Improved 4-compartment body-composition model for a clinically accessible measure of total body protein

Wilson, Joseph; Strauss, Boyd Josef Gimnicher; Fan, Bo; Duewer, Frederick W; Shepherd, John

doi:10.3945/ajcn.112.048074

Cited by 50 publications

(52 citation statements)

References 29 publications

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“…Older quantitative investigative techniques used to assess muscle mass included urinary creatinine excretion or underwater weighing which have suboptimal accuracy and provide limited information. Other more experimental techniques include neutron activation analysis and air displacement plethysmography which are highly accurate but not practical in the clinical setting . There are, however, techniques that can be performed within a normal hospital setting using easily accessible methods.…”

Section: Diagnosis Of Sarcopeniamentioning

confidence: 99%

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

Sinclair

Gow

Grossmann

et al. 2016

Aliment Pharmacol Ther

269

304

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Summary Background Sarcopenia (loss of muscle mass) is common in cirrhosis and is associated with poor outcomes. Current teaching recommends the use of protein supplementation and exercise, however, this fails to address many other factors which contribute to muscle loss in this setting. Aims To summarise existing knowledge regarding the aetiology of sarcopenia in cirrhosis, diagnostic modalities and the clinical significance of this condition. In addition to discuss recent research findings that may allow the development of more effective treatments. Methods We conducted a Medline and PubMed search using the search terms ‘sarcopenia’, ‘muscle’, ‘body composition’, ‘cirrhosis’, ‘liver’ and ‘malnutrition’ from inception to October 2015. Results Cirrhotic patients with sarcopenia have reduced survival, experience increased rates of infection and have worse outcomes following liver transplantation. The aetiology of this condition is more complex than simple protein and calorie malnutrition. Cirrhosis also results in depleted glycogen stores and metabolic alterations that cause excessive protein catabolism, increased activation of the ubiquitin–proteasome pathway and inappropriate muscle autophagy. Satellite cell differentiation and proliferation is also reduced due to a combination of elevated myostatin levels, reduced IGF‐1 and hypogonadism. Although there is some evidence supporting the use of late evening snacks, branched chain amino acid supplementation and high protein/high calorie diets, well designed clinical trials addressing the effects of treatment on body composition in cirrhosis are lacking. Conclusion Sarcopenia in cirrhosis has a complex pathogenesis and simple dietary interventions are insufficient. Improved understanding of the multiple mechanisms involved should allow the development of more effective therapies, which target the specific underlying metabolic derangements.

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Section: Diagnosis Of Sarcopeniamentioning

confidence: 99%

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

Sinclair

Gow

Grossmann

et al. 2016

Aliment Pharmacol Ther

269

304

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“…4C body composition was calculated with the use of the Lohman method (8) and the simplified DXA + BIA approach of Wilson et al (7). Linear regression analysis was performed to determine the agreement between body composition methods.…”

Section: Methodsmentioning

confidence: 99%

Validation of rapid 4-component body composition assessment with the use of dual-energy X-ray absorptiometry and bioelectrical impedance analysis

Liu

Wang

et al. 2018

The American Journal of Clinical Nutrition

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Abstract Background The 4-component (4C) model is a criterion method for human body composition that separates the body into fat, water, mineral, and protein, but requires 4 measurements with significant cost and time requirements that preclude wide clinical use. A simplified model integrating only 2 measurements—dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA)—and 10 min of patient time has been proposed. Objective We aimed to validate a rapid, simplified 4C DXA + BIA body composition model in a clinical population. Design This was a cross-sectional observational study of 31 healthy adults. Participants underwent whole-body DXA, segmental BIA, air displacement plethysmography (ADP), and total body water (TBW) measurement by deuterium (D2O) dilution. 4C composition was calculated through the use of the Lohman model [DXA mineral mass, D2O TBW, ADP body volume (BV), scale weight] and the simplified model (DXA mineral mass and BV, BIA TBW, scale weight). Accuracy of percentage of fat (%Fat) and protein measurements was assessed via linear regression. Test-retest precision was calculated with the use of duplicate DXA and BIA measurements. Results Of 31 participants, 23 were included in the analysis. TBWBIA showed good test-retest precision (%CV = 5.2 raw; 1.1 after outlier removal) and high accuracy to TBWD2O [TBWD2O = 0.956*TBWBIA, R2= 0.92, root mean squared error (RMSE) = 2.2 kg]. %Fat estimates from DXA, ADP, D2O, and BIA all showed high correlation with the Lohman model. However, only the 4C simplified model provides high accuracy for both %Fat (R2 = 0.96, RMSE = 2.33) and protein mass (R2= 0.76, RMSE = 1.8 kg). %Fat precision from 4C DXA + BIA was comparable with DXA (root mean square-SD = 0.8 and 0.6 percentage units, respectively). Conclusions This work validates a simplified 4C method that measures fat, water, mineral, and protein in a 10-min clinic visit. This model has broad clinical application to monitor many conditions including over/dehydration, malnutrition, obesity, sarcopenia, and cachexia.

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“…This device uses the frequencies ranged from 50 to 250 kHz, is affordable, and is not invasive (17,18). The comparison of this method with X-ray showed that it accurately assessed body composition (19)(20)(21). By this method, WHR, BMI, the percentage of body fat (PBF), total fat (TF), and FFM were measured, using the standard positions of outer and inner electrodes on the hand and foot (8 electrodes) (22,23).…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Waist-to-Hip Ratio Cutoff Points in a Large Sample of Southern Iranian Adults with Two Standard Procedures and Asian Studies

Jahanlou

Kouzekanani

2017

Shiraz E-Med J

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Improved 4-compartment body-composition model for a clinically accessible measure of total body protein

Abstract: A simple method to measure total body protein by using a DXA system and BIA unit was developed and compared with NAA as proof of principle. With additional validation, this method could provide a clinically useful way to monitor muscle-wasting conditions.

Cited by 50 publications

References 29 publications

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

Validation of rapid 4-component body composition assessment with the use of dual-energy X-ray absorptiometry and bioelectrical impedance analysis

A Comparison of Waist-to-Hip Ratio Cutoff Points in a Large Sample of Southern Iranian Adults with Two Standard Procedures and Asian Studies

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