Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

Assessment of muscle mass (MM) or its proxies, lean tissue mass (LTM) or fat-free mass (FFM), is an integral part of the diagnosis of protein-energy wasting (PEW) and sarcopenia in patients on hemodialysis (HD). Both sarcopenia and PEW are related to a loss of functionality and also increased morbidity and mortality in this patient population. However, loss of MM is a part of a wider spectrum, including inflammation and fluid overload. As both sarcopenia and PEW are amendable to treatment, estimation of MM regularly is therefore of major clinical relevance. Whereas, computer-assisted tomography (CT) or dual-energy X-ray absorptiometry (DXA) is considered a reference method, it is unsuitable as a method for routine clinical monitoring. In this review, different bedside methods to estimate MM or its proxies in patients on HD will be discussed, with emphasis on biochemical methods, simplified creatinine index (SCI), bioimpedance spectroscopy (BIS), and muscle ultrasound (US). Body composition parameters of all methods are related to the outcome and appear relevant in clinical practice. The US is the only parameter by which muscle dimensions are measured. BIS and SCI are also dependent on either theoretical assumptions or the use of population-specific regression equations. Potential caveats of the methods are that SCI can be influenced by residual renal function, BIS can be influenced by fluid overload, although the latter may be circumvented by the use of a three-compartment model, and that muscle US reflects regional and not whole body MM. In conclusion, both SCI and BIS as well as muscle US are all valuable methods that can be applied for bedside nutritional assessment in patients on HD and appear suitable for routine follow-up. The choice for either method depends on local preferences. However, estimation of MM or its proxies should always be part of a multidimensional assessment of the patient followed by a personalized treatment strategy.

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A Systematic Review with Meta-Analysis of the Effect of Resistance Training on Whole-Body Muscle Growth in Healthy Adult Males

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17041285 ◽

2020 ◽

Vol 17 (4) ◽

pp. 1285 ◽

Cited By ~ 1

Author(s):

Pedro J. Benito ◽

Rocío Cupeiro ◽

Domingo J. Ramos-Campo ◽

Pedro E. Alcaraz ◽

Jacobo Á. Rubio-Arias

Keyword(s):

Systematic Review ◽

Resistance Training ◽

Muscle Mass ◽

Meta Analysis ◽

Muscle Growth ◽

Fat Free Mass ◽

Muscle Size ◽

Whole Body ◽

Cochrane Library ◽

Significant Variable

We performed a systematic review and meta-analysis to study all published clinical trial interventions, determined the magnitude of whole-body hypertrophy in humans (healthy males) and observed the individual responsibility of each variable in muscle growth after resistance training (RT). Searches were conducted in PubMed, Web of Science and the Cochrane Library from database inception until 10 May 2018 for original articles assessing the effects of RT on muscle size after interventions of more than 2 weeks of duration. Specifically, we obtain the variables fat-free mass (FMM), lean muscle mass (LMM) and skeletal muscle mass (SMM). The effects on outcomes were expressed as mean differences (MD) and a random-effects meta-analysis and meta-regressions determined covariates (age, weight, height, durations in weeks…) to explore the moderate effect related to the participants and characteristics of training. One hundred and eleven studies (158 groups, 1927 participants) reported on the effects of RT for muscle mass. RT significantly increased muscle mass (FFM+LMM+SMM; Δ1.53 kg; 95% CI [1.30, 1.76], p < 0.001; I2 = 0%, p = 1.00). Considering the overall effects of the meta-regression, and taking into account the participants’ characteristics, none of the studied covariates explained any effect on changes in muscle mass. Regarding the training characteristics, the only significant variable that explained the variance of the hypertrophy was the sets per workout, showing a significant negative interaction (MD; estimate: 1.85, 95% CI [1.45, 2.25], p < 0.001; moderator: -0.03 95% CI [−0.05, −0.001] p = 0.04). In conclusion, RT has a significant effect on the improvement of hypertrophy (~1.5 kg). The excessive sets per workout affects negatively the muscle mass gain.

