Assessing abdominal fatness with local bioimpedance analysis: basics and experimental findings

Impedance Analysis to Evaluate Nutritional Status in Physiological and Pathological Conditions

A thorough knowledge of body composition assessment techniques is the cornerstone for initiating a customized nutritional program. The second step is to consider the potential of their application in different physiological and pathological conditions and their effectiveness in the management of a monitoring pathway during dietary interventions. To date, bioimpedance analysis is the most effective and reliable method for assessing body composition due to its advantages in terms of speed of execution, non-invasiveness and low cost. Therefore, this review article aims to analyze the main concepts and application areas of bioimpedance measurement techniques, in particular vector frequency-based analysis (BIVA) systems, in order to assess their validity in both physiological and pathological conditions.

Elastic Textile Wristband for Bioimpedance Measurements

In this paper, wristband electrodes for hand-to-hand bioimpedance measurements are investigated. The proposed electrodes consist of a stretchable conductive knitted fabric. Different implementations have been developed and compared with Ag/AgCl commercial electrodes. Hand-to-hand measurements at 50 kHz on forty healthy subjects have been carried out and the Passing-Bablok regression method has been exploited to compare the proposed textile electrodes with commercial ones. It is demonstrated that the proposed designs guarantee reliable measurements and easy and comfortable use, thus representing an excellent solution for the development of a wearable bioimpedance measurement system.

Accuracy of Y-scope, a newly developed portable abdominal impedance analyzer, for the assessment of abdominal visceral fat area

Aim

This study was conducted to evaluate the accuracy of a newly developed multifrequency segmental (MFS) bioelectrical impedance analysis (BIA) method using an additional portable abdominal (PA) impedance analyzer, in the assessment of abdominal visceral fat area (VFA).

Materials and methods

One hundred healthy Korean subjects aged 19 years or over (43 men and 57 women) were recruited, and VFA was estimated by a conventional MFS-BIA machine and a new MFS-BIA machine with a PA-BIA device, indicating MFS-VFA and MFS&PA-VFA, respectively. The accuracy of the VFA values was compared with those evaluated with CT at the level of the umbilicus (CT-VFA).

Results

The mean age was 41 years and mean body mass index (BMI) was 24.4 kg/m². The mean ± SD VFAs measured by CT, conventional MFS-BIA, and new MFS&PA-BIA together were 93.4 ± 60.9, 92.7 ± 53.4, and 93.6 ± 55.4 cm², respectively. Correlation coefficients comparing CT-VFA with MFS-VFA and MFS&PA-VFA were 0.612 and 0.932, respectively (P < 0.001 for both). The mean difference between CT-VFA and MFS&PA-VFA was less affected by age, sex, and BMI compared with that between CT-VFA and MFS-VFA. Intraclass correlation coefficient (95% CI) between CT-VFA and MFS&PA-VFA was also greater than that between CT-VFA and MFS-VFA, 0.96 (0.95–0.98) vs. 0.76 (0.64–0.84), respectively.

Conclusion

In this study, application of a newly developed MFS-BIA machine combined with a PA-BIA device significantly improved the correlation with CT-measured VFA without proportional error. This novel approach using advanced technology may be able to provide more reliable estimates of abdominal VFA.

Measurement of visceral fat and abdominal obesity by single-frequency bioelectrical impedance and CT: a cross-sectional study

OBJECTIVES

The measurement of visceral fat (VF) is clinically important for the identification of individuals at high risk of visceral obesity-related health conditions. Bioelectrical impedance analysis (BIA) is a widely available and frequently used body composition assessment method, but there have been few validation studies for the measurement of VF. This validation study investigated agreement between BIA and CT for the assessment of VF in adults.

DESIGN

Cross-sectional study.

SETTING

Between 2015 and 2016 in China.

PARTICIPANTS

A total of 414 adults (119 men and 295 women) aged 40-82 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

CT-visceral fat area (VFA) was derived at the L2-3 and umbilicus level and VFA cut-offs for visceral obesity applied. BIA measurements of visceral fat level were compared with CT VFA findings using scatter plots and receiver operator characteristic (ROC) curves.

RESULTS

Scatter plots showed poor agreement between BIA and CT-derived visceral fat measurements in both sexes (R=0.387-0.636). ROC curves gave optimum figures for sensitivity and specificity of 65% and 69% in women and 76% and 70% in men, respectively, for BIA to discriminate between adults with normal levels of VF and those with visceral obesity determined by CT.

CONCLUSION

BIA has limited accuracy for the assessment of VF in adults in practice when compared with the criterion method.

Visceral Fat Area by Abdominal Bioelectrical Impedance Analysis as a Risk of Obstructive Sleep Apnea

This is the first study to evaluate directly visceral fat area (VFA) using a visceral fat (VF) meter by the abdominal bioelectrical impedance analysis (A-BIA) method in obstructive sleep apnea (OSA) patients diagnosed with polysomnography (PSG). The purpose of this study is to clarify (1) whether VFA measurement using a VF meter by the A-BIA method is possible even in a private clinic without burdening patients and staff and (2) how much VFA affects OSA compared to body mass index (BMI). Even without a computed tomography scan, which is the gold standard for VFA measurement, a VF meter could analyze patients by the A-BIA method and easily measure VFA. Therefore, it could be used safely even in a private sleep clinic, with very little burden on the patients and the medical staff. We investigated the association between OSA and VFA in 133 OSA patients. Multiple regression analysis revealed that VFA (β = 0.28; P = 0.020) was a stronger coexisting factor for OSA than age, male gender, or BMI (β = 0.26; P = 0.032) in all OSA patients. In the OSA patients with VF accumulation, only VFA was a significant component of OSA severity (β = 0.36; P = 0.006). The A-BIA method instrument could become a useful device for the evaluation of VF accumulation in OSA patients in private sleep clinics. VF accumulation should be recognized as an important risk factor as well as a known risk factor for OSA.

