Background: Evaluation of fat-free mass (FFM) is becoming recognised as an important component in the assessment of clinical status and formulation of prognosis in patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to determine whether potential differences in FFM estimation performed by air displacement plethysmography (ADP), bioelectrical impedance (BIE) and anthropometry (ANTHRO) would assume clinical significance. Methods: Twenty-eight patients with moderate-to-severe COPD were submitted to FFM estimation by ADP, BIE and ANTHRO. FFM was then allometrically related to peak oxygen uptake (peak v̇O2) as determined by symptom-limited incremental cycle ergometry. Results: We found that ANTHRO classified fewer patients as ‘FFM-depleted’ than the other two techniques (p < 0.05). Although mean biases of the BIE-ADP differences were close to zero, their 95% confidence limits extended as high as 5.9 kg (16%). The ANTHRO-based allometric exponents for peak v̇O2 correction of FFM, therefore, were typically higher than those obtained by the other two methods in both depleted and non-depleted patients (ANTHRO: 1.45–1.41, BIE: 0.97–1.18, ADP: 1.08–1.14, respectively). Conclusion: We conclude that between-method differences in FFM estimation can be sufficiently large to have practical implications in patients with moderate-to-severe COPD. A single method of body composition assessment, therefore, should be used for FFM estimation in these patients.

Keywords:
Air displacement plethysmography, Bioelectrical impedance, Anthropometry, Body composition, Chronic obstructive pulmonary disease
1.
Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; The GOLD Scientific Committee: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256–1276.
2.
Wouters EF, Creutzberg EC, Schols AM: Systemic effects in COPD. Chest 2002;121(5 suppl):127S–130S.
3.
Mostert R, Goris A, Weling-Scheepers C, Wouters EF, Schols AM: Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respir Med 2000;94:859–867.
4.
Decramer M, Gosselink R, Troosters T, Verschueren M, Evers G: Muscle weakness is related to utilization of health care resources in COPD patients. Eur Respir J 1997;10:417–423.
5.
Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG: Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:961–966.
6.
Ellis KJ: Human body composition: In vivo methods. Physiol Rev 2000;80:649–680.
7.
Schols AM, Wouters EF, Soeters PB, Westerterp KR: Body composition by bioelectrical-impedance analysis compared with deuterium dilution and skinfold anthropometry in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 1991;53:421–424.
8.
Pichard C, Kyle UG, Janssens JP, Burdet L, Rochat T, Slosman DO, Fitting JW, Thiebaud D, Roulet M, Tschopp JM, Landry M, Schutz Y: Body composition by X-ray absorptiometry and bioelectrical impedance in chronic respiratory insufficiency patients. Nutrition 1997;13:952–958.
9.
Kyle UG, Pichard C, Rochat T, Slosman DO, Fitting JW, Thiebaud D: New bioelectrical impedance formula for patients with respiratory insufficiency: Comparison to dual-energy X-ray absorptiometry. Eur Respir J 1998;12:960–966.
10.
Engelen MP, Schols AM, Heidendal GA, Wouters EF: Dual-energy X-ray absorptiometry in the clinical evaluation of body composition and bone mineral density in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 1998;68:1298–1303.
11.
Neder JA, Lerario MC, Castro ML, Sachs A, Nery LE: Peak V̇O2 correction for fat-free mass estimated by anthropometry and DEXA. Med Sci Sports Exerc 2001;33:1968–1975.
12.
Winter EM: Scaling: Partitioning out differences in size. Pediatr Exerc Sci 1992;4:296–301.
13.
Nevill AM, Holder RL: Scaling, normalizing, and per ratio standards: An allometric modelling approach. J Appl Physiol 1995;79:1027–1031.
14.
American Thoracic Society: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987;136:225–244.
15.
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993;16(suppl):S5–S40.
16.
Crapo RO, Morris AH, Clayton PD, Nixon CR: Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 1982;18:419–425.
17.
Durnin JV, Womersley J: The relationship between skinfold thickness and body fat in adults of middle age. J Physiol (Lond) 1969;200:105–106.
18.
Siri WE: Body composition from fluid spaces and density: Analysis of methods; in Brozek J, Henschel A (eds): Techniques for Measuring Body Composition. Washington, NAS/NRC, 1961, pp 223–224.
19.
Deurenberg P, Van der Kooy K, Leenen R, Westrate JA, Seidell JC: Sex and age specific prediction formulas for estimating body composition from bioelectrical impedance: A cross validation study. Int J Obes 1991;15:17–20.
20.
Dempster P, Aitkens S: A new air displacement method for the determination of human body composition. Med Sci Sports Exerc 1995;27:1692–1697.
21.
Daniels F, Alberty RA: Physical Chemistry. New York, Wiley, 1967.
22.
Buchfuhrer MJ, Hansen JE, Robinson TE, Sue DY, Wasserman K, Whipp BJ: Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol 1983;55:1558–1564.
23.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;i:307–310.
24.
Bland JM, Altman DG: Measurement error proportional to the mean. BMJ 1996;313:106.
25.
Nevill A: Why the analysis of performance variables recorded on a ratio scale will invariably benefit from a log transformation. J Sports Sci 1997;15:457–458.
26.
VanItallie TB, Yang MU, Heymsfield SB, Funk RC, Boileau RA: Height-normalized indices of the body’s fat-free mass and fat mass: Potentially useful indicators of nutritional status. Am J Clin Nutr 1990;52:953–959.
27.
Baarends EM, Schols AM, Mostert R, Wouters EF: Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10:2807–2813.
28.
Yoshikawa M, Yoneda T, Kobayashi A, Fu A, Takenaka H, Narita N, Nezu K: Body composition analysis by dual energy X-ray absorptiometry and exercise performance in underweight patients with COPD. Chest 1999;115:371–375.
29.
Steiner MC, Barton RL, Singh SJ, Morgan MDL: Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J 2002;19:626–631.
30.
Astrand P-O, Rodahl K: Body dimensions and muscular exercise; in Astrand P-O, Rodahl K (eds): Textbook of Work Physiology. New York, McGraw-Hill, 1986, pp 391–411.
31.
Neder JA, Nery LE, Andreoni S, Sachs A, Whipp BJ: Oxygen cost for cycling as related to leg mass and composition in males and females, aged 20 to 80. Int J Sports Med 2000;21:263–269.
32.
McCrory MA, Gomez TD, Bernauer EM, Mole PA: Evaluation of a new air displacement plethysmograph for measuring human body composition. Med Sci Sports Exerc 1995;27:1686–1691.
33.
Biaggi RR, Vollman MW, Nies MA, Brener CE, Flakoll PJ, Levenhagen DK, Sun M, Karabulat Z, Chen KY: Comparison of air-displacement plethysmography with hydrostatic weighing and bioelectrical impedance analysis for the assessment of body composition in healthy adults. Am J Clin Nutr 1999;69:898–903.
34.
Gosselink R, Troosters T, Decramer M: Distribution of muscle weakness in patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil 2000;20:353–360.
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2004
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