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Activin-type II receptor B (ACVR2B) and follistatin haplotype associations with muscle mass and strength in humans

Journal of Applied Physiology ◽

10.1152/japplphysiol.01322.2006 ◽

2007 ◽

Vol 102 (6) ◽

pp. 2142-2148 ◽

Cited By ~ 30

Author(s):

Sean Walsh ◽

E. Jeffrey Metter ◽

Luigi Ferrucci ◽

Stephen M. Roth

Keyword(s):

Skeletal Muscle ◽

Genetic Variation ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Fat Free Mass ◽

Negative Regulator ◽

Interindividual Variation ◽

Whole Body ◽

Haplotype Structure ◽

Type Ii

Genetic variation in myostatin, a negative regulator of skeletal muscle, in cattle has shown remarkable influence on skeletal muscle, resulting in a double-muscled phenotype in certain breeds; however, DNA sequence variation within this gene in humans has not been consistently associated with skeletal muscle mass or strength. Follistatin and activin-type II receptor B ( ACVR2B) are two myostatin-related genes involved in the regulation and signaling of myostatin. We sought to identify associations between genetic variation and haplotype structure in both follistatin and ACVR2B with skeletal muscle-related phenotypes. Three hundred fifteen men and 278 women aged 19–90 yr from the Baltimore Longitudinal Study of Aging were genotyped to determine respective haplotype groupings (Hap Groups) based on HapMap data. Whole body soft tissue composition was measured by dual-energy X-ray absorptiometry. Quadriceps peak torque (strength) was measured using an isokinetic dynamometer. Women carriers of ACVR2B Hap Group 1 exhibited significantly less quadriceps muscle strength (shortening phase) than women homozygous for Hap Group 2 (109.2 ± 1.9 vs. 118.6 ± 4.1 N·m, 30°/s, respectively, P = 0.036). No significant association was observed in men. Male carriers of follistatin Hap Group 3 exhibited significantly less total leg fat-free mass than noncarriers (16.6 ± 0.3 vs. 17.5 ± 0.2 kg, respectively, P = 0.012). No significant associations between these haplotype groups were observed in women. These results indicate that haplotype structure at the ACVR2B and follistatin loci may contribute to interindividual variation in skeletal muscle mass and strength, although these data indicate sex-specific relationships.

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Whole Body Protein Turnover in Chronically Undernourished Individuals

Clinical Science ◽

10.1042/cs0860441 ◽

1994 ◽

Vol 86 (4) ◽

pp. 441-446 ◽

Cited By ~ 35

Author(s):

M. J. Soares ◽

L. S. Piers ◽

P. S. Shetty ◽

A. A. Jackson ◽

J. C. Waterlow

Keyword(s):

Body Weight ◽

Protein Synthesis ◽

Metabolic Rate ◽

Muscle Mass ◽

Basal Metabolic Rate ◽

Normal Weight ◽

Fat Free Mass ◽

Whole Body ◽

Body Protein ◽

Chronic Undernutrition

1. Two groups of adult men were studied in Bangalore, India, under identical conditions: the ‘normal weight’ subjects (mean body mass index 20.8 kg/m2) were medical students of the institute with access to habitual energy and protein intakes ad libitum. The other group, designated ‘undernourished’, were labourers on daily wages (mean body mass index 16.7 kg/m2). 2. In an earlier study we obtained lower absolute values for both basal metabolic rate and protein synthesis in the undernourished subjects; however, when the data were expressed on a body weight or fat-free mass basis, a trend towards higher rates of protein synthesis, as well as higher basal metabolic rate, was evident. The suggestion was made that such results reflected the relatively higher energy intakes per kg body weight of the undernourished subjects on the day of study. The objective of the present study was therefore to control for the dietary intake during the measurement of whole body protein turnover. 3. In the present study dietary intakes were equated on a body weight basis; however, expressed per kg fat-free mass, the normal weight subjects had received marginally higher intakes of energy and protein. The results, however, were similar to those of the previous study. In absolute terms, basal metabolic rate, protein synthesis and breakdown were lower in the undernourished subjects. When expressed per kg body weight or per kg fat-free mass, the undernourished subjects had higher basal metabolic rates than the well-nourished subjects, whereas no differences were seen in the rate of protein synthesis or breakdown. 4. Estimates of muscle mass, based on creatinine excretion, indicated that the undernourished subjects had a higher proportion of non-muscle to muscle mass. Nitrogen flux (Q) was determined from 15N abundance in two end products, urea (Qu) and ammonia (Qa). The ratio Qu/Qa was increased in the undernourished subjects and was significantly correlated with the ratio of non-muscle to muscle mass (r = 0.81; P < 0.005). These results fit in with our earlier suggestion of a greater proportion of non-muscle (visceral) mass in undernourished subjects. 5. The present data suggest that there are no changes in the rate of protein synthesis or breakdown in chronic undernutrition when results are expressed, conventionally, per kg fat-free mass. It can be theoretically shown, however, that there could be a 15% reduction in the rate of turnover of the visceral tissues in chronic undernutrition. This, together with the reduced urinary nitrogen excretion, would contribute to nitrogen economy in these individuals.

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A New Formula for Population-Based Estimation of Whole Body Muscle Mass in Males

Canadian Journal of Applied Physiology ◽

10.1139/h97-039 ◽

1997 ◽

Vol 22 (6) ◽

pp. 598-608 ◽

Cited By ~ 25

Author(s):

Malcolm B. Doupe ◽

Alan D. Martin ◽

Mark S. Searle ◽

Dean J. Kriellaars ◽

Gordon G. Giesbrecht

Keyword(s):

Muscle Mass ◽

Predictive Ability ◽

Population Based ◽

Fat Free Mass ◽

Whole Body ◽

Male Cadaver ◽

Group A ◽

New Equation ◽

Group B ◽

New Formula

A new equation to estimate muscle mass in males was developed using parameters common to the 1981 Canada Fitness Survey and the male cadaver data of Martin et al. (1990b). The cadavers (N = 12) were randomly divided into two groups. The equation was developed on cadaver Group A and then validated on Group B. Once the equation with the most suitable variables was validated on Group B, it was redeveloped on combined data from Groups A and B. The final equation is as follows: muscle mass (gm) = Ht (0.031MUThG2 + 0.064CCG2 + 0.089CAG2) −3.006; adjusted R2 = .96, SEE = 1,488 gm, F = 87.5, p = .0001. Variables (in cm) were Ht, height; MUThG, modified upper thigh girth; CCG, corrected calf girth; and CAG, corrected arm girth. The predictive ability of this equation was comparable to the original equation of Martin et al. (1990b) and can be a valuable tool for muscle mass estimation of male subjects in the 1981 Canada Fitness Survey. Key words: equation, estimation, body composition, body fat, fat free mass, lean body mass, Canada Fitness Survey

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Total Body Potassium and Body Fat Estimation in Relationship to Height, Sex, Age, Malnutrition and Obesity

Clinical Science ◽

10.1042/cs0480431 ◽

1975 ◽

Vol 48 (5) ◽

pp. 431-440 ◽

Cited By ~ 2

Author(s):

C. J. Edmonds ◽

B. M. Jasani ◽

T. Smith

Keyword(s):