Impedance Spectroscopy and ac Conductivity in Ba0.5Sr0.5TiO3-Ca10(PO4)6(OH)2 Ceramic Composites: An Electrical Approach to Unveil Biocomposites

We report bioceramic composites of varying concentrations of Ba_0.5Sr_0.5TiO₃ (BST) and Ca₁₀(PO₄)₆(OH)₂ (HAP) for the analysis of electrical properties. The motivation is to predict the suitability of the composites for bio-electrets or the practical possibility in designing electro-active scaffolds. X-ray diffraction (XRD) and field-emission scanning electron microscopy (FESEM) are used to analyze the microstructural evolution of the composites. A systematic variation in the grain and crystallite sizes is noticed from the FESEM and XRD, along with the presence of Sr₅(PO₄)₃(OH) (SAP). The temperature and frequency variations of the dielectric properties of the composites are studied. Modeling of the dielectric properties with the microstructural properties and at. % of the monolith BST is presented. Cole-Cole formalism is adopted to model the electrical behavior of the synthesized composites. Furthermore, the ac conductivity analysis reveals that Mott's variable range hopping (VRH) conduction is the most appropriate formalism that successfully describes the conduction process. The established Mott's VRH is also related to the polarization mechanisms active in the specimens. Our study projects a correlation between the electrical and biological properties by predicting the protein adsorption behavior from the perspective of impedance spectroscopy.

Standing 8-Electrode Bioelectrical Impedance Analysis as an Alternative Method to Estimate Visceral Fat Area and Body Fat Mass in Athletes

Purpose

To investigate the potential of standing 8-electrode bioelectrical impedance analysis (BIA) for assessing visceral fat area (VFA) and body fat mass (BFM) in athletes.

Materials and Methods

A total of 95 subjects (50 males and 45 females) were recruited. VFA and BFM measurements were obtained using three standing 8-electrode BIA devices, InBody230, InBody770, and IOI353. These acquired VFA and BFM were expressed as VFA_IOI353, VFA_InBody230, VFA_InBody770 V, BFM_IOI353, BFM_InBody230, and BFM_InBody770, respectively. As reference measurement, the VFA acquired from computer tomography (CT) was expressed as VFA_CT, and the BFM measured by dual-energy X-ray absorptiometry (DXA) was denoted as BFM_DXA.

Results

The coefficient of determination (r²) in regression analysis between the measurements by VFA_IOI353, VFA_InBody230, VFA_InBody770 and VFA_CT were 0.425, 0.492, and 0.473, respectively. Also, the limits of agreement (LOA) obtained from Bland–Altman analysis were −25.18 to 56.62, −29.74 to 62.44, and −32.96 to 71.93 cm². For BFM, r² in regression analysis between the measurements by BFM_IOI353, BFM_InBody230, BFM_InBody770 and BMF_DXA were 0.894, 0.950, and 0.955, respectively; LOA were −7.21 to 5.75, −4.70 to 4.05, and −5.48 to 3.05 kg, respectively.

Conclusion

The results showed when assessing BFM, these instruments delivered comparable measurements, and the degree of agreement ranged from excellent to moderate compared with the reference method. However, when assessing VFA, the agreements were weak. Therefore, the application of standing 8-electrode BIA devices for assessing athletes’ VFA still needs improvement.

Urine Specific Gravity Effect on Total and Segmental Body Composition Validity of Multifrequency Bioelectrical Impedance Analysis Compared With Dual Energy X-Ray Absorptiometry

ABSTRACT

Fleck, SJ, Hayes, A, Stadler, G, Goesch, T, Goldammer, M, and Braun, S. Urine specific gravity effect on total and segmental body composition validity of multifrequency bioelectrical impedance analysis compared with dual energy x-ray absorptiometry. J Strength Cond Res 35(2): 373-384, 2021-The purposes were to compare body composition measures between a specific multifrequency bioelectrical impedance analyzer (InBody770) and dual-energy x-ray absorptiometry (DXA) and determine if hydration status within a specified range affected these measures. Methods included determining urine specific gravity before testing. Urine specific gravity needed to be within typical well-hydrated (n = 37), euhydrated (n = 45), or slightly dehydrated (n = 20) ranges. Segmental and total body composition measures were determined with the InBody770 and by DXA within the same testing session. Paired sample t-tests revealed significant differences (p < 0.005) between InBody770 and DXA for all body composition variables for all 3 hydration statuses, except for trunk fat-free mass (FFM) and trunk fat mass (FM) of the well-hydrated and euhydrated groups and right leg FM and trunk FFM of the slightly dehydrated group. For the total sample (n = 102), InBody770 significantly underestimated total body FM, right arm FFM, left arm FFM, right leg FFM, and left leg FFM with the range of underestimation being between 0.16 and 2.87 kg. The total body FFM by InBody770 was overestimated by 2.33 ± 2.80 kg or 3.6%. Bland-Altman plots supported these results. The major conclusions are that differences between the InBody770 and DXA segmental and total body FFM and FM are not significantly affected by hydration status in the range investigated, and the FM and FFM determined by the 2 devices are generally significantly different.

