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Archives of Osteoporosis

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01-12-2018 | Original Article

Combination of DXA and BIS body composition measurements is highly correlated with physical function—an approach to improve muscle mass assessment

Authors: Adam J. Kuchnia, Yosuke Yamada, Levi Teigen, Diane Krueger, Neil Binkley, Dale Schoeller

Published in: Archives of Osteoporosis | Issue 1/2018

Abstract

Summary

Rationale: Fluid volume estimates may help predict functional status and thereby improve sarcopenia diagnosis. Main Result: Bioimpedance-derived fluid volume, combined with DXA, improves identification of jump power over traditional measures. Significance: DXA-measured lean mass should be corrected for fluid distribution in older populations; this may be a surrogate of muscle quality.

Purpose

Sarcopenia, the age-related loss of muscle mass and function, negatively impacts functional status, quality of life, and mortality. We aimed to determine if bioimpedance spectroscopy (BIS)-derived estimates of body water compartments can be used in conjunction with dual-energy X-ray absorptiometry (DXA) measures to aid in the prediction of functional status and thereby, ultimately, improve the diagnosis of sarcopenia.

Methods

Participants (≥ 70 years) had physical and muscle function tests, DXA, and BIS performed. Using a BMI correction method, intracellular water (ICW_c), extracellular water (ECW_c), and ECW_c to ICW_c (E/I_c) ratio was estimated from standard BIS measures. Jump power was assessed using jump mechanography.

Results

The traditional measure used to diagnose sarcopenia, DXA-derived appendicular lean mass (ALM) corrected for height (ALM/ht²), was the least predictive measure explaining jump power variability (r² = 0.31, p < 0.0001). The best measure for explaining jump power was a novel variable combining DXA ALM and BIS-derived E/I_c ratio (ALM/(E/I_c); r² = 0.70, p < 0.0001). ALM/(E/I_c) and ICW_c had the highest correlation with jump power and grip strength, specifically jump power (r = 0.84 and r = 0.80, respectively; p < 0.0001).

Conclusions

The creation of a novel variable (ALM/(E/I_c)) improved the ability of DXA to predict jump power in an older population. ALM/(E/I_c) substantially outperformed traditional lean mass measures of sarcopenia and could well be an improved diagnostic approach to predict functional status. DXA-measured ALM should be corrected for fluid distribution, i.e., ALM/(E/I_c); this correction may be considered a surrogate of muscle quality.

Dawson-Hughes B, Bischoff-Ferrari H (2016) Considerations concerning the definition of sarcopenia. Osteoporos Int 27:3139–3144. https://doi.org/10.1007/s00198-016-3674-8 CrossRefPubMedPubMedCentral

Janssen I, Heymsfield SB, 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. https://doi.org/10.1046/j.1532-5415.2002.50216.x CrossRefPubMed

Perez-Zepeda MU, Sgaravatti A, Dent E (2017) Sarcopenia and post-hospital outcomes in older adults: a longitudinal study. Arch Gerontol Geriatr 69:105–109. https://doi.org/10.1016/j.archger.2016.10.013 CrossRefPubMed

Manrique-Espinoza B, Salinas-Rodríguez A, Rosas-Carrasco O, Gutiérrez-Robledo LM, Avila-Funes JA (2017) Sarcopenia is associated with physical and mental components of health-related quality of life in older adults. J Am Med Dir Assoc 18:636.e1–636.e5. https://doi.org/10.1016/j.jamda.2017.04.005 CrossRef

Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, onder G (2012) Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr 31:652–658. https://doi.org/10.1016/j.clnu.2012.02.007 CrossRefPubMed

World Health Organization (2015) World Report on Ageing and Health

Trombetti A, Reid KF, Hars M, Herrmann FR, Pasha E, Phillips EM, Fielding RA (2016) Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life. Osteoporos Int 27:463–471. https://doi.org/10.1007/s00198-015-3236-5.Age-associated CrossRefPubMed

Lustgarten MS, Fielding RA (2011) Assessment of analytical methods used to measure changes in body composition in the elderly and recommendations for their use in phase II clinical trials. J Nutr Health Aging 15:368–375. https://doi.org/10.1007/s12603-011-0049-x CrossRefPubMedPubMedCentral

Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM, Kiel DP, Kritchevsky SB, Shardell MD, Dam TTL, Vassileva MT (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. Journals Gerontol - Ser A Biol Sci Med Sci 69(A):547–558. https://doi.org/10.1093/gerona/glu010 CrossRef

10.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis. Age Ageing 39:412–423. https://doi.org/10.1093/ageing/afq034 CrossRefPubMedPubMedCentral

11.

Fielding R, Vellas B, Evans W et al (2012) Sarcopenia:an undiagnosed condition in older adults. Consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc 12:249–256. https://doi.org/10.1016/j.jamda.2011.01.003.Sarcopenia CrossRef

12.

