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Papers by Dympna Gallagher

The FASEB Journal, 2008

Asian women are known to have a larger amount of abdominal fat (AF) for the same level of BMI com... more Asian women are known to have a larger amount of abdominal fat (AF) for the same level of BMI compared with Caucasian and African‐American women. This study was aimed to determine whether waist circumference (WC) could be useful as an index of AF compared with AF measured by dual energy x‐ray absorptiometry (DXA) before and after a weight‐loss program in Asian women. Thirty‐eight healthy, pre‐menopausal obese Korean women (body fat percent > 30%) were enrolled and followed during a 6‐week weight‐loss program including herbal formula, calorie restriction, and exercise. Anthropometry and DXA measurements were performed before and after weight‐loss. A specific region of interest (ROI, L2‐iliac crest) by DXA was correlated with anthropometry at baseline: WC (γ= 0.91) > BMI (γ = 0.87) > Waist‐Height ratio (WHtR, γ = 0.82) > WHR (γ = 0.46); and after weight loss: BMI (γ = 0.88) > WC (γ = 0.84) > WHtR (γ = 0.82), all p < 0.01. The change in DXA ROI showed a reasonable ...

The American Journal of Clinical Nutrition, 2008

Background: Extracellular water (ECW), a relevant molecular level component for clinical assessme... more Background: Extracellular water (ECW), a relevant molecular level component for clinical assessment, is commonly obtained by 2 methods that rely on assumptions that may not be possible to test at the time the measurements are made. Objective: The aim of the current study was to evaluate the degree of agreement between ECW assessment by the sodium bromide dilution (ECW NaBr) and total body potassium (TBK; whole-body 40 K counting) to total body water (TBW; isotope dilution) methods (ECW TBK-TBW) in an ethnically mixed group of children and adults. Design: ECW was measured with the ECW NaBr and ECW TBK-TBW methods in 526 white and African American males and females (86 nonobese children, 193 nonobese adults, and 247 obese adults). Fat mass was assessed with dual-energy X-ray absorptiometry. Multiple regression analysis was used to examine the variables related to between-ECW method differences. Results: Significant but generally small group mean (ȀSD) differences in ECW were found in the obese adults (1.28 Ȁ 2.54 kg) and children (Ҁ0.71 Ȁ 1.78 kg). The magnitude of the differences was related to mean ECW in obese adults, children, and nonobese adults, and the relations between these variables were modified by sex for nonobese adults. ECW differences were also dependent on age, weight, sex, and race or on interactions between these variables. Conclusions: Overall, although good between-method agreement was found across the 3 groups, the degree of agreement varied according to subject characteristics, particularly at the extremes of ECW and body weight. We advance a possible mechanism that may link subject characteristics with the degree of agreement between ECW measurement methods and their underlying assumptions.

American Journal of Physiology-Endocrinology and Metabolism, 2000

We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissu... more We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissue compartments, and related changes in protein metabolism, are appropriate for weight loss in obese older women. Subjects were 14 healthy weight-stable obese (BMI ≥30 kg/m2) postmenopausal women >55 yr who participated in a 16-wk, 1,200 kcal/day nutritionally complete diet. Measures at baseline and 16 wk included FFM and appendicular lean soft tissue (LST) by dual-energy X-ray absorptiometry; body cell mass (BCM) by 40K whole body counting; total body water (TBW) by tritium dilution; skeletal muscle (SM) by whole body MRI; and fasting whole body protein metabolism through l-[1-13C]leucine kinetics. Mean weight loss (±SD) was 9.6 ± 3.0 kg ( P < 0.0001) or 10.7% of initial body weight. FFM decreased by 2.1 ± 2.6 kg ( P = 0.006), or 19.5% of weight loss, and did not differ from that reported (2.3 ± 0.7 kg). Relative losses of SM, LST, TBW, and BCM were consistent with reductions in bo...

The American Journal of Clinical Nutrition, 2004

Background: Aging is associated with metabolic, physiologic, and functional impairments, in part ... more Background: Aging is associated with metabolic, physiologic, and functional impairments, in part through age-related changes in body composition. During the later adult years, skeletal muscle mass decreases and body fat becomes centralized. Objective: The goal of the study was to investigate body composition over time (x Ȁ SD: 2.04 Ȁ 0.6 y) in healthy, ambulatory, elderly African American women. The hypothesis that a reduction in totalbody skeletal muscle (SM) and increases in visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) are ongoing in healthy, weight-stable elderly was tested. Design: The study was a longitudinal evaluation of 26 women (age at baseline: 75.5 Ȁ 5.1 y) with a body mass index (in kg/m 2) of 27.0 Ȁ 4.0. Body composition was measured by using whole-body magnetic resonance imaging for the quantification of SM, total adipose tissue (TAT), VAT, SAT, and IMAT. Results: SM (P 0.001) and bone (P 0.05) masses decreased, and regional analyses showed a decrease in dual-energy X-ray absorptiometry-derived leg SM (P 0.05). VAT (P ҃ 0.011) and IMAT (P 0.001) increased. No changes occurred in TAT (P ҃ 0.45), SAT (P ҃ 0.96), physical function, or food intake. Conclusion: These data show an age-related remodeling of body composition with reductions in SM and corresponding increases in VAT and IMAT. Changes in the previously unstudied depot of IMAT may be involved in the deterioration of metabolic values frequently observed during aging.

The American Journal of Clinical Nutrition, 2008

Background: After weight loss, total energy expenditure-in particular, energy expenditure at low ... more Background: After weight loss, total energy expenditure-in particular, energy expenditure at low levels of physical activity-is lower than predicted by actual changes in body weight and composition. An important clinical issue is whether this reduction, which predisposes to weight regain, persists over time. Objective: We aimed to determine whether this disproportionate reduction in energy expenditure persists in persons who have maintained a bodyweight reduction of ͧ10% for 1 y. Design: Seven trios of sex-and weight-matched subjects were studied in an in-patient setting while receiving a weight-maintaining liquid formula diet of identical composition. Each trio consisted of a subject at usual weight (Wt initial), a subject maintaining a weight reduction of ͧ10% after recent (5-8 wk) completion of weight loss (Wt loss-recent), and a subject who had maintained a documented reduction in body weight of 10% for 1 y (Wt loss-sustained). Twentyfour-hour total energy expenditure (TEE) was assessed by precise titration of fed calories of a liquid formula diet necessary to maintain body weight. Resting energy expenditure (REE) and the thermic effect of feeding (TEF) were measured by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as NREE ҃ TEE-(REE ѿTEF). Results: TEE, NREE, and (to a lesser extent) REE were significantly lower in the Wt loss-sustained and Wt loss-recent groups than in the Wt initial group. Differences from the Wt initial group in energy expenditure were qualitatively and quantitatively similar after recent and sustained weight loss. Conclusion: Declines in energy expenditure favoring the regain of lost weight persist well beyond the period of dynamic weight loss.

International Journal of Obesity, 2007

Background-The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understoo... more Background-The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understood compared to those of visceral adipose tissue (VAT) even though the absolute quantities of both depots are similar in many individuals. Objective-The aim was to determine the independent relationship between whole-body IMAT and cardiovascular risk factor parameters. Design-Whole body magnetic resonance imaging (MRI) was used to quantify total skeletal muscle (SM), total adipose tissue (TAT) of which IMAT, defined as the AT visible by MRI within the boundary of the muscle fascia, is a sub-component. Fasting serum measures (n = 262) of glucose, total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), triglycerides (TG), protein bound glucose (PBG, n = 206) and insulin (n = 119) were acquired in healthy African-American (AA, n = 78) and Caucasian (Ca, n = 109) women (body mass index (BMI) 26.5±5.7 kg/ m 2 ; 44.4±16.4 years) and men (39 AA, 62 Ca; BMI 25.6±3.5 kg/m 2 ; 45.6±17.4 years). General linear models identified the independent effects of IMAT after covarying for SM, VAT, TAT, race, sex and two-way interactions. Results-Significant independent associations were observed for IMAT with glucose (P < 0.001), PBG (P < 0.001) and T-Chol (P < 0.05). The association of IMAT with cholesterol differed by race in such a manner that for a unit increase in IMAT, T-Chol increased more rapidly in Ca compared to AA (P < 0.05). TG, HDL-Chol and insulin had no independent association with IMAT. Conclusion-The strong independent associations of IMAT with fasting glucose and PBG suggest that IMAT may be related to glucose metabolism; however, IMAT is also associated with T-Chol in Ca.

Journal of Clinical Densitometry, 2015

Recent studies suggest that osteoporosis is not only related to body weight and total body fat, b... more Recent studies suggest that osteoporosis is not only related to body weight and total body fat, but also to bone marrow fat (1-3). One theory explaining the inverse association between marrow fat and bone is that an increase in the differentiation of MSCs to adipocytes will lead to a decrease in the differentiation of MSCs to osteoblasts, as adipocytes and osteoblasts share the same progenitor, the bone marrow mesenchymal stem cells (MSCs) (4-6). The differentiation of MSCs into either fat or bone is influenced by hormones, adipokines, PPARγ, as well as mechanical stimuli (5, 7, 8). Mechanisms that promote the adipogenic fate of MSCs actively suppress intracellular osteogenic signals(6). Consistent with previous findings for cancellous bone (1-3, 9), our group reported an inverse correlation between bone marrow adipose tissue and bone mineral density in the pelvis, spine, and hip regions in adults and in children, independent of gender and ethnicity (10-14). On the other hand, the relationship between marrow fat and bone at cortical bone sites has been reported in very few studies (15-17). Cortical bone strength is critical in weight-bearing and physical performance (18). Cortical bone plays an important role with

International journal of obesity (2005), 2011

Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify p... more Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify persons who carry more weight as fat-free mass and %fat can be misleading in cases of malnutrition or in disease states characterized by wasting of lean tissue. The fat-free mass index (FFMI) is proposed to assess body composition in individuals who have a similar body composition but differ in height allowing identification of those suffering from malnutrition, wasting or those that possess a relatively high muscle mass. The purpose was to determine whether the FFMI differs in a group of racially/ethnically diverse adults. Cross-sectional. Subjects were a multi-ethnic sample (Caucasian, CA; African American, AA; Hispanic, HIS and Asian, AS) of 1339 healthy males (n = 480) and females (n = 859) ranging in age from 18-110 years. Total body fat, total fat-free mass and bone mineral density were estimated using dual energy X-ray absorptiometry. FFMI differed among the four ethnic groups (P ≤...

The American journal of clinical nutrition, 2007

Although Quetelet first reported in 1835 that adult weight scales to the square of stature, limit... more Although Quetelet first reported in 1835 that adult weight scales to the square of stature, limited or no information is available on how anatomical body compartments, including adipose tissue (AT), scale to height. We examined the critical underlying assumptions of adiposity-body mass index (BMI) relations and extended these analyses to major anatomical compartments: skeletal muscle (SM), bone, residual mass, weight (AT+SM+bone), AT-free mass, and organs (liver, brain). This was a cross-sectional analysis of 2 body-composition databases: one including magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA) estimates of evaluated components in adults (total n=411; organs=76) and the other a larger DXA database (n=1346) that included related estimates of fat, fat-free mass, and bone mineral mass. Weight, primary lean components (SM, residual mass, AT-free mass, and fat-free mass), and liver scaled to height with powers of approximately 2 (all P<0.001); bone and bone ...

The American journal of clinical nutrition, 2006

African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) t... more African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) than do whites. Whether the composition of FFM at the organ-tissue level differs between African Americans and whites and, if so, whether that difference could account for differences by race in REE are unknown. The objectives were to quantify FFM in vivo in women and men at the organ-tissue level and to ascertain whether the mass of specific high-metabolic-rate organs and tissues differs between African Americans and whites and, if so, whether that difference can account for differences in REE. The study was a cross-sectional evaluation of 64 women (n = 34 African Americans, 30 whites) and 35 men (n = 8 African Americans, 27 whites). Magnetic resonance imaging measures of liver, kidney, heart, spleen, brain, skeletal muscle, and adipose tissue and dual-energy X-ray absorptiometry measures of fat and FFM were acquired. REE was measured by using indirect calorimetry. The mass of selected h...

The American journal of clinical nutrition, 2005

African Americans (AAs) have a higher prevalence of obesity and type 2 diabetes than do whites. H... more African Americans (AAs) have a higher prevalence of obesity and type 2 diabetes than do whites. Higher insulin resistance and hyperinsulinemia have been reported in adult AAs than in whites. Differences in adipose tissue and its distribution may account for these findings. The objective was to ascertain whether differences between AA and white women in adipose tissue (AT) and skeletal muscle (SM) volumes account for ethnic differences in insulin resistance. We used whole-body magnetic resonance imaging to measure AT and SM volumes and used the intravenous-glucose-tolerance test to measure insulin resistance. AAs (n = 32) were 29-42% more insulin resistant than were whites (n = 28) after adjustment for weight and height or any AT volumes (P < 0.05). After adjustment for SM volume, the difference decreased to 19% and became nonsignificant. AAs had a 163% greater acute insulin response to glucose than did whites; this difference was significant even after adjustment for insulin sens...

International Journal of Obesity, 2007

Background-Visceral adipose tissue (VAT) is widely recognized as conveying the highest health ris... more Background-Visceral adipose tissue (VAT) is widely recognized as conveying the highest health risk in humans among the currently measurable adipose tissue compartments. A recent study indicated that the traditionally measured VAT area at L 4-L 5 is not the VAT area with the highest correlation with total VAT volume. At present, it is unknown whether the area with the highest correlation is also the most strongly associated with obesity-related health risk. Objective-The study aim was to establish which VAT slice area(s) are most strongly associated with obesity-related health risk indicators. Design-The subjects were a convenience sample of healthy adults who completed whole-body magnetic resonance imaging (MRI) scans. The correlations, with appropriate adjustments, were examined between individual MRI slice VAT areas and fasting serum/plasma triglycerides (TG), high-density lipoprotein cholesterol (HDL), glucose, insulin and blood pressure. Results-The sample consisted of 283 healthy men (age (mean±s.d.) 41.9±15.8 years; BMI, 26.0±3.2 kg/m 2 ; VAT, 2.7±1.8 L) and 411 women (age, 48.1±18.7 years; BMI 27.0±5.4 kg/m 2 ; VAT, 1.7±1.2 L). After adjusting for age, race, menopause status, scan position and specific blood analysis laboratory, VAT area at L 4-L 5 had lower correlations with most metabolic risk factors including serum/plasma TG, HDL, glucose, insulin and blood pressure than VAT volume in both men and women. The VAT areas 10 and 15 cm above L 4-L 5 in men had higher or equal correlations with health risk measures than VAT volume. In women, the VAT area 5 cm above or below L 4-L 5 and total VAT volume had similar correlations with health risk measures. Conclusions-An appropriately selected single slice VAT area is an equally reliable phenotypic marker of obesity-related health risk as total VAT volume. However, in both men and women the VAT slice area at the traditional L 4-L 5 level is not the best marker of obesity-related health risk.

Journal of applied physiology (Bethesda, Md. : 1985), Jan 15, 2014

Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differ... more Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differs in adults with type 2 diabetes (T2DM) compared with nondiabetic healthy controls has not been investigated. A subset of African-American and Caucasian participants with T2DM from the Look AHEAD (Action for Health in Diabetes) trial had body composition assessed and compared with a sample of healthy controls. Skeletal muscle mass (SMM), liver, kidneys, and spleen mass were quantified using a contiguous slice magnetic resonance imaging (MRI) protocol. Cardiac mass was quantified by either a cardiac gated MRI protocol or by echocardiography. MRI volumes were converted to mass using assumed densities. Dual-energy X-ray absorptiometry assessed LBM. Using general linear models adjusted for height, weight, sex, age, race, and interactions of diabetes status with race or sex, persons with T2DM (n = 95) had less LBM (49.7 vs. 51.6 kg) and SMM (24.1 vs. 25.4 kg) and larger kidneys (0.40 vs. 0.36...

The American journal of clinical nutrition, 2003

Waist circumference (WC) is now accepted as a practical measure of adipose tissue distribution. F... more Waist circumference (WC) is now accepted as a practical measure of adipose tissue distribution. Four body sites for WC measurements are commonly used, as follows: immediately below the lowest ribs (WC1), the narrowest waist (WC2), the midpoint between the lowest rib and the iliac crest (WC3), and immediately above the iliac crest (WC4). We sought to compare the magnitude and reliability of WC measured at these 4 sites in males and females. WC was measured at each site 1 time in all subjects [49 males and 62 females, aged 7-83 y, with a body mass index (in kg/m(2)) of 9-43] and 3 times in a subgroup (n = 93) by one experienced observer using a heavy-duty inelastic tape. Body fat was measured in a subgroup (n = 74) with the use of dual-energy X-ray absorptiometry. The mean values of WC were WC2 < WC1 < WC3 < WC4 (P < 0.01) in females and WC2…

The American journal of clinical nutrition, 2005

Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests ... more Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests that the fat distribution immediately after weight restoration in patients with AN differs from the distribution typical of healthy adult women. The purpose of this study was to assess body fat distribution before and shortly after normalization of weight in women with AN. Body composition and fat distribution were assessed by anthropometry, dual-energy X-ray absorptiometry, and whole-body magnetic resonance imaging in 29 women with AN before and after weight normalization and at a single time point in 15 female control subjects. Hormone concentrations were also evaluated in patients and control subjects. During approximately 10.1 +/- 2.9 wk (range: 4-17.3 wk) of treatment, patients with AN gained 12.2 +/- 3.6 kg, and refed weight (54.1 +/- 4.2 kg) did not differ significantly from that of control subjects (54.7 +/- 4.4 kg). Waist-to-hip circumference ratio (P < 0.006), total trunk fa...

