold frequency could be used for characterizing the healthy tissues as well as the traditional bioelectric parameters.     

Body Composition Measured by Dual‐energy X‐ray Absorptiometry Half‐body Scans in Obese Adults

Dual‐energy X‐ray absorptiometry (DXA) has become a common measurement of human body composition. However, obese subjects have been understudied largely due to weight and scan area restrictions. Newer DXA instruments allow for heavier subjects to be supported by the DXA scanner, but the imaging area is still smaller than the body size of some obese subjects. In this study, we determined the validity of an automated half‐scan methodology by comparing to the standard whole‐body scans in a cohort of obese volunteers. Fifty‐two subjects whose BMI >30 kg/m² completed whole‐body iDXA (GE Lunar) scans. The resulting scans were analyzed in three ways: the standard whole‐body scan, total body estimated from the left side, and from the right side. Fat mass, nonbone lean mass, bone mineral content (BMC), and percent fat derived from each half scan were compared to the whole‐body scans. Total fat mass, nonbone lean mass, or percent fat was comparable for the whole‐body scans, left, and right side scans (>97% within individuals and >99.9% for the group). The BMC estimate using the right side scan was slightly but statistically higher than the whole‐body BMC (～30 g or 1%, P < 0.001), while the left side scan BMC estimate was lower than the whole‐body BMC by the same magnitude. No significant magnitude bias was found for any of the composition variables. We conclude that the new iDXA half‐body analysis in obese subjects appears to be closely comparable to whole‐body analysis for fat mass, nonbone lean mass, and percent fat.     

Free carnitine and acetyl carnitine plasma levels and their relationship with body muscular mass in athletes

Summary The purpose of the present study was to investigate the relationship between plasma carnitine concentration and body composition variation in relation to muscular and fat masses since there is no experimentally proved correlation between plasma carnitine and body masses. We used bioelectric impedance analysis (BIA), to determine body composition and to have a complete physical fitness evaluation. The post-absorptive plasma free carnitine and acetyl carnitine plasma levels, body composition as Fat-Free Mass (FFM) and Fat Mass (FM) in kg, as well as in percent of body mass, were analysed in 33 healthy subjects. A significant negative correlation was found between plasma acetyl carnitine and FFM in weight (kg) as well as in percent of body mass (respectively p < 0.0001; p < 0.01); a significant positive correlation was found only between FM in percent and plasma acetyl carnitine (p < 0.01). The observed negative correlation between plasma acetyl carnitine and muscular mass variation might reflect an oxidative metabolic muscle improvement in relation to muscular fat free mass increment and might be evidence that muscle metabolism change is in relation to plasma acetyl carnitine concentration.     

Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism

We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissue compartments, and related changes in protein metabolism, are appropriate for weight loss in obese older women. Subjects were 14 healthy weight-stable obese (BMI > or =30 kg/m(2)) postmenopausal women >55 yr who participated in a 16-wk, 1, 200 kcal/day nutritionally complete diet. Measures at baseline and 16 wk included FFM and appendicular lean soft tissue (LST) by dual-energy X-ray absorptiometry; body cell mass (BCM) by (40)K whole body counting; total body water (TBW) by tritium dilution; skeletal muscle (SM) by whole body MRI; and fasting whole body protein metabolism through L-[1-(13)C]leucine kinetics. Mean weight loss (+/-SD) was 9.6+/-3.0 kg (P<0.0001) or 10.7% of initial body weight. FFM decreased by 2.1+/-2.6 kg (P = 0.006), or 19.5% of weight loss, and did not differ from that reported (2.3+/-0.7 kg). Relative losses of SM, LST, TBW, and BCM were consistent with reductions in body weight and FFM. Changes in [(13)C]leucine flux, oxidation, and synthesis rates were not significant. Follow-up of 11 subjects at 23.7 +/-5.7 mo showed body weight and fat mass to be below baseline values; FFM was nonsignificantly reduced. Weight loss was accompanied by body composition and protein kinetic changes that appear appropriate for the magnitude of body mass change, thus failing to support the concern that diet-induced weight loss in obese postmenopausal women produces disproportionate LST losses.     

The Non-adipose Body Mass of Obese Women: Evidence of Increased Muscularity

Non-adipose body mass (NAB) is an approximate indicator of total muscle mass and body protein content. The indirect measurement of NAB in obese man is of interest because of its relationship to muscle mass and, therefore, to physical fitness. Furthermore, NAB might reflect reduced body protein in instances of suspected “metabolic obesity”.Adipose tissue mass and NAB were derived from measurements of body weight and total body water in 48 obese and 19 normally nourished women with the aid of previously determined constants for the water fractions of adipose tissue and NAB.The mean NAB was increased in 23 moderately obese patients (42.1 kg. vs. 35.2 kg. for the controls). A higher mean NAB (51.3 kg.) was found in eight grossly obese women.It was concluded that obese women have a larger than normal mean muscle mass.A height-weight table gave a grossly misleading estimate of the degree of obesity in two unusually muscular siblings.     

Serial Measurements of Body Composition in Obese Subjects During a Very-Low-Energy Diet (VLED) Comparing Bioelectrical Impedance with Hydrodensitometry

Bioelectrical impedance analysis (BIA) is a convenient, inexpensive, and noninvasive technique for measuring body composition. BIA has been strongly correlated with total body water (TBW) and also has been validated against hydrodensitometry (HD). The accuracy and clinical utility of BIA and HD during periods of substantial weight loss remain controversial. We measured body composition in moderately and severely obese patients serially using both methods during a very-low-energy diet (VLED). Mean initial weight in these patients was 116 (± 30) kg (range, 74–196 kg). Mean weight loss was 24 (± 13) kg with a decrease in fat mass (FM) by HD of 20 kg (p<0.001) and a decrease in fat-free mass (FFM) of 3.6 kg (p<0.05). Loss of FFM is best predicted by the rate (kg/wk) of weight loss (r² = 0.86, p<0.0001). FFM, as predicted from BIA equations, was highly correlated with FFM as estimated by HD during all testing sessions (r=0.92-0.98). Although highly correlated, BIA overestimated FFM relative to HD and this difference appeared to be more pronounced for taller patients with greater truncal obesity. Although the discrepancy was no greater during weight-loss treatment, the level of disagreement was considerable. Therefore, the two methods cannot be used interchangeably to monitor relative changes in body composition in patients with obesity during treatment with VLED. The discrepancy between BIA and HD may be caused by body mass distribution considerations and by perturbations in TBW which affect the hydration quotient for FFM (BIA) and/or which affect the density constants for FFM and FM (HD).