Methods for Body Composition Analysis in Adults

Composition of gestational weight gain impacts maternal fat retention and infant birth weight

PurposeThe study aimed to investigate the association between body composition and frailty in elder inpatients.Patients and MethodsThis is a cross-sectional study including 656 elder inpatients (275 females and 381 males) aged ≥65 years, from department of geriatrics of Zhejiang Hospital between January 2018 and March 2019. Sociodemographic, health-related data and anthropometric measurements were evaluated. Body composition was assessed by bioimpedance analysis (BIA), mainly including skeletal muscle mass, body fat mass, total body water, fat-free mass,percent body fat, basal metabolic rate. Frailty was assessed by Clinical Frailty Scale (CFS). Univariate logistic regression was used to analyze the association between body composition and frailty.ResultsFrailty was present in 43.9% of the participants. Frail inpatients showed higher waist circumference, body fat mass and percent body fat, non-frail inpatients showed greater upper arm circumference, calf circumference, skeletal muscle mass, total body water, fat-free mass and basal metabolic rate. Subjects with underweight (body mass index (BMI)<18.5 kg/m2; odds ratio (OR), 95% confidence interval (CI)=4.146 (1.286–13.368) P=0.017) and those with high waist circumference (OR 95% CI=1.428 (0.584–3.491) P<0.001), body fat mass (OR, 95% CI=1.143 (0.892–1.315) P<0.001) presented a higher risk of frailty compared to normal subjects. Skeletal muscle mass (OR; 95% CI=0.159 (0.064–0.396) P<0.001) was a protective factor for frailty.ConclusionFrailty in elder Chinese inpatients was characterized by a body composition phenotype with underweight, high waist circumference, low skeletal muscle mass and high body fat mass. Underweight, abdominal obesity and sarcopenic obesity may, therefore, be targets for intervention of frailty.

Studies have suggested that probiotics and synbiotics can improve body weight and composition. However, randomized controlled trials (RCTs) demonstrated mixed results. Hence, we performed a systematic review and meta-analysis to evaluate the effectiveness of probiotics and synbiotics on body weight and composition in adults. We searched PubMed/Medline, Ovid/Medline, Scopus, ISI Web of Science, and Cochrane library up to April 2023 using related keywords. We included all RCTs investigating the effectiveness of probiotics and/or synbiotics supplementation on anthropometric indices and body composition among adults. Random-effects models were applied for performing meta-analyses. In addition, we conducted subgroup analyses and meta-regression to explore the non-linear and linear relationship between the length of follow-up and the changes in each outcome. We included a total of 200 trials with 12,603 participants in the present meta-analysis. Probiotics or synbiotics intake led to a significant decrease in body weight (weighted mean difference [WMD]: -0.91 kg; 95% CI: -1.08, -0.75; p< 0.001), body mass index (BMI) (WMD: -0.28 kg/m2 ; 95% CI: -0.36, -0.21; p< 0.001), waist circumference (WC) (WMD: -1.14 cm; 95% CI: -1.42, -0.87; p< 0.001), waist-to-hip ratio (WHR) (WMD: -0.01; 95% CI: -0.01, -0.00; p< 0.001), fat mass (FM) (WMD: -0.92 kg; 95% CI: -1.05, -0.79; p< 0.001), and percentage of body fat (%BF) (WMD: -0.68%; 95% CI: -0.94, -0.42; p< 0.001) compared to controls. There was no difference in fat-free mass (FFM) and lean body mass (LBM). Subgroup analyses indicated that probiotics or synbiotics administered as food or supplement resulted in significant changes in anthropometric indices and body composition. However, compared to controls, FM and %BF values were only reduced after probiotic consumption. Our results showed that probiotics or synbiotics have beneficial effects on body weight, central obesity, and body composition in adults and could be useful as an add on to weight loss products and medications.

Total body water reference values and prediction equations for adults

Menopause induces various health problems and is associated with obesity, but the association between menopausal status and obesity is unclear due to several confounding factors, such as aging and reduced physical activity. The objective of this study was to examine the association of menopausal status with anthropometric indices and body composition indices in South Korean women. In this cross-sectional study, a total of 734 subjects (297 postmenopausal women, 437 premenopausal women) from five university hospitals in South Korea were included. A binary logistic regression analysis was performed to examine the association of menopause with anthropometric indices and body composition indices. Height, body mass index, waist-to-height ratio, waist-to-hip ratio, and neck, armpit, chest, rib, waist, iliac, and hip circumferences were associated with menopausal status in the crude analysis, but these associations disappeared in the adjusted models. Among the body composition indices, menopausal status was strongly associated with total body water, skeletal muscle mass, body fat mass, and body fat percentage in the crude analysis. However, the associations with body fat mass and body fat percentage disappeared in the adjusted models. Only the associations with total body water and skeletal muscle mass remained in the adjusted models. Most of the anthropometric indices and body composition indices were not associated with menopausal status, but total body water and skeletal muscle mass were significantly lower in postmenopausal women than in premenopausal women.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