Obesity, 2014

ObjectiveTo assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular ... more ObjectiveTo assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular (IMAT) adipose tissue by whole‐body MRI before surgery and at 12 months and 24 months post‐surgery in a subset of participants of the Longitudinal Assessment of Bariatric Surgery‐2.MethodsFrom 0 to 12 months, n = 20 females and 3 males; from 12 to 24 months, n = 42 females and 7 males. Paired t‐tests and GLM repeated measures examined changes in TAT, SAT, VAT, and IMAT at 12 and 24 months, with sex and age as covariates.ResultsChanges from 0 to 12 months included weight (−41.9 ± 12.1 kg; −36%), TAT (−33.5 ± 9.6 kg; −56%), SAT (−29.2 ± 8.2 kg; −55%), VAT (−3.3 ± 1.6 kg; −73%), and IMAT (−0.99 ± 0.68 kg; −50%), all P < 0.001. In females, from 12 to 24 months, despite relative weight stability (−1.8 ± 6.5 kg, −2%; P = 0.085), VAT (−0.5 ± 0.7 kg; −30%; P < 0.001) and IMAT (−0.2 ± 0.4 kg; −14%; P = 0.012) decreased further. In males, from 12 to 24 months, weight increased (5.1 ± 5.2 kg;...

Pediatric Research, 2012

Articles Clinical Investigation nature publishing group Background: The measurement of adipose ti... more Articles Clinical Investigation nature publishing group Background: The measurement of adipose tissue (aT) depots in vivo requires expensive imaging methods not accessible to most clinicians and researchers. The study aim was to derive mathematical models to predict total aT (TaT) and subdepots from total body fat derived from a dual-energy X-ray absorptiometry (DXa) scan. Methods: Models were developed to predict magnetic resonance imaging-derived TaT and subdepots subcutaneous aT, visceral aT, and intermuscular aT from DXa total body fat (Fat DXa) using cross-sectional data (time 0 (T0)) and validated results using 1 (T1) and 2 (T2) y follow-up data. subjects were 176 multiethnic healthy children ages 5-17 y at T0. Twenty-two were measured at T1 and T2. TaT was compared with Fat DXa. results: at T0, TaT was greater than Fat DXa (12.5 ± 8.4 vs.12.0 ± 9.4 kg; P < 0.0001), with a quadratic relationship between TaT and Fat DXa that varied by sex. Predicted mean TaTs were not different from measured TaTs: T1: (9.84 ± 4.45 kg vs. 9.50 ± 4.37 kg; P = 0.11); T2: (12.94 ± 6.75 kg vs. 12.89 ± 7.09 kg; P = 0.76). The quadratic relationship was not influenced by race or age. conclusion: In general, the prediction equations for TaT and subdepots were consistent with the measured values using T1 and T2 data.

Osteoporosis International, 2011

The relationship between bone marrow adipose tissue and bone mineral density is different between... more The relationship between bone marrow adipose tissue and bone mineral density is different between African Americans and Caucasians as well as between men and women. This suggests that the mechanisms that regulate the differentiation and proliferation of bone marrow stromal cells may differ in these populations. Introduction-It has long been established that there are ethnic and sex differences in bone mineral density (BMD) and fracture risk. Recent studies suggest that bone marrow adipose tissue (BMAT) may play a role in the pathogenesis of osteoporosis. It is unknown whether ethnic and sex differences exist in the relationship between BMAT and BMD. Methods-Pelvic BMAT was evaluated in 455 healthy African American and Caucasian men and women (age 18-88 years) using whole-body T1-weighted magnetic resonance imaging. BMD was measured using whole-body dual-energy X-ray absorptiometry. Results-A negative correlation was observed between pelvic BMAT and total body BMD or pelvic BMD (r=−0.533, −0.576, respectively; P<0.001). In multiple regression analyses with BMD as the dependent variable, ethnicity significantly entered the regression models as either an individual term or an interaction with BMAT. Menopausal status significantly entered the regression model with total body BMD as the dependent variable. African Americans had higher total body BMD than Caucasians for the same amount of BMAT, and the ethnic difference for pelvic BMD was greater in those participants with a higher BMAT. Men and premeno-pausal women had higher total body BMD levels than postmenopausal women for the same amount of BMAT. Conclusions-An inverse relationship exists between BMAT and BMD in African American and Caucasian men and women. The observed ethnic and sex differences between BMAT and BMD in the present study suggest the possibility that the mechanisms regulating the differentiation and proliferation of bone marrow stromal cells may differ in these populations.

Obesity, 2013

Objective-To develop a new geometrical index that combines height, waist circumference (WC), and ... more Objective-To develop a new geometrical index that combines height, waist circumference (WC), and hip circumference (HC) and relate this index to total and visceral body fat. Design and Methods-Subject data were pooled from three databases that contained demographic, anthropometric, dual energy X-ray absorptiometry (DXA) measured fat mass, and magnetic resonance imaging measured visceral adipose tissue (VAT) volume. Two elliptical models of the human body were developed. Body roundness was calculated from the model using a well-established constant arising from the theory. Regression models based on eccentricity and other variables were used to predict % body fat and % VAT. Results-A body roundness index (BRI) was derived to quantify the individual body shape in a height-independent manner. Body roundness slightly improved predictions of % body fat and % VAT compared to the traditional metrics of body mass index (BMI), WC, or HC. On this basis, healthy body roundness ranges were established. An automated graphical program simulating study results was placed at http://www.pbrc.edu/bodyroundness. Conclusions-Body roundness index, a new shape measure, is a predictor of % body fat and % VAT and can be applied as a visual tool for health status evaluations. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

Journal of Parenteral and Enteral Nutrition, 2011

The study of body composition is a rapidly evolving science. In today's environment, there is a g... more The study of body composition is a rapidly evolving science. In today's environment, there is a great deal of interest in assessing body composition, especially in the obese subject, as a guide to clinical and nutrition interventions. There are some strikingly different compartments of body composition between the obese and the lean patient. We do have the ability to measure body composition accurately, although these techniques can be labor intensive and expensive. The recognition of patients with sarcopenic obesity has identified a potential high-risk patient population. These body composition abnormalities may have even greater importance in the intensive care patient.