Sarcopenic obesity derived from PET/CT predicts mortality in lymphoma patients undergoing hematopoietic stem cell transplantation

BACKGROUND

Sarcopenic Obesity (SO) is associated with worse survival among chemotherapy recipients. Research on SO is scarce among lymphoma patients receiving Hematopoietic Stem Cell Transplantation (HSCT).

AIM

assess prevalence of SO pre-HSCT (T0) and 3 months post-HSCT (T1) in lymphoma patients and determine the power of SO at T0 and T1 in predicting survival.

METHODS

Consecutive patients (age ≥16 years) having B and T cell lymphoma who underwent SCT and who had PET/CT scan pre-SCT and 3 months post SCT were included in the study. A cross sectional image was analyzed at the level of the 3rd Lumber Vertebrae to assess body composition parameters.

RESULTS

93 patients [mean age: 38 (range: 17-70 years), 52 (55.9%) males, 45 (48%) Hodgkin and 48 (52%) Non-Hodgkin lymphoma, 81 (87%) autologous and 12 (13%) allogeneic SCT)] met the inclusion criteria. From T0 to T1, Sarcopenia rates increased (27% at T0 to 38% at T1, p = 0.013), Visceral adiposity decreased (46% at T0 to 30% at T1, p = 0.03) and SO decreased (42% at T0 to 20% at T1, p < 0.01). Length of stay, overall survival and progression free survival were significantly better in patients without sarcopenic obesity at T1. Cox-regression revealed SO at T1 was a risk factor for mortality [Adjusted Hazards Ratio = 8.2 (95% Confidence Interval: 1.9-36.2)].

CONCLUSION

Sarcopenic obesity, prevalent in 42% of patients pre-HSCT, decreased 3 months post HSCT as lymphoma patients lost skeletal muscle and visceral adipose tissues. SO at T1 was the most impactful risk factor for mortality.

Novel and Simple Ultrasonographic Methods for Estimating the Abdominal Visceral Fat Area

OBJECTIVES

To evaluate the abdominal visceral fat area (VFA), we developed novel ultrasonographic (US) methods for estimating.

METHODS

100 male volunteers were recruited, and their VFA was calculated by two novel US methods, the triangle method and the ellipse method. The VFA calculated by these methods was compared with the VFA calculated by CT.

RESULTS

Both the VFA calculated by the triangle method (r = 0.766, p < 0.001) and the ellipse method (r = 0.781, p < 0.001) showed a high correlation coefficient with the VFA calculated by CT. Also, the VFA calculated by our novel methods were significantly increased in subjects with one or more metabolic risk factors than in those without any risk factors. Furthermore, the correlation coefficients obtained using the two methods were enhanced by the addition of multiple regression analysis (with the triangle method, r = 0.8586, p < 0.001; with the ellipse method, r = 0.8642, p < 0.001).

CONCLUSIONS

The VFA calculated by the triangle or ellipse method showed a high correlation coefficient with the VFA calculated by CT. These US methods are easy to use, they involve no radiation exposure, and the measurements can be conducted frequently. We hope that our simple methods would be widely adopted for the evaluation of VFA.

Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ablations (RFAs) for SIJ pain. We report our pain-clinic experience with peripheral nerve field stimulation (PNFS) for two patients of intractable SIJ pain. They had reported absence of long-term pain relief (pain relief >50% for at least 2 weeks postinjection and at least 3 months post-RFA) with SIJ injections and SIJ RFAs. Two parallel permanent 8-contact subcutaneous stimulating leads were implanted under the skin overlying their painful SIJ. Adequate stimulation in the entire painful area was confirmed. For implantable pulse generator placement, a separate subcutaneous pocket was made in the upper buttock below the iliac crest level ipsilaterally. During the pain-clinic follow-up period, the patients had reduced their pain medications requirements by half with an additional report of more than 50% improvement in their functional status. The first patient passed away 2 years after the PNFS procedure due to medical causes unrelated to his chronic pain. The second patient has been comfortable with PNFS-induced analgesic regimen during her pain-clinic follow-up during last 5 years. In summary, PNFS can be an effective last resort option for SIJ pain wherein conventional interventional pain techniques have failed, and analgesic medication requirements are escalating or causing unwarranted side-effects.

Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area

OBJECTIVES

To compare the accuracy of abdominal visceral fat area (VFA) measurements between abdominal dual bioelectrical impedance analysis (BIA) and whole-body BIA referenced to computed tomography (CT) measures.

METHODS

Abdominal VFAs were measured in 102 individuals: 59 men and 43 women with a mean age of 44.2 ± 16.3 years (range 21 - 76), body mass index 23.9 ± 7.8 kg/m(2) (range 18 - 35) using a DUALSCAN HDS-2000 machine (dual abdominal BIA) and an InBody720 machine (whole-body BIA). The VFA values from each machine were compared with those from CT under various conditions.

RESULTS

Mean abdominal VFAs were 116 ± 69 cm(2) by CT, 89 ± 47 cm(2) by dual abdominal BIA, and 84 ± 33 cm(2) by whole-body BIA. The former measure showed a higher correlation with the CT measure than the latter (r=0.89 vs. r=0.64, P<0.001). Both BIA methods tended to underestimate abdominal VFAs compared with CT scans when CT VFA was not small. The dual abdominal BIA had less bias than the whole-body BIA in the assessment of VFAs. The whole-body BIA was affected by subcutaneous fat area.

