Gross Tissue Weights in the Human Body By Cadaver Dissection By J. P. Clarys', A. D. Martin2, D. T. Drinkwater? ABSTRACT Twenty-five culavers were completely dissected and skin, adipose tissue, muscle and skeleton were weighed. The sample ranged in age from 55-94 years and consisted of 12 embalmed (6 male, 6 female) and 13 unembalmed (6 male, 7 female) Belgian subjects. Females had more disscetable adipose tissue (40.5% of body weight) than males (28.1%), The mean composition of the adipose-tissue-free weight (analogous to lean body weight) for all eadavers was: skin, 8.54% (8.D. 1.2%); muscle, 50.0% (4.4%); hone, 20.6% (2.6%). These figures are compared to existing dissection data from the 19th and 20th century literature There have been two different, though overlapping, approaches to human body composition—chemical and anatomical. The chemical approach yields the amounts of water, fat, protein and various mineral elements in the different tissues and in the body as a whole. The anatomical approach partitions the body into those components which are readily separable by dissection. These inchide skin, muscle, adipose tissue, bone and organs In combination, the two approaches yield data on the chemical compos tion of the dissectable tissues: The best data on human body composition come from cadaver studies, but the literature since 1940 reveals only 8 complete adult dissections carried out for body composition purposes {Mitchell et al. 1945; R. M. . 1951; Moore et al. 1968). Of these, three were primarily chemical analyses (Widdowson et al. 1951) and no tissue masses were reported. Thus there are only five adult human bodies for which gross tissue weights have been determined this century. These data can be supplemented by the work of 19th century German anatomists who weighed many human tissues (Schwann, 1843; Bischoff, 1863; Dursy, 1863; von Liebig, 1874; Theile, 1884), Among these 5 there were, however, some unfortunate omissions. For example, Theile (1884) weighed to the nearest tenth of a gram all the individual muscles of some 20 cadavers, yet reported body weight for only one individual. Only four of the 19th century dissections reported weights for all four of the major Forbes et al. 1953, 1956: Widdowson et a Unstituut voor Morfologie Experimentele Anatomie, Vrije Universiteit Brussel, Brussels. Belgium 2Department of Kinesiology. Simon Fraser University, Burnaby, B.C., Canada Hunan Biology, September 1984, Vol. 56, No. 3, pp. 459-473, © Wayne State Cniversity Press. 1984J.P. Clarys, A. D. Martin, D. T. Drinkwater 460 des wiogy pareeanss, «Ht vor wat = co = wes. er - soo 0 PS ose = 2 Ws = 1) oeoyy W10L 5 28% a soa ps oN 61 sie ve tye ~ esl = ree 19a = one re 5 es V6 - 16 5 or wie - ays, 19M uouoassic] soanpoz fiq pog umanz] ympy aya wy snpsioay onssiy, sso.) " 1d py) ig hpog HAnpy ay, ip LL Tle461 Human Body Composition ydras woay parewnsst, ye ot oF ye ol 6 soa pis ee Sol oF ree ose LH WON W10 oo er 19 sr wo er sd PS ewe rene ose ou et wean eH Fw Ore re 06 4 vee ow = Eee ne w ee ore Fie or zy w = 7 we ze ~ w iss 66I OTF woe - © Ww Bue Tal ge vie ve w wHLNaD Ho zr wt 0a ow zor wealy Es n rd ror ree w oe oF t N 7 - - . n - — : W . - w a = w z ie Pst n 60 oot os 4 - - 4 HANA MOL mys as, ‘diaizy TpFiagy 90u,.-anssip-asodipy pun 1ystaqy fipog fo mwaoiag v sv fipog wmunyy ypy IYI UE SHPBIagy aNss1, 88042) @ lth462 J.P. Clarys, A. D. Martin, D. T. Drinkwater tissues: skin, adipose tissue, muscle and bone (Table 1). Table 2 gives tissue weights expressed as percentages of total body weight (W) and adipose-tissue-free weight (ATFW). This paucity of direct data has led to a proliferation of indirect meth- ods, in which some readily measurable body parameter is used to esti- mate the amount of one or more body constituents. Commonly used parameters are whole-body density, body potassium, body water and various anthropometric measurements, especially skinfold thickne: In 1921 Matiegka put forward a 4-component model in which the weights of muscle, skin plus subcutaneous adipose tissue and bone were estimated independently of one another from a series of anthropometric measurements and empirical constants. The fourth component, the ‘re- mainder’, was determined by subtracting the sum of the first 3 compo- nents from body weight. This anatomical model has been largely ne- glected with the rise in popularity of the 2-component chemical model for estimating the weights of the fat and fat-free components of the body. The pioneering work of Behnke (1942) and Brozek (Keys and Brozek, 1953) resulted in (1) the