Cardiovasc Prev Pharmacother.  2024 Oct;6(4):128-134. 10.36011/cpp.2024.6.e13.

Use of dual-energy x-ray absorptiometry for body composition in chronic disease management

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Abstract

As individuals age or contend with chronic diseases, shifts in body composition often emerge, characterized by a loss of muscle mass and an increase in fat mass, even among those with stable body weight. Both obesity and sarcopenia are key drivers of frailty, disability, and heightened morbidity and mortality. The simultaneous decline in skeletal muscle and accumulation of visceral fat can work synergistically, magnifying their detrimental effects on physical function and metabolic health. Today, dual-energy x-ray absorptiometry (DEXA) is widely recognized as one of the most versatile imaging techniques for assessing not only osteoporosis but also sarcopenia and obesity. Whole-body DEXA facilitates comprehensive analysis, offering detailed insights into fat mass, non-bone lean mass, and bone mineral content at both total and regional levels. DEXA is highly valued for its accuracy, reproducibility, speed, affordability, and low radiation exposure. Furthermore, advancements in DEXA technology and software now allow for precise estimation of visceral adipose tissue. This review underscores the clinical applications of whole-body DEXA, focusing on the use of muscle and fat mass indices in diagnosing low muscle mass, sarcopenia, and sarcopenic obesity, aligned with the latest research and guidelines.

Keyword

Dual-energy x-ray absorptiometry; Low muscle mass; Obesity; Sarcopenia; Sarcopenic obesity

Figure

  • Fig. 1. Abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) results are obtained with details including volume, mass, and area for each by dual-energy x-ray absorptiometry.