The FASEB Journal, 2008

Asian women are known to have a larger amount of abdominal fat (AF) for the same level of BMI com... more Asian women are known to have a larger amount of abdominal fat (AF) for the same level of BMI compared with Caucasian and African‐American women. This study was aimed to determine whether waist circumference (WC) could be useful as an index of AF compared with AF measured by dual energy x‐ray absorptiometry (DXA) before and after a weight‐loss program in Asian women. Thirty‐eight healthy, pre‐menopausal obese Korean women (body fat percent > 30%) were enrolled and followed during a 6‐week weight‐loss program including herbal formula, calorie restriction, and exercise. Anthropometry and DXA measurements were performed before and after weight‐loss. A specific region of interest (ROI, L2‐iliac crest) by DXA was correlated with anthropometry at baseline: WC (γ= 0.91) > BMI (γ = 0.87) > Waist‐Height ratio (WHtR, γ = 0.82) > WHR (γ = 0.46); and after weight loss: BMI (γ = 0.88) > WC (γ = 0.84) > WHtR (γ = 0.82), all p < 0.01. The change in DXA ROI showed a reasonable ...

The American Journal of Clinical Nutrition, 2008

Background: Extracellular water (ECW), a relevant molecular level component for clinical assessme... more Background: Extracellular water (ECW), a relevant molecular level component for clinical assessment, is commonly obtained by 2 methods that rely on assumptions that may not be possible to test at the time the measurements are made. Objective: The aim of the current study was to evaluate the degree of agreement between ECW assessment by the sodium bromide dilution (ECW NaBr) and total body potassium (TBK; whole-body 40 K counting) to total body water (TBW; isotope dilution) methods (ECW TBK-TBW) in an ethnically mixed group of children and adults. Design: ECW was measured with the ECW NaBr and ECW TBK-TBW methods in 526 white and African American males and females (86 nonobese children, 193 nonobese adults, and 247 obese adults). Fat mass was assessed with dual-energy X-ray absorptiometry. Multiple regression analysis was used to examine the variables related to between-ECW method differences. Results: Significant but generally small group mean (ȀSD) differences in ECW were found in the obese adults (1.28 Ȁ 2.54 kg) and children (Ҁ0.71 Ȁ 1.78 kg). The magnitude of the differences was related to mean ECW in obese adults, children, and nonobese adults, and the relations between these variables were modified by sex for nonobese adults. ECW differences were also dependent on age, weight, sex, and race or on interactions between these variables. Conclusions: Overall, although good between-method agreement was found across the 3 groups, the degree of agreement varied according to subject characteristics, particularly at the extremes of ECW and body weight. We advance a possible mechanism that may link subject characteristics with the degree of agreement between ECW measurement methods and their underlying assumptions.

American Journal of Physiology-Endocrinology and Metabolism, 2000

We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissu... more We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissue compartments, and related changes in protein metabolism, are appropriate for weight loss in obese older women. Subjects were 14 healthy weight-stable obese (BMI ≥30 kg/m2) postmenopausal women >55 yr who participated in a 16-wk, 1,200 kcal/day nutritionally complete diet. Measures at baseline and 16 wk included FFM and appendicular lean soft tissue (LST) by dual-energy X-ray absorptiometry; body cell mass (BCM) by 40K whole body counting; total body water (TBW) by tritium dilution; skeletal muscle (SM) by whole body MRI; and fasting whole body protein metabolism through l-[1-13C]leucine kinetics. Mean weight loss (±SD) was 9.6 ± 3.0 kg ( P < 0.0001) or 10.7% of initial body weight. FFM decreased by 2.1 ± 2.6 kg ( P = 0.006), or 19.5% of weight loss, and did not differ from that reported (2.3 ± 0.7 kg). Relative losses of SM, LST, TBW, and BCM were consistent with reductions in bo...

The American Journal of Clinical Nutrition, 2004

Background: Aging is associated with metabolic, physiologic, and functional impairments, in part ... more Background: Aging is associated with metabolic, physiologic, and functional impairments, in part through age-related changes in body composition. During the later adult years, skeletal muscle mass decreases and body fat becomes centralized. Objective: The goal of the study was to investigate body composition over time (x Ȁ SD: 2.04 Ȁ 0.6 y) in healthy, ambulatory, elderly African American women. The hypothesis that a reduction in totalbody skeletal muscle (SM) and increases in visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) are ongoing in healthy, weight-stable elderly was tested. Design: The study was a longitudinal evaluation of 26 women (age at baseline: 75.5 Ȁ 5.1 y) with a body mass index (in kg/m 2) of 27.0 Ȁ 4.0. Body composition was measured by using whole-body magnetic resonance imaging for the quantification of SM, total adipose tissue (TAT), VAT, SAT, and IMAT. Results: SM (P 0.001) and bone (P 0.05) masses decreased, and regional analyses showed a decrease in dual-energy X-ray absorptiometry-derived leg SM (P 0.05). VAT (P ҃ 0.011) and IMAT (P 0.001) increased. No changes occurred in TAT (P ҃ 0.45), SAT (P ҃ 0.96), physical function, or food intake. Conclusion: These data show an age-related remodeling of body composition with reductions in SM and corresponding increases in VAT and IMAT. Changes in the previously unstudied depot of IMAT may be involved in the deterioration of metabolic values frequently observed during aging.

