Methods for Assessing
Nutritional Status and Body
Composition
Introduction
Body composition assessment aims to
quantify the fat, lean, water and bone mass in
a body or in regions of a body.
Measurement techniques may be optimal for
measures of change in body composition,
rather than absolute masses.
Introduction
Some measurements rely on calibration
against a criterion method
Some methods lack the quality to be useful
for individual assessment but work well in
population studies
Introduction
Some methods enable the flux of nutrients to
and from tissues or organs to be observed
and quantified.
Some approaches help in discrimination
between normal or disordered composition
Definition of compartments
The study of body composition uses the
models and systems of human body
representation.
There is three models: anatomic model,
biochemical model and physiological model.
Definition of compartments
Anatomic model is more ancient and divides
the body in different tissues (adipose tissue,
muscle tissue, organs……….).
Biochemical model separates compounds of
the organism based on their chemical
properties: water, lipids, proteins,
carbohydrates, minerals……………
Definition of compartments
Physiological model introduces concept of
compartment.
A compartment is the group body compounds
functionnaly linked between them.
In nutrition we have several physiological
models:
Definition of compartments
1. Model to 2 compartments : lean body mass
and fat mass
Fat mass corresponds to triglycerides stored
to adipose tissue
Lean body mass corresponds to the sum of
water, bones and organs.
Definition of compartments
2. model to 3 compartments : active cellular
mass, extracellular water and fat mass
3. The model to 4 compartments: active
cellular mass, extracellular water and fat
mass and bone mineral mass.
Methods of assessment of
compartments
There is no direct methods to measure
compartments.
To obtain the mass of compartment the best
method is dissection
The known methods are indirect approaches.
Methods of assessment of
compartments
There is three types of methods:
[Link] vivo quantification methods of specific
constituants of the organism
[Link] vivo estimation methods of compartments
of organism
[Link] prediction methods of a compartment
of organism
Methods of assessment of
compartments
In vivo quantification methods use
radioactivity (potassium 40).
In vivo estimation methods measure water
density or volume
Value prediction methods use anthropometric
measurements. It is the methods most used in
clinical research
Measurement techniques
There is exist many techniques to masure
body composition:
[Link] of body density
[Link] method
[Link] of total water
[Link] absorptiometry
[Link]
[Link] measurements
Measurement techniques
Body density can be measured by
hydrodensitometry (using Archimede priciple)
or plethysmography (using Boyle-Mariote
law).
Siri equation is used to calculate fat mass
percentage: % MG = [(4,950/DC) – 4,500]
x100
Brozek : % MG = [(4,570/DC) – 4,142] x 100
Measurement techniques
Skinfold measurements: Skinfold thickness
offers an approach to measurement of
subcutaneous adiposity.
There are 4 skinfolds currently used for the
measurement (Biceps, Triceps, Sub-scapular,
supra-iliac)
The sum of 4 skinfolds is used to measure the
body density.
Measurement techniques
Disadvantage: bad estimation of deep
adipose tissue and under-estimate visceral
obesity.
Advantage: simple, easy to carry out and
cheap.
Actually, based on skinfold measurement it is
exist more predictive equations includiong
specific populations (children, teenagers,
sport…..)
Measurement techniques
Table: Predictive equations for body
density (BD) based on age and sex in adult
Age Men Women
17-19 BD = 1,1620 - 0,0630 BD = 1,1549 - 0,0678
(log S) (log S)
20-29 BD = 1,1631 - 0,0632 BD = 1,1599 - 0,0717
(log S) (log S)
30-39 BD = 1,1422 - 0,0544 BD = 1,1423 - 0,0632
(log S) (log S)
40-49 BD = 1,1620 - 0,0700 BD = 1,1333 - 0,0612
(log S) (log S)
S is the sum
≥50 BDof =
the1,1715
4 skinfolds (bicipital,
- 0,0779 tricipital,
BD = 1,1339 sub scapular and
- 0,0645
(log S) in mm.
supra-iliac) expressed (log S)
Measurement techniques
Measurement of total water: based on
total body water estimation, it is possible to
estimate lean mass:
LM= total water/0.73
Anthropometric measurements
A number of assessments have been
developed to relate adiposity and lean mass
to anthropometric measurements.
These commonly include body mass index,
skinfold measurement and waist and hip
circumferences.
Anthropometric measurements
1. Body mass index
Body mass index (BMI) derives from the work
of the nineteenth-century Belgian
mathematician Adolphe Quetelet.
It aims to reflect adiposity by expressing
body mass in a way that is independent of
stature.
Anthropometric measurements
BMI is calculated as:
BMI (Kg/m2) = Weight/height2
BMI is widely used for classifying individuals
into groups associated with weight-related
health risk,
Anthropometric measurements
Table 2: classification of individuals
based on BMI
Anthropometric measurements
2. Waist and hip circumference
Each of waist circumference alone, waist–hip
ratio or waist–height ratio offers a predictive
association with cardiovascular and metabolic
disease through its representation of central
or visceral adiposity
Anthropometric measurements
Protocols for the measurement of waist and
hip circumferences have been described by
the World Health Organization (WHO).
Measurements are recorded in centimetres.
Measurements should be repeated, and a
third taken if the first two measurements
differ by 2 cm or more
Anthropometric measurements
4. Neck circumference
The risk of developing obstructive sleep
apnoea increases with excess weight.
Neck circumference is also associated with
sleep apnoea and so its measurement may
have a place in any study that aims to
improve the condition through a weight-loss
intervention.
Anthropometric measurements
5. Body mass, height and age
Malnutrition in children presents in a number
of ways, depending both on the age at which
it occurs and its duration.
Several indices based on height, mass and
age may help to determine the presence and
history of under-nutrition in children. These
rely on reference to data from well-nourished
populations.
Anthropometric measurements
For determine malnutrition in children
population we have:
[Link] for age: stunting or chronic malnutrition
[Link] for age: underweight
[Link] for height: severe malnutrition or
wasting
Growth charts based on the WHO’s Child
Growth Standards may aid in the interpretation
of measurements
Anthropometric measurements
6. Mid upper-arm circumference
Mid upper-arm circumference is a valuable
screen for under-nutrition.
It may be used along with weight for height
in children to identify current malnutrition,
particularly protein-energy malnutrition, in
children.
It is also valuable for identifying nutritionally
compromised adults.
Bio-electrical impedance
methods
The estimation of body composition from bio-
electrical impedance analysis (BIA) is a
widely available methodology offered by
many manufacturers.
It offers a low-cost, portable option for
composition assessment.
Bio-electrical impedance
methods
The principle of the method is that the
electrical impedance of the body reflects total
body water (TBW).
From a simple electric model, total body
water then lean mass is determined
Bio-electrical impedance
methods
An alternating current is passed through the
body from electrodes placed at the
extremities of arms and legs.
The resulting potential difference (voltage)
between the electrodes is measured and the
impedance R calculated as voltage divided by
current.