Reference

1. Roubenoff R. Sarcopenic obesity: the confluence of two epidemics. Obes Res. 2004; 12:887–8.
Article
2. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:1195–200.
Article
3. Kim TN, Choi KM. The implications of sarcopenia and sarcopenic obesity on cardiometabolic disease. J Cell Biochem. 2015; 116:1171–8.
Article
4. Nam GE, Kim YH, Han K, Jung JH, Rhee EJ, Lee WY, et al. Obesity fact sheet in Korea, 2020: prevalence of obesity by obesity class from 2009 to 2018. J Obes Metab Syndr. 2021; 30:141–8.
Article
5. Nam GE, Kim YH, Han K, Jung JH, Rhee EJ, Lee SS, et al. Obesity fact sheet in Korea, 2019: prevalence of obesity and abdominal obesity from 2009 to 2018 and social factors. J Obes Metab Syndr. 2020; 29:124–32.
Article
6. Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond). 2005; 29:1011–29.
Article
7. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008; 18:388–95.
Article
8. Kim TN, Yang SJ, Yoo HJ, Lim KI, Kang HJ, Song W, et al. Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. Int J Obes (Lond). 2009; 33:885–92.
Article
9. Kim TN, Park MS, Lim KI, Yang SJ, Yoo HJ, Kang HJ, et al. Skeletal muscle mass to visceral fat area ratio is associated with metabolic syndrome and arterial stiffness: the Korean Sarcopenic Obesity Study (KSOS). Diabetes Res Clin Pract. 2011; 93:285–91.
Article
10. Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr. 2012; 31:583–601.
Article
11. Johnson Stoklossa CA, Sharma AM, Forhan M, Siervo M, Padwal RS, Prado CM. Prevalence of sarcopenic obesity in adults with class II/III obesity using different diagnostic criteria. J Nutr Metab. 2017; 2017:7307618.
12. Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: a cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev. 2017; 35:200–21.
Article
13. Barbat-Artigas S, Pion CH, Leduc-Gaudet JP, Rolland Y, Aubertin-Leheudre M. Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. J Am Med Dir Assoc. 2014; 15:303.
Article
14. Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: a meta-analysis of prospective cohort studies. Geriatr Gerontol Int. 2016; 16:155–66.
Article
15. Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, et al. Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2003; 51:323–30.
Article
16. Wang ZM, Pierson RN Jr, Heymsfield SB. The five-level model: a new approach to organizing body-composition research. Am J Clin Nutr. 1992; 56:19–28.
Article
17. Rico H, Revilla M, Villa LF, Alvarez de Buergo M. Age-related differences in total and regional bone mass: a cross-sectional study with DXA in 429 normal women. Osteoporos Int. 1993; 3:154–9.
Article
18. Buckley DC, Kudsk KA, Rose BS, Fatzinger P, Koetting CA, Schlatter M. Anthropometric and computerized tomographic measurements of lower extremity lean body mass. J Am Diet Assoc. 1987; 87:196–9.
Article
19. Heymsfield SB, McManus C, Smith J, Stevens V, Nixon DW. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr. 1982; 36:680–90.
Article
20. van der Kooy K, Seidell JC. Techniques for the measurement of visceral fat: a practical guide. Int J Obes Relat Metab Disord. 1993; 17:187–96.
21. Plourde G. The role of radiologic methods in assessing body composition and related metabolic parameters. Nutr Rev. 1997; 55:289–96.
Article
22. Adams JE. Single and dual energy X-ray absorptiometry. Eur Radiol. 1997; 7:20–31.
Article
23. Andreoli A, Scalzo G, Masala S, Tarantino U, Guglielmi G. Body composition assessment by dual-energy X-ray absorptiometry (DXA). Radiol Med. 2009; 114:286–300.
Article
24. Albanese CV, Diessel E, Genant HK. Clinical applications of body composition measurements using DXA. J Clin Densitom. 2003; 6:75–85.
Article
25. Cawthon PM. Assessment of lean mass and physical performance in sarcopenia. J Clin Densitom. 2015; 18:467–71.
Article
26. Kendler DL, Borges JL, Fielding RA, Itabashi A, Krueger D, Mulligan K, et al. The official positions of the International Society for Clinical Densitometry: indications of use and reporting of DXA for body composition. J Clin Densitom. 2013; 16:496–507.
Article
27. Petak S, Barbu CG, Yu EW, Fielding R, Mulligan K, Sabowitz B, et al. The official positions of the International Society for Clinical Densitometry: body composition analysis reporting. J Clin Densitom. 2013; 16:508–19.
Article
28. Kim KM, Jang HC, Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J Intern Med. 2016; 31:643–50.
Article
29. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39:412–23.
30. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48:601.
Article
31. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020; 21:300–7.
Article
32. Baker JF, Long J, Leonard MB, Harris T, Delmonico MJ, Santanasto A, et al. Estimation of skeletal muscle mass relative to adiposity improves prediction of physical performance and incident disability. J Gerontol A Biol Sci Med Sci. 2018; 73:946–52.
Article
33. Kim TN, Park MS, Kim YJ, Lee EJ, Kim MK, Kim JM, et al. Association of low muscle mass and combined low muscle mass and visceral obesity with low cardiorespiratory fitness. PLoS One. 2014; 9:e100118.
Article
34. Shea JL, King MT, Yi Y, Gulliver W, Sun G. Body fat percentage is associated with cardiometabolic dysregulation in BMI-defined normal weight subjects. Nutr Metab Cardiovasc Dis. 2012; 22:741–7.
Article
35. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes. 1996; 45:633–8.
Article
36. Brochu M, Starling RD, Tchernof A, Matthews DE, Garcia-Rubi E, Poehlman ET. Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. J Clin Endocrinol Metab. 2000; 85:2378–84.
Article
37. Bazzocchi A, Ponti F, Albisinni U, Battista G, Guglielmi G. DXA: technical aspects and application. Eur J Radiol. 2016; 85:1481–92.
Article
38. Karpe F, Pinnick KE. Biology of upper-body and lower-body adipose tissue: link to whole-body phenotypes. Nat Rev Endocrinol. 2015; 11:90–100.
Article
39. Muller MJ, Lagerpusch M, Enderle J, Schautz B, Heller M, Bosy-Westphal A. Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome. Obes Rev. 2012; 13 Suppl 2:6–13.
40. Micklesfield LK, Goedecke JH, Punyanitya M, Wilson KE, Kelly TL. Dual-energy x-ray performs as well as clinical computed tomography for the measurement of visceral fat. Obesity (Silver Spring). 2012; 20:1109–14.
Article
41. Kuk JL, Katzmarzyk PT, Nichaman MZ, Church TS, Blair SN, Ross R. Visceral fat is an independent predictor of all-cause mortality in men. Obesity (Silver Spring). 2006; 14:336–41.
Article
42. Kim TN, Park MS, Ryu JY, Choi HY, Hong HC, Yoo HJ, et al. Impact of visceral fat on skeletal muscle mass and vice versa in a prospective cohort study: the Korean Sarcopenic Obesity Study (KSOS). PLoS One. 2014; 9:e115407.
Article
Full Text Links
  • CPP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr