The New York Obesity Nutrition Research Center
Human Phenotyping/Body Composition Core - Laboratories

Laboratories

Anthropometry Laboratory
Bioelectrical Impedance Analysis Laboratory
Densitometry Laboratory
DXA Laboratory
Imaging Acquisition
Image Reading Center
Quantitative Magnetic Resonance Laboratory
Tracer Dilution Laboratory
Whole Body Counting Laboratory
Resting Energy Expenditure
Physical Performance Laboratory


Anthropometry   (Back to Laboratories)
Skinfold and circumference measurements can be used to evaluate the shape and composition of the human body. Skinfold measurements require use of a special caliper that painlessly pinches a fold of skin and underlying adipose tissue. About 10 standard skinfold measurements are made in out laboratory. Circumference measurements are similarly made at standard locations in the extremity, trunk, and head. The obtained information is then used to derive estimates of body fat, fat-free mass, skeletal muscle, and fat distribution. The Laboratory has several high-quality skinfold calipers and calibrated tape measures. (Body circumferences using Glulick II tension-calibrated tape measure; Bone breadth assessment; Skinfolds using Lang Skinfold Calipers [Cambridge Scientific Industries, Inc.] or Harpenden Skinfold Calipers).

Measurements of body circumferences and skinfold thickness have been carried out routinely in our laboratory since 1968. Since then, several types of calipers and tape measures have been cross-calibrated in a large number of subjects. We have evaluated the reliability of the prediction for body fatness and fat distribution by the anthropometric variables using reliable laboratory methods such as DXA and MRI as standards, and generated race, gender, and age specific prediction equations. We also tested the accuracy of the skinfold caliper by the direct roller measure at incisions during operation at specific locations where the skinfold thickness was measured by the caliper prior to the operation.

Total and regional body dimensions, such as body circumferences, lengths, widths, and thicknesses, can be obtained from a 3-dimensional photonic scan (see Densitometry section below)

The laboratory has serviced as a training center in several projects involving multi-center investigations. The laboratory also provides teaching programs to investigators or laboratory staff who are interested in learning anthropometry for physical fitness and nutrition assessment.

The telephone number for this laboratory is 212 523-4194.


Anthropometry Background and Applications

History


Anthropometric measurements are among the oldest applied in the body composition field. Early workers applied body weight, height, various skinfold thicknesses and circumferences, and other linear dimensions to characterize a subject’s fatness and nutritional status. Modern workers have calibrated various anthropometric dimensions against reference body composition estimates in order to develop specific component prediction models. This calibration approach allows estimation of total-body fat, adipose tissue, skeletal muscle, and other components from various anthropometric estimates. Anthropometric methods are widely available as they are inexpensive, simple to carry out, safe, and can be used in settings that range from the research laboratory to field facilities. Anthropometric methods have limitations including the need for trained observers, relatively high between-measurement technical error for some measurements, mechanical limitations of some instruments for the very obese, “errors” in some geometric prediction models assuming stable between-subject anatomic proportions, and population specificity of component prediction formulas.

Application

Anthropometric measurements include body weight, height, skinfold measurements, circumferences, and various body diameters. The use of these measurements vary, but either individually or combined they allow for reasonable predictions of body composition in non-obese subjects. For example, weight provides a simple measurement of body mass and thus total energy content. Skinfold measurements reflect the relative amount of fat for a given body site and may be used to describe regional adiposity. Finally, weight combined with skinfold measurements and body diameters can accurately estimate the amount of fat-free mass and fat mass. Each of these measurements will be discussed in more detail below.

Body mass index, weight in kilograms divided by height in meters squared, is among the simplest anthropometric expressions that can be applied in body fat estimation. The following is a multiple regression formula developed by setting BMI as an independent variable with percent fat set as the dependent variable: % body fat = 64.5 ­ 848 × (1/BMI) + 0.079 × age ­ 16.4 × sex + 0.05 × sex × age + 39.0 × sex × (1/BMI), with sex = 1 for male and 0 for female. Body fat in this study was measured using a four-component model as the reference method. The equation is applicable in Caucasians and African Americans while a separate equation is available for use in Asian subjects. Body mass index is limited as a measure of body composition as subjects of the same BMI or body weight may differ widely in fatness. Accordingly, BMI is considered a first level measure of body composition and higher resolution is gained by using other anthropometric estimates.

A large number of anthropometric body fat prediction models are reported in the literature based upon measured skinfolds and circumferences. These methods vary in the subject populations used to develop the prediction models, and the selected reference methods. Some models rely solely on measured skinfold thickness while others rely primarily on circumference measurements. Geometric models allow estimation of limb fat areas using combined extremity skinfold and circumference measurements.

An important feature of anthropometry is that selected skinfold and circumference measurements provide estimates of adipose tissue distribution. In particular, anthropometry allows for the estimation of subcutaneous adipose tissue distribution. For example, the waist circumference measurement provides a well-validated measure of visceral adipose tissue. According to National Institutes of Health Guidelines a waist circumference of 94 cm for men and 80 cm for women should be taken as the cut points for limiting weight gain while a waist circumference of 102 cm for men and 88 cm for women should be taken as the cut points for reducing weight.

While at one time the ratio of waist to hip circumference was applied as a measure of adipose tissue distribution, today only the waist circumference is usually measured. The saggital diameter, measured as the largest body thickness in supine subjects, is also used as a measure of visceral adipose tissue, but few studies have provided evidence that this anthropometric dimension is superior to the simpler waist circumference measurement. A major advantage of using anthropometry for assessing visceral adipose tissue is the relative ease with which measurements may be made, although well-trained technicians are essential requirement. Anthropometric measurements are less costly and easier than an comparable CT and MRI studies, but with these advantages comes a loss of precision and repeatability.

There have been many validation studies of anthropometric prediction methods, and most published total-body fat and adipose tissue models tend to cross validate when compared to reference methods. Among the various measurement methods, anthropometric techniques usually demonstrate the largest standard error and lowest correlation coefficients when compared against other techniques for estimating total-body fat such as DXA, BIA, or in-vivo neutron activation analysis. Some technical concerns should also be considered, including the requirement for technician training and the need for special calipers in very obese subjects. Thus, while anthropometric methods are useful in phenotyping subjects for fatness, anthropometry is usually not applied for individual subject evaluations, for examining short-term changes in body fat. Anthropometric methods are important in field studies of nutrition and obesity where other methods either cannot be applied or are impractical in the selected setting.


Relevant Laboratory/Core Publications (in chronological order)
Yang MU, Wang J, Pierson RN Jr, Van Itallie TB. Estimation of composition of weight loss in man: comparison method. J Appl Physiol, 43:331-338, 1977.
Pierson RN Jr, Wang J, Thornton JC, Van Itallie TB, Colt EWD. Body potassium by 4 pi counting: an anthropometric correction. Am J Physiol, 246:F234-239, 1984.
Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods. A comparative study. J Appl Physiol, 58:1556, 1985.
Weinsier RL, Norris DJ, Birch R, Bernstein RS, Wang J, Yang MU, Pierson RN Jr, Van Itallie TB. The relative distribution of body fat and fat pattern to blood pressure level. Hypertension, 7:578-585, 1985.

Foster CJ, Weinsier RJ, Birch R, Norris DJ, Bernstein RS, Wang J, Pierson RN Jr, Van Itallie TB.
Obesity and serum lipids: An evaluation of the relative contributions of body fat and fat distribution to lipid levels. Int J Obesity, 11:151-161, 1987.

Johnston PE, Wadden TA, Strunkard AJ, Pene M, Wang J, Pierson RN Jr, Van Itallie TB.
Body deposition in adult obese women, Part I; Pattern of fat distribution. Am J Clin Nutr, 47:225-228, 1988.

Wadden TA, Stunkard AJ, Johnston PE, Wang J, Pierson RN Jr, Van Itallie TB, Costello E, Pena M. Body fat deposition in adult obese women, Part II: Changes in fat distribution accompanying weight reduction. Am J Clin Nutr, 47:229-234, 1988.
Kotler DP, Tierney AR, Brenner SK, Couture S, Wang J, Pierson RN Jr. Preservation of short-term energy balance in clinically stable patients with AIDS. Am J Clin Nutr, 51:7-13, 1990.
VanItallie TB, Yang M, Heymsfield SB, Funk RC, Boileau RA. Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Nutr, 52:953-959, 1990.

Baumgartner RN, Heymsfield SB, Livhtman S, Wang J, Pierson RN Jr. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr, 53:1345-1353, 1991.
Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA.
Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.

Allison DB, Heshka S, Pierson RN Jr, Wang J, Heymsfield SB. The analysis and identification of homologizer/moderator variables when the moderator is continuous: An illustration with anthropometric data. Am J Human Biol, 4:775-778, 1992.
Mazariegos M, Wang ZM, Gallagher D, Baumgartner RN, Allison DB, Wang J, Pierson RN Jr, Heymsfield SB. Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model. J Geront, 49:M201-M208, 1994.
Wang J, Thornton JC, Russell M, Burastero S, Heymsfield SB, Pierson RN Jr. Asians have lower body mass index (BMI) but higher fat percent than do whites: comparisons of anthropometric measurements. Am J Clin Nutr, 60:23-28, 1994.
Stall SH, Ginsberg NS, DeVita MV, Zabetakis PM, Lynn RI, Gleim GW, Wang J, Pierson RN Jr, Michelis MF. Comparison of five body composition methods in peritoneal dialysis patients. Am J Clin Nutr, 64:125-130, 1996.
Apardi S, Horlick M, Wang J, Cuff P, Bamji M, Kotler D. Body composition in prepubertal children with human immunodeficiency virus type 1 infection, Arch Pediatr. Adolesc Med, 152:688-693, 1998.
Allison DB, Zannolli R, Faith MS, Heo M, Pietrobelli A, Van Itallie TB, Pi-Sunyer FX, Heymsfield SB. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. Int J Obes Relat Metab Disord, 23(6):601-611, 1999.
Clasey JL, Kanaley JA, Wideman L, Heymesfield SB, Teates CD, Gutgesell ME, Thorner MO, Hartman ML, Weltman A. Validity of methods of body composition assessment in young and older men and women. J Appl Physiol, 86(5):1728-1738, 1999.
Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA, 281(3):235-242, 1999.
Kotler DP, Rosenbaum K, Wang J, Pierson RN Jr. Studies of body composition and fat distribution in HIV-infected and control subjects. J Acquir Immune Defic Syndr Human Retrovirol, 20:228-237, 1999.
Mott JW, Wang J, Thornton JC, Allison DB, Heymsfield SB, Pierson RN Jr. Relation between body fat and age in four ethnic groups. Am J Clin Nutr, 69:1007-1013, 1999.
Funkhouser A, Laferrere B, Wang J, Thornton J, Pi-Sunyer FX, Measurement of percent body fat during weight loss in obese women: comparison of four methods. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:539-541.

Heymsfield SB, Bubez C, Testolin C, Gallagher D. Anthropometry and methods of body composition measurement for research and field application in the elderly. Eur J Clin Nutr, 54 Suppl 3:S26-S32, 2000.

Horlick MB, Rosenbaum M, Nicolson M, Levine LS, Fedun B, Wang J, Pierson RN Jr, Leibel RL. Effects of puberty on the relationship between circulating leptin and body composition. J Clin Endocrinol Metab, 85(7):2509-2518, 2000.

Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr, 72(3):796-803, 2000.

Michener J, Lam S, Kolesnik, Thornton JC, Wang J, Pierson RN Jr., Skinfolds versus bioimpedance analysis for predicting fat-free mass. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:339-341.

Punyanitya M, Nunez C, Rubiano F, Heymsfield SB. The assessment of stature using an infrared technique. Ann NY Acad Sci 2000;904:276-9.
Rubiano F, Nunez C, Heymsfield SB. A comparison of body composition techniques. Ann N Y Acad Sci, 904:335-338, 2000.
Wang J, Thornton JC, Kolesnik S, Pierson RN Jr. Anthropometry in body composition. An overview. Ann N Y Acad Sci, 904:317-326, 2000.

Boozer, C. N., Daly, P. A., Homel, P., Solomon, J. L., Blanchard, D., Nasser, J. et al. (2002). Herbal ephedra/ caffeine for weight loss: a 6- month randomized safety and efficacy trial. Int J Obes Relat Metab Disord, 26, 593-604.

Fontaine KR, Gadbury G, Heymsfield SB, Kral J, Albu JB, Allison D. Quantitative prediction of body diameter in severely obese individuals. Ergonomics 2002;45:49-60.

He Q, Horlick M, Fedun B, Wang J, Pierson RN Jr, Heshka S, et al. Trunk fat and bllod pressure in children through puberty. Circulation 2002;105:1093-8.

He, Q., Horlick, M., Thornton, J. C., Wang, J., Pierson, R. N. J., Heshka, S. et al. (2002). Sex and race differences in fat distribution among Asian, African- American and Caucasian prepubertal children. J.Clin Endocrinol Metab, 87, 2164-3170

Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 2002;75:683-8.

Janssen, I., Heymsfield, S., & Ross, R. (2002). Application of simple anthropometry in the assessmsnt of health risk: Implications for the Canadian Physical Activity, Fitness and Lifestyle Appraisal. Can.J.Appl.Physiol, 27, 396-414.BC

Wang J, Laferrere B, Thornton JC, Pierson RN Jr, Pi-Sunyer FX. Regional subcutaneous fat loss induced by caloric restriction in obese women. Obes Res, 10:885-890, 2002.

Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, Horlick M, Kotler D, Laferrare B, Mayer L, Pi-Sunyer FX, Pierson RN Jr. Comparisons of waist circumference measured at four sites. Am J Clin Nutr. 2003;77:379-85

Freedman, D. S., Thornton, J. C., Mei, Z., & et al (2004). Height and adiposity among children. Obesity Research, 12, 846-853.BC

He Q, Engelson ES, Wang J, Kenya S, Ionescu G, Heymsfield SB, Kotler DP. Validation of an elliptical anthropometric model to estimate visceral compartment area. Obes Res 2004;2:250-257.

Sopher AB, Thornton JC, Wang J, Pierson R, Heymsfield S, Horlick M. Measurement of percentage of body fat in 411 children and adolescents: A comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics, 2004;113:1285-1291.

Wang J, Bartsch G, Rahgavan S, Yurik T, Peng P, Chen L, LeSueur D, Shlay J. Reliability of body circumference and skinfold measurements by observers trained in groups. Int J Body Composition Res, 2004;2(1):31-36.

Zhu S, Heshka S, Wang ZM, Shen W, Allison DB, Ross R, Heymsfield SB. Combination of BMI and waist circumference for identifying cardiovascular risk factors in whites. Obes Res 2004;12:633-645.

Zhu S, Heymsfield SB, Toyoshima H, Wang ZM, Pietrobelli A, Heshka S. Race-ethnicity specific waist circumference cutoff points for identifying cardiovascular disease risk factors. Am J Clin Nutr, 2005;81:409-415.

Gallagher D. Overweight and obesity BMI cut-offs and their relation to metabolic disorders in Koreans/Asians. Obesity Research, 12, 440-441, 2005

He Q, Horlick M, Thornton J, Wang J, Pierson RN Jr, Heshka S, Gallagher D. (2005). Sex-specific fat distribution is not linear across pubertal groups in a multiethnic study. Obesity Research, 12, 725-733.

Kuk JL, Lee S, Heymsfield SB, Ross R. (2005). Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr, 81, 1330-1334

Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW (2005). Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr., 15, 152-158.

St-Onge MP, Jassen. I. Heymsfield. SB. (2005). Metabolic syndrome in normal-weight Americans: new definition of the metabolically obese, normal-weight individual. Diabetes Care, 27, 2222-2228.

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity (Silver Spring). 2006 Apr;14(4):727-36. PMID: 16741276 PMCID: PMC1894647

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity (Silver Spring). 2006;14:727-36.

Wang J, Gallagher D, Thornton JC, Yu W, Horlick M, Pi-Sunyer FX. Validation of a 3-dimensional photonic scanner for the measurement of body volumes, dimensions, and percentage body fat. Am J Clin Nutr. 2006 Apr;83(4):809-16.

Freedman DS, Wang J, Ogden CL, Thornton JC, Mei Z, Pierson RN, Dietz WH, Horlick M. The prediction of body fatness by BMI and skinfold thicknesses among children and adolescents. Ann Hum Biol. 2007;34:183-94.

He Q, Zhang X, He S, Gong L, Sun Y, Heshka S, Deckelbaum RJ, Gallagher D. Higher insulin, triglycerides, and blood pressure with greater trunk fat in Tanner 1 Chinese. Obesity (Silver Spring). 2007 Apr;15(4):1004-11.

Mayer LE, Roberto CA, Glasofer DR, Etu SF, Gallagher D, Wang J, Heymsfield SB, Pierson RN Jr, Attia E, Devlin MJ, Walsh BT. Does percent body fat predict outcome in anorexia nervosa? Am J Psychiatry. 2007;164(6):970-2.

Mei Z, Grummer-Strawn LM, Wang J, Thornton JC, Freedman DS, Pierson RN Jr, Dietz WH, Horlick M. Do skinfold measurements provide additional information to body mass index in the assessment of body fatness among children and adolescents? Pediatrics. 2007;119(6):e1306-13.

Mills TC, Gallagher D, Wang J, and Heshka S. Modelling the relationship between body fat and the BMI. Int J Body Composition Res, 2007;2:73-79.

Heymsfield SB, Martin-Nguyen A, Fong TM, Gallagher D, Pietrobelli A. Body circumferences: clinical implications emerging from a new geometric model. Nutr Metab (Lond). 2008 Oct 6;5:24. PMID: 18834550 PMCID: PMC2569934

Nevill AM, GS Metsios, AS Jackson, J Wang, J Thornton, D Gallagher. Can we use the Jackson and Pollock equations to predict body density/fat of obese individuals in the 21st century. Int J Body Comp Res 2008;6(3):114-121.

Hwang MJ, Chung WS, Gallagher D, Kim DY, Shin HD, Song MY. How useful is waist circumference for assessment of abdominal obesity in Korean pre-menopausal women during weight loss? Asia Pac J Clin Nutr. 2008;17(2):229-34.

Scherzer R, Shen W, Bacchetti P, Kotler D, Lewis CE, Shlipak MG, Heymsfield SB, Grunfeld C; Study of Fat Redistribution Metabolic Change in HIV Infection (FRAM). Simple anthropometric measures correlate with metabolic risk indicators as strongly as magnetic resonance imaging-measured adipose tissue depots in both HIV-infected and control subjects. Am J Clin Nutr. 2008;87:1809-17.

Keller KL, Reid A, Macdougall MC, Cassano H, Lee Song J, Deng L, Lanzano P, Chung WK, Kissileff HR. Sex Differences in the Effects of Inherited Bitter Thiourea Sensitivity on Body Weight in 4-6-Year-Old Children. Obesity (Silver Spring). 2009 Sep 24. [Epub ahead of print] PubMed PMID: 19779476. PMC Journal - In Process

Freedman DS, Wang J, Thornton JC, Mei Z, Sopher AB, Pierson Jr. RN, Dietz WH, Horlick M. The classification of body fatness by BMI-for-age categories among children. Archives of Pediatrics & Adolescent Medicine, 163:805-811, 2009. NIHMSID: 173460

Navder KP, He Q, Zhang X, He S, Gong L, Sun Y, Deckelbaum RJ, Thornton J, Gallagher D. Relationship between body mass index and adiposity in prepubertal children: ethnic and geographic comparisons between New York City and Jinan City (China). J Appl Physiol. 2009;107:488-93. PMCID: PMC2724321.

Sproule DM, Montes J, Montgomery M, Battista V, Koenigsberger D, Shen W, Punyanitya M, De Vivo DC, Kaufmann P. Increased fat mass and high incidence of overweight despite low body mass index in patients with spinal muscular atrophy. Neuromuscul Disord. 2009;19(6):391-6. PMCID: PMC2729661.



Bioelectrical Impedance Analysis Laboratory    (Back to Laboratories)
Bioimpedance analysis is method for evaluating body composition using a small harmless electrical current passed across body tissues. The Laboratory has pioneered the development of new BIA systems over the past decade. Many commercial BIA systems have also been evaluated in the Laboratory that houses about 10 state-of-the art systems for carrying out BIA in subjects of all ages. Some simpler systems are based on a single frequency while other rely on multiple frequencies and more complex methods for deriving body fat, fat-free mass, skeletal muscle, body water, and water distribution. Available bioimpedance analysis devices include: Whole-body single-frequency analysis using BCA Body Composition Analyzer Model 680; Bodystat Body Composition Monitoring Unit Model 1500; Omron Body Fat Analyzer HBF-300; Omron Body Fat Analyzer HBF-306; Tanita TBF-310; Tanita TBF-305A; Segmental single-frequency and multi-frequency analysis systems include: Tanita BC-418; Tanita MC-190; Tanita WS5-2; Xitron 4000B Bio-Impedance Analyzer; Solartron SI-1260 Impedance/Gain-Phase Analyzer.

Bioelectrical Impedance Analysis in Body Composition: Background and Applications

History
Bioimpedance analysis (BIA) methods were first conceived and evaluated for use in the study of human physiology during the 1930’s by Burger and Barnett. Modern BIA methods are all based on a similar principle: resistance to an applied alternating electrical current is a function of tissue composition. With technological improvements, by the mid 1980’s new and practical BIA methods were introduced for estimating total-body water, fat-free mass, and total-body fat. These methods proliferated, and by 1994 the National Institute of Health organized a watershed conference in which the clinical and research applicability of BIA methods were reviewed in detail.