The American Journal of Clinical Nutrition, 2008

Background: After weight loss, total energy expenditure-in particular, energy expenditure at low ... more Background: After weight loss, total energy expenditure-in particular, energy expenditure at low levels of physical activity-is lower than predicted by actual changes in body weight and composition. An important clinical issue is whether this reduction, which predisposes to weight regain, persists over time. Objective: We aimed to determine whether this disproportionate reduction in energy expenditure persists in persons who have maintained a bodyweight reduction of ͧ10% for 1 y. Design: Seven trios of sex-and weight-matched subjects were studied in an in-patient setting while receiving a weight-maintaining liquid formula diet of identical composition. Each trio consisted of a subject at usual weight (Wt initial), a subject maintaining a weight reduction of ͧ10% after recent (5-8 wk) completion of weight loss (Wt loss-recent), and a subject who had maintained a documented reduction in body weight of 10% for 1 y (Wt loss-sustained). Twentyfour-hour total energy expenditure (TEE) was assessed by precise titration of fed calories of a liquid formula diet necessary to maintain body weight. Resting energy expenditure (REE) and the thermic effect of feeding (TEF) were measured by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as NREE ҃ TEE-(REE ѿTEF). Results: TEE, NREE, and (to a lesser extent) REE were significantly lower in the Wt loss-sustained and Wt loss-recent groups than in the Wt initial group. Differences from the Wt initial group in energy expenditure were qualitatively and quantitatively similar after recent and sustained weight loss. Conclusion: Declines in energy expenditure favoring the regain of lost weight persist well beyond the period of dynamic weight loss.

International Journal of Obesity, 2007

Background-The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understoo... more Background-The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understood compared to those of visceral adipose tissue (VAT) even though the absolute quantities of both depots are similar in many individuals. Objective-The aim was to determine the independent relationship between whole-body IMAT and cardiovascular risk factor parameters. Design-Whole body magnetic resonance imaging (MRI) was used to quantify total skeletal muscle (SM), total adipose tissue (TAT) of which IMAT, defined as the AT visible by MRI within the boundary of the muscle fascia, is a sub-component. Fasting serum measures (n = 262) of glucose, total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), triglycerides (TG), protein bound glucose (PBG, n = 206) and insulin (n = 119) were acquired in healthy African-American (AA, n = 78) and Caucasian (Ca, n = 109) women (body mass index (BMI) 26.5±5.7 kg/ m 2 ; 44.4±16.4 years) and men (39 AA, 62 Ca; BMI 25.6±3.5 kg/m 2 ; 45.6±17.4 years). General linear models identified the independent effects of IMAT after covarying for SM, VAT, TAT, race, sex and two-way interactions. Results-Significant independent associations were observed for IMAT with glucose (P < 0.001), PBG (P < 0.001) and T-Chol (P < 0.05). The association of IMAT with cholesterol differed by race in such a manner that for a unit increase in IMAT, T-Chol increased more rapidly in Ca compared to AA (P < 0.05). TG, HDL-Chol and insulin had no independent association with IMAT. Conclusion-The strong independent associations of IMAT with fasting glucose and PBG suggest that IMAT may be related to glucose metabolism; however, IMAT is also associated with T-Chol in Ca.

Journal of Clinical Densitometry, 2015

Recent studies suggest that osteoporosis is not only related to body weight and total body fat, b... more Recent studies suggest that osteoporosis is not only related to body weight and total body fat, but also to bone marrow fat (1-3). One theory explaining the inverse association between marrow fat and bone is that an increase in the differentiation of MSCs to adipocytes will lead to a decrease in the differentiation of MSCs to osteoblasts, as adipocytes and osteoblasts share the same progenitor, the bone marrow mesenchymal stem cells (MSCs) (4-6). The differentiation of MSCs into either fat or bone is influenced by hormones, adipokines, PPARγ, as well as mechanical stimuli (5, 7, 8). Mechanisms that promote the adipogenic fate of MSCs actively suppress intracellular osteogenic signals(6). Consistent with previous findings for cancellous bone (1-3, 9), our group reported an inverse correlation between bone marrow adipose tissue and bone mineral density in the pelvis, spine, and hip regions in adults and in children, independent of gender and ethnicity (10-14). On the other hand, the relationship between marrow fat and bone at cortical bone sites has been reported in very few studies (15-17). Cortical bone strength is critical in weight-bearing and physical performance (18). Cortical bone plays an important role with

International journal of obesity (2005), 2011

Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify p... more Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify persons who carry more weight as fat-free mass and %fat can be misleading in cases of malnutrition or in disease states characterized by wasting of lean tissue. The fat-free mass index (FFMI) is proposed to assess body composition in individuals who have a similar body composition but differ in height allowing identification of those suffering from malnutrition, wasting or those that possess a relatively high muscle mass. The purpose was to determine whether the FFMI differs in a group of racially/ethnically diverse adults. Cross-sectional. Subjects were a multi-ethnic sample (Caucasian, CA; African American, AA; Hispanic, HIS and Asian, AS) of 1339 healthy males (n = 480) and females (n = 859) ranging in age from 18-110 years. Total body fat, total fat-free mass and bone mineral density were estimated using dual energy X-ray absorptiometry. FFMI differed among the four ethnic groups (P ≤...

The American journal of clinical nutrition, 2007

Although Quetelet first reported in 1835 that adult weight scales to the square of stature, limit... more Although Quetelet first reported in 1835 that adult weight scales to the square of stature, limited or no information is available on how anatomical body compartments, including adipose tissue (AT), scale to height. We examined the critical underlying assumptions of adiposity-body mass index (BMI) relations and extended these analyses to major anatomical compartments: skeletal muscle (SM), bone, residual mass, weight (AT+SM+bone), AT-free mass, and organs (liver, brain). This was a cross-sectional analysis of 2 body-composition databases: one including magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA) estimates of evaluated components in adults (total n=411; organs=76) and the other a larger DXA database (n=1346) that included related estimates of fat, fat-free mass, and bone mineral mass. Weight, primary lean components (SM, residual mass, AT-free mass, and fat-free mass), and liver scaled to height with powers of approximately 2 (all P<0.001); bone and bone ...

The American journal of clinical nutrition, 2006

African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) t... more African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) than do whites. Whether the composition of FFM at the organ-tissue level differs between African Americans and whites and, if so, whether that difference could account for differences by race in REE are unknown. The objectives were to quantify FFM in vivo in women and men at the organ-tissue level and to ascertain whether the mass of specific high-metabolic-rate organs and tissues differs between African Americans and whites and, if so, whether that difference can account for differences in REE. The study was a cross-sectional evaluation of 64 women (n = 34 African Americans, 30 whites) and 35 men (n = 8 African Americans, 27 whites). Magnetic resonance imaging measures of liver, kidney, heart, spleen, brain, skeletal muscle, and adipose tissue and dual-energy X-ray absorptiometry measures of fat and FFM were acquired. REE was measured by using indirect calorimetry. The mass of selected h...