CONCLUSIONS

Dual BIA was more accurate in assessing abdominal VFA than whole-body BIA.

Comparison of total and segmental body composition using DXA and multifrequency bioimpedance in collegiate female athletes

The purpose of this investigation was to determine the agreement between multifrequency bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DXA) for measuring body fat percentage (BF%), fat-free mass (FFM), and total body and segmental lean soft tissue (LST) in collegiate female athletes. Forty-five female athletes (age = 21.2 ± 2.0 years, height = 166.1 ± 7.1 cm, weight = 62.6 ± 9.9 kg) participated in this study. Variables measured through BIA and DXA were as follows: BF%, FFM, and LST of the arms (ARMS(LST)), the legs (LEGS(LST)), the trunk (TRUNK(LST)), and the total body (TOTAL(LST)). Compared with the DXA, the InBody 720 provided significantly lower values for BF% (-3.3%, p < 0.001) and significantly higher values for FFM (2.1 kg, p < 0.001) with limits of agreement (1.96 SD of the mean difference) of ±5.6% for BF% and ±3.7 kg for FFM. No significant differences (p < 0.008) existed between the 2 devices (InBody 720-DXA) for ARMS(LST) (0.05 kg), TRUNK(LST) (0.14 kg), LEGS(LST) (-0.4 kg), and TOTAL(LST) (-0.21 kg). The limits of agreement were ±0.79 kg for ARMS(LST), ±2.62 kg for LEGS(LST), ±3.18 kg for TRUNK(LST), and ±4.23 kg for TOTAL(LST). This study found discrepancies in BF% and FFM between the 2 devices. However, the InBody 720 and DXA appeared to provide excellent agreement for measuring total body and segmental LST. Therefore, the InBody 720 may be a rapid noninvasive method to assess LST in female athletes when DXA is not available.

Normal-weight obesity is associated with increased risk of subclinical atherosclerosis

BACKGROUND

Subjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). In this study, we aimed to evaluate whether NWO individuals have higher rates of subclinical atherosclerosis compared to NWL subjects.

METHODS

From a large-scale health checkup system, we identified 2078 normal weight (18.5 ≤ BMI < 25 kg/m(2)) subjects with no previous history of coronary artery disease who underwent analysis of atherosclerosis using coronary computed tomography angiography (CCTA) and pulse wave velocity (PWV). NWO was defined as normal BMI and highest tertile of body fat percentage by sex (men ≥ 25. 4 % and women ≥ 31.4 %). CCTA was performed using a 64-detector row CT. A plaque was defined as a structure >1 mm(2) within and/or adjacent to the vessel lumen and classified according to the presence/proportion of intraplaque calcification.

RESULTS

NWO subjects (n = 283) demonstrated metabolic dysregulation compared to NWL individuals (n = 1795). After adjusting for age, sex, and smoking, NWO individuals showed higher PWV values than NWL individuals (1474.0 ± 275.4 vs. 1380.7 ± 234.3 cm/s, p = 0.006 by ANCOVA). Compared with NWL subjects, NWO subjects had a higher prevalence of soft plaques even after age, sex, and smoking adjustment (21.6% vs. 14.5%, p = 0.039 by ANCOVA). The PWV value and the log{(number of segments with plaque) + 1} showed a positive correlation with numerous parameters such as age, systolic blood pressure, visceral fat, fasting glucose level, serum triglyceride level, and C-reactive protein (CRP) in contrast to the negative correlation with high-density lipoprotein-cholesterol level. The visceral fat was an independent determinant of log{(number of segments with plaque) + 1} (ß = 0.027, SE = 0.011, p = 0.016) even after adjustment for other significant factors. Most importantly, NWO was an independent risk factor for the presence of soft plaques (odds ratio 1.460, 95 % confidence interval 1.027-2.074, p = 0.035) even after further adjustment for multiple factors associated with atherosclerosis (blood pressure, blood glucose, lipid level, CRP, medication, smoking status, physical activity).

CONCLUSIONS

NWO individuals carry a higher incidence of subclinical atherosclerosis compared with NWL individuals, regardless of other clinical risk factors for atherosclerosis.

Subclinical vascular inflammation in subjects with normal weight obesity and its association with body fat: an 18 F-FDG-PET/CT study

Background

Although body mass index (BMI) is the most widely accepted parameter for defining obesity, recent studies have indicated a unique set of patients who exhibit normal BMI and excess body fat (BF), which is termed as normal weight obesity (NWO). Increased BF is an established risk factor for atherosclerosis. However, it is unclear whether NWO subjects already have a higher degree of vascular inflammation compared to normal weight lean (NWL) subjects; moreover, the association of BF with vascular inflammation in normal weight subjects is largely unknown.

Methods

NWO and NWL subjects (n = 82 in each group) without any history of significant vascular disease were identified from a 3-year database of consecutively recruited patients undergoing ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸ F-FDG-PET/CT) at a self-referred Healthcare Promotion Program. The degree of subclinical vascular inflammation was evaluated using the mean and maximum target-to-background ratios (TBRmean and TBRmax) of the carotid artery, which were measured by ¹⁸ F-FDG-PET/CT (a noninvasive tool for assessing vascular inflammation).