All tissues conduct an electrical current to an extent dependent upon the biological characteristics of each specific tissue. Tissues with long cylindrical cells and a high fluid and electrolyte content such as skeletal muscle impose relatively little resistance to an applied electrical current. In contrast, tissues with globular cells and a low water content such as adipose tissue pose a relatively high resistance to the conductivity of an alternating electrical current. This varying specific tissue resistivity allows empirical development of body composition prediction models. While advanced methods permit actual imaging of tissues, current BIA methods usually are developed by first setting the body component of interest as the dependant variable in prediction models. These dependant variables often include total-body water measured by the reference method of isotope dilution and fat-free mass as measured by DXA or underwater weighing. Measured resistance, or closely related impedance, is then set as the predictor variable in regression models. The electrical measurements are usually adjusted first for path length, typically as length2 or height2. Other predictor variables can also be inserted such as age, sex, race, and even selected anthropometric measurements. The developed prediction model is then cross validated prior to application.

Application
Bioimpedance analysis methods vary widely in the nature of the applied electrical current and the selected measurement pathway. Two system types are available, single frequency and multiple frequency. Single frequency systems are typically based on a 50 kHz alternating current. These systems provide a measure of impedance or resistance at a frequency of 50 kHz and some may also provide corresponding estimates of reactance and phase angle. The electrical properties are then used in body composition prediction models as previously described. Electrodes can vary from typical gel electrodes that must be applied first to stainless steel electrodes that maintain pressure contact with the subject. More advanced systems are based on multiple frequencies. These applied electrical frequencies can vary from as little as 1 kHz up to 1 MHz. Multiple frequency systems are applied when measuring fluid compartments and they offer little advantage to single frequency systems for estimation of fat-free mass and total-body fat.

The measured electrical circuit can also vary, ranging from an isolated region of a single leg to multiple limbs and the whole body. The most common approach is the “half body” pathway extending from one arm to the corresponding leg. Now, multisegmental BIA is available
in both single- and multifrequency systems. The multisegmental approach assumes that the body is made up of a group of cylinders as opposed to one cylinder only. The impedance of the left and right arms, the left and right legs, and the total body is measured. The summed value for the four limbs is subtracted from the total body to derive the impedance of the trunk.

An essential feature of BIA methods is that measurements are taken according to standardized conditions as suggested by the manufacturer or developer. Time of day, subject position, room temperature, level of prior physical activity, and meal ingestion are all variables that should be considered. When measurements are taken carefully, body composition estimates are usually well correlated with those provided by underwater weighing, DXA, and other reference methods. Consideration should also be given to the quality of the selected instrument and the appropriateness of the instrument’s calibration equations for the subjects under evaluation.

As BIA systems are relatively inexpensive to purchase and simple to operate, they have wide applicability in clinical and field settings. Results will be acceptable if properly applied and calibrated systems are used in evaluating appropriately selected subjects. BIA estimates are appropriate for long-term patient monitoring and in phenotyping groups of subjects for genetic studies. BIA body composition estimates are not generally reliable for evaluating short-term changes in body fluid or fat mass, although newer multiple frequency systems offer promise as a means of tracking short term fluid balance.


Relevant Laboratory/Core Publications (in chronological order)
Presta E, Wang J, Harrison GG, Bjorntorp P, Harker WH, Van Itallie TB. Measurement of total body electrical conductivity: a new method for estimation of body composition. Am J Clin Nutr, 37:735-739, 1983.

Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods. A comparative study. J Appl Physiol, 58:1556, 1985.

Segal KR, Burastero S, Chun A, Coronel P, Pierson RN Jr, Wang J. Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement. Am J Clin Nutr, 54:26-29, 1991.

Baumgartner RN, Heymsfield SB, Livhtman S, Wang J, Pierson RN Jr. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr, 53:1345-1353, 1991.
Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA. Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.
Segal KR, Burastero S, Chun A, Coronel P, Pierson RN Jr, Wang J. Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement. Am J Clin Nutr, 54:26-29, 1991.
Wang J, Dilmanian FA, Thornton JC, Russell-Aulet M, Burastero S, Mazariegos M, Heymsfield SB, Pierson RN Jr. In vivo neutron activation analysis (IVNA) for body fat: comparisons by seven methods. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models, and assessment. Plenum Press, New York, 31-34, 1993.
Wang J, Thornton JC, Russell-Aulet M, Burastero S, Heymsfield SB, Pierson RN Jr. Bio-impedance analysis for estimation of total body potassium, total body water and fat-free mass in white, black, and Asian adults. Am J Hum Biol, 7:33-40, 1995.

Arpadi SM, Wang J, Cuff PA, Thornton JC, Horlick M, Kotler DP, Pierson RN Jr. Application if bioimpedance analysis for estimating body composition in prepubertal children infected with human immunodeficiency virus type 1. J Pediatr, 129:755-757, 1996.

Kotler DP, Burastero S, Wang J, Pierson RN Jr. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr, 64(3 Suppl):489S-497S, 1996.
Stall SH, Ginsberg NS, DeVita MV, Zabetakis PM, Lynn RI, Gleim GW, Wang J, Pierson RN Jr, Michelis MF. Comparison of five body composition methods in peritoneal dialysis patients. Am J Clin Nutr, 64:125-130, 1996.
Nunez C, Gallagher D, Visser M, Pi-Sunyer FX, Wang Z, Heymsfield SB. Bioimpedance analysis: evaluation of let-to-leg system based on pressure contact footpad electrodes. Med Sci Sports Exerc, 29:524-531, 1997.

Faith MS, Pietrobelli A, Nunez C, Heo M, Heymsfield SB, Allison DB. Evidence for independent genetic influences on fat mass and body mass index in a pediatric twin sample. Pediatrics, 104(1 Pt 1):61-67, 1999.

Kotler DP, Rosenbaum K, Allison DB, Wang J, Pierson RN Jr. Validation of bioimpedance analysis as a measure of change in body cell mass as estimated by whole body counting of potassium in adults. J Parent Ent Nutr, 5:345-349, 1999.

Kotler DP, Thea DM, Heo M, Allison DB, Engelson ES, Wang J, Pierson RN Jr, St. Louis M, Keusch GT. Relative influences of sex, race, environment, and HIV infection on body composition in adults. Am J Clin Nutr, 69:432-439, 1999.

Nunez C, Gallagher D, Grammes J, Baumgartner RN, Ross R, Wang Z, Thornton J, Heymsfield SB. Bioimpedance analysis: potential for measuring lower limb skeletal mass. JPEN J Parenter Enteral Nutr, 23(2):96-103, 1999.
Zamboni M, Turcato E, Santana H, Maggi S, Harris TB, Pietrobelli A, Heymsfield SB, Micciolo R, Bosello O. The relationship between body composition and physical performance in older women. J Am Geriatr Soc, 47(12):1403-1408, 1999.
Funkhouser A, Laferrere B, Wang J, Thornton J, Pi-Sunyer FX, Measurement of percent body fat during weight loss in obese women: comparison of four methods. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:539-541

Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000;89:465-71

Michener J, Lam S, Kolesnik, Thornton JC, Wang J, Pierson RN Jr., Skinfolds versus bioimpedance analysis for predicting fat-free mass. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:339-341.

Nunez C, Tan YX, Zingaretti G, Punyanitya M, Rubiano F, Wang ZM, Heymsfield SB.
The best predictive model for estimating fat-free mass. Ann N Y Acad Sci, 904:333-334, 2000.

Rosenbaum K, Wang J, Pierson RN Jr. Kotler DP. Time-dependent variation in weight and body composition in healthy adults. J Parent Ent Nutr, 24(2):52-5, 2000.
Rubiano F, Nunez C, Heymsfield SB. A comparison of body composition techniques. Ann N Y Acad Sci, 904:335-338, 2000.
Zingaretti G, Nunez C, Gallagher D, Heymsfield SB. A new theoretical model for predicting bioelectrical impedance analysis. Ann N Y Acad Sci, 904:227-228, 2000.

Geliebter, A., Hassid, G., & Hashim, S. A. Test meal intake in obese binge eaters in relation to mood and gender. International Journal of Eating Disorders, 29, 488-494, 2001.

Boozer, C. N., Daly, P. A., Homel, P., Solomon, J. L., Blanchard, D., Nasser, J. et al. (2002). Herbal ephedra/ caffeine for weight loss: a 6- month randomized safety and efficacy trial. Int J Obes Relat Metab Disord, 26, 593-604.

Horlick, M., Arpadi, S. M., Bethel, J., & et al (2002). Bioelectrical impedance analysis models for prediction of total body water and fat- free mass in healthy and HIV- infected children and adolescents. Am J Clin Nutr, 76, 991-999

Janssen, I., Heymsfield, S., & Ross, R. (2002). Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc, 50, 889-896

Pietrobelli A, Nunez C, Zingaretti G, Battistini N, Morini P, Wang ZM, Yasumura S, Heymsfield SB. Assessment by bioimpedance of forearm muscle cell mass: A new approach to calibration. Eur J Clin Nutr, 2002;56:723-728.

Salinari S, Bertuzzi A, Mingrone G, Capristo E, Pietrobelli A, Campioni P, Greco AV, Heymsfield SB. New bioimpedance model accurately predicts lower limb muscle volume: validation by magnetic resonance imaging. Am J Physiol Endocrinol Metab 2002;282:E960-6.

He Q, Wang J, Engelson WS, Kotler DP. Detection of segmental internal fat by bioelectrical impedance analysis in a biological phantom. Nutrition. 2003;19:541-4

Sun SS, Chumlea WC, Heymsfield SB, Lukaski HC, Schoeller D, Friedl K, Kuczmarski RJ, Flegal KM, Johnson CL, Hubbard VS. Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys. Am J Clin Nutr. 2003;77:331-40.

Pietrobelli, A., Rubiano, F., St Onge, M. P., & Heymsfield, S. (2004). New bioimpedance analysis system: improved phenotyping with whole- body analysis. European Journal of Clinical Nutrition, 58, 1479-84.

Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW (2005). Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr., 15, 152-158.

Kim HJ, Gallagher D, Song MY. Comparison of body composition methods during weight loss in obese women using herbal formula. Am J Chin Med. 2005;33(6):851-8.

Carter M, Zhu F, Kotanko P, Kuhlmann M, Ramirez L, Heymsfield SB, Handelman G, Levin NW. Assessment of body composition in dialysis patients by arm bioimpedance compared to MRI and 40K measurements. Blood Purif. 2009;27(4):330-7. Epub 2009. PMID: 19270452 NIHMSID # 174809

Goldsmith R, Joanisse DR, Gallagher D, Pavlovich K, Shamoon E, Leibel RL, Rosenbaum M. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects. Am J Physiol Regul Integr Comp Physiol. 2010;298(1):R79-88. PubMed PMID: 19889869. PMC Journal - In Process

 


Densitometry Laboratory    (Back to Laboratories)
The calculation of body composition from measures of body density is the classic method with which most persons are familiar. Traditionally it involves submerging the subject in a water tank and measuring the subject’s weight while under water. More recently, devices have become available to measure body volume using small changes in air pressure in an enclosed chamber.

This laboratory has facilities for and has carried out thousands of underwater weighing measures for both clinical and research purposes. The available system includes two components, the underwater weighing tank with digital scale and the residual lung volume apparatus. The subject’s weight underwater, their weight on land, and residual lung volume are used to calculate body density. The procedure requires about 30 minutes and is safe, non-invasive, and accurate relative to other reference methods. The body density measurement is used to derive the fraction of body weight as fat and remainder, termed fat-free mass.

The underwater weighing system is unique in having the capacity to evaluate subjects who are very tall or obese. The present system was used to evaluate professional basketball players and morbidly obese subjects weighing several hundred pounds.

A recent alternative to measuring body density is referred to as air displacement plethysmography. Subjects enter a sealed container and sit quietly breathing through a mouthpiece. The system is designed to use changes in pressure and volume within the chamber to derive an estimate of body volume and body density. Results are comparable to underwater weighing, although development for very small subjects, notably children, is ongoing. Subjects up to about 250 pounds can fit comfortably within the system.

The telephone number for this laboratory is 212 523-4194.

 


Underwater Weighing/Air Plethysmography Applications and Background    (Back to Laboratories)

History

Over one century ago investigators sought a means of non-destructively establishing the oil content of fish. A novel means was devised whereby the fish specific gravity was established and oil estimated using a two-component model. The model qualitatively assumed that one component was oil with a low specific gravity and the second component was remaining tissue with a higher specific gravity. In effect, the specific gravity became a measure of the fish oil content. By the mid 1940’s the technique had been refined and extended by Albert Behnke and his colleagues. Behnke devised an underwater weighing system that included correction of specific gravity for residual air trapped in the lungs. Behnke and his colleagues also proposed a quantitative two-compartment model consisting of fat and fat-free mass, each with known and assumed constant densities. Siri and other workers later refined these densities such that fat is now assumed to have a density of 0.9 g/cm3 and fat-free mass a density of 1.1 g/cm3 at body temperature. Assuming these two known and constant density’s and given the subjects measured density by underwater weighing, one can then compute the percentage of body weight as fat. The hydrodensitometry or underwater weighing method served as a reference technique for at least four decades against which other methods were compared.

Application
The modern technique involves a watertight tank typically with an electronic scale either positioned above the tank or submerged on the floor of the tank. The subject exhales, expelling air, submerges, and underwater body weight is recorded. Density is then calculated from the subjects’ weight in air and their weight under water following corrections for water temperature. The subject’s residual lung volume is also measured either during the underwater weighing procedure or following the underwater weighing after they have emerged from the tank. Underwater weighing systems are relatively easy to construct and are inexpensive. Accordingly, many systems have been built throughout the world including in developing countries. The information provided has contributed significantly to our understanding of human body composition in health and disease.

The two-component model assumes that body weight consists of fat and fat-free mass. The density of fat is well established in both humans and animals and is approximately 0.9 g/cm3. Only minimal variation is recognized within and between species in the density of fat. This is because fat, or specifically lipid, is almost entirely triglycerides. On the other hand, fat-free mass is a heterogeneous compartment consisting of at least four major components including water, protein, glycogen, and minerals. The density of these components varies from a low of 0.994 g/cm3 for water to a high of 3.04 g/cm3 for minerals. The assumed density of 1.1 g/cm3 is based on observations made in a limited number of human cadavers suggesting relatively stable proportions of water, protein, glycogen and minerals. To the extent that these proportions change in any individual subject will introduce corresponding errors in the assumed density of fat-free mass. A number of studies suggest that the density of fat-free mass is relatively stable across age and sex groups, although some variation is recognized at the extremes of age and in patients who have underlying medical and surgical conditions. Additionally, there may exist race differences in the density of fat-free mass as well as variation among special groups such as body builders or other types of athletic participants. Thus, while underwater weighing and the two-compartment model served as a reference technique for several decades, newer approaches without these various assumptions are now replacing hydrodensitometry as the clinical reference method.

The importance of the underwater weighing method is that measurement systems are relatively inexpensive to construct, simple to operate, and the procedure is safe for patients varying widely in age and body weight. The method’s disadvantage is that some subjects have concerns about water submersion and thus either decline to participate or have technically inadequate measurements. Underwater weighing is also a technique that by necessity is stationary and cannot be moved around for field applications. A reasonable amount of technician skill is required to perform the method that under optimal conditions has a small technical error of about 0.001 g/cm3. The residual lung volume measurement can also be difficult from some patients and adds to the measurement error adds to the method’s total error.

The main concept of hydrodensitometry, that the body consists of two compartments of known and stable density, is very robust and as mentioned has served investigators well for several decades. This has led to a search for alternative means of quantifying body density in humans. A newer approach to estimating body volume and body density is referred to as air plethysmography. The air plethysmography technique is based on classical gas laws. Small volume changes are produced within a two-chambered plethysmograph and the corresponding pressure change measured. The subject’s body volume is determined by subtraction of the empty chamber volume. Additional corrections are made for body volume based on body surface area and thoracic gas volume. The adjusted value for body volume is used in estimating body density and fat mass is then calculated from body weight and the classical Siri equation (Siri, 1956). The available commercial system, BODPOD® (Life Measurements Instruments, Concord, CA), has been widely validated in adults and children. The system is adequately portable for use in isolated areas for phenotyping assuming electrical power is available and ambient conditions such as temperature and humidity are adequately controlled and are relatively stable. The currently available systems are optimized for adults and infants (PeaPod®, Life Measurements Inc). Software and hardware add-on to the BODPOD are under development for use in children who cannot be accommodated by the PeaPod® (where the child is too large) or BODPOD (where the child is too small). While many underwater weighing systems can accommodate extremely obese subjects, BODPOD’s size is finite and not all obese subjects fit within the fixed chamber volume.

Three-Dimensional Photonic Scanning. The use of a digitized optical method and computer
to generate a three-dimensional photonic scan (3-DPS) image of an object in humans was
developed more than four decades ago and has more recently been applied for the measurement of whole-body surface anthropometry, whole-body and regional volumes, and body fat. The 3-DPS is a noninvasive optical method that uses high-speed digital cameras and triangular mathematics to detect the position of eye-safe Class 1 laser light points (664 nm) projected onto the surface of an object and reflected to the cameras. Software connects the points to generate a 3-D image from which values for total and regional body volumes and dimensions, such as body circumferences, lengths, widths, and thicknesses, can be obtained. Validation studies for total body volume from the 3-DPS have been conducted in children and adults using underwater weighing and air displacement plethysmography techniques as standards. This technique is easy to perform, fast, and accurate for determining total and regional body volumes and dimensions in persons tested to date with a maximum weight of 182 kg and a maximum BMI of 63 kg/m2.

Relevant Laboratory/Core Publications (in chronological order)
Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods. A comparative study. J Appl Physiol, 58:1556, 1985.
Heymsfield SB, Wang J, Kehayias J, Heshka S, Lichtman S, Pierson RN Jr. Chemical determination of human body density in vivo: relevance to hydrodensitometry. Am J Clin Nutr, 50:1282-1289, 1989.

Wang J, Heymsfield SB, Russell-Aulet M, Thornton JC, Pierson RN Jr. Body fat from bone density: underwater weighing vs. dual-photon absorptiometry. Am J Physiol, 256:E829-E834, 1989.

Heymsfield SB, Lichtman S, Baumgartner RN, Wang J, Kamen Y, Aliprantis A, Pierson RN Jr.
Body composition of humans: comparison of two improved four-compartment models that differ in expense, technical complexity, and radiation exposure. Am J Clin Nutr, 52:52-58, 1990.
McKeon EW, Wang J, Pierson RN Jr, Kral JG. Dual-photon absorptiometry in obesity: effects of massive weight loss. Eds. Yasumura S, Harrison JE, McNeill KG, Woodhead AD, Dilmanian FA. In Vivo Body Composition Studies, Resent Advances. Basic Life Sciences, Vol. 55:191-196, Plenum, New York, 1990.
VanItallie TB, Yang M, Heymsfield SB, Funk RC, Boileau RA. Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Nutr, 52:953-959, 1990.
Baumgartner RN, Heymsfield SB, Livhtman S, Wang J, Pierson RN Jr. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr, 53:1345-1353, 1991.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr, Heymsfield SB. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1991.
Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA. Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.
Albu J, Smolowitz J, Lichtman S, Heymsfield SB, Wang J, Pierson RN Jr, Pi-Sunyer FX.
Composition of weight loss in severely obese women: A new look at old methods. Metabolism, 41:1068-1074, 1992.
Heymsfield SB, Wang ZM. Measurement of total body fat by underwater weighing: new insights and uses for an old method. Nutrition, 9:472-473, 1993.
Lederman SA, Pierson RN Jr, Wang J, Paxton A, Thornton J, Wendel J, Heymsfield SB. Body composition (BC) measurements during pregnancy. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models and assessment. Plenum Press, New York, 193-195, 1993.
Mazariegos M, Wang ZM, Gallagher D, Baumgartner RN, Allison DB, Wang J, Pierson RN Jr, Heymsfield SB. Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model. J Geront, 49:M201-M208, 1994.
Kotler DP, Burastero S, Wang J, Pierson RN Jr. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr, 64(3 Suppl):489S-497S, 1996.
Rosenbaum M, Nicolson M, Hirsch J, Heymsfield SB, Gallagher D, Chu F, Leibel RI. Effects of gender, body composition, and menopause on plasma concentrations of leptin. J Clin Endocrinol Metab, 81:3424-3427, 1996.
Clasey JL, Kanaley JA, Wideman L, Heymesfield SB, Teates CD, Gutgesell ME, Thorner MO, Hartman ML, Weltman A. Validity of methods of body composition assessment in young and older men and women. J Appl Physiol, 86(5):1728-1738, 1999.
Mott JW, Wang J, Thornton JC, Allison DB, Heymsfield SB, Pierson RN Jr. Relation between body fat and age in four ethnic groups. Am J Clin Nutr, 69:1007-1013, 1999.
Nunez C, Kovera AJ, Pietrobelli A, Heshka S, Horlick M, Kehayias J, Wang Z, Heymsfield SB.
Body composition in children and adults by air displacement plethysmography. Eur J Clin Nutr, 53(5):382-387, 1999.
Withers RT, Laforgia J, Heymsfield SB. Critical appraisal of the estimation of body composition via two-, three-, and four-compartment models. Am J Human Biol, 11(2):175-185, 1999.
Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based On body mass index. Am J Clin Nutr, 72(3):694-701, 2000.
Leone PA, Gallagher D, Wang J, Heymsfield SB, Relative Overhydration of fat-free mass in postobese versus never-obese subjects. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000 904:514-519.