Body Weight ◽

Food Intake ◽

Body Fat ◽

Fat Free Mass ◽

Whole Body ◽

Regression Equations ◽

Total Body Potassium ◽

Normal Individuals ◽

Males And Females ◽

Total Body

1. Total body potassium was estimated by 40K measurement with a high-sensitivity whole-body counter in normal individuals over a wide age range and in patients who were obese or were grossly wasted as a result of various conditions which restricted food intake. 2. Potassium concentration (mmol/kg body weight) fell with increasing age over 30 years in both normal males and females, but when individuals of different age groups were matched for height, a significant fall in total body potassium with increasing age was observed only in males. Total body potassium of females was about 75% that of males of similar height when young, the sex difference decreasing with ageing. In the normal population, total body potassium was significantly correlated with height and with weight; regression equations for various relationships are given. 3. Fat-free mass was estimated from total body potassium, values of 65 and 56 mmol of potassium/kg fat-free mass being used for males and females respectively. Body fat estimated by this method correlated well with skinfold measurements over a wide range of body weight but in malnourished individuals having inadequate food intake there was considerable discrepancy and present formulae for estimating fat-free mass from total body potassium appear unsatisfactory in malnutrition. Considerable differences between expected and observed values of total body potassium were found in muscular individuals and in normal individuals who were thin but whose body weight was relatively constant. 4. The patients with malnutrition were low both in body fat as estimated by skinfold thickness and in total body potassium estimated on the basis of height. Plasma potassium was, however, normal and potassium supplements did not increase the total body potassium. 5. Total body potassium of obese individuals was not significantly different from that of normal weight individuals on the basis of height. Total body potassium fell on weight reduction with a very low energy diet of 1260 kJ (300 kcal.) daily but changed little with a 3300 kJ (800 kcal.) diet over several months' observation. 6. For overweight, obese individuals, total body potassium was best predicted from the individual's height. For those whose body weight was less than expected, the use of weight gave the best prediction but the error was considerable when the weight deviation was large.

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Effects of whole-body electromyostimulation on function, muscle mass, strength, social participation, and falls-efficacy in older people: A randomized trial protocol

PLoS ONE ◽

10.1371/journal.pone.0245809 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245809

Author(s):

Túlio Medina Dutra de Oliveira ◽

Diogo Carvalho Felício ◽

José Elias Filho ◽

João Luiz Quagliotti Durigan ◽

Diogo Simões Fonseca ◽

...

Keyword(s):

Muscle Mass ◽

Social Participation ◽

Positive Impact ◽

The Elderly ◽

Good Choice ◽

Fat Free Mass ◽

Whole Body ◽

Control Group ◽

Before And After ◽

Physical Limitations

Background Resistance training has a positive impact on functional capacity and muscle mass in the elderly. However, due to physical limitations or a simple aversion against regular exercise, a majority of the elderly do not reach the recommended exercise doses. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient, and smooth training technology on physical function, fat-free mass, strength, falls-efficacy, and social participation of the elderly. Methods The present study is a randomized, parallel group clinical trial approved by the Ethics Committee of our Institution. Sixty-six volunteers (age ≥ 60 years) will be recruited from the geriatric outpatient department in a tertiary hospital and primary care units and randomized into two groups: WB-EMS group or active control group (aCG). The WB-EMS or aCG protocol will consist of 16 sessions for 8 consecutive weeks, twice per week. The primary outcomes will be maximal isometric knee extension (IKE), functional lower extremity strength, fat-free mass, gait speed, and risk of falls measured before and after intervention. The secondary outcomes will be social participation and falls-efficacy assessed before and after the intervention and at three and six months of follow-up. Participant’s satisfaction with and awareness of electrical stimulation therapy will also be assessed immediately after the 8-week intervention. Discussion Patients receiving WB-EMS exercises are believed to have better outcomes than those receiving conventional, more time-consuming resistance exercises. Hence, innovative, time-efficient, joint-friendly, and highly individualized exercise technologies (such as WB-EMS) may be a good choice for the elderly with time constraints, physical limitations, or little enthusiasm, who are exercising less than the recommended amounts for impact on muscle mass, strength, and function.