Results

We found that metabolically dysregulation was greater in NWO subjects than in NWL subjects, with a significantly higher blood pressure, higher fasting glucose level, and worse lipid profile. Moreover, NWO subjects exhibited higher TBR than NWL subjects (TBRmean: 1.33 ± 0.16 versus 1.45 ± 0.19, p < 0.001; TBRmax: 1.52 ± 0.23 versus 1.67 ± 0.25, p < 0.001). TBR was significantly associated with total BF (TBRmean: r = 0.267, p = 0.001; TBRmax: r = 0.289, p < 0.001), age (TBRmean: r = 0.170, p = 0.029; TBRmax: r = 0.165, p = 0.035), BMI (TBRmean: r = 0.184, p = 0.018; TBRmax: r = 0.206, p = 0.008), and fasting glucose level (TBRmean: r = 0.157, p = 0.044; TBRmax: r = 0.182, p = 0.020). In multiple linear regression analysis, BF was an independent determinant of TBRmean and TBRmax, after adjusting for age, BMI, and fasting glucose level (TBRmean: regression coefficient = 0.020, p = 0.008; TBRmax: regression coefficient = 0.028, p = 0.005). Compared to NWL, NWO was also independently associated with elevated TBRmax values, after adjusting for confounding factors (odds ratio = 2.887, 95% confidence interval 1.206–6.914, p = 0.017).

Conclusions

NWO is associated with a higher degree of subclinical vascular inflammation, of which BF is a major contributing factor. These results warrant investigations for subclinical atherosclerosis in NWO patients.

Obstructive sleep apnea and metabolic syndrome in spanish population

Obstructive sleep apnea (OSA) is a clinical picture characterized by repeated episodes of obstruction of the upper airway. OSA is associated with cardiovascular risk factors, some of which are components of metabolic syndrome (MS).

OBJECTIVES

First, determine the prevalence of MS in patients with OSA visited in sleep clinic. Second, evaluate whether there is an independent association between MS components and the severity of OSA.

METHODS

Patients with clinical suspicion of OSA were evaluated by polysomnography. Three groups were defined according to apnea hypoapnea index (AHI): no OSA (AHI <5), mild-moderate (AHI≥ 5 ≤30), and severe (AHI> 30). All patients were determined in fasting blood glucose, total cholesterol, HDL cholesterol, triglycerides and insulin. MS was defined according to criteria of National Cholesterol Education Program (NCEP).

RESULTS

A total of 141 patients (mean age 54 ± 11 years) were evaluated. According to AIH, 25 subjects had no OSA and 116 had OSA (41mild-moderate and 75 severe). MS prevalence ranged from 43-81% in OSA group. Also, a significant increase in waist circumference, triglycerides, glucose, blood pressure levels, and a decrease in HDL cholesterol levels was observed in more severe OSA patients. All polysomnographic parameters correlated significantly with metabolic abnormalities. After a multiple regression analysis, abdominal obesity (p <0.02), glucose (p <0.01) and HDL cholesterol (p <0.001) were independently associated with OSA.

CONCLUSIONS

Our findings show high prevalence of MS in OSA, especially in severe group. A significant association between OSA and some of the components of MS was found in Spanish population.

A Design Based on Bioimpedance Spectroscopy Method in Human Abdominal Adipose Measurement System

This article describes a measurement of human abdominal fat device designed based on BIS (bioimpedance spectroscopy), the device adopts four electrodes multi-frequency bioelectrical impedance measurement system, including the programmable signal generator module and the amplitude and phase detection module. Program controlled signal generator module can generate the high output impedance of the constant current source in the eight frequency points constant current source between 5KHz and1MHz; amplitude phase detecting module can detect the human body electrical impedance real part and imaginary part information. Therefore, the device can be accurate measurement of human abdominal impedance information in the whole frequency range. Meanwhile, according to the selected electrode fixed position and the appropriate measurement scheme, can calculate the corresponding depth of abdominal fat content.

Visceral adiposity as a target for the management of the metabolic syndrome

Atherosclerosis, the underlying cause of atherosclerotic cardiovascular disease (ACVD), develops due not only to a single cardiovascular risk factor but to a variety of complex factors. The concept of the multiple cardiometabolic risk factor clustering syndrome has been proposed as a highly atherogenic state, independent of hypercholesterolemia and smoking. Body fat distribution, especially visceral fat accumulation, is a major correlate of a cluster of diabetogenic, atherogenic, prothrombotic, and proinflammatory metabolic abnormalities referred to as the metabolic syndrome, with dysfunctional adipocytes and dysregulated production of adipocytokines (hypoadiponectinemia). Medical research has focused on visceral adiposity as an important component of the syndrome in Japanese subjects with a mild degree of adiposity compared with Western subjects. For the prevention of ACVD at least in Japan, it might be practical to stratify subjects with multiple risk factors for atherosclerotic cardiovascular disease based on visceral fat accumulation. Visceral fat reduction through health promotion programs using risk factor-oriented approaches may be effective in reducing ACVD events, as well as producing improvement in risks and hypoadiponectinemia. This review article discusses visceral adiposity as a key player in the syndrome. Visceral fat reduction with life-style modification is a potentially useful strategy in the prevention of ACVD in patients with the metabolic syndrome.

Determination of abdominal fat thickness using dual electrode separation in the focused impedance method (FIM)

Subcutaneous fat layer thickness in the abdomen is a risk indicator of several diseases and disorders like diabetes and heart problems and could be used as a measure of fitness. Skinfold measurement using mechanical calipers is simple but prone to error. Ultrasound scanning techniques are yet to be established as accurate methods for this purpose. magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide the answer but are expensive and not available widely. Some initiatives were made earlier to use electrical impedance to this end, but had inadequacies. In the first part of this paper, a 4-electrode focused impedance method (FIM) with different electrode separations has been studied for its possible use in the determination of abdominal fat thickness in a localized region. For this, a saline phantom was designed to provide different electrode separations and different layers of resistive materials adjacent to the electrodes. The background saline simulated the internal organs having low impedance while the resistive layers simulated the subcutaneous fat. The plot of the measured impedance with electrode separation had different 'slopes' for different thicknesses of resistive layers, which offered a method to obtain an unknown thickness of subcutaneous fat layer. In the second part, measurements were performed on seven human subjects using two electrode separations. Fat layer thickness was measured using mechanical calipers. A plot of the above 'slope' against fat thickness could be fitted using a straight line with an R(2) of 0.93. Then this could be used as a calibration curve for the determination of unknown fat thickness. Further work using more accurate CT and MRI measurements would give a better calibration curve for practical use of this non-invasive and low-cost technique in abdominal fat thickness measurement.

The relationship between physical work and the height premium: finnish evidence

This paper examines the role of physical strength in the determination of the height wage premium by using the "Health 2000 in Finland" data that contain both self-reported information on the physical strenuousness of work, and information on muscle mass from medical examinations. The results suggest that there are generally no distinct differences in the height premium between four different work strain categories. We also find that muscle mass is positively associated with wages per se. The premium is both statistically and economically more significant for men than for women. In terms of occupational sorting, we observe that the shortest men do physically very demanding work and the tallest do sedentary work, even after controlling for the influences of age and education.

Practical human abdominal fat imaging utilizing electrical impedance tomography

The fundamental cause of metabolic syndrome is thought to be abdominal obesity. Accurate diagnosis of abdominal obesity can be done by an x-ray computed tomography (CT) scan. But CT is expensive, bulky and entails the risks involved with radiation. To overcome such disadvantages, we attempted to develop a measuring device that could apply electrical impedance tomography to abdominal fat imaging. The device has 32 electrodes that can be attached to a subject's abdomen by a pneumatic mechanism. That way, electrode position data can be acquired simultaneously. An applied alternating current of 1.0 mArms was used at a frequency of 500 kHz. Sensed voltage data were carefully filtered to remove noise and processed to satisfy the reciprocal theorem. The image reconstruction software was developed concurrently, applying standard finite element methods and the Marquardt method to solve the mathematical inverse problem. The results of preliminary experiments showed that abdominal subcutaneous fat and the muscle surrounding the viscera could be imaged in humans. While our imaging of visceral fat was not of sufficient quality, it was suggested that we will be able to develop a safe and practical abdominal fat scanner through future improvements.

Estimating visceral fat area by multifrequency bioelectrical impedance

OBJECTIVE

We developed a new method of estimating visceral fat area (VFA) using multifrequency bioelectrical impedance (BI).

RESEARCH DESIGN AND METHODS

We considered abdominal composition as a parallel circuit model composed of VFA and subcutaneous fat area and calculated the impedance of VFA (IP(VFA)) from this model. The methods were tested against measures of VFA by computed tomography (CT). Multiple regression analysis was performed on 103 participants to estimate VFA. We cross-validated the regression equation against CT-measured VFA in 30 additional participants.

RESULTS

The regression equation was VFA = 3.57 x sagittal abdominal diameter + 311.97 x waist-to-height ratio + 0.71 x age + 23.93 x sex + 1.57 x IP(VFA) (250 kHz) - 174.35 (r = 0.904, P < 0.01). We observed a strong correlation by cross-validation (r = 0.905).

CONCLUSIONS

Our method using BI is a simple and convenient method for accurately estimating VFA.

Can abdominal bioelectrical impedance refine the determination of visceral fat from waist circumference?

Ryo et al (2005 Diabetes Care 28 451-3) reported a new method for measuring the visceral fat area (VFA) by combining abdominal bioelectrical impedance analysis (BIA) with measurement of waist circumference (WC), but very few methodological details were provided. Furthermore, the study did not test the use of WC alone as an indicator of VFA even though others had previously reported a strong correlation. We sought to determine the optimal measurement technique and analysis for measuring VFA by abdominal BIA and WC. 18 volunteers (age 23-64 years) underwent measurement of WC, abdominal impedance (Bodystat 500 four-electrode system) and a single cross-sectional CT scan at the umbilicus. VFA derived using WC(3) and measurements of abdominal impedance from electrode pairs sited at the flank predicted the value of VFA measured by CT with correlation r = 0.904 (p < 0.0001); the optimizing power of WC was 3.3 (r = 0.905). However, the use of WC(1.9) alone, without involving BIA at all, provided a similar correlation (r = 0.923). Our small preliminary study shows that abdominal BIA is potentially a practicable non-invasive technique for measurement of VFA but casts doubt on whether it adds any value to the use of WC alone. Larger studies are now required to test this finding.