Krueger D, Siglinsky E, Buehring B, Binkley N (2017) Total body less head measurement is most appropriate for lean mass assessment in adults. J Clin Densitom 20:128–129. https://doi.org/10.1016/j.jocd.2016.08.068 CrossRefPubMed

13.

Chamney PW, Wabel P, Moissl UM, et al (2007) A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 85:80–89 .CrossRefPubMed

14.

Yamada Y, Schoeller DA, Nakamura E, Morimoto T, Kimura M, Oda S (2010) Extracellular water may mask actual muscle atrophy during aging. Journals Gerontol - Ser A Biol Sci Med Sci 65 A:510–516. https://doi.org/10.1093/gerona/glq001 CrossRef

15.

Yamada Y, Buehring B, Krueger D, Anderson RM, Schoeller DA, Binkley N (2017) Electrical properties assessed by bioelectrical impedance spectroscopy as biomarkers of age-related loss of skeletal muscle quantity and quality. J Gerontol A Biol Sci Med Sci 72:1180–1186. https://doi.org/10.1093/gerona/glw225 CrossRefPubMed

16.

Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, Korth O, Müller MJ, Ellegård L, Malmros V, Kaitwatcharachai C, Kuhlmann MK, Zhu F, Fuller NJ (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933. https://doi.org/10.1088/0967-3334/27/9/012 CrossRefPubMed

17.

Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB, for the Health ABC Study (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol Med Sci 61:1059–1064. https://doi.org/10.1093/gerona/61.10.1059 CrossRef

18.

Marcelli D, Usvyat LA, Kotanko P, Bayh I, Canaud B, Etter M, Gatti E, Grassmann A, Wang Y, Marelli C, Scatizzi L, Stopper A, van der Sande FM, Kooman J, on behalf of the MONitoring Dialysis Outcomes (MONDO) Consortium (2015) Body composition and survival in dialysis patients: results from an international cohort study. Clin J Am Soc Nephrol 10:1192–1200. https://doi.org/10.2215/CJN.08550814 CrossRefPubMedPubMedCentral

19.

Chamney PW, Krämer M, Rode C, Kleinekofort W, Wizemann V (2002) A new technique for establishing dry weight in hemodialysis patients via whole body bioimpedance. Kidney Int 61:2250–2258. https://doi.org/10.1046/j.1523-1755.2002.00377.x CrossRefPubMed

20.

Kuchnia A, Earthman C, Teigen L, Cole A, Mourtzakis M, Paris M, Looijaard W, Weijs P, Oudemans-van Straaten H, Beilman G, Day A, Leung R, Compher C, Dhaliwal R, Peterson S, Roosevelt H, Heyland DK (2016) Evaluation of bioelectrical impedance analysis in critically ill patients: results of a multicenter prospective study [Epub ahead of print]. J Parenter Enter Nutr 41:1131–1138. https://doi.org/10.1177/0148607116651063 CrossRef

21.

Itobi E, Stroud M, Elia M (2006) Impact of oedema on recovery after major abdominal surgery and potential value of multifrequency bioimpedance measurements. Br J Surg 93:354–361. https://doi.org/10.1002/bjs.5259 CrossRefPubMed

22.

Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S (2015) Prognostic value of grip strength: findings from the prospective urban rural epidemiology (PURE) study. Lancet 386:266–273. https://doi.org/10.1016/S0140-6736(14)62000-6 CrossRefPubMed

23.

Studenski S, Perera S, Patel K (2011) Gait speed and survival in older adults. Jama 305:50–58. https://doi.org/10.1001/jama.2010.1923.Gait CrossRefPubMedPubMedCentral

24.

Siglinsky E, Krueger D, Ward RE et al (2015) Effect of age and sex on jumping mechanography and other measures of muscle mass and function. J Musculoskelet Neuronal Interact 15:301–308PubMedPubMedCentral

25.

Buehring B, Siglinsky E, Krueger D, Evans W, Hellerstein M, Yamada Y, Binkley N (2018) Comparison of muscle / lean mass measurement methods : correlation with functional and biochemical testing. Osteoporos Int 29:675–683CrossRefPubMed

26.

Menant JC, Weber F, Lo J, Sturnieks DL, Close JC, Sachdev PS, Brodaty H, Lord SR (2017) Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Osteoporos Int 28:59–70. https://doi.org/10.1007/s00198-016-3691-7 CrossRefPubMed

27.

Metter EJ (2004) Arm-cranking muscle power and arm isometric muscle strength are independent predictors of all-cause mortality in men. J Appl Physiol 96:814–821. https://doi.org/10.1152/japplphysiol.00370.2003 CrossRefPubMed

28.

Buehring B, Krueger D, Fidler E, Gangnon R, Heiderscheit B, Binkley N (2015) Reproducibility of jumping mechanography and traditional measures of physical and muscle function in older adults. Osteoporos Int 26:819–825. https://doi.org/10.1007/s00198-014-2983-z CrossRefPubMed

29.

