8-point Tactile Electrode Method
8-point tactile electrode method makes body composition analysis accurate and reproducible where electrodes touch hands and feet in 2 places for each, in a total of 8 points. This method measures the body divided in 5 segments (left and right arm, trunk, left and right leg), improving the reproducibility and accuracy. The common method, that utilizes 4-point electrodes, measures just a part of body (upper body or lower body) and it leads to a misinterpretation, while the 8-point tactile electrode method measures not just the whole body but all the 5 segments directly. This result minimizes the error and defines the body water composition and the level of muscle development. It helps patients and athletes that need accuracy in their measurements, and also it could be used perfectly in rehabilitative medicine or movement cure.
There are other methods to attach electrodes on body such as adhesive electrode system using pincers and ECG, but this tactile method is much easier in that it only requires barefoot up in the machine with hands holding the hand grip. It makes measurement start at the same spot on the wrist and on the ankles all the time enhancing data reproducibility.
8-point tactile electrode method is classified as tetra-polar method because it utilizes 4 electrodes at a time, selected automatically by an internal microprocessor.
Abdominal obesity is defined as a large waist size caused by fat concentration over the abdomen and back. It is also called ‘apple shape’ obesity, more commonly occurring in men. Persons with this kind of obesity are very likely to have other metabolic syndrome symptoms, including arteriosclerotic heart diseases, type-2-diabetes, and hyperlipidemia. According to WHO (World Health Organization), men with waist size>90cm and women with waist size>80cm are considered at the risk of abdominal obesity in Asia Pacific. The waist-hip ratio is another measurement method. There are two types of abdominal fat, subcutaneous fat and visceral fat, and the second one increases the risk of chronic diseases. At young age, more subcutaneous fat tends to accumulate whereas at middle-age, visceral fat tends to increase and affects body shape. It could be harmful to health. Continuous health examination is necessary to avoid these problems.
Accuracy and Reproducibility
Accuracy in general presents how close the measured value to the real value.
In body composition analysis, accuracy is an important factor in correct diagnosis and evaluation of treatment or methods. Comparison studies on accuracy of body composition analyzers are conducted against known gold standards methods, DEXA or underwater weighing. These two show relatively equal measurement.
Reproducibility is a factor that, together with accuracy, is utilized to evaluate the confidence of the device. It is similar to precision in that it evaluates whether numerous measurements, taken under the same condition, are close to one another.
Body composition analysis requires high accuracy as well as data reproducibility because patients have treatment for a long time, and each test must give the correct result to be compared with prior analysis.
In a common analogy, repeated measurements are compared to arrows that are fired at a target. Accuracy describes the closeness of arrows to the bull’s-eye at the target center. Arrows that strike closer to the bull’s-eye are considered more accurate. Precision would be the size of the arrow cluster. When all arrows are grouped tightly together, the cluster is considered precise since they all strike close to the same spot and this does not have to be near the bull’s-eye. The measurements are precise, though not necessarily accurate. However, it is not possible to reliably achieve accuracy without precision. If the arrows are not grouped close to one another, they can not all be adjusted to the bull’s-eye. These are essential components required in all good medical devices for correct analysis and treatment.
Active Metabolic Rate or thermal effect of exercise
The second largest contributor of 24-hour energy expenditure is the energy expended for muscular work, or thermic effect of exercise (TEE). Among all components of a healthy person’s 24-hour energy expenditure, this is the most variable. It depends of age, gender, type of activity, weight, hours in activity, and differences between individuals. It may accounts for about 15% to 20% of 24-hour energy expenditure but can be increased by two or more factors in regular, high-intensity, long-duration physical activity. Energy expended in exercise generally exceeds the REE in athletes who train several hours daily. Old persons have decreased physical activity, and it influences the energy expenditure. Also, obese persons have low energy expenditure, due to lack of exercise. This is one of the most important methods in obese treatment, increasing the resting energy expenditure by increasing the muscle quantity. After that, the energy from foods became lower than the expenditure, resulting in increase of weight loss. The more weight, more the energy expended, so obese persons have higher energy expenditure then normal persons. Therefore, during a treatment, physical activity has to be increased in obese persons, after certain weight loss.
World Health Organization (WHO) developed an equation predicting the daily energy expenditure in healthy persons. To calculate the estimation of 24-hour energy expenditure, the resting energy expenditure (REE) must be increased to account thermic effect of exercise (TEE). This is done multiplying REE with one of the activity factors, as shows in the table.
To estimate the 24-hour energy expenditure, the value for REE is then multiplied by activity factor that accounts the thermic effect of exercise. The 7th Korean RDA utilizes 1.31 for adults (20-49 years old) with light activities, 1.52 to adults with normal activities, 1.78 to men with vigorous activities and 1.68 for women.
The American College of Sports Medicine defines aerobic exercise as “any activity that uses large muscle groups that can be maintained continuously, and is rhythmic in nature”. The intake and expenditure volume of oxygen to produce energy becomes equal after the first 5 minutes of exercise. Jogging, running, swimming, bicycle, aerobic, marathon, etc. are examples of aerobic exercises.
The benefits of aerobic exercises include improvement of heart conditions, weight loss, mental health, immune system and stamina improvements, reduced risk of diseases, increased life span, improved muscle health and others. To better improvements, the heart rate is kept at the lower end of the target heart zone, or in other words, at 40-50% of maximum exercise capacity.
The Institute of Medicine (IOM) issued a report recommending that adults should spend at least 60 minutes in moderately intense physical activity every day of the week. But this frequency is individually different. Generally, normal adults exercise 3 times a week to improve the cardio respiratory resistance, and after that, the frequency has to be increased to 5 times a week to continuous improvement. Beginners should start with 5 minutes of exercise, 3-4 times a week. Persons that exercise more than 5 times a week should alternate body endurance exercises and other activities with less weight load, like swim or bicycle. Obese persons need more aerobic exercises, especially because after 30 minutes of exercise, the source of energy shifts from carbohydrates to fat, helping in body fat decreasing.
Bicycle exercises use legs, but the fat utilized is not just the fat concentrated in legs, but in all part of the body. That fat is degraded and used to product energy. Therefore, running or jogging is more adequate than sit-ups, and to improve the effects of exercise in obese persons that want to lose weight.
Obese persons need more aerobic exercises, because after 30 minutes of exercise, the source of energy shift from carbohydrates to fat, helping in fat burn and body fat decreasing.
In example, bicycle exercises use the legs, but the fat utilized is not just the fat concentrated in legs, but in all part of the body. That fat is degraded and used to product energy. So, running or jogging is better to lose weight in obese persons to improve the effects of exercise than sit-ups.
During anaerobic exercises, the anaerobic metabolism is increased, and oxygen is not used for energy production and a by-product, called lactic acid, is produced. It uses muscles at high intensity and high rate of work for a short period of time. Examples of anaerobic exercise include heavy weight lifting or short distance running that increases muscle strength. At the synthesis of adenosine triphosphate, it is known that 100% anaerobic or 100% aerobic exercises do not exist, and the division is determined by the rate of oxygen utilization. Trough exercise load test, the start point of anaerobic metabolism can be determined. In general population, this point begins at 55~70% of maximum volume of oxygen consumption.
Exercises performed closely to this point also improve the aerobic effects. Emphasis in aerobic exercise is important in obesity treatment, to increase the fat utilization as energy, but anaerobic exercise increase muscle quantity, which has strong correlation with basal metabolism. Both aerobic and anaerobic exercises are necessary to achieve good results.