establishment of densitometry as the criterion by which all other indirect methods were evaluated and (2) the acceptance of the 2-component model as the basis for body composition studies. The most common current technique for the determination of body composition is the use of skinfold calipers to predict body fat (Lohman, 1981). This method is doubly indirect since its prediction formulae are usually based on densitometry; hence its accuracy depends not only on the accuracy of the estimation of density from skinfolds, but on the valid- ity of the assumptions underlying densitometry and the 2-component model. None of the indirect methods has ever been validated against direct human cadaver evidence. More specifically, there is still no human body for which both whole body density and body fat are known. None of the 5 previously-mentioned dissections included any skinfold measurements or extensive anthropometry. Yet. use of the indirect methods has flourished, prompting Behnke (1963) to ask, so succinctly, in his closing comments to the largest-ever conference on human body composition: “we have all the techniques, where are the facts?” Because of this lack of basic data, a cadaver analysis study was carried out in Brussels from September 1979 to June 1980. While the scope of the entire study is given briefly in the following section, only the gross tissue weights are reported here. es.Human Body Composition 463 Tue Brussevs Capaver ANALysis Srupy In a joint project involving the Instituut voor Morfologie, Vrije Uni- versiteit Brussel, Belgium, and the Department of Kinesiology, Simon Fraser University, Canada, 25 elderly Belgian cadavers were subjected to an extensive series of measurements including anthropometry, radiogra- phy, photogrammetry and densitometry. This was followed by dissection of each cadaver into the gross tissue masses of skin, adipose tissue, mus- cle, bone and vital organs. The main objectives of the study were (1) to provide normative data on the weights and densities of skin, adipose tissue, muscle, bone and organs, (2) to investigate the validity of a number of currently used indirect methods for the in vivo estimation of body composition and (3) to provide new models for body composition analysis. SuBJECTS AND MeTHops By means of a testament system, adult Belgians may donate their bodies to the Belgian university of their choice. Cadavers obtained in this way were examined and weighed on receipt and those showing severe emaciation, physical abnormality or deterioration were not used. Twenty- five cadavers were selected ranging in age from 59 to 94 years. Of these, 12 were embalmed (6 male, 6 female) and 13 were used without any preservation (6 male, 7 female). A description of the subjects is shown in Table 3. Cause of death is listed as “natural” where a specific cause was not listed on the death certificate nor was grossly apparent upon dissection. To resolve any procedural problems, two pilot disse ied out prior to the main series of 25 cadavers were used. ons were car- dissections. No data from these two Embalming The use of embalmed material was based on several factors. One of the authors (JPC) had previously attempted the dissection of a fresh ca- daver and was unable to complete it because of the smell resulting from unanticipated deterioration of the internal tissues. Embalmed cadavers improved this aspect and also posed a considerably lower risk of infection, a very real concern in view of the size of the study. Some ear workers (Todd and Lindala, 1928) had argued that the embalming process restoredJ.P. Clarys, A. D. Martin, D. T. Drinkwater 464 f eG) su sa pis re est re ro eayy a6 oe v yt oe om oe For sur se yer ee 6 wie or sie 1 zr sor ur we bw tt ve re we ee ro 6) se caivana ayy ys a ” wg, pssnag pousaaamy afta “pms sistpuy soanpyry sjassnag “sjootqng fo uonduosog © een465 Human Body Composition WO CTS —/-+ 600 + £66'0 « WAND] 9UuIdns = ounpES paywewNss, oe ve eo zz vy et oy FoI «9 set WAND caw anvwad466 J.P. Clarys, A.D. Martin, D. T. Drinkwater the dehydrated cadaver toa morphology more representative of the living state, In addition, the availability of fresh cadavers was unpredictable and few were available at the time the project was begun. After 12 dissections however, we felt that fresh material would avoid some of the problems we were experiencing with the uneven distribution of embalming fluid in the cadaver, in particular, alterations in tissue weights and anthropometric measurements. Accordingly, we dissected a fresh cadaver, experienced no difficulty and continued