Edwards MH, Buehring B (2015) Novel approaches to the diagnosis of sarcopenia. J Clin Densitom 18:472–477. https://doi.org/10.1016/j.jocd.2015.04.010 CrossRefPubMed

30.

Kuchnia AJ, Teigen LM, Cole AJ, Mulasi U, Gonzalez MC, Heymsfield SB, Vock DM, Earthman CP (2016) Phase angle and impedance ratio: reference cut-points from the United States National Health and nutrition examination survey 1999–2004 from bioimpedance spectroscopy data [epub ahead of print]. J Parenter Enter Nutr 41:1310–1315. https://doi.org/10.1177/0148607116670378 CrossRef

31.

Wadsworth CT, Krishnan R, Sear M et al (1987) Interrater reliability of manual muscle testing and hand-held dynamometric muscle testing. Phys Ther 9:1342–1347CrossRef

32.

Mathiowetz V, Weber K, Volland G, Kashman N (1984) Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 9:222–226. https://doi.org/10.1016/S0363-5023(84)80146-X CrossRefPubMed

33.

McGregor RA, Cameron-Smith D, Poppitt SD (2014) It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life. Longev Heal 3:9. https://doi.org/10.1186/2046-2395-3-9 CrossRef

34.

Wang Z, St-Onge M-P, Lecumberri B, Pi-Sunyer FX, Heshka S, Wang J, Kotler DP, Gallagher D, Wielopolski L, Pierson RN Jr, Heymsfield SB (2004) Body cell mass: model development and validation at the cellular level of body composition. Am J Physiol Endocrinol Metab 286:E123–E128. https://doi.org/10.1152/ajpendo.00227.2003 CrossRefPubMed

35.

Moore F, Olesen K, McMurrey J et al (1963) The body cell mass and its supporting environment, Philadelphia

36.

Wang Z, Deurenberg P, Wang W et al (1999) Hydration of fat-free body mass: new physiological modeling approach. Am J Phys 276:E995–E1003CrossRef

37.

Taniguchi M, Yamada Y, Fukumoto Y, Sawano S, Minami S, Ikezoe T, Watanabe Y, Kimura M, Ichihashi N (2017) Increase in echo intensity and extracellular-to-intracellular water ratio is independently associated with muscle weakness in elderly women. Eur J Appl Physiol 117:1–7. https://doi.org/10.1007/s00421-017-3686-x CrossRef

38.

Yamada Y, Yoshida T, Yokoyama K, Watanabe Y, Miyake M, Yamagata E, Yamada M, Kimura M, Kyoto-Kameoka Study (2016) The extracellular to intracellular water ratio in upper legs is negatively associated with skeletal muscle strength and gait speed in older people. J Gerontol - Ser A Biol Sci Med Sci 72:293–298. https://doi.org/10.1093/gerona/glw125 CrossRef

39.

Matias CN, Santos DA, Gonçalves EM, Fields DA, Sardinha LB, Silva AM (2013) Is bioelectrical impedance spectroscopy accurate in estimating total body water and its compartments in elite athletes? Ann Hum Biol 40:152–156. https://doi.org/10.3109/03014460.2012.750684 CrossRefPubMed

40.

Matias CN, Júdice PB, Santos DA, Magalhães JP, Minderico CS, Fields DA, Sardinha LB, Silva AM (2016) Suitability of bioelectrical based methods to assess water compartments in recreational and elite athletes. J Am Coll Nutr 35:413–421. https://doi.org/10.1080/07315724.2015.1058198 CrossRefPubMed

41.

Tuuri G, Keenan MJ, West KM et al (2005) Body water indices as markers of aging in male masters swimmers. J Sport Sci Med 4:406–414

42.

Tengvall M, Ellegård L, Malmros V, Bosaeus N, Lissner L, Bosaeus I (2009) Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr 28:52–58. https://doi.org/10.1016/j.clnu.2008.10.005 CrossRefPubMed

43.

Schoeller DA (2000) Bioelectrical impedance analysis. What does it measure? Ann N Y Acad Sci 904:159–162 . doi: 10.1111/j.1749-6632.2000.tb06441.xCrossRef

44.

Kyle U, Genton L, Hans D (2001) Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years. Eur J 55:663–672

45.

Silva AM (2005) Extracellular water: greater expansion with age in African Americans. J Appl Physiol 99:261–267. https://doi.org/10.1152/japplphysiol.01317.2004 CrossRefPubMed

Title: Combination of DXA and BIS body composition measurements is highly correlated with physical function—an approach to improve muscle mass assessment
Authors: Adam J. Kuchnia
Yosuke Yamada
Levi Teigen
Diane Krueger
Neil Binkley
Dale Schoeller
Publication date: 01-12-2018
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2018
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-018-0508-7

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Springer Medicine

Combination of DXA and BIS body composition measurements is highly correlated with physical function—an approach to improve muscle mass assessment

Abstract

Summary

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

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