Previous studies on weight gain in pregnancy suggested that maternal weight on average increased by 0.5-2.0 kg in the first trimester of pregnancy. This study examined whether mean maternal weight or body composition changes in the first trimester of pregnancy. Prospective observational study. We studied 1,000 Caucasian women booking for antenatal care in the first trimester of pregnancy. Large university teaching hospital. Maternal height and weight were measured digitally in a standardized way and Body Mass Index (BMI) was calculated. Maternal body composition was measured using segmental multifrequency Bioelectrical Impedance Analysis (BIA). Sonographic examination confirmed the gestational age and a normal ongoing singleton pregnancy in all subjects. Maternal weight, maternal body composition. The mean BMI was 25.7 kg/m(2) and 19.0% of the women were in the obese category (> or =30.0 kg/m(2)). Cross-sectional analysis by gestational age showed that there was no change in mean maternal weight, BMI, total body water, fat mass, fat-free mass or bone mass before 14 weeks gestation. Contrary to previous reports, mean maternal weight and mean body composition values remain unchanged in the first trimester of pregnancy. This has implications for guidelines on maternal weight gain during pregnancy. We also recommend that calculation of BMI in pregnancy and gestational weight gain should be based on accurate early pregnancy measurements, and not on self-reported or prepregnancy measurements.

Case presentation: A 36-year-old nonsmoking, normotensive South Asian man presented to the emergency department of a community hospital with retrosternal chest pain of &60 minutes’ duration. His 12-lead ECG demonstrated 10 mm of ST-segment elevation in leads V2 through V6, and he received fibrinolytic therapy within 90 minutes of symptom onset. His pain resolved, but his ST segments only partially normalized; he had a peak creatine kinase of 4564 IU/L, and he showed signs of early heart failure. LDL cholesterol was 135 mg/dL, HDL 32 mg/dL, triglycerides 20 mg/dL, and total cholesterol 206 mg/dL; his body mass index (BMI) was 24 kg/m2. Cardiac catheterization demonstrated severe and diffuse triple-vessel disease, including occlusion of the proximal left anterior descending artery, as well as moderate left ventricular dysfunction. While in the hospital, he was diagnosed with new-onset type 2 diabetes mellitus and subsequently underwent uncomplicated coronary bypass surgery. South Asians are individuals whose ethnic roots originate from the Indian subcontinent, a large geographic area that includes India, Pakistan, Sri Lanka, Nepal, and Bangladesh. Collectively, South Asians represent one fifth of the global population. In North America, more than 2 million South Asians reside in the United States and almost 1 million in Canada. It is important to recognize that the term “South Asian” refers to a heterogeneous population, with important differences in diet, culture, and lifestyle among different South Asian populations and religions. Multiple studies of migrant South Asian populations have, however, confirmed a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death as compared with other ethnic groups.1–3 In an analysis of age-standardized coronary heart disease (CHD) mortality in Canada over a 15-year period, South Asians had the highest CHD mortality compared with individuals of Chinese and European descent.4 In …

BackgroundAs a result of both genetic and environmental factors, the body composition and topography of African populations are presumed to be different from western populations. Accordingly, globally accepted anthropometric markers may perform differently in African populations. In the era of rapid emergence of cardio-vascular diseases in sub-Saharan Africa, evidence about the performance of these markers in African settings is essential. The aim of this study was to investigate the inter-relationships among the four main anthropometric indices in measuring overweight and obesity in an urban poor African setting.MethodsData from a cardiovascular disease risk factor assessment study in urban slums of Nairobi were analyzed. In the major study, data were collected from 5190 study participants. We considered four anthropometric markers of overweight and obesity: Body Mass Index, Waist Circumference, Waist to Hip Ratio, and Waist to Height Ratio. Pairwise correlations and kappa statistics were used to assess the relationship and agreement among these markers, respectively. Discordances between the indices were also analyzed.ResultsThe weighted prevalence of above normal body composition was 21.6 % by body mass index, 28.9 % by waist circumference, 45.5 % by waist to hip ratio, and 38.9 % by waist to height ratio. The overall inter-index correlation was +0.44. Waist to hip ratio generally had lower correlation with the other anthropometric indices. High level of discordance exists between body mass index and waist to hip ratio. Combining the four indices shows that 791 (16.1 %) respondents had above normal body composition in all four indices. Waist circumference better predicted hypertension and hyperglycemia while waist to height ratio better predicted hypercholesterolemia.ConclusionsThere exists a moderate level of correlation and a remarkable level of discordance among the four anthropometric indices with regard to the ascertainment of abnormal body composition in an urban slum setting in Africa. Waist circumference is a better predictor of cardio-metabolic risk.

The purpose of this study was to evaluate changes in the estimated body composition of elite female and male Polish handball players during a five-week preseason training camp. Height and weight were measured, while body composition was estimated with bioelectrical impedance in 18 male and 17 female handball players before and after the five-week training protocol. Components of body composition included total body water (TBW), fat-free mass (FFM), muscle mass (MM), and absolute and relative fat mass (FM). Weight and body mass index (BMI) did not change in males, but declined in females after five weeks of training. FM and %FM declined, while estimated TBW, FFM, and MM increased significantly after training in both males and females. In contrast, comparisons of log transformed ratios for changes in weight, the BMI and body composition in males and females, respectively, suggested that estimated TBW, FFM, and MM increased relatively more in females than in males, while FM and %FM decline relatively more in males than females. Overall, the five-week preseason training program modified the body composition of male and female handball players. FM and %FM decreased, while estimated TBW, FFM, and MM increased, in both males and females after the preseason training program. Comparisons of log transformed ratios for changes in body composition in males and females suggested sexual dimorphism in response to intensive preseason training.

Puberty represents the final stage of sexual differentiation when the individual acquires reproductive capacity. Puberty is not only characterized by maturation of sexual organs and the formation of oocytes and mature spermatozoa, but also by the development of secondary sexual dimorphism. In industrialized countries, the age of puberty has decreased steadily over the last 150 years in association with improved socio-economic conditions. However, the decreased onset of puberty, especially in females, is associated with problematic changes in behaviour such as early onset of sexual activity resulting in high-risk teenage pregnancies. In our study, we analysed the association between body composition (fat tissue and fat-free body mass, estimated by BIA analyses), height, body mass index and fat distribution and signs of puberty such as the timing of menarche in 228 girls and voice breaking and facial hair growth in 191 boys ageing between 10 and 15 years. In both sexes, signs of puberty were associated, highly significantly, with body composition parameters. Nevertheless, marked differences between the two sexes were observed: Female puberty was positively associated with weight status and the absolute and relative amount of body fat, while in males, puberty was positively related with a higher amount of fat-free body mass and a decreased fat mass. Male voice breaking was significantly associated with increased stature, body weight, waist and hip circumference, lean body mass and total body water. In contrast, voice breaking was significantly negatively associated with the fat percentage, the total fat mass and the waist-to-hip ratio. Female menarche was significantly positively associated with increased body weight, weight status, waist and hip circumference and also with increased absolute and relative fat mass, relative hip circumference, lean body mass and total body water. Only the waist-to-hip ratio was significantly negatively associated with the onset of menarche.