Android Type Obesity
Android type of obesity is likened to the shape of an apple. The shoulders, face, arms, neck, chest and upper portion of the abdomen are bloated. The stomach gives a stiff appearance, also the arms, shoulders and breast. The back seems to be erect but the neck is compressed and the chest is protruding because of the bulk in the stomach. The lower portion of the body, hips, thighs and legs are thinner beyond proportion in comparison with the upper part. In these persons the vital organs affected will be mostly the heart, liver, kidneys and lungs.
This type of obesity is found more in males, but it is common in females too. Those females with this type of obesity are commonly under hormone treatment for their menstrual abnormalities or after childbirth, are more prone to this type of obesity. It occurs also in females around menopause due to thyroid gland’s functional disturbance. Females have more difficulties to reduce the excess than males. Waist-hip Ratio (Male: more than 0.90 / Female: more than 0.85) is utilized to the assessment of this type of obesity, and recently, waist circumference (Male: more than 100 cm/ Female: more than 90 cm) has been also utilized. Adolescents with this type of obesity are more exposed to diseases correlated to obesity, and needs more supervision because if they develop with the increased number of fat cells, they will be more difficult to improve.
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn’t get as much blood (hence as much oxygen) as it need. This usually happens because one or more of the heart’s arteries is narrowed or blocked. This disease usually results from an atherosclerosis. Also, there are some conditions that increase the risk of angina pectoris, like aging, smoking, high cholesterol, high blood pressure and diabetes. Typical angina is uncomfortable pressure, fullness, squeezing or pain in the center of the chest. The discomfort also may be felt in the neck, jaw, shoulder, back or arm. Many types of chest discomfort are not related to angina, like acid reflux and lung infection or inflammation.
Anthropometry quantifies body mass, provides a semiquantitative estimate of the components of body mass, particularly the bone, muscle, and fat compartments, and gives information concerning nutritional status. This is generally assessed by body weight, height, skeletal frame size, skinfold thickness, mid-arm muscle circumference, area, or diameter, or percent of the body mass, percent of usual body weight, percent of standard body weight, and BMI. Currently, it is utilized to diagnose obesity in clinical or epidemiological studies. It is a non- evasive, low price, easily performed measurement, but needs trained persons, and this reliability may be lower than other methods. Especially in old people or obese persons with low quantity of muscle, or athletes with high muscle quantity, this method may show wrong results.
These clinics are specialized in anti-aging treatment. It begins with investigation of disease, blood test, physical and nutritional assessment, body composition analysis and other questionnaires to find genetic disorders, general health conditions and lifestyle problems. This data is compared to the standard, and through this, the treatment direction is established, setting with exercise prescription, dietary modifications, and general changes in lifestyle through counseling. Treatments using growth hormone utilizes hormone supplementation, antioxidants administration, vitamins and minerals supplementation. The most utilized is telomeres treatment. Inside human DNA, telomere protects the DNA against impacts. This is reproduced by telomerase, but with age, this production decrease, and results in cell death. Telomerase is interdependent with growth hormone, so, some types like DHEA, Plegnenolone, Estrogen, Progesterone, female Testosterone, Thyroid Hormone, Meratonin Hormone, Human Growth Hormone, etc, is commonly utilized in anti-aging clinics.
Arm Circumference, AC
Arm Circumference (AC) is the circumference of the upper arm at the triceps skinfold site that is located midway between the lateral projection of the acromion process of the scapula and the olecranon process of the ulna, with the elbow flexed 90 degrees. The skin is grasped 1cm above and medial to the site along the axis, utilizing the Caliper. The arm circumference is measured with the subject standing, and the tape is placed around the arm, perpendicular to the long axis, at the level of the trixeps skinfold site. As an indicator of muscle and subcutaneous adipose tissue, it is an accepted measurement of nutritional status, together with arm muscle circumference. InBody uses the BIA principle and measures the circumference of body, utilizing the body impedance to figure out the total body shape by water volume measurement of each segment. Compared with the tape method, the correlation (r=0.948 SEE=1.25cm) showed excellent results, with high precision and reproducibility.
Arm Muscle Circumference, AMC
Arm Muscle Circumference (AMC) is calculated after measurement of the triceps skinfold site and the arm circumference (AC).
It is utilized as an index of lean tissue or muscle in the body, in example, arm muscle area. The arm muscle size is used to represent muscle protein reserves. It is an inexpensively and easily tool to collect nutritional status information and nutritional support responses.
InBody analyzes easily the arm muscle circumference without the necessity of triceps skinfold thickness measurement. It could be used to assessment of nutritional status.
Arthritis, in general terms, is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase of the fluid in the joints. Arthritis has multiple causes like in sore throat cases, with innumerous disease origins. Joint inflammation and arthritis are associated with many different illnesses. It is known that pains in lumbar parts and knee joints are intimately associated with increase in body fat. Long term support of heavy weight leads to degenerative arthritis.
Atherosclerosis comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). It is the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This build up is called plaque. It usually affects large and medium-sized arteries. Some hardening of arteries often occurs in old persons, due to their age.
Plaques can grow large enough to significantly reduce the blood’s flow through an artery. But most of the damage occurs when they become fragile and or when rupture. Plaques that rupture cause formation of blood clots that can block the blood flow or break off and travel to another part of the body. This reaction blocks a blood vessel that feeds the heart, causing heart attack. If it blocks a blood vessel that feeds the brain, it can cause stroke. And if any major blood supply to the arms or legs is reduced, it can cause difficulty to walk and far more, it can cause gangrene.
Basal Metabolic Rate
Basal metabolic rate is the lowest rate of energy required to meet the needs for basic function such as neurotransmissions, blood circulation, respiration, digestion, body temperature maintenance, and other cellular metabolisms. It is measured in rest, not asleep, for minimum 12 hours, with thermally neutral environment conditions of body. This rate is proportional to fat free mass quantity. Therefore, even of the same weight, individuals with less body fat mass and more quantity of muscle have greater basal metabolic rate.
There are three methods to expend energy: basal metabolism, thermic effect of food and voluntary activity. Energy expenditure by food consumption depends on digestion, distribution after absorption, and store, so this expenditure cannot be increased. Then, to lose weight it is necessary to increase the basal metabolism, or activity. Conducting an extremely low calorie diet without considering body fat quantity and lower basal metabolism can injure one’s health. Appropriate exercises, that increase muscle quantity and basal metabolism, are necessary to avoid diet’s side affects.
Bioelectrical Impedance Analysis
BIA (Bioelectrical Impedance Analysis) is a method to measure the body impedance by sending a low, safe electrical current through the body. The current passes only through fluids inside the body, and with obtained results, the volume of body water is calculated. Body water is usually inside muscle tissues, so through this, the fat free mass (FFM) is calculated.
The best advantage in using impedance is the high precision, accuracy and the convenience of the non-invasive method.
The limitation is the disadvantage of measuring the amount of body water accurately because it affects other results. For inside of body continuously changes, the body water content results in different values at each time. As such, the device must be accurate and analysis should be conducted under the same conditions at each measurement, to minimize errors.
Body Cell Mass
This is the total mass of all the cellular elements in the body which constitute all the metabolically active tissue of the body. They are constituents of muscle, and they are utilized as one of gold standards in nutritional assessment.
Usually, BMI or fat free mass could be utilized to nutritional assessment, but in patients with depletion of muscle, the body cell mass need to be measured to health evaluation. These patients have edema or other conditions that difficult the measurement of metabolically active tissues.
Body fat is considered an energy reserve, and deposited fat provides a number of other functions. It serves as a protective cushion and provides structural support to prevent injury to vital organs such as heart, liver, kidneys, and spleen. It also insulates the body from heat loss and extreme temperature changes and this deposits under the skin may be metabolized to generate heat in response to lower skin temperatures. Lipids yield 9 kcal of energy per gram while carbohydrates and proteins yield only 4 kcal of energy per gram. Most of the fat in food is in a form of triglyceride. Fatty acids are classified according to their degree of saturation as saturated, monounsaturated and polyunsaturated fatty acids. For these fatty acids are hydrophobic, they are transported in the blood in the form of lipoprotein.