Obesity and labour market success in Finland: the difference between having a high BMI and being fat

This paper examines the relationship between obesity and labour market success in Finland, using various indicators of individual body composition along with body mass index (BMI). Weight, height, fat mass and waist circumference are measured by health professionals. We find that only waist circumference has a negative association with wages for women, whereas no obesity measure is significant in the linear wage models for men. However, all measures of obesity are negatively associated with women's employment probability and fat mass is negatively associated with men's employment probability. We also find that the use of categories for waist circumference and fat mass has a substantial influence on the results. For example, the category for high fat mass is associated with roughly 5.5% lower wages for men. All in all, the results indicate that in the absence of measures of body composition, there is a risk that labour market penalties associated with obesity are measured with bias.

Is bioelectrical impedance accurate for use in large epidemiological studies?

Percentage of body fat is strongly associated with the risk of several chronic diseases but its accurate measurement is difficult. Bioelectrical impedance analysis (BIA) is a relatively simple, quick and non-invasive technique, to measure body composition. It measures body fat accurately in controlled clinical conditions but its performance in the field is inconsistent. In large epidemiologic studies simpler surrogate techniques such as body mass index (BMI), waist circumference, and waist-hip ratio are frequently used instead of BIA to measure body fatness. We reviewed the rationale, theory, and technique of recently developed systems such as foot (or hand)-to-foot BIA measurement, and the elements that could influence its results in large epidemiologic studies. BIA results are influenced by factors such as the environment, ethnicity, phase of menstrual cycle, and underlying medical conditions. We concluded that BIA measurements validated for specific ethnic groups, populations and conditions can accurately measure body fat in those populations, but not others and suggest that for large epdiemiological studies with diverse populations BIA may not be the appropriate choice for body composition measurement unless specific calibration equations are developed for different groups participating in the study.

Absolute conductivity reconstruction in magnetic induction tomography using a nonlinear method

Magnetic induction tomography (MIT) attempts to image the electrical and magnetic characteristics of a target using impedance measurement data from pairs of excitation and detection coils. This inverse eddy current problem is nonlinear and also severely ill posed so regularization is required for a stable solution. A regularized Gauss-Newton algorithm has been implemented as a nonlinear, iterative inverse solver. In this algorithm, one needs to solve the forward problem and recalculate the Jacobian matrix for each iteration. The forward problem has been solved using an edge based finite element method for magnetic vector potential A and electrical scalar potential V, a so called A, A - V formulation. A theoretical study of the general inverse eddy current problem and a derivation, paying special attention to the boundary conditions, of an adjoint field formula for the Jacobian is given. This efficient formula calculates the change in measured induced voltage due to a small perturbation of the conductivity in a region. This has the advantage that it involves only the inner product of the electric fields when two different coils are excited, and these are convenient computationally. This paper also shows that the sensitivity maps change significantly when the conductivity distribution changes, demonstrating the necessity for a nonlinear reconstruction algorithm. The performance of the inverse solver has been examined and results presented from simulated data with added noise.

Development of methods for body composition studies

This review is focused on experimental methods for determination of the composition of the human body, its organs and tissues. It summarizes the development and current status of fat determinations from body density, total body water determinations through the dilution technique, whole and partial body potassium measurements for body cell mass estimates, in vivo neutron activation analysis for body protein measurements, dual-energy absorptiometry (DEXA), computed tomography (CT) and magnetic resonance imaging (MRI, fMRI) and spectroscopy (MRS) for body composition studies on tissue and organ levels, as well as single- and multiple-frequency bioimpedance (BIA) and anthropometry as simple easily available methods. Methods for trace element analysis in vivo are also described. Using this wide range of measurement methods, together with gradually improved body composition models, it is now possible to quantify a number of body components and follow their changes in health and disease.

Fat and Hydration Monitoring by Abdominal Bioimpedance Analysis: Data Interpretation by Hierarchical Electrical Modeling

In a previous publication, it was demonstrated that the abdominal subcutaneous fat layer thickness (SFL) is strongly correlated with the abdominal electrical impedance when measured with a transversal tetrapolar electrode arrangement. This article addresses the following questions: 1) To which extent do different abdominal compartments contribute to the impedance? 2) How does the hydration state of tissues affect the data? 3) Can hydration and fat content be assessed independently? For simulating the measured data a hierarchical electrical model was built. The abdomen was subdivided into three compartments (subcutaneous fat, muscle, mesentery). The true anatomical structure of the compartment boundaries was modeled using finite-element modeling (FEM). Each compartment is described by an electrical tissue model parameterized in physiological terms. Assuming the same percent change of the fat fraction in the mesentery and the SFL the model predicts a change of 1,24 omega/mm change of the SFL compared to 1,1 omega/mm measured. 42% of the change stem from the SFL, 56% from the mesentery and 2% from changes of fat within the muscle compartment. A 1% increase of the extracellular water in the muscle is not discernible from a 1% decrease of the SFL. The measured data reflect not only the SFL but also the visceral fat. The tetrapolar electrode arrangement allows the measurement of the abdominal fat content only if the hydration remains constant.

Bioelectrical impedance analysis-part II: utilization in clinical practice

BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.