Objective To analyze the differences of body composition and islet function between patients with or without nonalcoholic fatty liver disease (NAFLD), and between patients with or without visceral obesity in type 2 diabetes mellitus (T2DM). The effects of fatty liver and visceral fat on islet function were also investigated. Methods A total of 519 patients with T2DM were divided into 4 groups according to the presence or absence of fatty liver and visceral obesity. Group 1: 242 cases of T2DM+ NAFLD with visceral obesity, group 2: 59 cases of T2DM + NAFLD without visceral obesity, group 3: 101 cases of T2DM with visceral obesity but without NAFLD and group 4: 117 cases of T2DM without NAFLD and visceral obesity. Bioelectrical impedance method was used to analyze human body composition, including visceral fat area, skeletal muscle content, mineral content and other indicators. At the same time, biochemical indicators such as liver and kidney function, blood lipid, oral glucose tolerance and islet function were measured in all patients. Variance analysis or nonparametric test was used to compare the difference of body composition and biochemical indexes between groups. Spearman rank correlation was used for correlation analysis, and binary logistic regression was used for multivariate analysis. Results (1)The mineral content, protein content, total body water, body mass index in group 1 were higher than those in group 4 (F=16.202-100.482, all P<0.05); the percentage of fat was decreased gradually from group 1 to group 4 (T=47.027, P<0.05); the skeletal muscle content in group 2 was higher than that in group 1 (T=2.879, P<0.05). (2)The white blood cell, C-reactive protein, total protein, albumin, gamma glutamyl transferase, alanine aminotransferase, aspertate aminotransferase, estimated glomerular filtration rate, serum uric acid, triglyceride, low-density lipoprotein-cholesterol and very low-density lipoprotein-cholesterol showed a downward trend, and the level of high density lipoprotein-cholesterol was increased gradually (F/T=4.036-18.831, all P<0.05) from group 1 to group 4. (3)Among the four groups, homeostatic model assessment of insulin resistance, homeostasis model assessment of β cell function, insulin sensitivity index, area under curve of insulin and area under curve of C-peptide showed a downward trend from group 1 to group 4, with significant difference between group 1 and group 4 (F/T=5.757-13.860, all P<0.05). (4)After adjusting for age and sex, the visceral fat area was positively correlated with body mass index, waist to hip ratio, visceral fat content, subcutaneous fat content, basal metabolic volume, gamma glutamyl transferase, alanine aminotransferase, aspertate aminotransferase and serum uric acid(r=0.340-0.916, all P<0.05), and negatively correlated with high density lipoprotein-cholesterol(r=-0.442, P<0.05). (5)Visceral fat content(OR=5.463, 95% CI: 1.886-4.451, P=0.071)and low-density lipoprotein-cholesterol (OR=1.224, 95% CI: 1.180-1.227, P=0.025)were independent risk factors for NAFLD in patients with T2DM. Conclusions Both T2DM patients with NAFLD or visceral obesity have insulin resistance and compensatory increase of insulin secretion. The most serious insulin resistance is found in T2DM patients with NAFLD and visceral obesity simultaneously. Increasing skeletal muscle content is beneficial to control visceral obesity and improve islet function in patients with NAFLD. Reducing visceral fat area is beneficial to improve metabolic indicators. Key words: Type 2 diabetes mellitus; Non-alcoholic fatty liver disease; Visceral obesity; Body composition; Insulin resistance

Central Adiposity and Risk of Barrett’s Esophagus

BackgroundObesity is accompanied by hormonal, inflammatory and endothelial alterations. These alterations induce a stimulation of several other mechanisms that contribute to the hypertensive state and to increase the cardiovascular morbidity. This pilot, open - label, single- center, prospective clinical trial aimed to evaluate the effect of very low- calorie ketogenic diet (VLCKD) on blood pressure (BP) in women with of obesity and hypertension.MethodsA total of 137 women, who met the inclusion criteria and accepted to adhere to VLCKD, were consecutively enrolled. Assessment of anthropometric parameters (weight, height, and waist circumference), body composition (through bioelectrical impedance analysis), systolic (SBP) and diastolic blood pressure (DBP) and blood sample collection were carried out at baseline and after 45 days of the active phase of VLCKD.ResultsAfter VLCKD all the women experienced a significant reduction in body weight and an overall improvement of body composition parameters. In addition, high sensitivity C reactive protein (hs- CRP) levels were significantly diminished (p < 0.001), while phase angle (PhA) increased by almost 9% (p < 0.001). Interestingly, both SBP and DBP were significantly improved (-12.89% and − 10.77%, respectively; p < 0.001). At baseline, SBP and DBP showed statistically significant correlations with body mass index (BMI), waist circumference, hs-CRP levels, PhA, total body water (TBW), extracellular water (ECW), Na / K ratio, and fat mass. Even after VLCKD, all correlations among SBP and DBP with the study variables were statistically significant, except for the association between DBP and Na / K ratio. Changes (%) in both SBP and DBP were associated with ∆BMI%, ∆PhA% and ∆hs- CRP levels (p < 0.001). In addition, only ∆SBP% was associated with ∆waist circumference (p = 0.017), ∆TBW (p = 0.017), and ∆fat mass (p < 0.001); while only ∆DBP% was associated with ∆ECW (p = 0.018), and ∆Na / K ratio (p = 0.048). After adjusting for ∆BMI, ∆WC, ∆PhA, ∆TBW, and ∆fat mass, the correlation between changes in ∆SBP and ∆hs -CRP levels remained statistically significant (p < 0.001). Similarly, the correlation between ∆DBP and ∆hs- CRP levels also remained statistically significant after adjustment for ∆BMI, ∆PhA, ∆Na / K ratio, and ∆ECW (p < 0.001). From multiple regression analysis ∆hs- CRP levels seemed to be the main predictor of changes of BP (p < 0.001).ConclusionVLCKD reduces BP in women with of obesity and hypertension in a safely manner.

Impedance change during intentional weight loss in Thai obese patients