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Whole Body Fat Free Mass and Vo2peak in Recreationally Active Men and Women

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5448.2020 ◽

2020 ◽

Vol 91 (2) ◽

pp. 102-105

Author(s):

Charles Paul Lambert

Keyword(s):

Muscle Mass ◽

Body Fat ◽

Cycle Ergometer ◽

Fat Free Mass ◽

Whole Body ◽

Men And Women ◽

Primary Driver ◽

Hydrostatic Weighing ◽

Verification Test ◽

Oxygen Difference

BACKGROUND: Vo2peak has traditionally been thought to be regulated by cardiac output and arteriovenous-oxygen difference. A “muscle-centric” view suggests the cardiovascular system is secondarily responsive to the primary driver: active muscle mass.METHODS: A total of 19 recreationally active men (N = 10) and women (N = 9) performed a Vo2peak test, a Vo2peak verification test on an electrically braked cycle ergometer on the same day, and a hydrostatic weighing test to assess fat free mass after providing written informed consent.RESULTS: Vo2peak was significantly higher in men (3.74 ± 0.6 L · min−1) than women (2.22 ± 0.30 L · min−1). Whole body fat free mass explained 91% of the variability in Vo2peak (R2 = 0.91) in the men and women combined, 81% of the variability in Vo2peak in men alone, and 46% of the variability in Vo2peak in women alone. None of these subjects were highly trained.DISCUSSION: Fat free mass, a surrogate for muscle mass, was the primary predictor of Vo2peak in this group of recreationally active men and women. Therefore, it appears that whole body fat free mass (a surrogate for muscle mass) is the primary driver for Vo2peak in these recreationally active men and women. These data have implications as to the type of training NASA personnel should be undertaking: resistance training as opposed to aerobic training.Lambert CP. Whole body fat free mass and Vo2peak in recreationally active men and women. Aerosp Med Hum Perform. 2020; 91(2):102–105.

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Abstract P177: Urine Creatinine Based Estimates of Fat Free Mass: The Rancho Bernardo Study

Circulation ◽

10.1161/circ.125.suppl_10.ap177 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Simerjot K Jassal ◽

Christina L Wassel ◽

Gail A Laughlin ◽

Elizabeth Barrett-Connor ◽

Dena E Rifkin ◽

...

Keyword(s):

Muscle Mass ◽

Older Persons ◽

Community Dwelling ◽

Fat Free Mass ◽

Regression Equations ◽

Limits Of Agreement ◽

Simple Method ◽

Spot Urine ◽

Urine Creatinine ◽

Highly Correlated

Background: Sarcopenia is difficult to identify without imaging. An accurate, easily obtainable screening tool would allow identification of older persons who might benefit from interventions to increase muscle mass. Urine creatinine excretion rate (CER) on 24-hour urine collections is highly correlated with muscle mass but collection is cumbersome. Spot urine creatinine (UCr) may also mark muscle mass, but is influenced by transient changes in urine tonicity. We previously developed a prediction equation to estimate CER (eCER) on 24-hour urine specimens. Whether this equation is associated with measures of muscle mass and whether spot UCr provides similar estimates to eCER is unknown. Methods: We measured spot UCr and fat free mass (FFM) by dual energy x-ray absorptiometry (DXA) among 1372 community-dwelling individuals. We used the equation developed in our prior study to estimate CER: eCER (mg/day) = 879.89 + 12.51*weight (kg) - 6.19*age + 34.51 if black - 379.42 if female. Spearman correlation coefficients and linear regression were used to determine strengths of association of eCER and spot UCr with FFM by DXA. Results: Mean (SD) age was 70 (11) years, 58% were women, and mean eGFR was 69 (15) ml/min/1.73m 2 . Mean values for FFM by DXA, eCER, and spot UCr were 47 (11) kg, 1107 (339) mg/day, and 94 (55) mg/dL, respectively. eCER was more strongly correlated with FFM by DXA (r = 0.93, p<0.001) than spot UCr (r = 0.39, p<0.001). Figure 1 shows the mean regression lines and 95% limits of agreement for the association of eCER (A) and spot UCr (B) with FFM; the 95% limits of agreement were narrower for eCER compared to spot UCr. The regression equations were: FFM (kg) = 13.21 + 0.03*eCER (mg/day) and FFM (kg) = 39.3 + 0.08* spot UCr (mg/dL). Conclusions: An equation incorporating age, weight, sex, and race to estimate CER was highly correlated with FFM by DXA and was more precise than spot UCr in community-dwelling older adults. Future studies should evaluate whether eCER provides a simple method to predict frailty and mortality in older persons.