Underwater weighing is considered one of the gold standards of body composition assessment. In this procedure, body density is calculated from body volume according to the Archimedes principle of displacement, which states that an object submerged in water is buoyed up by the weight of water displaced. Once body density has been determined, this value is converted to percent body fat through calculations.
Using electric methods to measure the body fat, it is known that electric current does not flow through body fat. So, the more fat in body, the more increase in resistance, utilizing BIA to measure. Fat is the most concentrated source of energy, and in excess, it may be harmful to health. Excess of body fat, higher than standard values adjusted to weight, is considered obesity, and it accumulates in abdomen or subcutaneously.
Body Mass Index, BMI
BMI is the body mass index, and it is calculated by weight above height square, showing obesity range. Generally, it is utilized to diagnose obesity in medical, nutritional, sports clinics, but shows errors when utilized to diagnose athletic persons, with increased muscle quantity, or child in growth stage, persons with more than 65 years, pregnant and nursing mothers. The classification may be different by year, sex and also by researcher. InBody uses the standard presented by World Health Organization (WHO) and by Korean Obesity Society to Asia and Asia Pacific.
InBody measures the BMI, and standardizes 22 for men and 21 for women, in the range 18.5- 24.9 generally.
Body surface area
Body surface area (BSA) is the measured or calculated surface of human body, used as an indicator of metabolic mass, with results less affected by abnormal adipose mass. In Asians, 1m2
results 35kcal/hr, approximately and general population has 15,000 ~ 20,000 cm2, in average.
Bone Mineral Contents
Minerals are micro components essential for good health. A large number of minerals are present in the body; calcium, sodium, potassium and many other trace elements. Calcium helps regulate muscle contraction and plays a role in neuronal transmission and blood clotting. It also forms part of structural components of bones and maintains the bone density. Bone minerals are absorbed and eliminated continually, with participation of the female sex hormone called estrogen. After menopause, decrease in this hormone may cause the rapid drop of bone mineral content resulting in development of osteoporosis.
Bone mineral content is proportional to muscle content in body thus, decrease in muscle mass is followed by loss of bone mineral content. The standard measure of bone mineral content is DEXA (Dual Energy X-ray Absorptiometry), and in BIA (Bioelectrical Impedance Analysis), it is calculated by regression methods.
Botulinum toxin is the product of Clostridium botulinum and there exit seven serologically distinct types of botulinum toxin: A, B, C1, D, E, F, and G. Botulinum toxin type A (Botox; Allergan, Irvine, CA) was identified in 1920 as its impure form, and its utility in medical field was spread by an ophthalmologist, Dr. Alan B. Scott. He confirmed that it could be used to correct strabismus for it efficiently represses extra ocular muscle contraction without any damages to injection sites or toxicity to the whole body. In 1970, he founded Oculinum Inc. In 1989, the Food and Drug Administration (FDA) approved its utilization for patients over 12 years old in treating dystonia and related diseases such as strabismal blepharospasmus. After that, Allergan Inc. took charge of Oculinum and named it Botoxⓡ.
In expanding of its clinical uses, its cosmetic effects were discovered as well. Botoxⓡ has been successfully used to improve the cosmetic appearance of glabellar frown lines and to treat muscular tonicity disorders such as muscles of mastication, muscular contraction of gastrocnemiusm, unilateral facial spasms, blepharospasm, torticollis (head and neck tremors), writer’s clamp, dystonia and myotonia, migraine, and hyperhidrosis (excessive sweating).
Brown Adipose Tissue
In general, only white adipose tissue is considered to be associated with fat. Despite the relatively small amount in fat portion, brown adipose tissue is both functionally and structurally different from white adipose tissue. It transfers energy from food into heat.
The followings are the two major functions of brown adipose tissue in a body.
- It generates heat from oxidative degradation of fat in organs controlling sympathetic nervous system, and protects the body from cold weather.
- It converts excessive energy stored in body into heat by thermic effect of food and releases it out of body acting as a protector against heat.
White adipose cells are filled with large fat droplets and their nucleus and cytoplasm are pressed down by neighbor tissues. On the other hand, brown adipose cells are filled with fat droplets and many mitochondria. Brown adipose tissue is deposited regions near axillae, the shoulder blades, kidney, heart, blood vessels and bone marrow.
It has been believed that accumulation of fat in white adipose tissue causes obesity due to excessive energy intake from overeating. However, studies on rodents have revealed that there is another cause of obesity other than excessive energy ingestion. It is when brown adipose tissue does not function properly. Conversion of chemical energy to heat energy by brown adipose tissue falls and extra energy is stored as fat leading to obesity. However, brown adipose tissue only constitutes 1% of total fat mass, and as people get older its amount decreases with infants having the greatest amount.
There have been studies on obesity related genes reporting that the obese have less amount of brown adipose tissue than the non-obese. Moreover, when brown adipose tissue is not functionally healthy, energy conversion to heat during days does not occur as much as it needs to consume extra energy. This is due to low basic metabolic rate (BMR) resulting in fat storage, thus having greater possibility of developing obesity.
This is a disease caused by uncontrolled growth of abnormal cells that have mutated from normal tissues. This growth can kill when these cells prevent normal function of vital organs or spread throughout the body, damaging essential systems. It’s is classified as carcinoma or sarcoma, accordingly to originate cell. There are multiple factors (oncogene) that cause cancer, like radiation, sunlight, tobacco, certain viruses, benzene, certain poisonous mushrooms and aflatoxins, but the most certain cause is the damage to DNA. The signs and symptoms depend on the size of the cancer, and they include unexplained weight loss, fever, fatigue, pain, and changes in the skin.
The prevalence of gastric cancer, liver cancer and uterus cancer is higher in Asian groups, while lung cancer, colon cancer and breast cancer have high prevalence in Americans. Obesity is associated with colon, breast and kidney cancer, and some studies have also reported links between obesity and cancer of the gallbladder, ovaries, and pancreas.
Cellulite is a normal human variation on the skin, with the appearance of orange peel or cottage cheese that appears on hips, thighs, and buttocks. It may be formed when connective tissues beneath the skin that shape the fat become weak and deformed due to poor circulation or lack of exercise. There are different theories for causes of cellulite, including: damaged circulation, free radicals, digestion, hormonal imbalances, excess estrogen, lack of exercise with poor lymphatic circulation, over exertion and bad diet with toxin buildup.
It may occur also in slim persons. Treatment methods includes: liposuction, body wraps, mesotheraphy, electric muscle stimulation and massage. Also, there are methods using lotion and creams.
Also described together with cerebral infarction and cerebral hemorrhage definitions, the main causes of cerebral paralysis are embolism or cerebral thrombosis after occlusion of cerebral vessels. Cerebral infarction occurs after ischemia and necrosis of the damage area in the brain, and cerebral hemorrhage occurs by hydrostatic pressure after blood vessels rupture. Depending of the damaged area of the brain, it may paralyze all body movements or the speak ability or lead to conscious disorders. Obesity and hypertension are important factors in the development of cerebral damages.
Cholesterol is a soft, waxy substance found among lipids (fats) in the bloodstream and in all body’s cells, produced in liver. It is used to strengthen cell membranes and to produce hormones. Most of it is incorporated in the membranes from which cells are constructed and is an indispensable component of them. One of the major uses of cholesterol is the synthesis of bile acids and also, is the precursor from which the body synthesis vitamin D.
High blood cholesterol increases the risk of coronary heart disease, but low cholesterol level also increases risk of anxiety, depression, cancer, hemorrhagic stroke, respiratory diseases, and suicide. Cholesterol is necessary to normal growth in children, so they must intake natural sources of cholesterol, like eggs and milk.
High blood cholesterol levels increase the risk of heart problems, so persons with high levels should decrease their diet intake of cholesterol. At growth, the cholesterol levels are normalized through exercises, and hormone production. But after this age, especially at forties, usually check-ups and blood exams are necessary tom aintain and to control the levels.
Coefficient of Correlation
The correlation coefficient (r) is a measure of how well the predicted values from a forecast model “fit” with the real-life data. It is represented as a number between 0 and 1. If there is no relationship between the predicted values and the actual values the correlation coefficient is 0 or close to 0. As the strength of the relationship between the predicted values and actual values increases so does the correlation coefficient. A perfect fit gives a coefficient of 1.0. Thus, as it gets closer to 1.0, it is better.
Diabetes mellitus is characterized by fasting hyperglycemia and the presence of glucose in the urine. These symptoms are results from inadequate secretion or action of insulin. Generic tests standards are 140mg/dl blood glucose at fasting conditions and 200mg/dl blood glucose 2 hours after meal. There are two forms of diabetes mellitus: insulin dependent diabetes mellitus (also called type I diabetes) and non-insulin-dependent diabetes mellitus (type II diabetes). About 90% of the people who have diabetes have the type II, and it occurs frequently in obesity. Glucose and ketone bodies are excreted in the urine and cause excessive excretion of water. It provokes severe dehydration, which, together with ketoacidosis and associated disturbances in electrolyte balance, may lead to coma and death.
Edema is a condition of abnormality of the interstitial water volume in the circulatory system. Some diseases may cause the edema, including glomerulonephritis, renal failure, nephrotic syndrome, cardiac failure, and liver cirrhosis. However, most of the times, it is the idiopathic edema whose causes are not easily identified.
If the extracellular water volume has abnormally increased in relation to intracellular water volume, it should be suspected as having edema. Also, this unbalanced distribution of parts appears in persons with lymphedema.
It is one of the major fibrillar proteins, together with collagen. They are responsible for tissue strength and resilience, because of their dynamic role in promotion of cell growth and differentiation. Elastin is constituted by amino acids, hydrophobic, and contains praline and glycine. There are some anti-aging treatments using elastin to increase skin strength and to stimulate elastin production.
An empirical estimation refers to the application of variables from personal information inputted, such as gender or age, and from some known general assumptions saying athletes usually have more muscle than regular persons. Conducting body composition analysis in a female, for example, she will always have more fat than when she changes her gender input to male. This is because of the empirical fact that women usually have more body fat mass than men. Thus, an empirical estimation refers to those variables that may affect the results of a body composition analysis in order to make up for inaccurate measurement.
Estrogens are a group of steroid compounds that function as the primary female sex hormone. They are produced primarily by developing follicles in ovaries, corpus luteum and in placenta. The three naturally occurring estrogens are estradiol, estriol and estrone. In the body, these are all produced from androgens through enzyme action. The use of estrogen, especially together with progesterone, is a controversial treatment for the treatment of menopause.
Exercise stress test
Sometimes called treadmill test or exercise test, this is a general screening toll to test the effect of exercise to heart. During the test, the electrical activity of the heart is measured while walking on a treadmill or pedal a stationary bicycle. Thus, the test measures the heart’s reaction to the body’s increased demand for oxygen.
It is performed to determine causes of chest pain, the exercise capacity of heart, appropriate exercise levels in those initiating an exercise program, and to identify rhythm disturbances during exercise. The American College of Sports Medicine (ACSM) recommends the exercise stress test to men more than 45 years and women more than 55 years who plan to exercise at more than 60 percent VO2max.
Objectives of exercise stress test:
- To determine maximum volume of oxygen intake
- To find out abnormalities that may be invisible at rest, and that manifest after exercise
- To determine the blood circulation and endurance ability, and together with maximum volume of oxygen intake, it is utilized as parameters to evaluate fitness level
- Heart rate
- Blood pressure
- Volume of oxygen intake
- Volume of CO2 discharge
- Volume of maximum voluntary ventilation
- Volume of residual oxygen
- Volume of lactate
- Residual volume
- Diffusing capacity for carbon monoxide
- Metabolic rate at rest
- Subjective level of exercise
- Target Heart rate zone
1. Master’s two step test
A standardized test created by Arthur Morris Master. For 90 second the patient repeatedly walks up and down a small stair or footstool consisting of a middle step and two sidesteps. Due to the disadvantage that it is not possible to control the quantity of exercise, now it has been replaced by treadmill.
2. Treadmill exercise test
This machine is similar to the running machines at gym. The treadmill is started at a relatively slow “warm-up” speed. The speed and slope or inclination, are increased, and the heart rate and blood pressure is recorded during each stage. When the target heart rate is achieved, the machine is stopped. This is the type of exercise test most utilized in Korea.
3. Bicycle ergometer
It is a method utilizing a bicycle with pedals, which is possible to control the load intensity.
This is the total amount of non-fat parts of the body. There are some differences between Fat-Free Mass and Lean Body Mass.
One of the parameters to classify Lean Body Mass or Fat-Free Mass is the content of phospholipids in cell membrane. This membrane is a zone composed with lipids, organized to form a bilayer. It is composed by two opposing layers of lipid molecules arranged to their hydrocarbon tails face one another and to form the oily bilayer core. The lipid content is hydrophobic, so it is classify as fat. But, anatomically, it is not possible to separate the lipid, so it is not classified as adipose tissue. In other words, the cell membrane’s fat is part of lean body mass, but it is not part of fat free mass. In the human body, it occupies 3-8%, and is denominated essential fat.
Analyzing the body composition in 4-compartment model (Fat, Protein, Water, Mineral), essential fat is considered at minimum 3% in men’s body and 8% in women, at healthy condition.
Muscle is the most part of Fat-Free Mass. Excluding the intermuscular and intramuscular fat, the rest of muscle cells are considered Fat Free Mass. Therefore, more Fat-Free Mass, more muscle mass in the body. Car engines with big displacement use more fuel to produce energy, and the same happens to human body. The more muscle mass, the more energy is required, and the basal metabolism becomes higher.
Even the same calorie intake, persons with high basal metabolism spend more energy, and the proportion of stored fat decreases, together with the risk of obesity.
The accumulation of triglycerides in liver result a yellow discoloration in liver. Although this is not a normal condition, fat in liver usually causes no damage by itself. However, in some occasions, it can be a sign that other more harmful conditions are established. Fatty liver may be associated with or may lead to liver inflammation, which cause scarring and hardening in liver. When scarring becomes extensive, it is called cirrhosis. The major causes of cirrhosis are excessive intake of alcohol over many years or certain forms of viral hepatitis. Also, there are several other causes, like obesity and diabetes. Persons with abdominal obesity have increased risk of fatty liver.
Gynoid Type Obesity
Gynoid type obesity is more prevalent in obese women, with fat distributed around hips, thighs and bottom. Also called pear shape, it is considered when the waist-hip ratio is less than 0.75. The body percent fat is high, but the appearance is not big that occurs in android type. The risk of disease is lower than the android type, but it is also a type of obesity, and treatment is necessary.
The prevalence is higher in women than men, but it can occur in males. This difference is not by sex, but by fat distribution around organs or body parts.
Human Growth Hormone
Human Growth Hormone (HGH) is a protein constituted hormone, produced by the pituitary gland in the center of the brain and is necessary to stimulate growth in children. It’s also known as somatrem and somatropin. Researchers from Stanford University, in 1990-1992, examined the efficacy of HGH, as shown below:
- Stimulates the protein synthesis, increasing the fat formation, and decreasing the fat mass inside the body.
- Improve bone density
- Improve muscle tone, immune and heart function, brain function, memory and mental focus.
- Improve strength and endurance, healing time and cholesterol, sleep better, sex performance, boost energy and others.
It is produced at little quantity during the day, and the most of HGH quantity is produced at night. Rest at night is necessary, especially in children, to improve the hormone production.
A child with growth hormone deficiency does not produce enough growth hormone, and growth begins to slow after a while. Without treatment, this child may be very short for his age, and he may deposit more fat in the abdomen and face, with decreased blood sugar levels. Nowadays, this hormone is utilized in anti-aging therapy and growth therapy, produced in synthetic version, using DNA technology, from a genetically altered bacterium (E.coli). In addition, there was another method, using natural growth hormone derived from the pancreas of cadavers, but the recombinant human growth hormone has allowed for an essentially unlimited supply of the drug.
Hyperlipidemia is an elevation of lipids (fats) in the blood stream. These lipids include cholesterol, cholesterol esters (compounds), phospholipids and triglycerides. They are transported in the blood as part of large molecules called lipoproteins.
Considering cells, obesity can be classified as hyperplastic obesity and hypertrophic obesity. Too many adipose cells causes hyperplastic obesity whereas too large adipose cells in size causes hypertrophic obesity.
Hyperplastic obesity is commonly found among children and teens as the number of their cells increase for growth. The number of cells, once established, is almost impossible to decline. Persons with increased numbers of adipose cells have high risk of yoyo effects.
A disorder characterized by high blood pressure; generally includes systolic blood pressure (the “top” number of blood pressure measurement, generated when the heart beats) consistently higher than 160mmHg, or diastolic blood pressure (the “bottom” number of blood pressure measurement, which represents the pressure in the vessels when the heart is not beating fast, and the body is resting) consistently over 95mmHg.
Impedance, denoted Z, is an expression of the opposition that an electronic component, circuit, or system offers to alternate and/or direct electric current. This is a vector quantity consisting of a sum of electric resistance (R), inductive reactance (XL) and capacitive reactance (Xc).
Resistor is a device used to control the current in an electric circuit, providing resistance. In human body, the water volume is the resistor, consisting in intracellular and extracellular fluids. There is no substance similar to coil in body, so the inductive reactance is ignored.
Capacitor is an electrical element used to store the charge temporarily, consisting of two metallic plates separated and insulated from each other by a dielectric. The resistance of capacitor is called reactance, and in the body, the cell membrane has this function.
Therefore, human body has all the components necessary to an electronic component. The figure shows the circuit that is equivalent in human body. The impedance is expressed by sum of the vectors as:
Impedance2 = Resistance2 + Reactance2
Intracellular Water/ Extracellular Water
Total body water is classified in intracellular water (ICW) and extracellular water (ECW). The water inside the cell membrane is considered intracellular water (ICW), and the extracellular water (ECW) is the water in the space between cells (interstitial fluid) in addition to the plasma fluid. The proportion between intracellular and extracellular water is well balanced in healthy normal individuals, and difference in this proportion is caused by edema, resulted by increase of interstitial water.
Leptin is an anorexigenic hormone, first discovered in 1994, by Jeffrey Friedman’s laboratory, Rockefeller University, New York. They used obese mice, with leptin genes mutation, and found correlation between leptin and obesity.
This hormone is released in blood vessels by fat tissue, and affects central nerve receptors after passing the blood-brain barrier. This effect suppress food intake, decrease weight and promotes the energy expenditure. This manifestation is increased after food consumption and decreased in fasting. Also, with the decrease in leptin manifestation, there is induction of insulin resistibility.
There was great expectation about the utilization of leptin as prescription to obesity and diabetes, but clinical findings are not conclusive yet.
There are some discussions about leptin resistance, and many studies have been conducted recently to find the concrete function of leptin. Actually, there are some studies that found correlation with growth and with inflammation reaction at breast cancer progression.
Liposuction is procedures that model the body, removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. Fluid is lost along with the fat, and it is replaced during the procedure to prevent shock. The risks of this surgery are delays in healing, formation of fat clots or blood clots, excessive fluid loss, friction burns or damage to the skin or nerves and perforation injury to the vital organs. The ultrasonic liposuction device is similar to the hand- held devices used to treat deeper tissues such as muscle and fibrous tissues in physical therapy. A vibrating handpiece is held on the outside skin of the suctioned areas. Before the application, those areas are first pumped with fluid and then shaken by sound/shock waves of the device. Adipose cells are removed by surgery, and it avoids the continuous accumulation of fat.
Low-frequency treatment (transcutaneous electrical nerve stimulation, TENS)
In the past, it was utilized in facial pain treatment or general musculoskeletal pain treatment, but now it is also utilized in obesity treatments.
A bioelectric neuromuscular stimulating device that uses low current at low-frequency oscillation, stimulate the production of body’s natural painkillers, but professional opinions are conflicted. Muscle contraction and relaxation is controlled by electric stimulation. With low-frequency, the muscle is stimulated, and this fatigue of muscle produces lactate. This effect is similar to anaerobic exercise. The equipment utilizes electrode patches on the skin, in the area to be treated, and also water and jelly patches.
This is a machine originated in France by Louis Paul Guatay to help rid the body of the appearance of cellulite and to improve skin texture in general. It’s also utilized in obesity treatment, edema and scar treatment, and after liposuction, rehabilitation and to improve blood circulation. LPG is a patented vacuum device which creates suction to temporarily immobilize and lift the soft tissue while dual “rollers” create deep, subdermal massage to the connective tissue and fat globules to improve the appearance of cellulite. The act of massage may also promote new collagen growth which is thought to help strengthen the connective tissue thereby prohibiting fat globules from pressing through the honeycomb structure of the connective tissue itself.
It can be defined as an accumulation of fluid between the spaces in the body’s cells. It is accompanied with chronic inflammation, fibrosis secondary to the impairment of the lymph vessels and adverse effect after operation involving lymph circulation. The appearance may vary among individuals and lead to hypertrophy cases. Using body composition analysis, it is possible to identify
edema in advance or to monitor the progress of edema treatment.
Mesotherapy is a treatment method, originated in 1952 by the French doctor Pistor, and came from the word meso of mesotherm added to theraphy. It is utilized in obesity treatments, cellulite reduction, wrinkle elimination, using combination of drugs and vitamins injected by a 4~6mm syringe, in the mesoderm, which is the layer of fat and connective tissue under the skin. The advantage of this treatment is the use of drug in low dose at short period of time, with reduced side effects. Before treatment, it is necessary to check atopy skin and specific drugs allergies. Also, women must avoid the treatment in menstruation period, because it could lead to pelvic region hematoma due to blood vein rupture. No ion treatment or electrical therapy should be performed until three days after the mesotherapy (risk of necrosis in the micro wounded part by electrical current).
Mineral are constituents of all tissues and internal fluids of body. They are combined with other substances, like calcium or phosphate in the bone, or independently like natrium ion or calcium ion in intracellular fluid. They are classified as trace minerals or major minerals, and consist in 5~6% of the body’s mass. InBody shows the sum of mineral content in dry bone mass and in the body fluids. The dry bone mass is based in the BMC measured by DEXA, bone mineral density diagnose equipment.
Mineral and health
There are strong correlation between bone and diet and physical exercises too. Based in the literature, it is known that individuals with high physical activity have more muscles than individuals with lack of exercise, and the same result appeared in bone mineral density. This occurs by the increase in mineral content due to exercise. On the contrary, lack of exercise could lead to a low bone density, and also, an increased risk of osteoporosis.
InBody’s mineral content results are an important screening tool to prevent osteoporosis. If the results show lack of mineral, more specific bone density examination is necessary to diagnose the osteoporosis.