The American journal of clinical nutrition, 2005

African Americans (AAs) have a higher prevalence of obesity and type 2 diabetes than do whites. H... more African Americans (AAs) have a higher prevalence of obesity and type 2 diabetes than do whites. Higher insulin resistance and hyperinsulinemia have been reported in adult AAs than in whites. Differences in adipose tissue and its distribution may account for these findings. The objective was to ascertain whether differences between AA and white women in adipose tissue (AT) and skeletal muscle (SM) volumes account for ethnic differences in insulin resistance. We used whole-body magnetic resonance imaging to measure AT and SM volumes and used the intravenous-glucose-tolerance test to measure insulin resistance. AAs (n = 32) were 29-42% more insulin resistant than were whites (n = 28) after adjustment for weight and height or any AT volumes (P < 0.05). After adjustment for SM volume, the difference decreased to 19% and became nonsignificant. AAs had a 163% greater acute insulin response to glucose than did whites; this difference was significant even after adjustment for insulin sens...

International Journal of Obesity, 2007

Background-Visceral adipose tissue (VAT) is widely recognized as conveying the highest health ris... more Background-Visceral adipose tissue (VAT) is widely recognized as conveying the highest health risk in humans among the currently measurable adipose tissue compartments. A recent study indicated that the traditionally measured VAT area at L 4-L 5 is not the VAT area with the highest correlation with total VAT volume. At present, it is unknown whether the area with the highest correlation is also the most strongly associated with obesity-related health risk. Objective-The study aim was to establish which VAT slice area(s) are most strongly associated with obesity-related health risk indicators. Design-The subjects were a convenience sample of healthy adults who completed whole-body magnetic resonance imaging (MRI) scans. The correlations, with appropriate adjustments, were examined between individual MRI slice VAT areas and fasting serum/plasma triglycerides (TG), high-density lipoprotein cholesterol (HDL), glucose, insulin and blood pressure. Results-The sample consisted of 283 healthy men (age (mean±s.d.) 41.9±15.8 years; BMI, 26.0±3.2 kg/m 2 ; VAT, 2.7±1.8 L) and 411 women (age, 48.1±18.7 years; BMI 27.0±5.4 kg/m 2 ; VAT, 1.7±1.2 L). After adjusting for age, race, menopause status, scan position and specific blood analysis laboratory, VAT area at L 4-L 5 had lower correlations with most metabolic risk factors including serum/plasma TG, HDL, glucose, insulin and blood pressure than VAT volume in both men and women. The VAT areas 10 and 15 cm above L 4-L 5 in men had higher or equal correlations with health risk measures than VAT volume. In women, the VAT area 5 cm above or below L 4-L 5 and total VAT volume had similar correlations with health risk measures. Conclusions-An appropriately selected single slice VAT area is an equally reliable phenotypic marker of obesity-related health risk as total VAT volume. However, in both men and women the VAT slice area at the traditional L 4-L 5 level is not the best marker of obesity-related health risk.

Journal of applied physiology (Bethesda, Md. : 1985), Jan 15, 2014

Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differ... more Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differs in adults with type 2 diabetes (T2DM) compared with nondiabetic healthy controls has not been investigated. A subset of African-American and Caucasian participants with T2DM from the Look AHEAD (Action for Health in Diabetes) trial had body composition assessed and compared with a sample of healthy controls. Skeletal muscle mass (SMM), liver, kidneys, and spleen mass were quantified using a contiguous slice magnetic resonance imaging (MRI) protocol. Cardiac mass was quantified by either a cardiac gated MRI protocol or by echocardiography. MRI volumes were converted to mass using assumed densities. Dual-energy X-ray absorptiometry assessed LBM. Using general linear models adjusted for height, weight, sex, age, race, and interactions of diabetes status with race or sex, persons with T2DM (n = 95) had less LBM (49.7 vs. 51.6 kg) and SMM (24.1 vs. 25.4 kg) and larger kidneys (0.40 vs. 0.36...

The American journal of clinical nutrition, 2003

Waist circumference (WC) is now accepted as a practical measure of adipose tissue distribution. F... more Waist circumference (WC) is now accepted as a practical measure of adipose tissue distribution. Four body sites for WC measurements are commonly used, as follows: immediately below the lowest ribs (WC1), the narrowest waist (WC2), the midpoint between the lowest rib and the iliac crest (WC3), and immediately above the iliac crest (WC4). We sought to compare the magnitude and reliability of WC measured at these 4 sites in males and females. WC was measured at each site 1 time in all subjects [49 males and 62 females, aged 7-83 y, with a body mass index (in kg/m(2)) of 9-43] and 3 times in a subgroup (n = 93) by one experienced observer using a heavy-duty inelastic tape. Body fat was measured in a subgroup (n = 74) with the use of dual-energy X-ray absorptiometry. The mean values of WC were WC2 < WC1 < WC3 < WC4 (P < 0.01) in females and WC2…

The American journal of clinical nutrition, 2005

Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests ... more Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests that the fat distribution immediately after weight restoration in patients with AN differs from the distribution typical of healthy adult women. The purpose of this study was to assess body fat distribution before and shortly after normalization of weight in women with AN. Body composition and fat distribution were assessed by anthropometry, dual-energy X-ray absorptiometry, and whole-body magnetic resonance imaging in 29 women with AN before and after weight normalization and at a single time point in 15 female control subjects. Hormone concentrations were also evaluated in patients and control subjects. During approximately 10.1 +/- 2.9 wk (range: 4-17.3 wk) of treatment, patients with AN gained 12.2 +/- 3.6 kg, and refed weight (54.1 +/- 4.2 kg) did not differ significantly from that of control subjects (54.7 +/- 4.4 kg). Waist-to-hip circumference ratio (P < 0.006), total trunk fa...