Boozer, C. N., Nasser, J., Wang, V., Chen, G., & Soloman, J. L. (2001). An herbal supplement containing Ma Huang- Guarana for weight loss: a randomized, double- blind trial. International Journal of Obesity, 25, 316-324.

Sopher AB, Thornton JC, Wang J, Pierson R, Heymsfield S, Horlick M. Measurement of percentage of body fat in 411 children and adolescents: A comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics, 2004;113:1285-1291.

Wang J, Gallagher D, Thornton JC, Yu W, Horlick M, Pi-Sunyer FX. Validation of a 3-dimensional photonic scanner for the measurement of body volumes, dimensions, and percentage body fat. Am J Clin Nutr. 2006 Apr;83(4):809-16. PMID: 16600932 PMCID: PMC2723741

Wang Z, Heshka S, Wang J, Heymsfield SB. Total body protein mass: validation of total body potassium prediction model in children and adolescents. J Nutr. 2006 Apr;136(4):1032-6.

Wang J, Gallagher D, Thornton JC, Yu W, Weil R, Kovac B, Pi-Sunyer FX. Regional Body Volumes, BMI, Waist Circumference, and Percentage Fat in Severely Obese Adults. Obesity (Silver Spring). 2007;15(11):2688-2698. PMID: 18070760 PMCID: PMC2741388

Levitt DG, Heymsfield SB, Pierson RN Jr, Shapses SA, Kral JG. Physiological models of body composition and human obesity. Nutr Metab (Lond). 2007 Sep 20;4:19. PMID: 17883858 PMCID: PMC2082278

Chambers EC, Heshka S, Huffaker LY, Xiong Y, Wang J, Eden E, Gallagher D, Pi-Sunyer FX. Truncal adiposity and lung function in older black women. Lung. 2008 Jan-Feb;186(1):13-7. PMID: 17952506

Heymsfield SB, Martin-Nguyen A, Fong TM, Gallagher D, Pietrobelli A. Body circumferences: clinical implications emerging from a new geometric model. Nutr Metab (Lond). 2008 Oct 6;5:24.

Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008 Oct;88(4):906-12. PMID: 18842775



DXA Laboratory    (Back to Laboratories)
Three DXA systems are available in the laboratory: GE Lunar Prodigy; GE Lunar iDXA; and a Hologic Delphi QDR for Whole body: fat, lean, bone mineral; Regional: arms, legs, and trunk soft tissue and bone; and abdominal region of interest; Regional: femur-hip, spine, and wrist. The two GE Lunar systems have been cross-calibrated on volunteer subjects so that results for bone mineral and body composition measured by any one system can be translated to results on the other system, including previous Lunar systems that have been retired (DPX, DPXL).

The laboratory has provided measurements of total and regional bone mineral and body composition to investigators from the local region in multiple research projects and in many clinical trials for two decades. It has carried out more than 20,000 subject studies in the past 20 years with more than 50% of these for research purposes. It is also a major center for bone density evaluation for physicians for clinical purposes from pediatric to geriatric patients. The laboratory has served as a QC and reading center in several projects involving multi-center investigations. The laboratory also provides teaching programs to investigators or laboratory staff who are interested in learning DXA techniques for bone mineral and body composition measurements.

The telephone number for human study is 212 523-BONE (2663).


Background and Application of Dual-Energy X-Ray Absorptiometry

History

Anthropologists and health care workers in the field of metabolic bone disease required a method of quantifying bone mass. The selected approach was to expose one side the wrist to a photon-emitting radioactive source and a scintillation counter was positioned on the other side of the wrist. The number of detected counts was related to the amount of attenuating calcium or bone present. The wrist was usually selected for measurement as bone is the main attenuating tissue, unlike conditions at the hip or spine in which soft tissue is also present. Later investigators explored means of evaluating hip and spine as these are clinically important bone areas involved in osteoporosis. The single photon system evolved to a dual-photon system, now based on a filtered x-ray source and referred to as dual-energy x-ray absorptiometry (DXA). DXA systems required information about soft tissue composition in order to quantify bone mineral within a soft-tissue containing pixel. The capability of quantifying the fat and lean soft tissue content of a pixel evolved into DXA’s central role in modern body composition analysis.

Application
DXA systems all operate on similar principals, although important technical details prevail. An x-ray source provides a broad photon beam that is usually filtered, yielding two main energy peaks. Some systems produce the two energy peaks using a pulsating voltage source. The emitted photons traverse the subject’s tissues and are attenuated to an extent dependent upon the tissue’s elemental make-up. Low atomic weight elements, such as hydrogen, minimally attenuate photons while elements such as calcium are highly attenuating. Additionally, the difference in attenuation between the two energy peaks is characteristic for each element and thus each tissue. The characteristic attenuation signature for fat, lean, and bone mineral allows development of pixel-by-pixel composition estimates using a series of assumptions and reconstruction algorithms. Some systems use a simple “pencil-beam” configuration as the patient is scanned and others have a “fan-beam” configuration of x-ray source and detector. Fan beam systems tend to be faster, requiring only several minutes for each scan compared to longer scan times for pencil beam models. Accuracy varies with system design and software. Calibrations are carried out by the manufacturer that allow resolution of the three molecular level components, bone mineral, fat, and lean soft tissue. System calibration and function is also carried out once systems are operational on a regular basis. DXA x-ray exposure is minimal (<1 mrem), allowing longitudinal studies in children and adults.

Current DXA systems designed for body composition analysis can provide estimates for the three components of the whole body and for specific regions such as the arms, legs, and trunk. This unique capability of DXA provides several important opportunities: regional or total-body fat mass can be quantified using standard system settings or for investigator-initiated specific anatomic sites; appendicular lean soft tissue can be quantified and used as a measure of regional or total-body skeletal muscle mass; and acquired bone mineral can be applied not only to the study of osteoporosis, but to development of more complex multicomponent models. DXA measurements provide valuable insights in longitudinal studies as measurement precision is very high. Many studies have now validated DXA body composition estimates against other reference methods with good overall agreement for body fat estimates. Some variation in fat and bone mineral estimates is usually observed when different instruments are compared, necessitating close scrutiny of the selected instrument with respect to calibration and accuracy. Although providing regional “total” fat estimates, unlike CT and MRI DXA is not capable of estimating visceral adipose tissue.

DXA systems are increasingly available, are accurate when properly calibrated and applied, and relatively safe to use in the majority of subjects. As a result, DXA is becoming the method of choice for accurately measuring fat and bone mineral mass at research centers lacking IVNA systems. Disadvantages are that DXA cannot be used in pregnant women, cost is reasonably high, and very large or obese subjects cannot be easily accommodated on most presently available systems.

An important feature of DXA is that it provides investigators with an estimate of bone mineral mass. Combining measured bone mineral with estimates of body volume by underwater weighing/air plethysmography and total-body water by isotope dilution allows development of “multi-component” models. The best recognized of these is the family of models based on body volume estimates, beginning with the classic two-component model and advancing to three components with addition of total-body water, and four components with addition of bone mineral estimates. The main advantage of multicomponent models, in addition to providing more compartmental estimates of biological interest, is that fewer assumptions are made regarding component relationships that are assumed stable or constant across subjects (e.g., fat-free mass hydration). Accordingly, multicomponent methods are usually applied as the reference against which other techniques are validated or compared.

Relevant Laboratory/Core Publications (in chronological order)
Heymsfield SB, Wang J, Kehayias J, Pierson RN Jr. Dual photon absorptiometry: comparison of bone mineral and soft tissue mass measurements in vivo with established methods. Am J Clin Nutr, 49:1283-1289, 1989.

Heymsfield SB, Wang J, Lichtman S, Kamen Y, Kehayias J, Pierson RN Jr. Body composition in elderly subjects: a critical appraisal of clinical methodology. Am J Clin Nutr, 50:1167-1175, 1989.
Heymsfield SB, Wang J, Kehayias J, Heshka S, Lichtman S, Pierson RN Jr. Chemical determination of human body density in vivo: relevance to hydrodensitometry. Am J Clin Nutr, 50:1282-1289, 1989.
Wang J, Heymsfield SB, Russell-Aulet M, Thornton JC, Pierson RN Jr. Body fat from bone density: underwater weighing vs. dual-photon absorptiometry. Am J Physiol, 256:E829-E834, 1989.

Heymsfield SB, Lichtman S, Baumgartner RN, Wang J, Kamen Y, Aliprantis A, Pierson RN Jr.
Body composition of humans: comparison of two improved four-compartment models that differ in expense, technical complexity, and radiation exposure. Am J Clin Nutr, 52:52-58, 1990.

Heymsfield SB, Smith R, Russell-Aulet M, Bensen B, Lichtman S, Wang J, Pierson RN Jr.
Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr, 52:214-218, 1990.

Heymsfield SB, Wang J, Russell-Aulet M, Kehayias J, Lichtman S, Kamen Y, Dilmanian FA, Lindsay R, Pierson RN Jr. Dual photon absorptiometry: validation of mineral and fat measurements. Eds. Yasumura S, Harrison JE, McNeill KG, Woodhead AD, Dilmanian FA. In Vivo Body Composition Studies, Recent Advances. Basic Life Sciences, Vol. 55:327-337, Plenum Press, New York, 1990.

McKeon EW, Wang J, Pierson RN Jr, Kral JG. Dual-photon absorptiometry in obesity: effects of massive weight loss. Eds. Yasumura S, Harrison JE, McNeill KG, Woodhead AD, Dilmanian FA. In Vivo Body Composition Studies, Resent Advances. Basic Life Sciences, Vol. 55:191-196, Plenum, New York, 1990.

Baumgartner RN, Heymsfield SB, Livhtman S, Wang J, Pierson RN Jr. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr, 53:1345-1353, 1991.

Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA. Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.
Russell-Aulet M, Wang J, Thornton JC, Colt EWD, Pierson RN Jr. Bone mineral density and mass by total body dual-photon absorptiometry in normal Caucasian & Asian men. J Bone Miner Res, 10:1109-1113, 1991.
Russell-Aulet M, Wang J, Thornton JC, Pierson RN Jr. Comparison of dual-photon absorptiometry systems for total-body bone and soft tissue measurements: dual-energy X-rays versus gadolinium 153. J Bone Miner Res, 6:411-415, 1991.
Albu J, Smolowitz J, Lichtman S, Heymsfield SB, Wang J, Pierson RN Jr, Pi-Sunyer FX.
Composition of weight loss in severely obese women: A new look at old methods. Metabolism, 41:1068-1074, 1992.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr, Heymsfield SB. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1992.
Wang J, Kotler DP, Russell-Aulet M, Burastero S, Mazariegos M, Thornton J, Dilmanian FA, Pierson RN Jr, Weber DA, Kamen Y.
Body-fat measurement in patients with acquired immunodeficiency syndrome: which method should be used? Am J Clin Nutr, 56:963-967, 1992.
Wang J, Russell-Aulet M, Mazariegos M, Burastero S, Thornton J, Lichtman S, Heymsfield SB, Pierson RN Jr. Body fat by dual-photon absorptiometry (DPA): comparisons with traditional methods in Asians, blacks, and Caucasians. Am J Hum Biol, 4:501-510, 1992.
Mazariegos M, Heymsfield SB, Wang ZM, Wang J, Yasumura S, Dilmanian FA, Pierson RN Jr.
Aging affects body composition: Young versus elderly women pair-matched by body mass index. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models, and assessment. Plenum press, New York, 245-250, 1993.
Russell-Aulet M, Wang J, Thornton JC, Colt EWD, Pierson RN Jr. Bone mineral density and mass in a cross-sectional study of white and Asian woman. J Bone Miner Res, 8:575-582, 1993.
Wang J, Dilmanian FA, Thornton JC, Russell-Aulet M, Burastero S, Mazariegos M, Heymsfield SB, Pierson RN Jr. In vivo neutron activation analysis (IVNA) for body fat: comparisons by seven methods. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models, and assessment. Plenum Press, New York, 31-34, 1993.
Gerace L, Aliprantis A, Russell M, Baumgartner RN, Wang J, Pierson RN Jr, Heymsfield SB.
Differences in skeletal muscle and bone mineral mass between black and white males and their relevance to estimates of body composition. Am J Hum Biol, 6:255-262, 1994.
Mazariegos M, Wang ZM, Gallagher D, Baumgartner RN, Allison DB, Wang J, Pierson RN Jr, Heymsfield SB. Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model. J Geront, 49:M201-M208, 1994.
Wang J, Thornton JC, Russell M, Burastero S, Heymsfield SB, Pierson RN Jr. Asians have lower body mass index (BMI) but higher fat percent than do whites: comparisons of anthropometric measurements. Am J Clin Nutr, 60:23-28, 1994.

Gasperino JA, Wang J, Pierson RN Jr, Heymsfield SB. Age-related changes in musculoskeletal mass between black and white women. Metabolism, 44(1):30-34, 1995.

Pierson RN Jr, Wang J, Thornton JC, Kotler DP, Heymsfield SB, Weber A, Ma RM. Bone mineral and body fat measurements by two absorptiometry systems: comparisons with neutron activation analysis. Calc Tissue Int, 56:93-98, 1995.

Sepulveda D, Allsion DB, Gomez JE, Kreibich K, Brown RA, Pierson RN Jr, Heymsfield SB.
Low spinal and pelvic bone mineral density among individuals with Down syndrome. Am J Ment Retard, 100:109-114, 1995.

Arpadi SM, Wang J, Cuff PA, Thornton JC, Horlick M, Kotler DP, Pierson RN Jr. Application if bioimpedance analysis for estimating body composition in prepubertal children infected with human immunodeficiency virus type 1. J Pediatr, 129:755-757, 1996.

Economos CD, Nelson ME, Fiatarone MA, Dallal GE, Heymsfield SB, Wang J, Russell-Aulet M, Yasumura S, Ma RM, Vaswani AN, Pierson RN Jr. A multi-center comparison of dual energy X-ray absorptiometers: in vivo and in vitro measurements of bone mineral content and density. J Bone Miner Res, 11:275-285, 1996.

Gallagher D, Visser M, Sepulveda D, Pierson RN Jr, Harris T, Heymsfield SB. How useful is body mass index for comparison across age, gender, and ethnic groups? Am J Epidemiol, 143:228-239, 1996.

Ma KZ, Kotler DP, Wang J, Thornton JC, Ma RM, Pierson RN Jr. Reliability of in vivo neutron activation analysis for measuring body composition: comparisons with tracer dilution and dual-energy X-ray absorptiometry. J Lab Clin Med, 127:420-427, 1996.
Stall SH, Ginsberg NS, DeVita MV, Zabetakis PM, Lynn RI, Gleim GW, Wang J, Pierson RN Jr, Michelis MF. Comparison of five body composition methods in peritoneal dialysis patients. Am J Clin Nutr, 64:125-130, 1996.
Schambelan M, Mulligan K, Grunfeld C, Daar ES, LaMarca A, Kotler DP, Wang J, Bozzette SA, Breitmeyer. Recombinant human growth hormone in patients with HIV-associated wasting. A randomized, placebo, controlled trial. Serostim Study Group. Ann Intern Med, 125(11):873-882, 1996.
Wang J, Thornton JC, Burastero S, Shen J, Tanenbaum S, Heymsfield SB, Pierson RN Jr.
Comparisons for body mass index and body fat percent among Puerto Ricans, blacks, whites, and Asians living in the New York City area. Obesity Research, 4:377-384, 1996.

Wang ZM, Visser M, Ma RM, Baumgartner RN, Kotler D, Gallagher D, Heymsfield SB.
Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. J Appl Physiol, 80:824-831, 1996.

Gallagher D, Visser M, DeMeersman RE, Sepulveda D, Baumgartner RN, Pierson RN Jr, Harris T, Heymsfield SB. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol, 82:229-239, 1997.

Marcus MA, Wang J Thornton JC, MA RM, Burastero S, Pierson RN Jr. Anthropometrics do not influence dual X-ray absorptiometry (DXA) measurement of fat in normal to obese adults: a comparison with in vivo neutron activation analysis (IVNA). Obesity Res, 5:122-130, 1997.

Apardi S, Horlick M, Wang J, Cuff P, Bamji M, Kotler D. Body composition in prepubertal children with human immunodeficiency virus type 1 infection, Arch Pediatr. Adolesc Med, 152:688-693, 1998.

Gallagher D, Heymsfield SB. Muscle distribution: variation with body weight, gender, and age. Appl radiat Isotopes, 49:733-734, 1998.

Marcus M, Wang J, Pi-Sunyer Fx, Thornton JC, Kofopoulou I, Pierson RN Jr. Effects of ethnicity, gender, obesity and age on central fat distribution: comparison of dual X-ray absorptiometry measurements in white, black and Puerto Rican adults. Am J Hum Biol, 10:361-369, 1998.

Wang J, Thornton JC, Heymsfield SB, Pierson RN Jr. Correlation between skeletal calcium mass and muscle mass in man revisited: age, gender, and ethnicity. Appl Radiat Isotopes, 49:597-598, 1998.

Bauman WA, Spungen AM, Wang J, Pierson, RN Jr, Schwartz E. Continuous loss of bone during chronic immobilization: a monozygotic twin study. Osteoporos Int, 10(2):123-127, 1999.
Clasey JL, Kanaley JA, Wideman L, Heymesfield SB, Teates CD, Gutgesell ME, Thorner MO, Hartman ML, Weltman A. Validity of methods of body composition assessment in young and older men and women. J Appl Physiol, 86(5):1728-1738, 1999.
Economos CD, Nelson ME, Fiatarone Singh MA, Kehayias J, Dallal GE, Heymsfield SB, Wang J, Yasumura S, Ma R, Pierson RN Jr. Bone mineral measurements: a comparison of delayed gamma neutron activation, dual-energy X-ray absorptiometry and direct chemical analysis. Osteoporos Int, 10(3):200-206, 1999.
Engelson ES, Kotler DP, Tan Y, Agin D, Wang J, Pierson RN Jr, Heymsfield SB. Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body Magnetic resonance imaging. Am J Clin Nutr, 69(6):1162-1169, 1999.
Heymsfield SB, Greenberg AS, Fujioka K, Dixon RM, Kushner R, Hunt T, Lubina JA, Patane J, Self B, Hunt P, McCamish M. Recombinant leptin for weight loss in obese and lean adults: a randomized, controlled, dose-escalation trial. JAMA, 282(16):1568-1575, 1999.
Mott JW, Wang J, Thornton JC, Allison DB, Heymsfield SB, Pierson RN Jr. Relation between body fat and age in four ethnic groups. Am J Clin Nutr, 69:1007-1013, 1999.
Nunez C, Kovera AJ, Pietrobelli A, Heshka S, Horlick M, Kehayias J, Wang Z, Heymsfield SB.
Body composition in children and adults by air displacement plethysmography. Eur J Clin Nutr, 53(5):382-387, 1999.
Wang J, Horlick M, Thornton JC, Levine LS, Heymsfield SB, Pierson RN Jr. Correlation between skeletal muscle mass and bone mass in children 6-18 years: Influences of sex, ethnicity, and pubertal status. Growth, Development, and Aging, 66:99-109, 1999.

Wang J, Thornton JC, Horlick M, Formica C, Wang W, Rahn M, Pierson RN Jr. Dual X-ray absorptiometry in pediatric studies: changing scan modes alters bone and body composition measurements. J Clin Dens, 2:135-141, 1999.

Wang W, Wang Z, Faith MS, Kotler D, Shih R, Heymsfield SB. Regional skeletal muscle measurement: evaluation of new dual-energy X-ray absorptiometry model. J Appl Physiol, 87(3):1163-1171, 1999.
Withers RT, Laforgia J, Heymsfield SB. Critical appraisal of the estimation of body composition via two-, three-, and four-compartment models. Am J Human Biol, 11(2):175-185, 1999.
Zamboni M, Turcato E, Santana H, Maggi S, Harris TB, Pietrobelli A, Heymsfield SB, Micciolo R, Bosello O. The relationship between body composition and physical performance in older women. J Am Geriatr Soc, 47(12):1403-1408, 1999.
Arpadi SM, Cuff PA, Kotler DP, Wang J, Bamji M, Lange M, Pierson RN Jr, Matthews DE.
Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children. J Nutr, 130(10):2498-2502, 2000.
Bedogni G, Pietrobelli A, Heymsfield SB, Rountauroli C, Borghi A, Ferrari F, Battistini N, Salvioli G. Influence of body composition on bone mineral content in elderly women. A preliminary report. Ann N Y Acad Sci, 904:489-490, 2000.
Economos, C. D., Nelson, M. E., Fiatarone, M. A., Singh, M. A., Kehayias, J. J., Dallall, G. E. et al. (2000). A multi- center comparison of dual- energy X- ray absorptiometers: in vivo and in vitro measurements of bone mineral content and density. Am J Clin Nutr, 71, 1392-1402.

Funkhouser A, Laferrere B, Wang J, Thornton J, Pi-Sunyer FX, Measurement of percent body fat during weight loss in obese women: comparison of four methods. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:539-541.

Gallagher D, A Allen, Z Wang, S Heymsfield, & N Krasnow. Smaller organ-tissue mass in elderly fails to explain lower resting metabolic rate. Ann N.Y. Acad. Sci. 904:449-455, 2000.

Gallagher D, AJ Kovera, G Clay-Williams, D Agin, P Leone, J Albu, DE Matthews, & SB Heymsfield. Weight loss in post-menopausal women: no adverse alterations in body composition and protein metabolism. Am. J. Physiol. Endo. & Metab. 279:124-131, 2000.