Conventional BIA with single frequency estimates the amount of intracellular water from extracellular, as the low frequency current cannot pass through cellular membrane and assess intracellular water directly. This results in inaccurate measurement. The proportion of intra and extracellular water is well balanced in a healthy body; however, in the elderly and patients suffering from obesity or geriatric diseases, these amounts often go out of balance. Generally, extracellular water is measured by low frequency currents (lower than 50kHz), and total body water is measured by high frequency currents (higher than 250kHz).
Multi-frequency analysis utilizes variation from 1kHz to 1MHz frequencies to measure the amount of body water accurately. This is the principal component in BIA. Its accurate measurement helps calculate edema score which is the ratio between extracellular water and the total body water. As contact resistance becomes higher at frequencies lower than 50 kHz and electrical current loss increases at higher frequencies, it is difficult to conduct analysis with BIA. Thus, capability of analysis with multi-frequency presents the superior technology of body composition analyzers.
Muscular obesity type individuals have high quantity of muscles in relation to the weight, but they also have high quantity of body fat. It is commonly found in overweight athletes with great body muscle and fat quantity.
Nephropathy is a disease of the kidneys. The kidneys, a pair of bean-shaped organs, are located at the bottom of the ribcage in the right and left sides of the back. They receive blood from the aorta, filter it, and send it back to the heart with the right balance of chemicals and fluid for use throughout the body. The urine created by kidneys is moved out of body via urinary tract. When the kidneys are not working properly, waste products and fluid can build up to dangerous levels. Diabetes, high blood pressure and atherosclerosis can impair the kidney’s ability. The symptoms of nephropathy are hard to detect at initial stages, even with 20-30% of kidney’s ability damaged. Furthermore, these damages cannot be rehabilitated. There is strong correlation between body water content and kidney’s disease.
BIA is used to control the body water variation in patients in dialysis.
Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. It is hard to define the amount, without considering just the body shape or appearance, but the injuries to health that occur with this fat excess.
Until 90’s, obesity was considered just as one factor that leads to diseases or a symptom caused by medical condition, but after that, WHO defined obesity as a disease, with necessary control and treatment. Now, obesity is one of the world’s most important diseases, with several diagnoses and treatments.
Framingham study showed results that 20% more weight than the standard increases the risk of health injury, and 120% more was considered obesity. National Institute of Health (NIH) agreed with this definition and concluded that 20% more weight than the standard or BMI more than 85% in young people increase the risk.
Development of methods to evaluate obesity is more accurate. They have been utilizing methods like body mass index (BMI), subcutaneous skinfold measurement, WHR, waist circumference, underwater weighing densitometry, etc. After 1980, with the technology improvement, the methods to diagnose obesity improved too, like BIA, CT, DEXA, MRI, infrared therapy, ultrasound, etc.
Percent Body Fat
Percent body fat is the ratio of body fat mass against body weight in percent.
Percent Body Fat = Body Fat Mass(㎏) / Body Weight(㎏)ⅹ100
The standard percent body fat is 15% for men, at the range of 10-20%1, and 23% for women, at the range of 18-28%2.
1. Robert D.Lee, David C. Niteman, Nutritional Assessment 2th, McGraw-Hill, 1998
2. George A. Bray, MD. Contemporary Diagnosis and Management of Obesity, Handbooks in Health Care Co.,1998.
InBody standards the percent body fat to 20% for 7 years-old children, and increase 0.5% each year, achieving 15% at 17 years-old.
Physical activities, also called weight training, are exercises practiced to increase muscle contents and to improve muscular strength. It does not utilize oxygen as energy source, so it is called anaerobic exercise. Muscle stimulation facilities the blood circulation around it, and increase muscle fibers.
The activities must start in big muscles and then with the little ones. To beginners, is recommended three sets of exercise, each time. One set of exercise represents 10-12 times of repeated exercise with specified weight equipment. Breathing is important in physical activity, with inspiration when the weight equipment goes up, and expiration when goes down. It’s required to do not hold breathe during the exercises. To decrease the injury and pain by lactate accumulation, each exercise session should begin with a warm-up and aerobic exercise. There are many activities examples like dumbbells, push-ups and curl-ups or equipments like shoulder press and leg curls.
Importance of physical activity
90% of body energy is consumed by muscles, so the principal fat burner is muscle. Therefore, muscles and bone development with increase in physical activity increases calorie consumption of the body.
Steady physical activity maintains the elasticity of the skin and balance the body shape. Necessary in the prevention against osteroporosis by stimulation of the bone, which maintains the increase in bone density.
Muscle density is weighed then fat density. So, even with the same weight, persons with higher muscle content will look thinner. More weight is common in good shape women.
Postpartum weight retention
Postpartum weight retention occurs in women with 2.5% or more than pre-pregnancy weight, even 6 months postpartum. High gestational weight gain is a factor of risk in this kind of obesity, and the possibility of caesarean operation increases. The greatest amount of weight loss occurs in the first three months postpartum and then continues at a slow and steady rate until six months postpartum.
After that, treatment to weight loss is necessary, especially in women that had pregnancy toxemia, or multiparity. After prenatal, prolactin hormone secretion is increased and estrogen secretion decreased. Due to this condition, the lower basal metabolism is the perfect condition to weight gain. After 10 months, the prolactin secretion begins to decrease, and this is the time to weight loss. Breastfeeding women have lower potential to be obese than women that do not breastfeed. That’s because breastfeeding is the best method to use the accumulated fat, using it as energy. These women need approximately 500kcal more than usual intake, and women that do not breastfeed can avoid weight gain with intake of usual diet consumed before pregnancy.
A large molecule composed of amino acids, with many different functions and utilized to various measurements, including nutritional assessment. Defined as the bio molecule that composes all life creatures. Important component of cell membrane and structure, also required in muscle, bone, blood and immunization system.
Protein is necessary in metabolism, and sometimes, directly utilized to produce energy. Antibodies are proteins that protect the body against antigens.
Elementary component of cell membrane, protein regulates the transport of nutrients, hormones and ions, in and out of cell. Also, it is the principal component of hormones, neurotransmission substances, and enzymes structure.
In malnutrition, protein is utilized as energy source, and it occurs especially in cancer patients, elders or chronic diseases patients. Muscle cells are destroyed and utilized as nutrient to continue the vital functions. It occurs, also, in diet control to lose weight. Therefore, adequate physical activity is necessary in dietary control. In nutritional assessment, due to its intimate relationship with patient nutritional status, protein quantity is utilized as standard to qualify the patient health.
A purified form of sibutramin. It acts by inhibiting the reuptake of serotonin and noradrenaline. It is used in weight lost programs, inducing the feeling of satiety, and basal metabolic rate promotion. Without dopamine influence, there are no reports of toxic effect yet. It has the advantage of lower misapplication, because it is not monoamine free. Some side effects include loss of appetite, dry mount, constipation, and difficulty with sleeping. No heart effect was reported, and no relationship with alcohol or anticonception steroid medication.
Also called physiatry, this is the branch of medicine that emphases the prevention, diagnosis and treatment of disorders – particularly musculoskeletal, cardiovascular, and pulmonary systems – that may produce temporary or permanent impairment. It also provides integrated care in the treatment of all neurological and musculoskeletal disabilities caused by traumatic brain injury to lower back pain. The specialty focuses on the restoration of function to people with problems ranging from simple physical mobility problems to those with complex cognitive involvement.
Respiratory Gas Analysis
Human body always utilizes oxygen in respiration and respire carbon dioxide as metabolism results. Respiratory gas analyzers measure the oxygen and carbon dioxide to calculate lung capacity and cardiopulmonary capacity, and also are used for measurement of resting energy expenditure. Exhaled air contains less oxygen and more carbon dioxide than inspired air.