Obesity, 2014

ObjectiveTo assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular ... more ObjectiveTo assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular (IMAT) adipose tissue by whole‐body MRI before surgery and at 12 months and 24 months post‐surgery in a subset of participants of the Longitudinal Assessment of Bariatric Surgery‐2.MethodsFrom 0 to 12 months, n = 20 females and 3 males; from 12 to 24 months, n = 42 females and 7 males. Paired t‐tests and GLM repeated measures examined changes in TAT, SAT, VAT, and IMAT at 12 and 24 months, with sex and age as covariates.ResultsChanges from 0 to 12 months included weight (−41.9 ± 12.1 kg; −36%), TAT (−33.5 ± 9.6 kg; −56%), SAT (−29.2 ± 8.2 kg; −55%), VAT (−3.3 ± 1.6 kg; −73%), and IMAT (−0.99 ± 0.68 kg; −50%), all P < 0.001. In females, from 12 to 24 months, despite relative weight stability (−1.8 ± 6.5 kg, −2%; P = 0.085), VAT (−0.5 ± 0.7 kg; −30%; P < 0.001) and IMAT (−0.2 ± 0.4 kg; −14%; P = 0.012) decreased further. In males, from 12 to 24 months, weight increased (5.1 ± 5.2 kg;...

Pediatric Research, 2012

Articles Clinical Investigation nature publishing group Background: The measurement of adipose ti... more Articles Clinical Investigation nature publishing group Background: The measurement of adipose tissue (aT) depots in vivo requires expensive imaging methods not accessible to most clinicians and researchers. The study aim was to derive mathematical models to predict total aT (TaT) and subdepots from total body fat derived from a dual-energy X-ray absorptiometry (DXa) scan. Methods: Models were developed to predict magnetic resonance imaging-derived TaT and subdepots subcutaneous aT, visceral aT, and intermuscular aT from DXa total body fat (Fat DXa) using cross-sectional data (time 0 (T0)) and validated results using 1 (T1) and 2 (T2) y follow-up data. subjects were 176 multiethnic healthy children ages 5-17 y at T0. Twenty-two were measured at T1 and T2. TaT was compared with Fat DXa. results: at T0, TaT was greater than Fat DXa (12.5 ± 8.4 vs.12.0 ± 9.4 kg; P < 0.0001), with a quadratic relationship between TaT and Fat DXa that varied by sex. Predicted mean TaTs were not different from measured TaTs: T1: (9.84 ± 4.45 kg vs. 9.50 ± 4.37 kg; P = 0.11); T2: (12.94 ± 6.75 kg vs. 12.89 ± 7.09 kg; P = 0.76). The quadratic relationship was not influenced by race or age. conclusion: In general, the prediction equations for TaT and subdepots were consistent with the measured values using T1 and T2 data.

Osteoporosis International, 2011

The relationship between bone marrow adipose tissue and bone mineral density is different between... more The relationship between bone marrow adipose tissue and bone mineral density is different between African Americans and Caucasians as well as between men and women. This suggests that the mechanisms that regulate the differentiation and proliferation of bone marrow stromal cells may differ in these populations. Introduction-It has long been established that there are ethnic and sex differences in bone mineral density (BMD) and fracture risk. Recent studies suggest that bone marrow adipose tissue (BMAT) may play a role in the pathogenesis of osteoporosis. It is unknown whether ethnic and sex differences exist in the relationship between BMAT and BMD. Methods-Pelvic BMAT was evaluated in 455 healthy African American and Caucasian men and women (age 18-88 years) using whole-body T1-weighted magnetic resonance imaging. BMD was measured using whole-body dual-energy X-ray absorptiometry. Results-A negative correlation was observed between pelvic BMAT and total body BMD or pelvic BMD (r=−0.533, −0.576, respectively; P<0.001). In multiple regression analyses with BMD as the dependent variable, ethnicity significantly entered the regression models as either an individual term or an interaction with BMAT. Menopausal status significantly entered the regression model with total body BMD as the dependent variable. African Americans had higher total body BMD than Caucasians for the same amount of BMAT, and the ethnic difference for pelvic BMD was greater in those participants with a higher BMAT. Men and premeno-pausal women had higher total body BMD levels than postmenopausal women for the same amount of BMAT. Conclusions-An inverse relationship exists between BMAT and BMD in African American and Caucasian men and women. The observed ethnic and sex differences between BMAT and BMD in the present study suggest the possibility that the mechanisms regulating the differentiation and proliferation of bone marrow stromal cells may differ in these populations.

Obesity, 2013

Objective-To develop a new geometrical index that combines height, waist circumference (WC), and ... more Objective-To develop a new geometrical index that combines height, waist circumference (WC), and hip circumference (HC) and relate this index to total and visceral body fat. Design and Methods-Subject data were pooled from three databases that contained demographic, anthropometric, dual energy X-ray absorptiometry (DXA) measured fat mass, and magnetic resonance imaging measured visceral adipose tissue (VAT) volume. Two elliptical models of the human body were developed. Body roundness was calculated from the model using a well-established constant arising from the theory. Regression models based on eccentricity and other variables were used to predict % body fat and % VAT. Results-A body roundness index (BRI) was derived to quantify the individual body shape in a height-independent manner. Body roundness slightly improved predictions of % body fat and % VAT compared to the traditional metrics of body mass index (BMI), WC, or HC. On this basis, healthy body roundness ranges were established. An automated graphical program simulating study results was placed at http://www.pbrc.edu/bodyroundness. Conclusions-Body roundness index, a new shape measure, is a predictor of % body fat and % VAT and can be applied as a visual tool for health status evaluations. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

Journal of Parenteral and Enteral Nutrition, 2011

The study of body composition is a rapidly evolving science. In today's environment, there is a g... more The study of body composition is a rapidly evolving science. In today's environment, there is a great deal of interest in assessing body composition, especially in the obese subject, as a guide to clinical and nutrition interventions. There are some strikingly different compartments of body composition between the obese and the lean patient. We do have the ability to measure body composition accurately, although these techniques can be labor intensive and expensive. The recognition of patients with sarcopenic obesity has identified a potential high-risk patient population. These body composition abnormalities may have even greater importance in the intensive care patient.