Gallagher D, E Ruts, M Visser, S Heshka, RN Baumgartner, J Wang, RN Pierson, FX Pi-Sunyer, & SB Heymsfield. Weight stability masks sarcopenia in elderly men and women. Am. J. Physiol. 279:E366-E375, 2000.

Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr, 72(3):694-701, 2000.

Horlick M, Thornton J, Wang J, Levine L. Bone mineral in prepubertal children: Gender and Ethnicity. J Bone and Mineral Res, J Bone and Mineral Res 2000. 15, 1393-7.

Horlick MB, Rosenbaum M, Nicolson M, Levine LS, Fedun B, Wang J, Pierson RN Jr, Leibel RL. Effects of puberty on the relationship between circulating leptin and body composition. J Clin Endocrinol Metab, 85(7):2509-2518, 2000.

Johnson VL, Wang J, Kaskel FJ, Pierson RN Jr. Changes in body composition of children with chronic renal failure on growth hormone. Pediatr Nephrol, 14(7):695-700, 2000.

Laferrère B, ABS Funkhouser, JC Thornton, F.X. Pi-Sunyer, Total body calcium (TBCa) in obese women: validation of dual-energy x-ray absorptiometry (DXA) against in vivo neutron activation analysis (IVNA). Ann NY Acad Sci, 2000; Vol 904, p507-513.

Leone PA, Gallagher D, Wang J, Heymsfield SB. Relative over-hydration of fat-free mass in post-obese versus never-obese subjects. Ann N Y Acad Sci, 904:514-519, 2000.
Michener J, Lam S, Kolesnik S, Thornton JC, Wang J, Pierson RN Jr. Skinfold versus bioimpedance analysis for predicting fat-free mass. Ann N Y Acad Sci, 904:339-341, 2000.
Nunez C, Tan YX, Zingaretti G, Punyanitya M, Rubiano F, Wang ZM, Heymsfield SB. The best predictive model for estimating fat-free mass. Ann N Y Acad Sci, 904:333-334, 2000.

Rosenbaum K, Wang J, Pierson RN Jr. Kotler DP. Time-dependent variation in weight and body composition in healthy adults. J Parent Ent Nutr, 24(2):52-5, 2000.
Rubiano F, Nunez C, Heymsfield SB. A comparison of body composition techniques. Ann N Y Acad Sci, 904:335-338, 2000.
Shih R, Wang Z, Heo M, Wang W, Heymsfield SB. Lower limb skeletal muscle mass: development of dual-energy X-ray absorptiometry prediction model. J Appl Physiol, 89(4):1380-1386, 2000.

Spungen AM, Wang J, Pierson RN Jr, Bauman WA. Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury. J Appl Physiol, 88(4):1310-1315, 2000.

Testolin CG, Gore R, Rivkin T, Horlick M, Arbo J, Wang Z, Chiumello G, Heymsfield SB.
Dual-energy X-ray absorptiometry: analysis of pediatric fat estimate errors due to tissue hydration effects. J Appl Physiol, 89(6):2365-2372, 2000.

Arpadi SM, Cuff PA, Horlick M, Wang J, Kotler DP. Lipodystrophy in HIV-infected children is associated with high viral load and low CD4+ -lymphocyte count and CD4+ -lymphocyte percentage at baseline and use of protease inhibitors and stavudine. J Acquir Immune Defic Syndr 2001;27:30-4.

Chumlea WC, Guo SS, Zeller CM, Reo NV, Baumgartner RN, Garry PJ, Wang J, Pierson RN Jr, Heymsfield SB, Siervogel RM. Total body water reference values and prediction equations for adults. Kidney Int 2001;59:2250-8.

Faith, M. S., Berman, N., Heo, M., & et al (2001). Effects of contingent television on physical activity and television viewing in obese children. Pediatrics, 107, 1043-1048.

Lawal A, Engelson ES, Wang J, Heymsfield SB, Kotler DP. Equivalent osteopenia in HIV-infected subjects studied before and during the era of highly active antiretroviral therapy. AIDS 2001;15:278-280.

Ricci, M. R., Heymsfield, S., Schreiber, T. B., Chowdhury, H. A., Rosato, M. T., & Shapses, S. A. (2001). Moderate caloric restriction increases bone resorption in obese postmenopausal women. American Journal of Clinical Nutrition, 73, 347-352

Rosenbaum, M., Pietrobelli, A., Vasselli, J., Heymsfield, S., & Leibel, R. L. (2001). Sexual dimorphism in circulating leptin concentrations is not accounted for by differences in adipose tissue distribution. International Journal of Obesity, 25, 1365-1371.

Shapses, S. A., Von Thun, N., Heymsfield, S., Ricci, M. R., Ospina, M., Pierson, R. N. J. et al. (2001). Bone turnover and density in obese premenopausal women during moderate weight loss and calcium supplementation. J Bone Miner Res, 16, 1329-1336.

Sopher AB, Thornton JC, Silfen ME, Manibo A, Oberfield SE, Wang J, Pierson RN Jr, Levine LS, Horlick M. Prepubertal girls with premature adrenarche have greater bone mineral content and density than controls. J Clin Endocrinol Metab. 2001;86(11):5269-72.

Wang ZM, Pi-Sunyer FX, Kotler DP, Wang J, Pierson RN Jr, Heymsfield SB. Magnitude and variation of total body potassium to fat-free mass ratio: A cellular level modeling study. Am J Physiol 2001;281:E1-E7.

Hayes M, Chustek M, Wang ZM, Gallagher D, Heska S, Spungen A, Bauman W, Heymsfield SB. DXA: Potential for creating a metabolic map of organ-tissue resting energy expenditure components. Obes Res, 2002; 10:969-977.

He Q, Horlick M, Fedun B, Wang J, Pierson RN Jr, Heshka S, et al. Trunk fat and bllod pressure in children through puberty. Circulation 2002;105:1093-8.

He, Q., Horlick, M., Thornton, J. C., Wang, J., Pierson, R. N. J., Heshka, S. et al. (2002). Sex and race differences in fat distribution among Asian, African- American and Caucasian prepubertal children. J.Clin Endocrinol Metab, 87, 2164-3170

Heymsfield SB, Gallagher D, Kotler DP, Wang ZM, Allison DB, Heska S. Body-size dependence of resting energy expenditure can be attributed to non-energetic homogeneity of fat-free mass. Am J Physiol. 2002;282:E132-E138

Horlick, M., Arpadi, S. M., Bethel, J., & et al (2002). Bioelectrical impedance analysis models for prediction of total body water and fat- free mass in healthy and HIV- infected children and adolescents. Am J Clin Nutr, 76, 991-999

Kaufman BA, Warren MP, Dominguez JE, Wang J, Heymsfield SB, Pierson RN. Bone density and amenorrhea in ballet dancers are related to a decreased resting metabolic rate and lower leptin levels. J Clin Endocrinol Metab. 2002;87:2777-83.
Kim J, Wang ZM, Heymsfield ZM, Baumgartner RN, Gallagher D. Total-body skeletal muscle mass: Estimation by new dual-energy X-ray absorptiometry method. Am J Clin Nutr, 2002; 76:378-383

Laferrère B, Zhu S, Clarkson JR, Yoshioka MR, Krauskopf K, Thornton JC, Pi-Sunyer FX. Race, menopause, health-related quality of life, and psychological well-being in obese women. Obes Res. 2002;10:1270-5.

Padilla J, Ioannidou E, Wang J, Heymsfield SB, Thornton JC, Horlick M, Gallagher D, Pierson RN Jr. Pencil vs. fan-beam dual-energy X-ray absorptiometry comparisons across 4 systems: II. Bone mineral content. Acta Diabetologica 2002:39;105-192.

Park YW, Heymsfield SB, Gallagher D. Are dual-energy X-ray absorptiometry regional estimates associated with visceral adipose tissue mass? Int J Obes Relat Metab Disord. 2002;26:978-83.

Pietrobelli A, Faith MS, Wang J, Brambilla P, Chiumello G, Heymsfield SB. Association of lean tissue and fat mass with bone mineral content in children and adolescents. Obes Res 2002;10:56-60.

Song MY, Kim J, Horlick M, Wang J, Pierson RN Jr, Heo M, Gallagher D. Prepubertal Asians have less limb skeletal muscle. J Appl Physiol 2002;92:2285-91.

Wang J, Laferrere B, Thornton JC, Pierson RN Jr, Pi-Sunyer FX. Regional subcutaneous fat loss induced by caloric restriction in obese women. Obes Res, 10:885-890, 2002.

Zhang K, Sun M, Werner P, Kovera AJ, Albu J, Pi-Sunyer FX, Boozer CN. Sleeping metabolic rate in relation to body mass index and body composition. Int J Obes Relat Metab Disord. 2002;26:376-83

Fernandez, J., Shriver, M. D., Beasley, M., & et al (2003). Association of African genetic admixture with resting metabolic rate and obesity among women. Obesity Research, 11, 904-911.

Fernandez JR, Heo M, Heymsfield SB, Pearson RN Jr, Pi-Sunyer X, Wang ZM, Wang J, Hayes M, Allison DB, Gallagher D. Is percentage body fat differentially related to body mass index in Hispanic Americans, African American and European American? Am J Clin Nutr, 2003; 77:71-75.

Ioannidou E, Padilla J, Wang J, Heymsfield SB, Thornton JC, Horlick M, Gallagher D, Pierson RN Jr. Pencil-beam versus fan-beam dual-energy X-ray absorptiometry comparisons across four systems: appendicular lean soft tissue. Acta Diabetol. 2003;40 Suppl 1:S83-5.

Lan SJJ, Engelson ES, Agin D, Wang J, Heymsfield SB, Kotler DP. Validation of dual- energy X-ray absorptiometry as a measure of change in fat compartments as estimated by magnetic resonance imaging in HIV-infected adults. Int J Body Composition Res. 2003;1:37-43

Rosenbaum, M., Vandenborne, K., Goldsmith, R., & et al (2003). Effects of experimental weight perturbation on skeletal muscle work efficiency in human subjects. Am.J.Physiol Regul.Integr.Comp.Physiol, 285, R183-R192.

Sun AJ, Heshka S, Heymsfield SB, Wang J, Pierson RN Jr, Gallagher D. Is there an association between skeletal muscle mass and bone mineral density among African-American, Asian-American, and European-American women? Acta Diabetol. 2003;40 Suppl 1:S101-5.

Sun A, DeNino WF, Jing T, Heymsfield SB, Philips G. Relationship of leptin and sex hormones to bone mineral density in men. Acta Diabetol. 2003 Oct;40 Suppl 1:S101-5.

Wang ZM, Heshka S, Wielopolski L, Pi-Sunyer FX, Pierson RN Jr, Heymsfield SB. Total-body protein mass in adults: Development of a dual-energy x-ray absorptiometry prediction model. Int J Body Composition Res, 2003;1:161-167.

Wang, Z., Shen, W., Kotler, D. P., & et al (2003). Total body protein: a new cellular level mass and distribution prediction model. Am J Clin Nutr, 78, 979-984.

Arpadi, S., Horlick, M., & Shane, E. (2004). Metabolic bone disease in human immunodeficiency virus- infected children. J Clin Endocrinol Metab, 89, 21-23.
Freedman, D. S., Thornton, J. C., Mei, Z., & et al (2004). Height and adiposity among children. Obesity Research, 12, 846-853.BC

Horlick M, Pierson RN, Thornton JC, Wang J. Prediction models for evaluation of total-body bone mass with dual-energy X-ray absorptiometry among children and adolescents. Pediatrics, 2004; 114:e337-345.

Jones A Jr, Shen W, St.Onge M-P, Gallagher D, Heshka S, Wang ZM, Heymsfield SB. Body-composition differences between African American and white women: Relation to resting energy requirements. Am J Clin Nutr, 2004; 79:780-786.

Kim J, Heshka S, Gallagher D, Kotler DP, Mayer L, Albu J, Shen W, Freda PU, Heymsfield SB. Intermuscular adipose tissue-free skeletal muscle mass: Estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol 2004;97:655-60.

Shapses, S. A., Heshka, S., & Heymsfield, S. (2004). Effect of calcium supplementation on weight and fat loss in women. J.Clin Endocrinol Metab, 89, 632-637.
Silva AM, Shen W, Wang ZM, Aloia JF, Nelson M, Heymsfield SB, Sardinha LB, Heshka S. Three-compartment model: Critical evaluation based upon neutron activation analysis. Am J Physiol 2004;287:E962-E969.

Song MY, E Ruts, J Kim, I Janumala, S Heymsfield, & D Gallagher. Sarcopenia and increased muscle adipose tissue infiltration in elderly African-American women. Am J Clin Nutr. 79:874-880, 2004.

Sopher AB, Thornton JC, Wang J, Pierson R, Heymsfield S, Horlick M. Measurement of percentage of body fat in 411 children and adolescents: A comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics, 2004;113:1285-1291.

Soriano JM, Ioannidou E, Wang J, Thornton JC, Horlick MN, Gallagher D, Heymsfield SB, Pierson RN. Pencil-beam vs. fan-beam dual-energy X-ray absorptiometry comparisons across four systems: body composition and bone mineral. J Clin Densitom, 2004;7(3):281-9.

St-Onge M-P, Wang J, Shen W, Wang ZM, Allison DB, Heshka S, Heymsfield SB. Dual-energy X-ray absorptiometry-measured lean soft tissue mass: Differing relation to body cell mass across the adult lifespan. J Gerontol 2004;59A:796-800.

St-Onge M-P, Wang ZM, Horlick M, Wang J, Heymsfield SB. Dual-energy X-ray absorptiometry lean soft tissue hydration: Independent contributions of intra- and extracellular water. Am J Physiol 2004;287: E842-E847.

Wang ZM, St-Onge MP, Lecumberii B, Pi-Sunyer FX, Heshka S, Wang J, Kotler DP, Gallagher D, Wielopolski L, Pierson RN Jr, Heymsfield SB. Body cell mass: Model development and validation at the cellular level of body composition. Am J Physiol. 2004;286:E123-E128

Freedman, D. S., Wang, J., Maynard, L. M., Thornton, J., Mei, Z., Pierson, R. N. Jr. et al. (2005). Relation of BMI to fat and fat- free mass among children and adolescents. Int J Obes Relat Metab Disord, 29, 1-8.

He Q, Horlick M, Thornton J, Wang J, Pierson RN Jr, Heshka S, Gallagher D. (2005). Sex-specific fat distribution is not linear across pubertal groups in a multiethnic study. Obesity Research, 12, 725-733.

Hoffman DJ, Wang. ZM. Gallagher. D. Heymsfield. SB. (2005). Comparison of visceral adipose tissue mass in adult African Americans and whites. Obesity Research, 13, 66-74.

Kim HJ, Gallagher D, Song MY. Comparison of body composition methods during weight loss in obese women using herbal formula. Am J Chin Med. 2005;33(6):851-8.

Margulies L, Horlick M, Thornton JC, Wang J, Ionnidou E, Heymsfield SB. Reproducibility of pediatric whole body bone and body composition measures by dual energy X-ray absorptiometry (GE Lunar Prodigy). J Clin Densitom. 2005 Fall;8(3):298-304

Shen W, St-Onge MP, Pietrobelli A, Wang J, Wang ZM, Heshka S, Heymsfield SB. Four-compartment cellular level body composition model: Comparison of two approaches differing in cost and availability. Obes Res. 2005;13(1):58-65.

Wang J, Thornton JC, Ioannidou E, Soriano J, Gallagher D, Heymsfield SB, Horlick M, Pierson RN, Allen LR. Four commonly used dual-energy X-ray absorptiometry scanners do not identically classify subjects for osteopenia or osteoporosis by T-score in four bone regions. J Clin Densitom. 2005;8(2):191-8.

Wang ZM, Heshka S, Heymsfield SB, Shen W, Gallagher D. A cellular-level approach to predicting resting energy expenditure across the adult years. Am J Clin Nutr. 2005;81:799-806

Ackerman A, Thornton JC, Wang J, Pierson RN Jr, Horlick M. Sex difference in the effect of puberty on the relationship between fat mass and bone mass in 926 healthy subjects, 6 to 18 years old. Obesity (Silver Spring). 2006 May;14(5):819-25. PMID: 16855191.

Chambers EC, Heshka S, Gallagher D, Wang J, Pi-Sunyer FX, Pierson RN Jr. Serum magnesium and type-2 diabetes in African Americans and Hispanics: a New York cohort. J Am Coll Nutr. 2006 Dec;25(6):509-13.

Dubois SG, Heilbronn LK, Smith SR, Albu JB, Kelley DE, Ravussin E; Look AHEAD Adipose Research Group. Decreased expression of adipogenic genes in obese subjects with type 2 diabetes. Obesity (Silver Spring). 2006;14(9):1543-52.

Engelson ES, Agin D, Kenya S, Werber-Zion G, Luty B, Albu JB, Kotler DP. Body composition and metabolic effects of a diet and exercise weight loss regimen on obese, HIV-infected women. Metabolism. 2006 Oct;55(10):1327-36. PMID: 16979403

Gallagher D, Albu J, He Q, Heshka S, Boxt L, Krasnow N, Elia M. Small organs with a high metabolic rate explain lower resting energy expenditure in African American than in white adults. Am J Clin Nutr. 2006 May;83(5):1062-7.

Kim J, Shen W, Gallagher D, Jones A Jr, Wang Z, Wang J, Heshka S, Heymsfield SB. Total-body skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in children and adolescents. Am J Clin Nutr. 2006 Nov;84(5):1014-20. PMID: 17093152 PMCID: PMC2747777

Lee H, Wang J, Gallagher D, Heshka S, Shen W, Chamber E, Heymsfield SB, Wang ZM. Dual-energy X-ray absorptiometry: Validity of the Lunar Prodigy fan-beam system for body composition in pediatrics. International Journal of Body Composition Research, 2006; 4;81-86.

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity (Silver Spring). 2006;14:727-36.

Wang Z, Heshka S, Wang J, Heymsfield SB. Total body protein mass: validation of total body potassium prediction model in children and adolescents. J Nutr. 2006 Apr;136(4):1032-6.

Azuma K, Heilbronn LK, Albu JB, Smith SR, Ravussin E, Kelley DE; and the Look AHEAD Adipose Research Group. Adipose tissue distribution in relation to insulin resistance in type 2 diabetes mellitus. Am J Physiol Endocrinol Metab. 2007 Jul;293(1):E435-42.

Dolan MS, Sorkin JD, Hoffman DJ. Birth weight is inversely associated with central adipose tissue in healthy children and adolescents. Obesity (Silver Spring). 2007;15(6):1600-8. PMID: 17557998

Freedman DS, Wang J, Ogden CL, Thornton JC, Mei Z, Pierson RN, Dietz WH, Horlick M. The prediction of body fatness by BMI and skinfold thicknesses among children and adolescents. Ann Hum Biol. 2007 Mar-Apr;34(2):183-94. PMID: 17558589

He Q, Zhang XJ, He SY, Gong LX, Sun YG, Deckelbaum R, Gallagher D. Greater trunk fat is associated with higher insulin, triglycerides, and blood pressure in Tanner 1 Chinese children. Obesity, (Silver Spring). 2007 Apr;15(4):1004-11.PMID: 17426336 PMCID: PMC2726721

Heymsfield SB, Gallagher D, Mayer L, Beetsch J, Pietrobelli A. Scaling of human body composition to stature: new insights into body mass index. Am J Clin Nutr. 2007 Jul;86(1):82-91. PMID: 17616766 PMCID: PMC2729090

Mayer LE, Roberto CA, Glasofer DR, Etu SF, Gallagher D, Wang J, Heymsfield SB, Pierson RN Jr, Attia E, Devlin MJ, Walsh BT. Does percent body fat predict outcome in anorexia nervosa? Am J Psychiatry. 2007 Jun;164(6):970-2. PMID: 17541059 PMCID: PMC2741391

Mei Z, Grummer-Strawn LM, Wang J, Thornton JC, Freedman DS, Pierson RN Jr, Dietz WH, Horlick M. Do skinfold measurements provide additional information to body mass index in the assessment of body fatness among children and adolescents? Pediatrics. 2007;119(6):e1306-13. PMID: 17545361

Mills TC, Gallagher D, Wang J, and Heshka S. Modelling the relationship between body fat and the BMI. Int J Body Composition Res, 2007;2:73-79.

Shen W, Chen J, Punyanitya M, Shapses S, Heshka S, Heymsfield SB. MRI-measured bone marrow adipose tissue is inversely related to DXA-measured bone mineral in Caucasian women. Osteoporos Int. 2007;18:641-7.

Wang Z, Heshka S, Wang J, Gallagher D, Deurenberg P, Chen Z, Heymsfield SB. Metabolically active portion of fat-free mass: a cellular body composition level modeling analysis. Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E49-53. Epub 2006 Aug 1.

Wu CH, Heshka S, Wang J, Pierson RN Jr, Heymsfield SB, Laferrère B, Wang Z, Albu JB, Pi-Sunyer X, Gallagher D. Truncal fat in relation to total body fat: influences of age, sex, ethnicity and fatness. Int J Obes (Lond). 2007 Sep;31(9):1384-91. Epub 2007 Apr 24. PMID: 17452992 PMCID: PMC2752389

Chambers EC, Heshka S, Huffaker LY, Xiong Y, Wang J, Eden E, Gallagher D, Pi-Sunyer FX. Truncal adiposity and lung function in older black women. Lung. 2008 Jan-Feb;186(1):13-7. PMID: 17952506

Hwang MJ, Chung WS, Gallagher D, Kim DY, Shin HD, Song MY. How useful is waist circumference for assessment of abdominal obesity in Korean pre-menopausal women during weight loss? Asia Pac J Clin Nutr. 2008;17(2):229-34.