Body composition modeling in the calf using an equivalent circuit model of multi-frequency bioimpedance analysis

An equivalent electrical circuit model is used to describe the response of different tissue components in the calf to multi-frequency current. This model includes seven electrical components: skin resistance, contact capacitance, fat resistance, fat capacitance, extracellular resistance, intracellular resistance and cell membrane capacitance. Calf bioimpedance was measured on 30 pts using a multi-frequency bioimpedance device (Xitron 4200) with a range of frequency from 5 kHz to 1000 kHz. MRI was performed on each measured calf to provide body composition components: fat, muscle mass and bone. An equivalent circuit containing seven parameters (P1, P2, P3, P4, Q1, Q2, Q3) was constructed to represent the model. To identify the effect of different body compositions on their parameters, subjects were subgrouped according to (1) their range of fat mass: F1>0.4 kg, F2>0.4 & F2<0.25 kg and F3<0.25 kg; (2) their range of muscle mass: M1>1.2 kg, M2<1.2 & M2>1.0 kg and M3<0.25 kg. Curve fitting and simulation programs (Matlab Toolbox) were used to obtain the solution of the electrical equations. The results show a decrease in impedance with an increase in excitation frequency that differed among subjects with different fat contents. Simulation results show a high correlation (R2>0.98) between the bioimpedance measurements and the value calculated from the model. There are significant differences in parameters P1 (32.5+/-5.9 versus 26+/-4.4, p<0.05), P3 (-15,330+/-3352 versus -10,973+/-3448, p<0.05) and P4 (42,640 versus 24,191, p<0.05) between groups F1 and F3. P2 is significantly different (1045+/-442 versus 1407+/-349, p<0.05) between groups M1 and M2. The parameters that characterize the bioimpedance data depend upon many more tissue characteristics of electrical properties than those incorporated in current models and they are affected by aspects of body composition that are not considered in the fitting of bioimpedance data. This study shows a new model and methodology to analyze bioimpedance data and further work is likely to lead to much better understanding of electrical properties of body tissue.

Influência da gordura corporal no controle clínico e metabólico de pacientes com diabetes mellitus tipo 2

Avaliamos a influência da gordura corporal (GC) determinada por bioimpedância, índice de massa corpórea (IMC) e a medida da cintura abdominal (CA) em determinadas variáveis clínicas e laboratoriais em 43 pacientes com diabetes tipo 2 (DM2), 26F/17M, pareados pela idade, com 13,6±9,1 anos de duração do DM. As mulheres apresentaram maior IMC: 30,3±5,4 vs. 26,9±2,9kg/m² (p= 0,04), GC: 35,4±6,2 vs. 19,6±6,2% (p= 0,000), níveis de colesterol total (CT): 235±41 vs. 204± 39mg/dL (p= 0,017), triglicerídeos (TG): 146± 61 vs. 116±57mg/dL (p= 0,06) e HbA1c (HPLC): 7,1±1,7 vs. 6,9±1,4% (p= 0,02) do que os homens, não havendo diferença entre HDL e LDL colesterol. A GC correlacionou-se significativamente com os níveis de TG, HbA1c, pressão arterial diastólica (PAD), IMC e CA. Na regressão múltipla com GC, CA e IMC como variáveis independentes e TG (r= 0,34; r²= 0,11; p= 0,02) e PAD (r= 0,39; r²= 0,15; p= 0,008) como dependentes, a GC foi a variável independente significativa. No mesmo modelo com a HBA1c como variável dependente, a GC (r= 0,31; r²= 0,10; p= 0,037) e o IMC (r= 0,43; r²= 0,19; p= 0,01) foram as variáveis significativas. Concluímos que o aumento da GC no paciente com DM2 constituiu um importante fator de risco para piora do controle metabólico e dos níveis tensionais. As mulheres, por terem tido maior percentual de GC e níveis de lipídios, devem ter uma abordagem mais agressiva e diferenciada para sua redução.

Segmental bioelectrical impedance analysis in children aged 8-12 y: 2. The assessment of regional body composition and muscle mass

OBJECTIVES

To investigate the potential of segmental bioelectrical impedance analysis (BIA) for assessing regional composition and muscle mass in children.

DESIGN

Strengths of relationships were determined between (a) BIA indices of trunk, limbs or limb segments and (b) segment fat or fat-free mass (FFM) assessed using dual-energy X-ray absorptiometry (DXA); the extent of agreement was established between two independent models, based on DXA and BIA, of limb muscle and adipose tissue (AT) mass.

SUBJECTS

Eighteen boys and 19 girls aged 8-12 y.

MEASUREMENTS

BIA and anthropometry of trunk, whole limbs, limb segments and defined sections were used to calculate segmental impedance indices and specific resistivities; segment fat and FFM were obtained using DXA; muscle and AT masses of limbs, segments and sections were estimated using DXA and BIA models, and by anthropometry.

RESULTS

Segmental BIA indices were significantly related to composition of the segments assessed using DXA; although substantial bias was observed, there was fairly good agreement (low 95% limits of agreement) between the BIA and DXA models of muscle mass and estimates from each were similarly categorised in tertiles, as were estimates of AT.

CONCLUSION

Segmental BIA appears to have potential for assessing in children the composition of body segments, as obtained using DXA, and the masses of muscle and AT in whole limbs, limb segments and defined sections.

Methods of assessing body shape and composition in HIV-associated lipodystrophy

Although HIV-associated lipodystrophy can be diagnosed just from clinical examination, criteria for diagnosis and judgement of severity are not clearly defined. Clinical assessment can be systematized with questionnaires for patients and physicians. Computed tomography, nuclear magnetic imaging and dual-energy X-ray absorptiometry are objective reference methods but are expensive for routine follow-up and diagnosis. Therefore, anthropometry and other non-invasive bedside methods deserve further validation studies.