When the volume of exhaled air is known and the differences in oxygen and carbon dioxide concentrations in inspired and exhaled air are known, the body’s energy expenditure can be calculated. Estimations of energy expenditure by indirect calorimetry have been shown to be practically identical to those derived from direct calorimetry. Respiratory gas analysis includes CPX test (cardiopulmonary exercise test), indirect calorimetry and spirometers to test the lung capacity. CPX involves submaximal and maximal treadmill or bicycle exercise with continuous electrocardiography monitoring and breathe determination of oxygen uptake and carbon dioxide output as well as spirometry. This determine exercise capacity, peak heart rate, maximal oxygen consumption, anaerobic threshold, respiratory gas exchange ratio, and ventilatory equivalent to evaluate physical condition, or medical conditions as heart diseases. Also, it is performed in athletes and obese patients to evaluate treatments. Indirect calorimetry is used to assess energy requirements based in relationship between energy expended, proportion of carbon in energy source burnt, and oxygen consumed. 1L of oxygen consumed is considered about 5 kcal of energy expended. The volume of inspired and expired air (known as minute ventilation) is typically measured using a pneumotachograph. Gas analyzers are used to determine the oxygen and carbon dioxide content of both inspired and expired air, and they determine the caloric requirements and substrate utilization. In terms of accuracy and reproducibility of energy expenditure measurements, computerized metabolic monitors have been utilized to compare favorably with more time-consuming approaches. They are relatively easy to operate, and they analyze data quickly. Before all procedures, a protocol has to be established, and patient’s consent is necessary.
Resting Energy Expenditure, REE
Basal metabolic rate (BMR) is defined as the lowest resting energy expenditure of an individual. It is calculated from oxygen consumption measured over a 6-to 12-minute period when the subject is in a postabsorptive state (no food consumed during the previous 12 hours) and in quietly rest for the previous 30 minutes in a thermally neutral environment. To be precise, however, the point of lowest energy expenditure- the true BMR – occurs in the early morning hours of deep sleep. Obtaining a truly basal metabolic measurement is impractical in most instances. Therefore, the more appropriate term for metabolic rate or energy expenditure in the awake, resting, postabsoptive subject is resting energy expenditure (REE), also known as resting metabolic rate. REE is the largest component of 24-hour energy expenditure, accounting for roughly 65% to 75% of 24-hour energy expenditure in healthy persons. There is strong correlation between muscle quantity and REE. Persons, with the same weight or age, may have different REE, due to differences in the quantity of energy expended by muscles. Old persons have low REE, because the quantity of muscle decreased, and body fat increased. It may occur after extremely diet that leads to muscles depletion. Basically, it is considered the principle of yoyo effect.
Sarcopenic obesity patients have standard weight, but low BMI with high percent body fat. It is easily found among Korean young women, with low amount of lean body mass and high in body fat despite the slender appearance. It is very difficult to identify this kind of obesity just by using BMI or general observations, so it is necessary to conduct body composition analysis. Treatment for this type of obesity has to focus on increasing muscle quantity and decreasing body fat. Alternatively, low fat diet and increased protein consumption are recommended, with weight training and physical activity.
Saturated Fatty Acid
Saturated fats are simply fats that contain mostly saturated fatty acids. They have no unsaturated linkages and cannot be altered by hydrogenation or halogenation. Diets high in saturated fat (or high-glycemic index carbohydrates) lead to an increased production of acetate fragments in the body, which usually raise the production of cholesterol. They are found mainly in animal fats, including dairy products, butters, sausages, bacon, palm and coconut oil. Due to this characteristics, other kinds of oils are recommended, like sesame, olive, canola oil, etc.
Segmental measurement is the technology that defines the body as five cylinders, separated in four limbs and a trunk, and measures the impedance of each part separately. Segmental body composition analysis provides the amount of body water and fat free mass in each one of the five cylinders. Furthermore, the analysis is highly accurate because the measured value of each part does not affect the measurements of other segments. These values are results from directly measurement, and not from estimations. Other body composition analyzers fall in accuracy to measure body fat, so patient’s body shape cannot be exactly figured out. They use empirical references to correct the inaccurate measured values by estimation. InBody with segmental analysis measures individual differences caused by gender, aging, disease and ethnical background without empirical estimation and examines the patient’s segmental development.
The trunk measurement is the most important and critical in the segmental measurement. Although the trunk takes up the largest portion of body, its impedance value is only about 20Ω, and a small difference in trunk impedance reading affects greatly.
Arms usually have impedance about 300Ω and 2-3Ω only causes a small error. However, in the trunk, the same 2-3Ω can be considered as a significant error, capable to affect the results. Therefore, to assure the accuracy of the whole body analysis, accurate trunk measurement is the most important.
Since the first commercially available body composition analyzers, single-frequency analysis at 50 kHz was commonly used. For an electrical current at 50 kHz has the most appropriate frequency to identify characteristics of body and is very easy to control in conducting analysis.
However, it only measures extracellular water quantity, and the rest of the body composition is calculated based on this single information. Thus, single frequency analysis requires more assumptions. These assumptions are perfectly applicable to healthy persons, with balanced intracellular and extracellular quantities, but in persons with unbalanced conditions, like edemas, or in the elders, children, those pregnant, or obese, these results could be different from the actual values, or even completely wrong. Patients with obesity or edema need an accurate examination. Multi-frequency analyzer that utilizes low frequencies and high frequencies simultaneously is recommended. Single-frequency analyzer measures the phase angle or reactance that occurs in the cell membrane to supplement the results, but multi-frequency analyzers do not need these supplements, so, recently, they have been strongly recommended for medical purposes.
Skeletal muscle is the principal component of body’s muscle and does not contract without nervous stimulation. It works under voluntary control and lacks anatomic cellular connections between fibers. Unlike abdomen, legs and arms muscles, except vasomotor muscles, are mostly skeletal muscle. Therefore, changes in amount of limb muscles present changes in skeletal muscles of four limbs. Since skeletal muscle is made up of many smooth longitudinal fibril arrays, it has fairly even resistance. This is one of the various reasons of why impedance is much easily measured in the limbs than in the trunk.
Skinfold thickness is the most widely used to indirectly estimate percent body fat in clinical settings. It involves several calculations based on measures using a caliper applied to a skinfold, and than applied to a formula that results in the percent body fat. The skinfold is firmly grasped by the thumb and index finger of the left hand about 1cm proximal to the skinfold site and pulled away from the body. The thicker the fat layer under the skin, the wider the necessary fold. The caliper is held in the right hand, perpendicular to the long axis of the skinfold and with the caliper’s dial facing up and easily readable. The caliper tips are placed in the site, about 1cm distal to the fingers holding the skinfold, so the pressure from the fingers will not affect the measured value. Practice is recommended to consistently grasp skinfolds at the same location every time.
Soft Lean Mass
Common definition: Muscle
There are three types of muscle tissue: skeletal, cardiac, and smooth. They have different forms and functions. Skeletal muscle is called voluntary muscle because its contraction is consciously controlled. It is arranged in bundles, and within these bundles the fibers extend in parallel from one end to the end of the bundle. The smooth muscles do not have the striations and it’s found in the digestive tract, blood vessels, bronchioles, and in the ducts of the urinary and reproductive systems. Cardiac muscle is striated, with similar characteristic of skeletal and smooth muscle, but with intercalated discs. The contraction cannot be controlled, and the stimulation of one myocardial cell results in the stimulation of all other cells in the mass.
InBody’s definition: Soft Lean Mass
InBody classifies the body in parts and show the results quantitatively. These parts are water in body-fluid compartments, proteins, body fat mass and mineral quantity. Protein and water content is called soft lean mass.