Scherzer R, Shen W, Bacchetti P, Kotler D, Lewis CE, Shlipak MG, Punyanitya M, Heymsfield SB, Grunfeld C; Study of Fat Redistribution Metabolic Change in HIV Infection. Comparison of dual-energy X-ray absorptiometry and magnetic resonance imaging-measured adipose tissue depots in HIV-infected and control subjects. Am J Clin Nutr. 2008;88:1088-96.

Yim JE, Heshka S, Albu JB, Heymsfield SB, Gallagher D. Femoral-gluteal subcutaneous and intermuscular adipose tissues have independent and opposing relationships with CVD risk. J Appl Physiol. 2008 Mar;104(3):700-7.

Albu JB, Heilbronn LK, Kelley DE, Smith SR, Azuma K, Berk E, Pi-Sunyer FX, Ravussin E; the Look AHEAD Adipose Research Group. Metabolic Changes Following a One-year Diet and Exercise Intervention in Patients with Type 2 Diabetes. Diabetes. 2009 Dec 22. [Epub ahead of print] PubMed PMID: 20028945. PMC Journal - In Process

Aleman Mateo H, Lee SY, Javed F, Thornton J, Heymsfield SB, Pierson RN, Pi Sunyer FX, Wang ZM, Wang J, Gallagher D. Elderly Mexicans Have Less Muscle and Greater Total and Truncal Fat Compared to African-Americans and Caucasians with the Same BMI. J Nutr Health Aging. 2009. 13(10):919-23. NIHMSID: 173448

Arpadi SM, Bethel J, Horlick M, Sarr M, Bamji M, Abrams EJ, Purswani M, Engelson ES. Longitudinal changes in regional fat content in HIV-infected children and adolescents. AIDS. 2009 Jul 31;23(12):1501-9. PubMed PMID: 19550288. NIHMSID # 174804

Freda PU, Shen W, Reyes-Vidal CM, Geer EB, Arias-Mendoza F, Gallagher D, Heymsfield SB. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab. 2009;94:2880-6. PMCID: PMC2730874.

Freedman DS, Wang J, Thornton JC, Mei Z, Sopher AB, Pierson Jr. RN, Dietz WH, Horlick M. The classification of body fatness by BMI-for-age categories among children. Archives of Pediatrics & Adolescent Medicine, 163:805-811, 2009. NIHMSID: 173460

He Q, Heshka S, Albu J, Boxt L, Krasnow N, Elia M, Gallagher D. Smaller organ mass with greater age, except for heart. J Appl Physiol. 2009;106(6):1780-4. PMCID: PMC2692775.

Heymsfield SB, Chirachariyavej T, Rhyu IJ, Roongpisuthipong C, Heo M, Pietrobelli A. Differences between brain mass and body weight scaling to height: potential mechanism of reduced mass-specific resting energy expenditure of taller adults. J Appl Physiol. 2009; 106(1):40-8. PubMed PMID: 19008483. NIHMSID: 173472

Hull H, He Q, Thornton J, Javed F, Allen L, Wang J, Pierson RN Jr, Gallagher D. iDXA, Prodigy, and DPXL Dual-Energy X-ray Absorptiometry Whole-Body Scans: A Cross-Calibration Study. J Clin Densitom. 2009 Jan-Mar;12(1):95-102. Epub 2008 Nov 22. PMID: 19028125 PMCID: PMC2661815

Keller KL, Reid A, Macdougall MC, Cassano H, Lee Song J, Deng L, Lanzano P, Chung WK, Kissileff HR. Sex Differences in the Effects of Inherited Bitter Thiourea Sensitivity on Body Weight in 4-6-Year-Old Children. Obesity (Silver Spring). 2009 Sep 24. [Epub ahead of print] PubMed PMID: 19779476. PMC Journal - In Process

Leibel N, Shen W, Mao X, Punyanitya M, Gallagher D, Horlick M, Shungu DC, Oberfield SE. Body composition in premature adrenarche by structural MRI, 1H MRS and DXA. J Pediatr Endocrinol Metab. 2009 Apr 2(4):301-7. PubMed PMID: 19554803.

Navder KP, He Q, Zhang X, He S, Gong L, Sun Y, Deckelbaum RJ, Thornton J, Gallagher D. Relationship between body mass index and adiposity in prepubertal children: ethnic and geographic comparisons between New York City and Jinan City (China). J Appl Physiol. 2009;107(2):488-93. PMCID: PMC2724321.

Sproule DM, Montes J, Montgomery M, Battista V, Koenigsberger D, Shen W, Punyanitya M, De Vivo DC, Kaufmann P. Increased fat mass and high incidence of overweight despite low body mass index in patients with spinal muscular atrophy. Neuromuscul Disord. 2009;19(6):391-6. PMCID: PMC2729661.

Zemel B, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield SE, Mahboubi S, Shepard JA, Hangartner T, Frederic MM, Winer K, Kalkwarf HJ. Adjustment for height in the clinical assessment of DXA measures of bone mass and density in children. In Press, J Clin Endocrinol Metab, 2009. PMC Journal - In Process

Goldsmith R, Joanisse DR, Gallagher D, Pavlovich K, Shamoon E, Leibel RL, Rosenbaum M. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects. Am J Physiol Regul Integr Comp Physiol. 2010 Jan;298(1):R79-88. PubMed PMID: 19889869. PMC Journal - In Process

Silva AM, Shen W, Heo M, Gallagher D, Wang Z, Sardinha LB, Heymsfield SB. Ethnicity-related skeletal muscle differences across the lifespan. Am J Hum Biol. 2010;22(1):76-82. PMCID: PMC2795070.

Wang ZM, Heymsfield SB, Ying Z, Pierson RN Jr, Gallagher D, Gidwani S. A cellular level approach to predicting resting energy expenditure: Evaluation of applicability in adolescents. Am J Hum Biol. 2010 Jan 7. [Epub ahead of print] In press. PMID: 20058259. NIHMSID: 173523.

Javed F, He Q, Davidson L, Thornton JC, Albu J, Boxt L, Krasnow N, Elia M, Kang P, Heshka S, Gallagher D. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. In Press. PMC Journal - In Process



Imaging Acquisition
   (Back to Laboratories)

For consultation of study design regarding body compositon and spectroscopy research, contact Drs. Wei Shen (ws2003@columbia.edu) or Dympna Gallagher (dg108@columbia.edu).

For consultation on research involving fMRI, contact Dr. Joy Hirsch (jh2155@columbia.edu)

For all Imaging Analysis services, contact Mark Punyanitya (vmp11@columbia.edu)


MRI scanners listed below can be used for research scans for Columbia/St. Luke investigators:
• 1.5T GE 6X scanner at St. Luke’s site
• 1.5T GE scanner at Roosevelt site
• 1.5T GE Signa Excite at Columba Circle Off-site Imaging Facility (Columbus Circle)
• 1.5T GE Signa LX at Columba Circle Off-site Imaging Facility (Columbus Circle)
• 1.5T GE scanner at Columbia Medical Center
• 1.5T Philips scanner at Columbia Medical Center (Hirsch Lab)
• 3.0T Philips scanner at Columbia Medical Center (Hirsch Lab)

The selection of MRI scanner for use in research depends on the specific protocol needs as well as the vicinity to the investigator.

Relevant Laboratory/Core Publications (in chronological order)
Wang ZM, Heshka S, Heymsfield SB. Application of computerized axial tomography in the study of body composition: evaluation of lipid, water, protein, and mineral in healthy men. Human body composition: in vivo methods, models, and assessment. Plenum Press, New York, 343-344, 1993.

Engelson ES, Kotler DP, Tan Y, Agin D, Wang J, Pierson RN Jr, Heymsfield SB. Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body Magnetic resonance imaging. Am J Clin Nutr, 69(6):1162-1169, 1999.

Gallagher D, Allen A, Wang Z, Heymsfield SB, Krasnow N. Smaller organ tissue mass in the elderly fails to explain lower resting metabolic rate. Ann N Y Acad Sci, 904:449-455, 2000.

Gallagher D, Kovera AJ, Clay-Williams G, Agin D, Leone P, Albu J, Matthews DE, Heymsfield SB. Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism. Am J Physiol Endocrinol Metab, 279(1):E124-E131, 2000.

Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner RN, Wang J, Pierson RN Jr, Pi-Sunyer FX, Heymsfield SB. Weight stability masks sarcopenia in elderly men and women. Am J Physiol Endocrinol Metab, 279(2):E366-E375, 2000.

Janssen I, Heymsfield SB, Wang ZM, Ross. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol, 89(1):81-88, 2000.
Kotler DP, Lopez J, Engelson ES, Wang J, Agin D, Heymsfield SB. Interactions among sex, HIV infection, and fat redistribution. AIDS Read, 10(10):589-594, 2000.
Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr, 72(3):796-803, 2000.

Shih R, Wang ZM, Heo M, Wang W, Heymsfield SB. Lower limb skeletal muscle mass: Evaluation of dual-energy X-ray absorptiometry by magnetic resonance imaging. J Appl Physiol, 2000; 89:1380-1386.

Tang, H., Wu, E., Ma, Q. Y., Gallagher, D., Perera, G. M., & Zhuang, T. (2000). MRI brain image segmentation by multi- resolution edge detection and region selection. Comput Med Imaging Graph, 24, 349-357

Tang, H., Vasselli, J., Wu, E., & Gallagher, D. (2000). High resolution magnetic resonance imaging (MRI) for the in- vivo study of body composition in rats. NY Acad Sci, 904, 32-41.

Lee RC, Wang ZM, Heymsfield SB. Skeletal muscle mass and aging: Regional and whole-body measurement methods. Canad J Appl Physiol, 2001; 26:102-122.

Park YW, Allison DB, Heymsfield SB, Gallagher D. Larger amounts of visceral adipose tissue in Asian Americans. Obes Res 2001;9:381-7.

Rosenbaum, M., Pietrobelli, A., Vasselli, J., Heymsfield, S., & Leibel, R. L. (2001). Sexual dimorphism in circulating leptin concentrations is not accounted for by differences in adipose tissue distribution. International Journal of Obesity, 25, 1365-1371.

Tang, H., Vasselli, J., Wu, E., Boozer, C. N., & Gallagher, D. (2001). High resolution magnetic resonance imaging tracks change in organ and tissue mass in rats. Am.J.Physiol, 282, R890-R899.

Wang ZM, Heo M, Lee RC, Kotler DP, Withers RT, Heymsfield SB. Muscularity in adult humans: Proportion of adipose tissue-free body mass as skeletal muscle. Am J Hum Biol, 2001;13:612-619.

Wang, Z., Heo, M., Lee, R. C., Kotler, D. P., Withers, R. T., & Heymsfield, S. (2001). Muscularity in adult humans: Proportions of adipose- free body mass as skeletal muscle. American Journal of Human Biology, 13, 612-619.

Andrade S, Lan SJ, Engelson ES, Agin D, Wang J, Heymsfield SB, Kotler DP. Use of a Durnin-Womersley formula to estimate change in subcutaneous fat content in HIV-infected subjects. Am J Clin Nutr 2002;75:587-92.

Engelson ES, Glesby MJ, Mendez D, Albu JB, Wang J, Heymsfield SB, Kotler DP. Effect of recombinant human growth hormone in the treatment of visceral fat accumulation in HIV infection. J Acquir Immunodefic Syndr. 2002;30:379-91

Hayes M, Chustek M, Wang ZM, Gallagher D, Heska S, Spungen A, Bauman W, Heymsfield SB. DXA: Potential for creating a metabolic map of organ-tissue resting energy expenditure components. Obes Res, 2002; 10:969-977.

Heymsfield SB, Gallagher D, Kotler DP, Wang ZM, Allison DB, Heska S. Body-size dependence of resting energy expenditure can be attributed to non-energetic homogeneity of fat-free mass. Am J Physiol. 2002;282:E132-E138

Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 2002;75:683-8.

Laferrère B, Zhu S, Clarkson JR, Yoshioka MR, Krauskopf K, Thornton JC, Pi-Sunyer FX. Race, menopause, health-related quality of life, and psychological well-being in obese women. Obes Res. 2002;10:1270-5.

Salinari S, Bertuzzi A, Mingrone G, Capristo E, Pietrobelli A, Campioni P, Greco AV, Heymsfield SB. New bioimpedance model accurately predicts lower limb muscle volume: validation by magnetic resonance imaging. Am J Physiol Endocrinol Metab 2002;282:E960-6.
Song MY, Kim J, Horlick M, Wang J, Pierson RN Jr, Heo M, Gallagher D. Prepubertal Asians have less limb skeletal muscle. J Appl Physiol 2002;92:2285-91.

He Q, Engelson ES, Albu JB, Heymsfield SB, Kotler DP. Preferential loss of omental-mesenteric fat during growth hormone therapy of HIV-associated lipodystrophy. J Appl Physiol. 2003;94:2051-7.

Hsu A, S Heshka, I Janumala, M Song, M Horlick, N Krasnow, & D Gallagher. Larger mass of high metabolic rate organs does not explain higher REE in children. Am J Clin Nutr. 2003;77:1506-11.

Kotler DP, Ionescu G, Johnson JA, Inada Y, He Q, Engelson ES, Albu JB. Studies of adipose tissue metabolism in HIV-associated lipodystrophy. Clin Infect Dis. 2003; 37(Suppl 2); S47-51

Jin Y, Imieliñska CZ, Laine A, Udupa J, Shen W, Heymsfield SB. Segmentation and evaluation of adipose tissue from whole body MRI scans. Medical Image Computing and Computer Assisted Intervention (MICCAI), Montreal, Canada 2003 Proceedings; pp635-642.

Lan SJJ, Engelson ES, Agin D, Wang J, Heymsfield SB, Kotler DP. Validation of dual- energy X-ray absorptiometry as a measure of change in fat compartments as estimated by magnetic resonance imaging in HIV-infected adults. Int J Body Composition Res. 2003;1:37-43

Shen W, Mao X, Wang ZM, Punyanitya M, Heymsfield SB, Shungu DC. Measurement of intramyocellular lipid levels with 2-D magnetic resonance spectroscopic imaging at 1.5 T. Acta Diabetologica, 2003;40:S51-S54.

Shen W, Wang ZM, Tang H, Heshka S, Punyanitya M, Zhu S, Lei J, Heymsfield SB. Volume estimates derived in vivo by imaging methods: Model comparisons with visible woman as the reference. Obes Res, 2003; 11: 217-225.

He Q, Engelson ES, Wang J, Kenya S, Ionescu G, Heymsfield SB, Kotler DP. Validation of an elliptical anthropometric model to estimate visceral compartment area. Obes Res 2004;2:250-257.

Jones A Jr, Shen W, St.Onge M-P, Gallagher D, Heshka S, Wang ZM, Heymsfield SB. Body-composition differences between African American and white women: Relation to resting energy requirements. Am J Clin Nutr, 2004; 79:780-786.

Lee, S. J., Janssen, I., Heymsfield, S. B., & Ross, R. (2004). Relationship between whole- body and regional measures of human skeletal muscle. Am J Clin Nutr, 80, 1215-1221
Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol, 2004;97: 2333-2338.

Shen W, Punyanitya M, Wang ZM, Gallagher D, St-Onge M-P, Albu J, Heymsfield SB, Heshka S. Visceral adipose tissue: Relationships between single slice areas and total volume. Am J Clin Nutr, 2004;80:271-278.

Song MY, E Ruts, J Kim, I Janumala, S Heymsfield, & D Gallagher. Sarcopenia and increased muscle adipose tissue infiltration in elderly African-American women. Am J Clin Nutr. 79:874-880, 2004.

Gallagher D, P Kuznia, S Heshka, J Albu, S Heymsfield, B Goodpaster, M Visser, T Harris. Adipose tissue in muscle: A novel depot similar in size to visceral adipose tissue. Am J Clin Nutr. 81:903-910, 2005

He Q, Engelson ES, Kotler SP. A comparison of abdominal subcutaneous adipose tissue pattern in obese and lean HIV-infected women. J Nutr 2005;135:53-57.

Hoffman DJ, Wang. ZM. Gallagher. D. Heymsfield. SB. (2005). Comparison of visceral adipose tissue mass in adult African Americans and whites. Obesity Research, 13, 66-74.

Kuk JL, Lee S, Heymsfield SB, Ross R. (2005). Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr, 81, 1330-1334

Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW (2005). Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr., 15, 152-158.

Wang ZM, Heshka S, Heymsfield SB, Shen W, Gallagher D. A cellular-level approach to predicting resting energy expenditure across the adult years. Am J Clin Nutr. 2005;81:799-806

Engelson ES, Agin D, Kenya S, Werber-Zion G, Luty B, Albu JB, Kotler DP. Body composition and metabolic effects of a diet and exercise weight loss regimen on obese, HIV-infected women. Metabolism. 2006 Oct;55(10):1327-36. PMID: 16979403

Gallagher D, Albu J, He Q, Heshka S, Boxt L, Krasnow N, Elia M. Small organs with a high metabolic rate explain lower resting energy expenditure in African American than in white adults. Am J Clin Nutr. 2006 May;83(5):1062-7. PMID: 16685047 PMCID: PMC1847651

Sarkar SR, Kuhlmann MK, Kotanko P, Zhu F, Heymsfield SB, Wang J, Meisels IS, Gotch FA, Kaysen GA, Levin NW. Metabolic consequences of body size and body composition in hemodialysis patients. Kidney Int. 2006 Nov;70(10):1832-9. Epub 2006 Oct. PMID: 17021607

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Visceral Adipose Tissue: Relationships between Single Slice Areas at Different Locations and Obesity Related Health Risks Int J Obesity Int J Obes (Lond). 2007 May;31(5):763-9. Epub 2006 Oct 24. PMID: 17060927

Ruan XY, Gallagher D, Harris T, Albu J, Heymsfield SB, Kuznia P, Heshka S. Estimating whole-body intermuscular adipose tissue from single cross-sectional magnetic resonance images. J Appl Physiol. 2006 Oct 19; 2007 Feb;102(2):748-54. Epub 2006 Oct 19. PMID: 17053107 PMCID: PMC2758818

Sarkar SR, Kuhlmann MK, Kotanko P, Zhu F, Heymsfield SB, Wang J, Meisels IS, Gotch FA, Kaysen GA, Levin NW. Metabolic consequences of body size and body composition in hemodialysis patients. Kidney Int. 2006;70(10):1832-9. Epub 2006 Oct.

Albu JB, Kenya S, He Q, Wainwright M, Berk ES, Heshka S, Kotler DP, Engelson ES. Independent associations of insulin resistance with high whole-body intermuscular and low leg subcutaneous adipose tissue distribution in obese HIV-infected women. Am J Clin Nutr. 2007 Jul;86(1):100-6. PMID: 17616768 PMCID: PMC2670485

Demerath EW, Shen W, Lee M, Choh A, Czerwinski SA, Siervogel RM, Towne B. Approximation of total visceral adipose tissue with a single magnetic resonance image. Am J Clin Nutr 2007 Feb;85(2):362-8.

Heymsfield SB, Gallagher D, Mayer L, Beetsch J, Pietrobelli A. Scaling of human body composition to stature: new insights into body mass index. Am J Clin Nutr. 2007 Jul;86(1):82-91. PMID: 17616766 PMCID: PMC2729090

Heymsfield SB, Heshka S. Visceral adipose tissue: relationships between single slice areas at different locations and obesity-related health risks. Int J Obes (Lond). 2007;31:763-9.

Shen W, Chen J, Punyanitya M, Shapses S, Heshka S, Heymsfield SB. MRI-measured bone marrow adipose tissue is inversely related to DXA-measured bone mineral in Caucasian women. Osteoporos Int. 2007 May;18(5):641-7. Epub 2006 Dec 1. PMID: 17139464 PMCID: PMC2034514

Yim JE, Heshka S, Albu J, Heymsfield S, Kuznia P, Harris T, Gallagher D. Intermuscular adipose tissue rivals visceral adipose tissue in independent associations with cardiovascular risk. Int J Obes (Lond). 2007 Sep;31(9):1400-5. Epub 2007 Apr 24. PMID: 17452994 PMCID: PMC2752367

Freda PU, Shen W, Heymsfield SB, Reyes-Vidal CM, Geer EB, Bruce JN, Gallagher D. Lower visceral and subcutaneous but higher intermuscular adipose tissue depots in patients with growth hormone and insulin-like growth factor I excess due to acromegaly. J Clin Endocrinol Metab. 2008;93:2334-43.

He Q, Engelson ES, Ionescu G, Glesby MJ, Albu JB, Kotler DP. Insulin resistance, hepatic lipid and adipose tissue distribution in HIV-infected men. Antivir Ther. 2008;13(3):423-8. PMID: 18572755

Korner J, M Punyanitya, C Taveras, DJ McMahon, HJ Kim, W Inabnet, M Bessler, D Gallagher. Sex differences in visceral adipose tissue post-bariatric surgery compared to matched non-surgical controls. Int J Body Comp Res 6(3):93-99

Heymsfield SB, Martin-Nguyen A, Fong TM, Gallagher D, Pietrobelli A. Body circumferences: clinical implications emerging from a new geometric model. Nutr Metab (Lond). 2008 Oct 6;5:24.