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Skeletal Muscle Mass and Aging: Regional and Whole-Body Measurement Methods

Canadian Journal of Applied Physiology ◽

10.1139/h01-008 ◽

2001 ◽

Vol 26 (1) ◽

pp. 102-122 ◽

Cited By ~ 41

Author(s):

Robert C. Lee ◽

Zimian Wang ◽

Steven B. Heymsfield

Keyword(s):

Skeletal Muscle ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Nutritional Assessment ◽

Whole Body ◽

Imaging Methods ◽

Key Words Skeletal Muscle ◽

Body Counting ◽

Magnetic Resonance Imaging Mri

Skeletal muscle is a large compartment that can now be quantified using research and clinically applicable regional and whole-body methods. The most important advances are the two imaging methods, computed tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI can serve as regional and whole-body reference methods when evaluating other approaches for estimating skeletal muscle mass. Imaging methods also afford the opportunity to quantify both anatomic skeletal muscle and the smaller adipose-tissue free skeletal muscle component. Other available methods for estimating skeletal muscle, either regional or at the whole body level, include dual-energy x-ray absorptiometry, in vivo neutron activation analysis-whole body counting, anthropometry, ultrasound, bioimpedance analysis, and urinary metabolite markers. Each method is reviewed in the context of the aging process, cost, availability, practicality, and desired accuracy. New insights should be possible when skeletal muscle mass, measured using these methods, is combined with other descriptors of muscle biochemical and mechanical function. Key words: skeletal muscle mass, aging, nutritional assessment, function

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Estimation of body composition from bioelectrical impedance of body segments: Comparison with dual-energy X-ray absorptiometry

British Journal Of Nutrition ◽

10.1079/bjn19930066 ◽

1993 ◽

Vol 69 (3) ◽

pp. 645-655 ◽

Cited By ~ 52

Author(s):

S. P. Stewart ◽

P. N. Bramley ◽

R. Heighton ◽

J. H. Green ◽

A. Horsman ◽

...

Keyword(s):

Body Composition ◽

Muscle Mass ◽

Bioelectrical Impedance ◽

Dual Energy ◽

Fat Free Mass ◽

Whole Body ◽

Simple Method ◽

Creatinine Excretion ◽

X Ray ◽

Body Segments

In twenty-eight healthy subjects, ten men and eighteen women, with a range in body mass index (BMI) of 17.9–31.6 kg/m2 and an age range 20–60 years, body composition was estimated by dual-energy X-ray absorptiometry (DEXA), skinfold anthropometry (SFA) and bioelectrical impedance analysis (BIA) of the ‘whole body’and body segments. In thirteen subjects muscle mass was also estimated by 24 h urinary creatinine excretion. The relationship between fat-free mass (FFM) determined by DEXA and the impedance index of each body segment (calculated as Iength2/impedance (Z)) was analysed. The strongest correlation was between FFM (DEXA) and height2/‘whole-body’Z (Zw) (r 0.97 for the combined sexes, standard error of estimate (SEE) 2.72 kg). Separate prediction equations were found to be necessary for males and females when estimating FFM from BIA measurement of the arm (for men, r 0.93, SEE 1.98 kg; for women, r 0.75, SEE 2.87 kg). Muscle mass derived from 24 h creatinine excretion showed weak correlation with FFM (DEXA) (r 0.57, P = 0.03) and no correlation with FFM (SFA). FFM (SFA) correlated well with both FFM (DEXA) (r 0.96, SEE = 3.12 kg) and with height2/Zw (r 0.92, SEE 4.52 kg). Measurement of the impedance of the arm offers a simple method of assessing the composition of the whole body in normal individuals, and it appears comparable with other methods of assessment.

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