Muscle is anatomically composed by water content, protein, fat mass and bone, and Inbody do not classifies the muscle anatomically, but by their chemistry composition. In other words, the hard part of body without water is considered mineral content and fat mass. The rest is considered soft lean mass, and this is called muscle content. This is the difference between
the two definitions above.
Standard weight is the weight appropriate to the individual, considering age and height. There are many methods to calculate the standard weight. Also, the percent of obesity is calculated by:
(Real weight – Standard weight)*100/Standard weight
The subcutaneous fat layer cushions the dermis from underlying tissues such as muscle and bones. This tissue is usually composed by fat cells and other structures that run through it, like blood vessels, nerves, etc. There are some differences in the quantity of subcutaneous fat by gender and age. Women have more subcutaneous fat than adolescents, and men have lesser quantity. Animals have large amounts of fat, because they need to maintain their body temperature, which is the most important function in humans, too; another function is storage of excess of energy. Abdominal fat and subcutaneous fat are both included in body fat, but subcutaneous fat is not threatening to health than abdominal obesity.
Thermic Effect of Food ,TEF
It describes the energy expended by the body in order to eat and process (digest, transport, metabolize and store) food. It was called specific dynamic effect of food, in the past, and currently it is called effect-induced thermogenesis. 10% is generally used to account for the thermic effect, and it can be increased depending on the composition of each meal. Protein process requires more amount of energy, ranging as high as 30%. Dietary fat, on the contrary, is easily processed and turned into body fat, with little thermic effect (2-3%). The amount of energy required to process carbohydrates falls between that of protein and fat.
Total Body Water
About 99% of all molecules in the body are water, which is about 70% of body weight. The water supply in the body is responsible for and involved in nearly every metabolism, including digestion, absorption, circulation, and excretion. It also helps maintain normal body temperature and is essential to carry waste products out of the body. There are protein and water inside muscles. So, through body water composition, the muscle quantity can be measured. The body water is distributed in different compartments of body. Three fifths are considered intracellular water, and the other two fifths are considered extracellular water. One- fifth of extracellular water consists of blood plasma, and extracellular fluid constitutes the other four-fifths. Also, through total water composition, it is possible to figure out the body shape and the balance between different parts of the body.
Triglycerides are the chemical form in which most fat exists in food as well in the body. They are also present in blood plasma and, in association with cholesterol, form the plasma lipids. They are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates. Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Immediately after a meal, triglycerides appear in the blood as the major constituent of chylomicrons, and under normal circumstances, triglycerides within chylomicrons are stripped of fatty acids as they pass through various tissues. The chylomicron remnant is then taken up by the liver so that disappear from the blood within 2 or 3 hours. People with high triglycerides often have high total cholesterol, high LDL cholesterol and a low HDL cholesterol level. These elevated levels appear to be a risk factor of developing heart disease. Also, it can cause pancreatitis, an enlarged liver and spleen, and fatty deposits called xanthomas. The triglycerides blood level should be less then 200mg/dl.
Ultrasound is performed in many situations, like treatments, surgeries, pregnancy check and others. It utilizes high frequency sound waves and echoes into the body, using a probe.
This device utilizes sonic vibrations to reduce body lines, leaving the skin firm and smooth. It is similar to traditional liposuction procedures, but it uses ultrasonography to target and remove fatty tissues more selectively and with minimal impact on surrounding tissues and blood vessels.
Upper and lower bodies balance
Body composition analyzers measures left and right arms, left and right legs and trunk’s skeletal muscle and visceral muscle quantity. Healthy and exercised body has balanced development of upper and lower bodies. Unbalanced bodies have correlation with diseases or lack of exercise. In middle-aged men, the lower body is usually weak and unbalanced, but it can occur in the upper body, resulted by insufficient arm muscle mass. Young Korean females and children have this same insufficiency in arms, because they do not exercise this part regularly, unlike the legs, that move while walking or stand up. This weakness of upper and lower bodies is usually results of lack of exercise, but the differences between individuals and age have to be considered.
Vibrators are equipments used to muscle contraction and dilatation utilizing vibration. The majority of this kind of equipments have a vibrator footing and a handle, with 30~60 vibrations per second. It seemed that dissolve cellulite and concentrated fat. Also, it said that improve blood circulation or increase the metabolism. It can be utilized for all ages, including old people or athletes, and the effect in muscle development contributes to physical therapy, rehabilitation therapy, shape improvement, etc. Hard intensity prejudices the muscle skeleton, so instructions must be followed. As a passive treatment, it is frequently utilized in obesity treatment. But the patient must be assured that obesity’s best treatment is the improvement of lifestyle with exercises and diet.
There are two different types of fat- subcutaneous fat and visceral fat. Subcutaneous fat is the fat just below the skin, but the really worrisome fat is visceral fat. This is the fat that is found in the abdomen and surrounding vital organs.
Visceral fat accumulation around the digestive organs is accompanied be several metabolic disorders.
This accumulation pressures the organs and their blood circulation. Different from the subcutaneous fat, they secrets great quantities of fatty acids. It increases the risk of diseases related to obesity, also liver cirrhosis, hyperlipidemia and diabetes. The gold standard to measure the visceral fat is CT scan that calculates the fat area, at the spinal bone number 4-5, or at the umbilical level. Other methods are the waist circumference or the waist hip ratio, but these methods have the disadvantage of error during measurement.
Abdominal obesity uses the waist-hip ratio (WHR) to classify obesity according to fat distribution. Vague (France) in 1940, proposed the correlation between fat distribution and disease, and in 1980, Kissehah (USA) and Bjontorp (Sweden) started to measure the buttocks and waist to classify obesity.
- Waist – measure the horizontal circumference of waist at the navel
- Hip – measure the greatest horizontal circumference around the buttocks
- WHR = Waist Cir. / Hip Cir.
Men with WHR>0.90 and women with WHR>0.85 are considered abdominal obesity. Even with the same fat quantity, the distribution is more relevant to evaluate the risk of diseases.
Also known as orlistat, this is a white to off-white crystalline powder, insoluble in water, freely soluble in chloroform and very soluble in methanol and ethanol. Available for oral administration in dark-blue, hard-gelatin capsules, with light-blue imprinting of Roche®. Each capsule contains 120mg of the active ingredient orlistat.
Mechanism of action:
Orlistat is a reversible inhibitor of lipases. It exerts its therapeutic activity in the lumen of the stomach and small intestine by forming a covalent bond with the active serine residue site of gastric and pancreatic lipases. The inactivated enzymes are thus unavailable to hydrolyze dietary fat in the form of triglycerides into absorbable free fatty acids and monoglycerides. At the recommended therapeutic dose of 120mg three times a day, orlistat inhibits dietary fat absorption by approximately 30%.
Xenical is contraindicated in patients with chronic malabsorption syndrome or cholestasis, and in patients with known hypersensitivity to Xenical or to any component of this product. Also, is contraindicated to pregnant women and nursing mothers.
Commonly observed adverse reactions:
Oily spotting, flatus with discharge, fecal urgency, fatty/oil stool, oily evacuation, increased defecation, fecal incontinence, abdominal pain/discomfort, nausea, infectious diarrhea, tooth disorder, vomiting, back pain, pain lower extremities, joint disorder, headache, dizziness, fatigue, sleep disorder, rash, dry skin and others.
The patient should be on a nutritionally balanced, reduced-calorie diet that contains approximately 30% of calories from fat. The daily intake of fat, carbohydrate, and protein should be distributed over three main meals. Because Xenical has been shown to reduce the absorption of some fat-soluble vitamins and beta-carotene, patients should be counseled to take multivitamin containing fat-soluble vitamins to ensure adequate nutrition.