Scherzer R, Shen W, Bacchetti P, Kotler D, Lewis CE, Shlipak MG, Heymsfield SB, Grunfeld C; Study of Fat Redistribution Metabolic Change in HIV Infection (FRAM). Simple anthropometric measures correlate with metabolic risk indicators as strongly as magnetic resonance imaging-measured adipose tissue depots in both HIV-infected and control subjects. Am J Clin Nutr. 2008 Jun;87(6):1809-17. PMID: 18541572 PMCID: PMC2587301

Scherzer R, Shen W, Bacchetti P, Kotler D, Lewis CE, Shlipak MG, Punyanitya M, Heymsfield SB, Grunfeld C; Study of Fat Redistribution Metabolic Change in HIV Infection. Comparison of dual-energy X-ray absorptiometry and magnetic resonance imaging-measured adipose tissue depots in HIV-infected and control subjects. Am J Clin Nutr. 2008 Oct;88(4):1088-96. PMID: 18842798

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C,
Freda PU, Shen W, Heymsfield SB, Reyes-Vidal CM, Geer EB, Bruce JN, Gallagher D. Lower visceral and subcutaneous but higher intermuscular adipose tissue depots in patients with growth hormone and insulin-like growth factor I excess due to acromegaly. J Clin Endocrinol Metab. 2008 Jun;93(6):2334-43. PMID: 18349062 PMCID: PMC2435633

Yim JE, Heshka S, Albu JB, Heymsfield SB, Gallagher D. Femoral-gluteal subcutaneous and intermuscular adipose tissues have independent and opposing relationships with CVD risk. J Appl Physiol. 2008 Mar;104(3):700-7. Epub 2007 Dec 13. PMID: 18079271 PMCID: PMC2745606

Carter M, Zhu F, Kotanko P, Kuhlmann M, Ramirez L, Heymsfield SB, Handelman G, Levin NW. Assessment of body composition in dialysis patients by arm bioimpedance compared to MRI and 40K measurements. Blood Purif. 2009;27(4):330-7. Epub 2009. PMID: 19270452 NIHMSID # 174809

Freda PU, Shen W, Reyes-Vidal CM, Geer EB, Arias-Mendoza F, Gallagher D, Heymsfield SB. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab. 2009 Aug;94(8):2880-6. Epub 2009 Jun 2. PMCID: PMC2730874.

Gallagher D, Kelley DE, Yim JE, Spence N, Albu J, Boxt L, Pi-Sunyer FX, Heshka S; MRI Ancillary Study Group of the Look AHEAD Research Group. Adipose tissue distribution is different in type 2 diabetes. Am J Clin Nutr. 2009 Mar;89(3):807-14. Epub 2009 Jan 21. PubMed PMID: 19158213; PubMed Central PMCID: PMC2714397.

He Q, Heshka S, Albu J, Boxt L, Krasnow N, Elia M, Gallagher D. Smaller organ mass with greater age, except for heart. J Appl Physiol. 2009;106(6):1780-4. PMCID: PMC2692775.

Heymsfield SB, Chirachariyavej T, Rhyu IJ, Roongpisuthipong C, Heo M, Pietrobelli A. Differences between brain mass and body weight scaling to height: potential mechanism of reduced mass-specific resting energy expenditure of taller adults. J Appl Physiol. 2009; 106(1):40-8. PubMed PMID: 19008483. NIHMSID: 173472

Heymsfield SB, Scherzer R, Pietrobelli A, Lewis CE, Grunfeld C. Body mass index as a phenotypic expression of adiposity: quantitative contribution of muscularity in a population-based sample. Int J Obes (Lond). 2009 Dec;33(12):1363-73. NIHMSID: 138252

Kaysen GA, Kotanko P, Zhu F, Sarkar SR, Heymsfield SB, Kuhlmann MK, Dwyer T, Usvyat L, Havel P, Levin NW. Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients. J Ren Nutr. 2009 Sep;19(5):357-64. Epub 2009 Jul 10. PubMed PMID: 19596588. NIHMSID: 113607

Leibel N, Shen W, Mao X, Punyanitya M, Gallagher D, Horlick M, Shungu DC, Oberfield SE. Body composition in premature adrenarche by structural MRI, 1H MRS and DXA. J Pediatr Endocrinol Metab. 2009 Apr 2(4):301-7. PubMed PMID: 19554803.

Mayer LE, Klein DA, Black E, Attia E, Shen W, Mao X, Shungu DC, Punyanita M, Gallagher D, Wang J, Heymsfield SB, Hirsch J, Ginsberg HN, Walsh BT. Adipose tissue distribution after weight restoration and weight maintenance in women with anorexia nervosa. Am J Clin Nutr. 2009 Nov;90(5):1132-7. PubMed Central PMCID: PMC2762154.

Shen W, Punyanitya M, Silva AM, Chen J, Gallagher D, Sardinha LB, Allison DB, Heymsfield SB. Sexual dimorphism of adipose tissue distribution across the lifespan: a cross-sectional whole-body magnetic resonance imaging study. Nutr Metab (Lond). 2009;6:17. PMCID: PMC2678136.

Sproule DM, Montes J, Montgomery M, Battista V, Koenigsberger D, Shen W, Punyanitya M, De Vivo DC, Kaufmann P. Increased fat mass and high incidence of overweight despite low body mass index in patients with spinal muscular atrophy. Neuromuscul Disord. 2009;19(6):391-6. PMCID: PMC2729661.

Wang ZM, Heymsfield SB, Ying Z, Pierson RN Jr, Gallagher D, Gidwani S. A cellular level approach to predicting resting energy expenditure: Evaluation of applicability in adolescents. Am J Hum Biol. 2010 Jan 7. [Epub ahead of print] In press. PMID: 20058259. NIHMSID: 173523.


Javed F, He Q, Davidson L, Thornton JC, Albu J, Boxt L, Krasnow N, Elia M, Kang P, Heshka S, Gallagher D. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. 2010 Feb 17. In Press. PMC Journal - In Process


Image Reading Center    (Back to Laboratories)

Imaging Methods for Body Composition Background and Applications

History

Early workers in the field of clinical nutrition used standard x-ray techniques to examine fat layer thickness. The high radiation exposure and low image contrast limited the research and clinical applicability of this approach. In 1973 Geoffrey Hounsfield and his colleagues introduced the first computerized axial tomography (CT) system and by the early 1980s CT scanners were installed in hospitals throughout the world. The early CT approach provided cross-sectional images with high contrast and by 1979 the first reports of skeletal muscle measurement appeared. The first measurements of visceral organ volumes were reported in 1979 as were estimates of visceral adipose tissue in 1981. Several contiguous image slices were assembled into the complete three-dimensional adipose tissue or organ compartment of interest. While CT was a major breakthrough in quantifying the volumes of tissues and organs, applicability was limited by radiation exposure. Within a decade the first reports of magnetic resonance imaging (MRI) of humans appeared and Foster et al. in 1980s’reported the first MRI body composition studies. As with CT, MRI provides the unique capability of quantifying tissue and organ volumes in vivo but without radiation hazard. Gradual advances in both CT and MRI capabilities now make single or multiple slice tissue and organ analysis a reference approach against which other techniques can be compared.

Application

Both CT and MRI provide high-resolution cross-sectional images through selected anatomic regions. At one extreme the entire body can be imaged and the volume of all major tissue-system level components estimated. Volume estimates can be converted to mass values by assuming specific tissue densities. Depending on the selected slice number, whole-body evaluations require scan times ranging from about 20 minutes to an hour. As CT exposes subjects to radiation, there are only several reports of whole-body CT studies in humans. Moreover, CT and MRI in phantom and cadaver studies provide similar tissue volume estimates and the trend today is to apply MRI whenever possible. Specific aspects of scanning protocols are reported in earlier studies.

Once images are collected, analyses can take one of several different pathways. For CT, pixel intensities are designated in Hounsfield units (HU), and calibrations are similar among all CT scanners. Hounsfield unit ranges differ among tissues, notably adipose tissue, lean soft tissues, and bone vary sufficiently in pixel intensity to allow component separation using designated HU ranges. Hounsfield unit ranges for adipose tissue, muscle/organs, and bone are: -190 to -30 HU; -30 to +100 HU; >100 HU.

Selected organs and tissues can also be traced directly on the CT scanner console and related areas within each slice established. As CT imaging time is usually rapid, several seconds per slice, images of moving objects such as the viscera secondary to peristalsis and respiration are still relatively sharp and boundaries are clear. Analysis of MRI scans is more complex as pixel intensity varies according to the selected imaging sequence and other factors. Standard pixel “ranges” cannot therefore be set and analysis is on a scan-by-scan basis. Dedicated image analysis software is usually applied rather than standard system radiology software. Image acquisition times for MRI are usually longer than they are for CT and patients should maximize their breath holds and maintain a stable position during the scan. Images of the viscera tend to be less sharp than they are for CT, although new MRI scanning sequences are improving image clarity. Gated MRI scans allow development of high contrast images of the myocardium. For both CT and MRI, training is required for image analysis and reading times can vary from several minutes for a single tissue component of a single slice to several days for multiple tissue components of a whole body.

Imaging methods, both CT and MRI, are uniquely capable of acquiring tissue-organ level volume estimates including all major organs and tissues, visceral adipose tissue, and regional estimates. CT and MRI estimates of visceral adipose tissue, either a single slice or multiple slices, are considered the reference against which other techniques are compared. Cost, instrument access, and the need for trained image analysis technicians may limit routine imaging method use to specialized research studies and centers. CT and MRI are not appropriate for use in field studies of body composition, although both methods can be used to “calibrate” or validate other simpler less costly methods.

While today we still focus mainly on produced images, rapid growth in magnetic resonance spectroscopy and functional MRI offer great promise in the study of human physiology and metabolism. It is likely that these new developments will not only add to our ability to quantify body composition, but to enhance of knowledge of closely-related metabolic processes as well.

The telephone number for Imaging Analysis Services is 212 523-1738.



Quantitative Magnetic Resonance Laboratory    (Back to Laboratories)

A recently available quantitative magnetic resonance (QMR) system (EchoMRI-AH™; Echo Medical Systems, Houston, TX) relies on proton nuclear magnetic resonance (NMR) to measure human total body composition. The system output includes values for total body fat mass, lean tissue mass, free water mass, and total water mass in units of kilograms

The telephone number for this laboratory is 212 523-4194.


Relevant Laboratory/Core Publications
Gallagher D, Thornton JC, He Q, Wang J, Yu W, Bradstreet TE, Burke J, Heymsfield SB, Rivas V, Kaufman R. Quantitative magnetic resonance fat measurements in humans correlate with established methods but are biased. Obesity. In Press.



Tracer Dilution Laboratory    (Back to Laboratories)
This laboratory was established in 1970. The first phase of work was to develop the tracer dilutions for measurement of total body water (TBW), extracellular water (ECW), exchangeable sodium and plasma volume in animals. The second phase was to apply these techniques in human studies. Most of the tracers used in the early studies were radioactive materials, however, since 1999, only non-radioactive tracers have been used for measurements. In 1999, the main instruments used in this laboratory were upgraded with the latest models, and the measurement precision was significantly improved to ±1.0% for TBW measurements and to ±1.3% for ECW measurements.

The laboratory has developed study packages for TBW and ECW measurements that contain tracer dose, specimen collection tubes, and instructions for performing the measurement and for specimen shipment. The study package can be shipped to any location in the world for investigators to administer the tracer dose, collect the specimens and mail back to the lab for analysis. The study packages can be prepared according to special requirement based on study population and research design. For example, the laboratory measures tracer concentrations in saliva instead of plasma in pediatric subjects.

The laboratory has performed more than 7000 TBW and 5000 ECW measurements in many research projects and clinical trials and has served as the central laboratory for studies involved multiple sites. The laboratory has provided services to investigators across the USA, and also to investigators in Africa, Canada, Europe, and South-America. The laboratory has trained many scientists from Europe and Southern America.

The telephone number for this laboratory is 212 523-2021.

Background and Applications for Tracer Dilution Studies

History
Three isotopes of water are recognized in nature, deuterium, tritium, and oxygen-18 labeled water. Schloerb et al. were the first to measure total-body water in 1951 using the isotope deuterium. The methods importance greatly increased after the report of Pace and Rathbun in 1945 indicating that water existed in a relatively stable proportion to fat-free mass, approximately 0.73. This subsequently led to the widespread use of total-body water as means of estimating fat-free mass and total-body fat in both animals and humans.

Application
The method is relatively straightforward and simple to apply. Subjects ingest a known amount of isotope, and at some later time point the isotope remaining in the body is quantified. The water compartment is then re-sampled through urine, saliva, or blood. Total-body water is then calculated using the classic dilution formula.

Details of the procedure vary depending on isotope used, analytical method, and accuracy desired. Deuterium is relatively inexpensive to purchase, simple to measure in secretions and blood samples, and safe as the isotope is stable. The isotope tritium is also inexpensive, easy to measure in blood samples, and exposes the subject to a small amount of radiation. Today deuterium is usually favored as an isotope for water dilution over that of tritium because of radiation exposure with tritium and the increasing ease with which deuterium can be measured in samples. Oxygen-18 labeled water is relatively expensive and measurement is possible only in specialized laboratories that have mass spectroscopy equipment. Oxygen-18 labeled water is useful for measuring total-body water when carrying out doubly labeled water studies of energy expenditure.

Once the dilution space is known from the evaluation protocol, total-body water mass must then be calculated. The dilution spaces of deuterium and tritium are slightly larger than actual total-body water as proton exchange with other organic constituents increase the apparent volume of distribution. Most investigators today assume the overestimate of total-body water by deuterium and tritium is approximately 4%. A correction for water density is also required when converting from water volume to water mass. The oxygen-18 space is also slightly larger that actual total-body water by about 1% in most studies. Some investigators thus assume that oxygen-18 represents an even more accurate assessment of actual total-body water, the oxygen exchange being substantially less than that of the proton exchange for deuterium and tritium.

The technical error of total-body water measurement varies depending on the specific protocol applied. However, most approaches allow reliable measurement of total-body water with a technical error in the range of 1% to 3%. Assuming subjects are healthy weight stable adults, the proportion of fat-free mass as total-body water is relatively stable at 0.73. Some variability in this ratio is recognized across age groups and in various disease states. The advantage of total-body water as a means of estimating fat-free mass and total-body fat is that the method is simple, relatively inexpensive, and easy to carry out even in isolated settings. The disadvantage of the method is that dilution protocols often require several hours and subject conditions can be very variable depending on hydration status, the presence of disease, or ambient conditions such as environmental temperature. Hydrometry is the only approach capable of measuring extremely large subjects who weigh over several hundred kilograms. Similarly hydrometry is widely applied in the study of large animals including whales and other aquatic mammals.


Relevant Laboratory/Core Publications (in chronological order)
Wang J, Pierson RN Jr, Kelly WG. A rapid method for the determination of deuterium oxide in urine: Application to the measurement of total water. J Lab Clin Med, 82:170-178, 1973.

Wang J, Pierson RN Jr. Disparate hydration states of adipose and lean tissue require a new model for body water distribution in man. J Nutr, 106:1678-1693, 1976.

Pierson RN Jr, Wang J, Yang M, Van Itallie TB. The assessment of body composition in weight reduction evaluation of a new model for clinical studies. J Nutr, 106:1694-1701, 1976.

Pierson RN Jr, Wang J, Frank W, Allen C, Rayyes A. Alcohol affects intracellular potassium, sodium and water distributions in rats and man. Ed. Seixas FK. Currents in Alcoholism, Grune & Stratton, Inc. New York, 1:161-178, 1977.

Yang MU, Wang J, Pierson RN Jr, Van Itallie TB. Estimation of composition of weight loss in man: comparison method. J Appl Physiol, 43:331-338, 1977.

Colt EWD, Wang J, Pierson RN Jr. Effect on body water of running 10 miles. Am J Physiol, 45:999-1001, 1978.

Pierson RN Jr, Prince DC, Wang J, Jain RK. Extracellular water measurements: organ tracker kinetics of bromide and sucrose in rats and man. Am J Phys, 235:F254-264, 1978.
Pierson RN Jr, Wang J, Dempsey GN, Allen GB, Fieve RR. Interaction of lithium, alcohol, and affective disorders on sodium potassium and cellular water. Ed. Seixus FA. Currents in Alcoholism, Vol. IV. Psychiatric Psychological, Social and Epidemiological Studies. Grune & Stratten, Inc. New York, 1978.
Pierson RN Jr, Wang J, Colt EWD. Body composition measurements in normal man: the potassium, sodium, sulfate and tritium space in 58 adults. J Chronic Dis, 35:419-428, 1982.

Colt EWD, Dunner DL, Wang J, Ross DC, Pierson RN Jr, Fieve RR. Body composition in affective disorders before, during and after lithium. Arch Gen Psych, 39:557-581, 1982.

Berstein MD, Thornton JC, Yang MU, Wang J, Redmond AM, Pierson RN Jr, Pi-Sunyer FX, Van Itallie TB. Prediction of the resting metabolic rate in obese patients. Am J Clin Nutr, 37:595-602, 1983.
Presta E, Wang J, Harrison GG, Bjorntorp P, Harker WH, Van Itallie TB. Measurement of total body electrical conductivity: a new method for estimation of body composition. Am J Clin Nutr, 37:735-739, 1983.
Pierson RN Jr, Wang J, Thornton JC, Van Itallie TB, Colt EWD. Body potassium by 4 pi counting: an anthropometric correction. Am J Physiol, 246:F234-239, 1984.
Kotler DP, Wang J, Pierson RN Jr. Body composition studies with the acquired immunodeficiency syndrome. Am J Clin Nutr, 42:1225-1265, 1985.
Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods. A comparative study. J Appl Physiol, 58:1556, 1985.
Weinsier RL, Norris DJ, Birch R, Bernstein RS, Wang J, Yang MU, Pierson RN Jr, Van Itallie TB. The relative distribution of body fat and fat pattern to blood pressure level. Hypertension, 7:578-585, 1985.

Weinsier RL, Norris DJ, Birch R, Bernstein RS, Pi-Sunyer FX, Yang MU, Wang J, Pierson RN Jr, Van Itallie TB. Serum insulin and blood pressure in an obese population. Int J Obesity, 10:11-17, 1986.

Foster CJ, Weinsier RJ, Birch R, Norris DJ, Bernstein RS, Wang J, Pierson RN Jr, Van Itallie TB.
Obesity and serum lipids: An evaluation of the relative contributions of body fat and fat distribution to lipid levels. Int J Obesity, 11:151-161, 1987.
Wang J, Colt EWD, Pierson RN Jr. Body water extracellular water, body potassium and exchangeable sodium in body builders using anabolic steroids. Eds. Ellis KJ, Yasumura S, Morgan WD. In Vivo Body Composition studies, IPSM, London, 149-154, 1987.
Foster GD, Wadden TA, Mullen JL, Stunkard AJ, Wang J, Feurer ID, Pierson RN Jr, Yang MU, Presta E, Van Itallie TB, Lemberg PS, Gold J. Resting energy expenditure, body composition and excess weight in the obesity. Metabolism 37:467-472, 1988.

Johnston PE, Wadden TA, Strunkard AJ, Pene M, Wang J, Pierson RN Jr, Van Itallie TB.
Body deposition in adult obese women, Part I; Pattern of fat distribution. Am J Clin Nutr, 47:225-228, 1988.

Wadden TA, Stunkard AJ, Johnston PE, Wang J, Pierson RN Jr, Van Itallie TB, Costello E, Pena M. Body fat deposition in adult obese women, Part II: Changes in fat distribution accompanying weight reduction. Am J Clin Nutr, 47:229-234, 1988.
Heymsfield SB, Wang J, Kehayias J, Heshka S, Lichtman S, Pierson RN Jr. Chemical determination of human body density in vivo: relevance to hydrodensitometry. Am J Clin Nutr, 50:1282-1289, 1989.
Kotler DP, Wang J, Pierson RN Jr. Studies of body composition in patients with acquired immunodeficiency syndrome. Food Nutr Bul, 11:55-60, 1989.
Heymsfield SB, Lichtman S, Baumgartner RN, Wang J, Kamen Y, Aliprantis A, Pierson RN Jr.
Body composition of humans: comparison of two improved four-compartment models that differ in expense, technical complexity, and radiation exposure. Am J Clin Nutr, 52:52-58, 1990.

Kotler DP, Tierney AR, Brenner SK, Couture S, Wang J, Pierson RN Jr. Preservation of short-term energy balance in clinically stable patients with AIDS. Am J Clin Nutr, 51:7-13, 1990.

Baumgartner RN, Heymsfield SB, Livhtman S, Wang J, Pierson RN Jr. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr, 53:1345-1353, 1991.
Heymsfield SB, Waki M, Kehayias J, Lichtman S, Dilmanian FA, Kamen Y, Wang J, Pierson RN Jr. Chemical and elemental analysis of humans in vivo using improved body composition models. Am J Physiol, 261:E190-E198, 1991.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr, Heymsfield SB. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1991.
Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA. Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.
Segal KR, Burastero S, Chun A, Coronel P, Pierson RN Jr, Wang J. Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement. Am J Clin Nutr, 54:26-29, 1991.
Waki M, Kral JG, Mazariegos M, Wang J, Pierson RN Jr, Heymsfield SB. Relative expansion of extracellular fluid in obese vs. non-obese woman. Am J Physiol, 261:E199-E203, 1991.
Albu J, Smolowitz J, Lichtman S, Heymsfield SB, Wang J, Pierson RN Jr, Pi-Sunyer FX. Composition of weight loss in severely obese women: A new look at old methods. Metabolism, 41:1068-1074, 1992.
Mazariegos M, Kral JG, Wang J, Waki M, Heymsfield SB, Pierson RN Jr, Thornton JC, Yasumura S. Body composition and surgical treatment of obesity: effects of weight loss on fluid distribution. Annals of Surgery, 216:67-73, 1992.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1992.
Wang J, Kotler DP, Russell-Aulet M, Burastero S, Mazariegos M, Thornton J, Dilmanian FA, Pierson RN Jr, Weber DA, Kamen Y. Body-fat measurement in patients with acquired immunodeficiency syndrome: which method should be used? Am J Clin Nutr, 56:963-967, 1992.
Lederman SA, Pierson RN Jr, Wang J, Paxton A, Thornton J, Wendel J, Heymsfield SB. Body composition (BC) measurements during pregnancy. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models and assessment. Plenum Press, New York, 193-195, 1993.
Mazariegos M, Heymsfield SB, Wang ZM, Wang J, Yasumura S, Dilmanian FA, Pierson RN Jr.
Aging affects body composition: Young versus elderly women pair-matched by body mass index. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models, and assessment. Plenum press, New York, 245-250, 1993.
Wang ZM, Ma RM, Pierson RN Jr, Heymsfield SB. Five-level model: reconstruction of body weight at atomic, molecular, cellular, and tissue-system levels from neutron activation analysis. Human body composition: In vivo methods, models, and assessment. Plenum Press, New York, 125-128, 1993.
Mazariegos M, Wang ZM, Gallagher D, Baumgartner RN, Allison DB, Wang J, Pierson RN Jr, Heymsfield SB. Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model. J Geront, 49:M201-M208, 1994.
Wang J, Thornton JC, Russell-Aulet M, Burastero S, Heymsfield SB, Pierson RN Jr. Bio-impedance analysis for estimation of total body potassium, total body water and fat-free mass in white, black, and Asian adults. Am J Hum Biol, 7:33-40, 1995.
Arpadi SM, Wang J, Cuff PA, Thornton JC, Horlick M, Kotler DP, Pierson RN Jr. Application if bioimpedance analysis for estimating body composition in prepubertal children infected with human immunodeficiency virus type 1. J Pediatr, 129:755-757, 1996.
Kotler DP, Burastero S, Wang J, Pierson RN Jr. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr, 64(3 Suppl):489S-497S, 1996.
Ma KZ, Kotler DP, Wang J, Thornton JC, Ma RM, Pierson RN Jr. Reliability of in vivo neutron activation analysis for measuring body composition: comparisons with tracer dilution and dual-energy X-ray absorptiometry. J Lab Clin Med, 127:420-427, 1996.
Schambelan M, Mulligan K, Grunfeld C, Daar ES, LaMarca A, Kotler DP, Wang J, Bozzette SA, Breitmeyer. Recombinant human growth hormone in patients with HIV-associated wasting. A randomized, placebo, controlled trial. Serostim Study Group. Ann Intern Med, 125(11):873-882, 1996.
Burrowes JD, Bluestone PA, Wang J, Pierson RN Jr. The effects of moderate does of megestrol acetate on nutritional status and body composition in a hemodialysis patient. J Ren Nutr, 9(2):89-94, 1999.
Clasey JL, Kanaley JA, Wideman L, Heymesfield SB, Teates CD, Gutgesell ME, Thorner MO, Hartman ML, Weltman A. Validity of methods of body composition assessment in young and older men and women. J Appl Physiol, 86(5):1728-1738, 1999.
Kim J, Wang Z, Gallagher D, Kotler DP, Ma KZ, Heymsfield SB. Extracellular water: sodium bromide dilution estimates compared with other markers in patients with acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr, 23(2):61-66, 1999.

Lederman SA, Paxton A, Heymsfield SB, Wang J, Thornton J, Pierson RN Jr. Maternal body fat and water during pregnancy: do they raise infant birth weight? Am J Obstet Gynecol, 180(1 Pt 1):235-240, 1999.
Mott JW, Wang J, Thornton JC, Allison DB, Heymsfield SB, Pierson RN Jr. Relation between body fat and age in four ethnic groups. Am J Clin Nutr, 69:1007-1013, 1999.
Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB. Hydration of fat-free body mass: review and critique of a classic body-composition constant. Am J Clin Nutr, 69(5):833-841, 1999.

Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB. Hydration of fat-free body mass: new physiological modeling approach. Am J Physiol, 276(6 Pt 1):E995-E1003, 1999.
Withers RT, Laforgia J, Heymsfield SB. Critical appraisal of the estimation of body composition via two-, three-, and four-compartment models. Am J Human Biol, 11(2):175-185, 1999.
Arpadi SM, Cuff PA, Kotler DP, Wang J, Bamji M, Lange M, Pierson RN Jr, Matthews DE.
Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children. J Nutr, 130(10):2498-2502, 2000.
Funkhouser A, Laferrere B, Wang J, Thornton J, Pi-Sunyer FX, Measurement of percent body fat during weight loss in obese women: comparison of four methods. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000, 904:539-541.
Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based On body mass index. Am J Clin Nutr, 72(3):694-701, 2000.
Gallagher D, Kovera AJ, Clay-Williams G, Agin D, Leone P, Albu J, Matthews DE, Heymsfield SB. Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism. Am J Physiol Endocrinol Metab, 279(1):E124-E131, 2000.
Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner RN, Wang J, Pierson RN Jr, Pi-Sunyer FX, Heymsfield SB. Weight stability masks sarcopenia in elderly men and women. Am J Physiol Endocrinol Metab, 279(2):E366-E375, 2000.
Leone PA, Gallagher D, Wang J, Heymsfield SB, Relative Overhydration of fat-free mass in postobese versus never-obese subjects. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000 904:514-519.

Johnson VL, Wang J, Kaskel FJ, Pierson RN Jr. Changes in body composition of children with chronic renal failure on growth hormone. Pediatr Nephrol, 14(7):695-700, 2000.

Testolin CG, Gore R, Rivkin T, Horlick M, Arbo J, Wang Z, Chiumello G, Heymsfield SB.
Dual-energy X-ray absorptiometry: analysis of pediatric fat estimate errors due to tissue hydration effects. J Appl Physiol, 89(6):2365-2372, 2000.

Wang Z, Deurenberg P, Heymsfield SB. Cellular-level body composition model. A new approach to study fat-free mass hydration. Ann N Y Acad Sci, 904:306-311, 2000.

Wang, Z., Deurenberg, P., Wang, W., Pietrobelli, A., Baumgartner, R. N., & Heymsfield, S. (2000). Hydration of fat- free body mass: new physiological modeling approach. Am J Physiol Endocrinol Metab, 278, E752-E753.

Chumlea WC, Guo SS, Zeller CM, Reo NV, Baumgartner RN, Garry PJ, Wang J, Pierson RN Jr, Heymsfield SB, Siervogel RM. Total body water reference values and prediction equations for adults. Kidney Int 2001;59:2250-8.

Horlick, M., Arpadi, S. M., Bethel, J., & et al (2002). Bioelectrical impedance analysis models for prediction of total body water and fat- free mass in healthy and HIV- infected children and adolescents. Am J Clin Nutr, 76, 991-999

Pietrobelli A, Allison DB, Heshka S, Heo M, Wang ZM, Bertkau A, Laferrere B, Rosenbaum M, Aloia JF, Pi-Sunyer FX, Heymsfield SB. Sexual dimorphism in the energy content of weight change. Int J Obes 2002;26:1339-1348.

Lee RC, Ramirez LM, Wielopolski L, Heymsfield SB, Wang ZM. Ratio of soft-tissue to total body water: A stable body composition ratio. Int J Body Composition Res 2003; 1:77-80

Wang, Z., Shen, W., Kotler, D. P., & et al (2003). Total body protein: a new cellular level mass and distribution prediction model. Am J Clin Nutr, 78, 979-984.

Silva AM, Shen W, Wang ZM, Aloia JF, Nelson M, Heymsfield SB, Sardinha LB, Heshka S. Three-compartment model: Critical evaluation based upon neutron activation analysis. Am J Physiol 2004;287:E962-E969.

Sopher AB, Thornton JC, Wang J, Pierson R, Heymsfield S, Horlick M. Measurement of percentage of body fat in 411 children and adolescents: A comparison of dual-energy X-ray absorptiometry with a four-compartment model. Pediatrics, 2004;113:1285-1291.

St-Onge M-P, Wang ZM, Horlick M, Wang J, Heymsfield SB. Dual-energy X-ray absorptiometry lean soft tissue hydration: Independent contributions of intra- and extracellular water. Am J Physiol 2004;287: E842-E847.

Wang ZM, St-Onge MP, Lecumberii B, Pi-Sunyer FX, Heshka S, Wang J, Kotler DP, Gallagher D, Wielopolski L, Pierson RN Jr, Heymsfield SB. Body cell mass: Model development and validation at the cellular level of body composition. Am J Physiol. 2004;286:E123-E128 .


Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW (2005). Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr., 15, 152-158.

Shen W, St-Onge MP, Pietrobelli A, Wang J, Wang ZM, Heshka S, Heymsfield SB. Four-compartment cellular level body composition model: Comparison of two approaches differing in cost and availability. Obes Res. 2005;13(1):58-65.

Silva AM, Wang J, Pierson Jr RN, Wang ZM, Heymsfield SB, Sardinha LB, Heshka S. Extracellular water: Relative expansion with greater age in adults. J Appl Physiol. 2005 Feb 24; [Epub ahead of print].

Wang Z, Heshka S, Wang J, Gallagher D, Deurenberg P, Chen Z, Heymsfield SB. Metabolically active portion of fat-free mass: a cellular body composition level modeling analysis. Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E49-53. Epub 2006 Aug 1.

Wang Z, Heshka S, Wang J, Heymsfield SB. Total body protein mass: validation of total body potassium prediction model in children and adolescents. J Nutr. 2006 Apr;136(4):1032-6.

Levitt DG, Heymsfield SB, Pierson RN Jr, Shapses SA, Kral JG. Physiological models of body composition and human obesity. Nutr Metab (Lond). 2007 Sep 20;4:19. PMID: 17883858 PMCID: PMC2082278

Silva AM, Wang J, Pierson RN Jr, Wang Z, Spivack J, Allison DB, Heymsfield SB, Sardinha LB, Heshka S. Extracellular water across the adult lifespan: reference values for adults. Physiol Meas. 2007 May;28(5):489-502. Epub 2007 Apr 5. PMID: 17470983.

Wang Z, Heshka S, Wang J, Gallagher D, Deurenberg P, Chen Z, Heymsfield SB. Metabolically active portion of fat-free mass: a cellular body composition level modeling analysis. Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E49-53. Epub 2006 Aug 1. PMID: 16882929 PMCID: PMC2723740

Silva AM, Heymsfield SB, Gallagher D, Albu J, Pi-Sunyer XF, Pierson RN Jr, Wang J, Heshka S, Sardinha LB, Wang Z. Evaluation of between-methods agreement of extracellular water measurements in adults and children. Am J Clin Nutr. 2008 Aug;88(2):315-23. PMID: 18689366 PMCID: PMC2752354


Whole Body Counting Laboratory    (Back to Laboratories)
The 4 whole body liquid scintillation counting system at St. Luke's-Roosevelt Hospital in New York City was transferred from the Walter Reed Army Institute of Research in 1967. The whole body counter consists of a cylinder 72 inches long and 20 inches in interior diameter surrounded by a cylindrical tank containing 144 gallons of scintillator fluid. Gamma scintillations, primarily Compton interactions, in the annular volume of the detector, are viewed by 30 5-inch photomultiplier tubes in a 5x6 symmetrical array. The entire scintillation cylinder is shielded by a closed cylinder of 5-inch, pre-1945 steel lined with 1/2 inch of lead and 1/16 inch of copper to reduce low-energy back-scattered gamma radiation. The standardized counting time is 9 minutes for one subject measurement.

This whole body counting system has been mainly used for measuring total body potassium (TBK) by counting the trace amount of naturally occurring 40K in the body but it can also be used to study metabolism of elements such as calcium by counting a trace amount of radioactive 47Ca given to the study subject to determine the turnover rate of calcium.

There have been three major upgrades of the system which have improved the reproducibility of measurements to ±2.2% for human subjects weighing 40 to 250 lbs. Since the installation of the system, more than 10,000 subjects have been measured with ages 2 to 107 years, patient cohorts ranges from anorexia to severe obesity for a large number of research projects and clinical purposes for investigators working at this center and at other institutions in the New York area.

The telephone number for this laboratory is 212 523-2021.

Background and Applications of 40K Counting for Body Composition Research

History
Potassium in nature occurs as three isotopes, 39K (93.1%), 40K (0.0118%), and 41K (6.9%). The most abundant forms, 39K and 41K, are non-radioactive while the naturally-occurring radioactive potassium isotope 40K (t_=1.3 x 109 years) gives off a 1.46 MeV gamma-ray that can be counted using detectors such as crystalline sodium iodide. The proportion of total potassium found in human tissues as 40K is constant at 0.0118% of total potassium. Thus, by measuring 40K one can compute total-body potassium (TBK). In turn, potassium is distributed almost entirely within the intracellular compartment of fat-free mass. As the ratio of total-body potassium to fat-free mass is relatively stable in adult humans, one can compute fat-free mass and total-body fat if TBK is known. Forbes and his colleagues were the first to report in 1961 the measurement of 40K and thus TBK using a whole-body counter. From measured TBK Forbes and his colleagues proposed the use of the relatively stable TBK to fat-free mass ratio as a means of estimating in vivo fat-free mass and total-body fat. The whole body 40K counting method became the reference approach for evaluating total-body fat for several decades.

Application
The widespread use of whole body 40K counting as a means of estimating total-body fat proliferated for use in humans and animals because the method, once established, is relatively simple to carry out, safe, and inexpensive after instrument costs are considered. The measurement approach involves first shielding the subject from naturally occurring radiation in the environment using concrete, lead, or steel. Once external radiation is minimized, the subject’s natural radiation as 40K is measured using scintillation counters. The 40K counts are quantified over a specified time period and then, using an appropriate calibration standard, the subject’s 40K and ultimately TBK are estimated. The average adult human has approximately 80-150 g of total potassium and smaller amounts in regions such as the arms, legs, and trunk. While the most common counter type is for the whole body, it is also possible to construct small regional counters for the arms, legs, or even miniature counters for small animals. The technology for quantifying either regional or whole body potassium is well developed and measurements can be completed with a relatively small technical error in the range of 2-4%.

While early investigators proposed the use of an assumed stable TBK to FFM ratio as a means of estimating fat-free mass and fat, it is now recognized that the TBK/FFM ratio varies as a function of age, sex, and other potential influencing factors. For this reason, investigators have sought other means of estimating total-body fat and these will be described in later sections. On the other hand, TBK offers an important opportunity to estimate two other components, body cell mass and skeletal muscle mass. Almost all of potassium is distributed in the intracellular compartment and the concentration of potassium in the intracellular fluid is stable in mammals at approximately 150-160 mmol/kg. Total-body potassium is thus frequently used as a measure of body cell mass and hence metabolically active tissue. Additionally, approximately 60% of total-body potassium is distributed in the skeletal muscle compartment. Accordingly, TBK is often used as a surrogate measure of cellular regional and whole-body muscle mass. Moreover, recent studies indicate that the relationship between TBK and skeletal muscle in adults is stable across age and sex groups. This stable relationship can be exploited as a means of predicting total-body skeletal muscle mass from measured total-body potassium.

In summary, estimation of TBK is recognized as a classical method of quantifying total-body fat that has been replaced by newer more accurate approaches that will be described in later sections. While whole body counters are very costly instruments to install, their operational expenses are relatively small. Systems are simple to operate and there are no recognized health risks. As the regional and whole body counters are extremely heavy, they cannot be used outside of specialized research laboratories dedicated to the study of metabolic diseases and human body composition. Whole-body counters are not widely available, the measurements are sometimes time consuming, and with some systems the procedure may be difficult for subjects. Finally, the measurement of potassium offers a means of quantifying both regional and whole body cell mass and skeletal muscle mass.


Relevant Laboratory/Core Publications (in chronological order)
Pierson RN Jr, Wang J, Yang M, Van Itallie TB. The assessment of body composition in weight reduction evaluation of a new model for clinical studies. J Nutr, 106:1694-1701, 1976.
Wang J, Pierson RN Jr. Disparate hydration states of adipose and lean tissue require a new model for body water distribution in man. J Nutr, 106:1678-1693, 1976.
Yang MU, Wang J, Pierson RN Jr, Van Itallie TB. Estimation of composition of weight loss in man: comparison method. J Appl Physiol, 43:331-338, 1977.
Pierson RN Jr, Wang J, Dempsey GN, Allen GB, Fieve RR. Interaction of lithium, alcohol, and affective disorders on sodium potassium and cellular water. Ed. Seixus FA. Currents in Alcoholism, Vol. IV. Psychiatric Psychological, Social and Epidemiological Studies. Grune & Stratten, Inc. New York, 1978.
Colt EWD, Wang J, Stallone F, Pierson RN Jr, Van Itallie TB. A possible low intercellular potassium in obesity. Am J Clin Nutr, 34:361-367, 1981.
Pierson RN Jr, Wang J, Colt EWD. Body composition measurements in normal man: the potassium, sodium, sulfate and tritium space in 58 adults. J Chronic Dis, 35:419-428, 1982.
Pierson RN Jr, Wang J, Thornton JC, Van Itallie TB, Colt EWD. Body potassium by 4 pi counting: an anthropometric correction. Am J Physiol, 246:F234-239, 1984.

Kotler DP, Wang J, Pierson RN Jr. Body composition studies with the acquired immunodeficiency syndrome. Am J Clin Nutr, 42:1225-1265, 1985.
Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods. A comparative study. J Appl Physiol, 58:1556, 1985.
Weinsier RL, Norris DJ, Birch R, Bernstein RS, Wang J, Yang MU, Pierson RN Jr, Van Itallie TB. The relative distribution of body fat and fat pattern to blood pressure level. Hypertension, 7:578-585, 1985.

Foster CJ, Weinsier RJ, Birch R, Norris DJ, Bernstein RS, Wang J, Pierson RN Jr, Van Itallie TB.
Obesity and serum lipids: An evaluation of the relative contributions of body fat and fat distribution to lipid levels. Int J Obesity, 11:151-161, 1987.

Pierson RN Jr, Wang J. The quality of the lean body mass: implications for clinical medicine. In vivo body composition studies. The Institute of Physical Sciences in Medicine, London, 123-130, 1987.

Wang J, Colt EWD, Pierson RN Jr. Body water extracellular water, body potassium and exchangeable sodium in body builders using anabolic steroids. Eds. Ellis KJ, Yasumura S, Morgan WD. In Vivo Body Composition studies, IPSM, London, 149-154, 1987.

Foster GD, Wadden TA, Mullen JL, Stunkard AJ, Wang J, Feurer ID, Pierson RN Jr, Yang MU, Presta E, Van Itallie TB, Lemberg PS, Gold J. Resting energy expenditure, body composition and excess weight in the obesity. Metabolism 37:467-472, 1988.

Johnston PE, Wadden TA, Strunkard AJ, Pene M, Wang J, Pierson RN Jr, Van Itallie TB.
Body deposition in adult obese women, Part I; Pattern of fat distribution. Am J Clin Nutr, 47:225-228, 1988.

Wadden TA, Stunkard AJ, Johnston PE, Wang J, Pierson RN Jr, Van Itallie TB, Costello E, Pena M. Body fat deposition in adult obese women, Part II: Changes in fat distribution accompanying weight reduction. Am J Clin Nutr, 47:229-234, 1988.

Kotler DP, Tierney AR, Wang J, Pierson RN Jr. The magnitude of body cell mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr, 50:444-447, 1989.

Grunfeld C, Kotler DP, Hamadeh R, Wang J, Pierson RN Jr. Hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med, 1986:27-31, 1989.
Kotler DP, Wang J, Pierson RN Jr. Studies of body composition in patients with acquired immunodeficiency syndrome. Food Nutr Bul, 11:55-60, 1989.
Kotler DP, Tierney AR, Brenner SK, Couture S, Wang J, Pierson RN Jr. Preservation of short-term energy balance in clinically stable patients with AIDS. Am J Clin Nutr, 51:7-13, 1990.
Heshka S, Yang M-U, Wang J, Burt P, Pi-Sunyer FX. Weight loss and change in resting metabolic rate. Am J Clin Nutr, 52:981-986, 1990.

Kotler DP, Tierney AR, Brenner SK, Couture S, Wang J, Pierson RN Jr. Preservation of short-term energy balance in clinically stable patients with AIDS. Am J Clin Nutr, 51:7-13, 1990.

Kotler DP, Tierney AR, Ferraro R, Cuff P, Wang J, Pierson RN Jr. Enteral alimentation and repletion of body cell mass in malnourished patients with acquired immunodeficiency syndrome. Am J Clin Nutr, 53:149-154, 1991.
Heymsfield SB, Waki M, Kehayias J, Lichtman S, Dilmanian FA, Kamen Y, Wang J, Pierson RN Jr. Chemical and elemental analysis of humans in vivo using improved body composition models. Am J Physiol, 261:E190-E198, 1991.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr, Heymsfield SB. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1991.
Pierson RN Jr, Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M, Smith R, Thornton JC, Kehayias J, Weber DA, Dilmanian FA. Measuring body fat: calibrating the rulers. Intermethod comparison in 389 normal Caucasian subjects. Am J Physiol, 261:E103-E108, 1991.
Albu J, Smolowitz J, Lichtman S, Heymsfield SB, Wang J, Pierson RN Jr, Pi-Sunyer FX. Composition of weight loss in severely obese women: A new look at old methods. Metabolism, 41:1068-1074, 1992.
Mazariegos M, Kral JG, Wang J, Waki M, Heymsfield SB, Pierson RN Jr, Thornton JC, Yasumura S. Body composition and surgical treatment of obesity: effects of weight loss on fluid distribution. Annals of Surgery, 216:67-73, 1992.
Ortiz O, Russell-Aulet M, Daley TL, Baumgartner RN, Waki M, Lichtman S, Wang J, Pierson RN Jr. Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr, 55:8-13, 1992.
Wang J, Kotler DP, Russell-Aulet M, Burastero S, Mazariegos M, Thornton J, Dilmanian FA, Pierson RN Jr, Weber DA, Kamen Y. Body-fat measurement in patients with acquired immunodeficiency syndrome: which method should be used? Am J Clin Nutr, 56:963-967, 1992.
Lederman SA, Pierson RN Jr, Wang J, Paxton A, Thornton J, Wendel J, Heymsfield SB. Body composition (BC) measurements during pregnancy. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models and assessment. Plenum Press, New York, 193-195, 1993.
Mazariegos M, Heymsfield SB, Wang ZM, Wang J, Yasumura S, Dilmanian FA, Pierson RN Jr.
Aging affects body composition: Young versus elderly women pair-matched by body mass index. Eds. Ellis KJ, Eastman JD. Human body composition: In vivo methods, models, and assessment. Plenum press, New York, 245-250, 1993.
Spungen Am, Bauman WA, Wang J, Pierson RN Jr. The relationship between total body potassium and resting energy expenditure in individuals with paraplegia. Arch Phys Med Rehabil, 74:965-968, 1993.
Mazariegos M, Wang ZM, Gallagher D, Baumgartner RN, Allison DB, Wang J, Pierson RN Jr, Heymsfield SB. Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model. J Geront, 49:M201-M208, 1994.
Gasperino JA, Wang J, Pierson RN Jr, Heymsfield SB. Age-related changes in musculoskeletal mass between black and white women. Metabolism, 44(1):30-34, 1995.
Wang J, Thornton JC, Russell-Aulet M, Burastero S, Heymsfield SB, Pierson RN Jr. Bio-impedance analysis for estimation of total body potassium, total body water and fat-free mass in white, black, and Asian adults. Am J Hum Biol, 7:33-40, 1995.
Wang ZM, Visser M, Ma RM, Baumgartner RN, Kotler D, Gallagher D, Heymsfield SB. Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. J Appl Physiol, 80:824-831, 1996.

Gallagher D, Visser M, Wang Z, Harris T, Pierson RN Jr, Heymsfield S. Metabolically active component of fat-free body mass: influence of age, adiposity, and gender. Metabolism, 45:992-997, 1996.
Stall SH, Ginsberg NS, DeVita MV, Zabetakis PM, Lynn RI, Gleim GW, Wang J, Pierson RN Jr, Michelis MF. Comparison of five body composition methods in peritoneal dialysis patients. Am J Clin Nutr, 64:125-130, 1996.
Gallagher D, Visser M, DeMeersman RE, Sepulveda D, Baumgartner RN, Pierson RN Jr, Harris T, Heymsfield SB. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol, 82:229-239, 1997.
Apardi S, Horlick M, Wang J, Cuff P, Bamji M, Kotler D. Body composition in prepubertal children with human immunodeficiency virus type 1 infection, Arch Pediatr. Adolesc Med, 152:688-693, 1998.
Kotler DP, Thea DM, Allison DB, Wang J, St. Louis M, Keusch GT, Pierson RN Jr. Relative and interacting effects of sex, race and environment upon body cell mass in healthy adults. Am J Hum Biol, 10:259-268, 1998.

Pierson RN Jr, Wang J, Thornton Jc, Heymsfield SB. The quality of the body cell mass--1996. Are we ready to measure it? Appl Radait Isotopes, 49:429-435, 1998.
Burrowes JD, Bluestone PA, Wang J, Pierson RN Jr. The effects of moderate does of megestrol acetate on nutritional status and body composition in a hemodialysis patient. J Ren Nutr, 9(2):89-94, 1999.
Kim J, Wang Z, Gallagher D, Kotler DP, Ma KZ, Heymsfield SB. Extracellular water: sodium bromide dilution estimates compared with other markers in patients with acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr, 23(2):61-66, 1999.

Kotler DP, Rosenbaum K, Wang J, Pierson RN Jr. Studies of body composition and fat distribution in HIV-infected and control subjects. J Acquir Immune Defic Syndr Human Retrovirol, 20:228-237, 1999.
Kotler DP, Rosenbaum K, Allison DB, Wang J, Pierson RN Jr. Validation of bioimpedance analysis as a measure of change in body cell mass as estimated by whole body counting of potassium in adults. J Parent Ent Nutr, 5:345-349, 1999.
Wang J, Horlick M, Thornton JC, Levine LS, Heymsfield SB, Pierson RN Jr. Correlation between skeletal muscle mass and bone mass in children 6-18 years: Influences of sex, ethnicity, and pubertal status. Growth, Development, and Aging, 66:99-109, 1999.
De Lorenzo A, Andreoli A, Puija A, Wang J, Pierson RN Jr. Total Body potassium in healthy Italians and Americans. A cross-calibration study. Ann N Y Acad Sci, 904:366-368, 2000.
Gallagher D, Kovera AJ, Clay-Williams G, Agin D, Leone P, Albu J, Matthews DE, Heymsfield SB. Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism. Am J Physiol Endocrinol Metab, 279(1):E124-E131, 2000.
Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner RN, Wang J, Pierson RN Jr, Pi-Sunyer FX, Heymsfield SB. Weight stability masks sarcopenia in elderly men and women. Am J Physiol Endocrinol Metab, 279(2):E366-E375, 2000.
Gallagher D, A Allen, Z Wang, S Heymsfield, & N Krasnow. Smaller organ-tissue mass in elderly fails to explain lower resting metabolic rate. Ann N.Y. Acad. Sci. 904:449-455, 2000.

Johnson VL, Wang J, Kaskel FJ, Pierson RN Jr. Changes in body composition of children with chronic renal failure on growth hormone. Pediatr Nephrol, 14(7):695-700, 2000.

Leone PA, Gallagher D, Wang J, Heymsfield SB, Relative Overhydration of fat-free mass in postobese versus never-obese subjects. In Vivo Body Composition Studies. Ann NY Acad. Sci. 2000 904:514-519.
Rosenbaum K, Wang J, Pierson RN Jr. Kotler DP. Time-dependent variation in weight and body composition in healthy adults. J Parent Ent Nutr, 24(2):52-5, 2000.
Wang ZM, Pi-Sunyer FX, Kotler DP, Wang J, Pierson RN Jr, Heymsfield SB. Magnitude and variation of total body potassium to fat-free mass ratio: A cellular level modeling study. Am J Physiol 2001;281:E1-E7.

Pietrobelli A, Allison DB, Heshka S, Heo M, Wang ZM, Bertkau A, Laferrere B, Rosenbaum M, Aloia JF, Pi-Sunyer FX, Heymsfield SB. Sexual dimorphism in the energy content of weight change. Int J Obes 2002;26:1339-1348.

Ramirez LM, Wielopolski L, Coyle PK, Heymsfield SB. Partial body potassium measurements in brain. Sixth Int Symp In Vivo Body Composition Studies, 2002

He Q, Heo M, Heshka S, Wang J, Pierson RN, Albu J, Wang ZM, Heymsfield SB, Gallagher D. Longitudinal changes in total body potassium in adults differ by sex and race. Am J Clin Nutri, 2003; 78:72-77.

Wang, J., Thornton, J. C., Heymsfield, S., & Pierson, R. N. J. (2003). The relationship between body mass index and body cell mass in Asian, African- American and Caucasian adults. Acta Diabetologica, 40, S305-S308.

Wang, Z., Shen, W., Kotler, D. P., & et al (2003). Total body protein: a new cellular level mass and distribution prediction model. Am J Clin Nutr, 78, 979-984.

Wang ZM, Zhu S, Wang J, Pierson RN Jr, Heymsfield SB. Whole-body skeletal muscle mass: Validation of estimates by total-body potassium-cellular level model. Am J Clin Nutr, 2003; 77: 76-82.

Wielopolski, L., Ramirez, L. M., Coyle, J. T., & Wang, Z. (2003). Some aspects of measuring levels of potassium in the brain. Acta Diabetologica, 40, S73-S75.

Wielopolski, L., Ramirez, L. M., Coyle, J. T., Wang, Z., & Heymsfield, S. B. (2004). Proof of principle to measure potassium in the human brain: a feasibility study. International journal of Body Composition Research, 2, 37-43.

Ramirez LM, Wielopolski L. Analysis of potassium spectra with low counting statistics using trapezoidal and library least-squares methods. Appl. Rad. Isot. 2004; 61(6):1367-1373.

Schneider B, Wang J, Thornton JC, Arbo J, Horlick M, Heymsfield SB, Pierson RN. Accuracy, reproducibility and normal total body potassium (TBK) ranges measured using the renovated whole body 40K counter of St. Luke's-Roosevelt Hospital. Int J Body Composition Res, 2004;2(2):51-60.

Silva AM, Shen W, Wang ZM, Aloia JF, Nelson M, Heymsfield SB, Sardinha LB, Heshka S. Three-compartment model: Critical evaluation based upon neutron activation analysis. Am J Physiol 2004;287:E962-E969.

St-Onge M-P, Wang ZM, Horlick M, Wang J, Heymsfield SB. Dual-energy X-ray absorptiometry lean soft tissue hydration: Independent contributions of intra- and extracellular water. Am J Physiol 2004;287: E842-E847.

Wang ZM, St-Onge MP, Lecumberii B, Pi-Sunyer FX, Heshka S, Wang J, Kotler DP, Gallagher D, Wielopolski L, Pierson RN Jr, Heymsfield SB. Body cell mass: Model development and validation at the cellular level of body composition. Am J Physiol. 2004;286:E123-E128 .

Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW (2005). Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr., 15, 152-158.

Silva AM, Wang J, Pierson Jr RN, Wang ZM, Heymsfield SB, Sardinha LB, Heshka S. Extracellular water: Relative expansion with greater age in adults. J Appl Physiol. 2005 Feb 24; [Epub ahead of print].

Shen W, St-Onge MP, Pietrobelli A, Wang J, Wang ZM, Heshka S, Heymsfield SB. Four-compartment cellular level body composition model: Comparison of two approaches differing in cost and availability. Obes Res. 2005;13(1):58-65..

Wang ZM, Heshka S, Heymsfield SB, Shen W, Gallagher D. A cellular-level approach to predicting resting energy expenditure across the adult years. Am J Clin Nutr. 2005;81:799-806

Wang ZM, Pierson RN Jr, Heshka S, Wang J, Gallagher D, Heymsfield SB. Total body potassium by whole body 40K counting: A classic method that remains useful for body composition research. International Journal of Body Composition Research 2006; 4:101-110.

Wang Z, Heshka S, Wang J, Heymsfield SB. Total body protein mass: validation of total body potassium prediction model in children and adolescents. J Nutr. 2006 Apr;136(4):1032-6. PMID: 16549470

Wielopolski L, Ramirez LM, Gallagher D, Heymsfield SB, Wang ZM. Measuring partial body potassium in the arm versus total body potassium. J Appl Physiol. 2006 Sep;101(3):945-9. Epub 2006 Jun 1. PMID: 16741259 PMCID: PMC1850529

Silva AM, Wang J, Pierson RN Jr, Wang Z, Spivack J, Allison DB, Heymsfield SB, Sardinha LB, Heshka S. Extracellular water across the adult lifespan: reference values for adults. Physiol Meas. 2007;28(5):489-502. .

Wang Z, Heshka S, Pietrobelli A, Chen Z, Silva AM, Sardinha LB, Wang J, Gallager D, Heymsfield SB. A new total body potassium method to estimate total body skeletal muscle mass in children. J Nutr. 2007 Aug;137(8):1988-91. PMID: 17634275 PMCID: PMC2745126

Silva AM, Heymsfield SB, Gallagher D, Albu J, Pi-Sunyer XF, Pierson RN Jr, Wang J, Heshka S, Sardinha LB, Wang Z. Evaluation of between-methods agreement of extracellular water measurements in adults and children. Am J Clin Nutr. 2008;88(2):315-23.

Carter M, Zhu F, Kotanko P, Kuhlmann M, Ramirez L, Heymsfield SB, Handelman G, Levin NW. Assessment of body composition in dialysis patients by arm bioimpedance compared to MRI and 40K measurements. Blood Purif. 2009;27(4):330-7. Epub 2009. PMID: 19270452 NIHMSID # 174809

Wang ZM, Heymsfield SB, Ying Z, Pierson RN Jr, Gallagher D, Gidwani S. A cellular level approach to predicting resting energy expenditure: Evaluation of applicability in adolescents. Am J Hum Biol. 2010 Jan 7. [Epub ahead of print] In press. PMID: 20058259. NIHMSID: 173523.



Human Energy Expenditure    (Back to Laboratories)

Background and Applications of REE Measurements for Body Composition Research

History
There has been a long history of energy expenditure and balance studies carried out at the NYONRC and in the past was a major site of increasing bio-engineering and biological research activity. The human energy expenditure services being provided can be grouped into three main areas of activity: 1) resting metabolic rate/substrate evaluation; 2) 24-hour energy expenditure/substrate oxidation and energy and nutrient balance assessment; and 3) free living assessment of physical activity and energy expenditure.

Energy Expenditure Facilities include:
• Indirect calorimetry for measurement of resting energy expenditure and food thermogenesis using a metabolic cart (TrueOne® 2400 Metabolic Measurement Systems: Parvo Medics Inc) is located in the Body Composition Unit.
• 24-hour Indirect Calorimetry Chamber: Whole body resting, dietary, and exercise energy expenditure is measured using the Columbia Respiratory Chamber-Indirect Calorimeter which is a thermoneutral environment. Rates of oxygen consumption and carbon dioxide production will be analyzed using magnetopneumatic oxygen (Magnos 4G) and carbon dioxide (Magnos 3G) analyzers (Hartmann & Braun, Frankfurt, Germany) and the data displayed and stored by an on-line computer system. The system is designed as a 2-room chamber, each consisting of an air-tight, temperature-controlled room with an entrance door containing an inflatable seal, an air-lock pass-through for food, a sink and toilet, a television, table, chair, bed and telephone. All data are recorded and processed on-line by a computer program that measures variables such as oxygen and carbon dioxide gas concentrations, flow, temperature and barometric pressure and computes energy expenditure in real time.

The telephone numbers for:
• resting metabolic rate 212-523-4194
• 24-hr energy expenditure using Human Calorimeter 212 523-4183


Relevant Laboratory/Core Publications (in chronological order)
Bernstein MD, Thornton JC, Yang MU, Wang J, Redmond AM, Pierson RN Jr, Pi-Sunyer FX, Van Itallie TB. Prediction of the resting metabolic rate in obese patients. Am J Clin Nutr, 37:595-602, 1983.
Foster GD, Wadden TA, Mullen JL, Stunkard AJ, Wang J, Feurer ID, Pierson RN Jr, Yang MU, Presta E, Van Itallie TB, Lemberg PS, Gold J. Resting energy expenditure, body composition and excess weight in the obesity. Metabolism 37:467-472, 1988.
Heshka S, Yang M-U, Wang J, Burt P, Pi-Sunyer FX. Weight loss and change in resting metabolic rate. Am J Clin Nutr, 52:981-986, 1990.
Spungen Am, Bauman WA, Wang J, Pierson RN Jr. The relationship between total body potassium and resting energy expenditure in individuals with paraplegia. Arch Phys Med Rehabil, 74:965-968, 1993.
Arpadi SM, Cuff PA, Kotler DP, Wang J, Bamji M, Lange M, Pierson RN Jr, Matthews DE.
Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children. J Nutr, 130(10):2498-2502, 2000.
Gallagher D, Allen A, Wang Z, Heymsfield SB, Krasnow N. Smaller organ tissue mass in the elderly fails to explain lower resting metabolic rate. Ann N Y Acad Sci, 904:449-455, 2000.
Heymsfield SB, Gallagher D, Wang Z. Body composition modeling. Application to exploration of the resting energy expenditure fat-free mass relationship. Ann N Y Acad Sci, 904:290-297, 2000.
Wang Z, Heshka S, Gallagher D, Boozer CN, Kotler DP, Heymsfield SB. Resting energy expenditure-fat-free mass relationship: new insight provided by body composition modeling. Am J Physiol Endocrinol Metab, 279(3):E539-E545, 2000.
Wang ZM, Heshka S, Zhang K, Boozer C, Heymsfield SB. Resting energy expenditure: Systematic organization and critique of prediction methods. Obes Res, 2001;9:331-336.

Heymsfield SB, Gallagher D, Kotler DP, Wang ZM, Allison DB, Heska S. Body-size dependence of resting energy expenditure can be attributed to non-energetic homogeneity of fat-free mass. Am J Physiol. 2002;282:E132-E138

Kaufman BA, Warren MP, Dominguez JE, Wang J, Heymsfield SB, Pierson RN. Bone density and amenorrhea in ballet dancers are related to a decreased resting metabolic rate and lower leptin levels. J Clin Endocrinol Metab. 2002;87:2777-83.

Rosenbaum, M., Murphy, E., Heymsfield, S., Matthews, D. E., & Leibel, R. L. (2002). Low dose leptin administration reverses effects of sustained weight- reduction on energy expenditure and circulating concentrations of thyroid hormones. J.Clin Endocrinol Metab, 87, 2391-2394.

Fernandez, J., Shriver, M. D., Beasley, M., & et al (2003). Association of African genetic admixture with resting metabolic rate and obesity among women. Obesity Research, 11, 904-911.
Hsu A, S Heshka, I Janumala, M Song, M Horlick, N Krasnow, & D Gallagher. Larger mass of high metabolic rate organs does not explain higher REE in children. Am J Clin Nutr. 2003;77:1506-11.

Bauman A, William M, Spungen A, Wang J, Pierson RN Jr. The relationship between energy expenditure and lean tissue in monozygotic twins discordant for spinal cord injury. J Rehabilitation Res Development, 2004;41(1):1-9.

Jones A Jr, Shen W, St.Onge M-P, Gallagher D, Heshka S, Wang ZM, Heymsfield SB. Body-composition differences between African American and white women: Relation to resting energy requirements. Am J Clin Nutr, 2004; 79:780-786.

Wang ZM, Heshka S, Heymsfield SB, Shen W, Gallagher D. A cellular-level approach to predicting resting energy expenditure across the adult years. Am J Clin Nutr. 2005;81:799-806

Berk ES, Kovera AJ, Boozer CN, Pi-Sunyer FX, Albu JB. Metabolic inflexibility in substrate use is present in African-American but not Caucasian healthy, premenopausal, nondiabetic women. J Clin Endocrinol Metab. 2006 Oct;91(10):4099-106. Epub 2006 Jul 25.

Engelson ES, Agin D, Kenya S, Werber-Zion G, Luty B, Albu JB, Kotler DP. Body composition and metabolic effects of a diet and exercise weight loss regimen on obese, HIV-infected women. Metabolism. 2006;55:1327-36.

Gallagher D, Albu J, He Q, Heshka S, Boxt L, Krasnow N, Elia M. Small organs with a high metabolic rate explain lower resting energy expenditure in African American than in white adults. Am J Clin Nutr. 2006 May;83(5):1062-7.

Wang ZM, Pierson RN Jr, Heshka S, Wang J, Gallagher D, Heymsfield SB. Total body potassium by whole body 40K counting: A classic method that remains useful for body composition research. International Journal of Body Composition Research 2006; 4:101-110.

Wielopolski L, Ramirez LM, Gallagher D, Heymsfield SB, Wang ZM. Measuring partial body potassium in the arm versus total body potassium. J Appl Physiol. 2006 Sep;101(3):945-9. Epub 2006 Jun 1.

Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008 Oct;88(4):906-12.

Javed F, He Q, Davidson L, Thornton JC, Albu J, Boxt L, Krasnow N, Elia M, Kang P, Heshka S, Gallagher D. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. 2010. In Press. PMC Journal - In Process

St-Onge MP, Gallagher D. Body composition changes with aging: The cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. [Epub ahead of print] PubMed PMID: 20004080.

Wang ZM, Heymsfield SB, Ying Z, Pierson RN Jr, Gallagher D, Gidwani S. A cellular level approach to predicting resting energy expenditure: Evaluation of applicability in adolescents. Am J Hum Biol. 2010 Jan 7. [Epub ahead of print] In press. PMID: 20058259. NIHMSID: 173523.


Physical Performance Laboratory    (Back to Laboratories)

The Human Performance Laboratory (equipped with on-site resuscitation cart) contains the following:

  • A multi-station resistance gym (Tuff Stuff Apollo 4® System)
  • Treadmills:
  • Quinton Medtrack ST Programmable Treadmill
  • Jas Fitness Systems Trackmaster® TMX 425C
  • Monark 818E Professional Cycle Ergometer
  • Monark 881E Rehab Trainer- Hand Cycle
  • Polar Heart Rate monitors
  • Quinton 3000B ECG Stress Test Monitor
  • TrueOne® 2400 Metabolic Measurement Systems (Parvo Medics Inc) portable gas exchange system for stress testing
  • Hexagonal dumbbells (8 to 15 lbs)
  • Heavy duty bench for free-weight exercises
  • Dynamometers:
  • Takei TKK 5002 Type-2 Back-Leg Dynamometer
  • Hand-Grip Dynamometers:
  • Lafayette 78010 hand dynamometer
  • Takei 1857 electronic grip dynamometer

The telephone number for this laboratory is 212 523-4194.

Publications
Copyright 2010, New York Obesity Nutrition Research Center. 
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