using unem- balmed material for the remainder of the study. If the cadaver was to be preserved, a volume of embalming fluid (about 6 litres) was infused via gravity feed into either the left femoral or carotid artery. This process took 10-15 hours after which specimens re- mained in the mortuary at room temperature (20° for 24 to 48 hours. At the end of this period the embalmed cadaver was weighed, placed into a body bag and stored at 4° C until use, at which time it was reweighed. From this point the treatment of embalmed and unembalmed cadavers was essentially the same. The unembalmed cadavers were dissected with- in 48-96 hours of death. Anthropometry In order to measure the cadaver conveniently, it was suspended in an adapted orthopaedic head harness. Before any anthropometric measure- ments were taken, subjects which had been refrigerated were brought to room temperature (20° C). Extensive anthropometric measurements including skinfolds, girths, depths, breadths, and lengths were made bilaterally and in duplicate at marked sites on the body by two observers. The subject was pho- tographed and then weighed underwater. Soft tissue radiographs were taken of the triceps, biceps and forearm skinfold sites and the medial thigh and medial calf skinfold sites. The thickness of skin plus sub- cutaneous adipose tissue was measured directly at cach of the skinfold sites by inserting a small metal ruler into an incision through the skin to the underlying muscle fascia. Dissection Immediately prior to dissection, the subject was reweighed. Since the tissues from the limbs, trunk and head were to be kept apart from one another, the dissection was begun by marking the division lines between head, limbs and trunk as follows: 1. Head: a transverse plane through a point immediately superior to the thyroid cartilage.Human Body Composition 467 2. Upper limbs: a plane through the acromiale and axillary fold. 3. Lower limbs: diagonally up the inguinal fold, along the outer edge of the iliac crest, then immediately medial to the gluteus max- imus muscle to the coccyx. The segments are not equivalent to those of Clauser et al. (1969) and Dempster (1955) in that the heads of the humeri and femora were in- cluded with their associated limbs. The dissection of the skin and sub- cutaneous adipose tissue was done according to the normal anatomical procedures as described in Grant (1967) This was followed by the separation of skeletal muscle and major organs (brain, heart, lungs, liver, kidneys, and spleen). The remaining soft tissues, that is, those of the gastrointestinal tract, major vessels, the spinal cord, internal and external genitalia were retained as a unit which we refer to as undifferentiated tissues. Vascular, nervous and connective tissues were retained with the gross tissues in which they were found. After the removal of the major masses of soft tissue the individual bones were separated at their articulations and scraped to leave their surfaces free of muscle and adipose tissue. Ligaments were included with muscle and the cartilage of any articular surface was retained with the bone. Any fluid separating from the tissues during the dissection was om the fresh tissues was reduced by the use of plastic coverings over tissues not being processed. All dissected tissues, including scrapings, were stored in airtight plas- tic buckets according to the segment from which they originated. The buckets were fitted with stainless steel strainers to collect any fluid that might separate. All bones were stored in plexiglass boxes containing moist sponges to reduce evaporative weight loss. All the collected tissues and fluids were weighed to 0.1 g. The bones were weighed separately except for those of the hands, feet and spinal column, which were weighed as anatomical units. All tissues were then weighed under water to 0.01 g for density determination. The dissect and weighing were completed within one day to minimize evaporative losses. This required a team of 10-12 people working for 10-15 hours, depending on the size and ease of dissection of the cadaver. collected. Evaporative loss f ion RESULTS AND Discussion During each dissection approximately 2 kg weight loss was observed. This was determined from the difference between the total body weight measured at the beginning of dissection and the summation of all tissue and fluid weights at the end of dissection. Since tissue losses were negligi-J.P. Clarys, A. D. Martin, D. T. Drinkwater 468 AC PIS erg ows fer ve a oF re 9 fe se re rug wont ss ty, ovo re re 00 re tr os we on zy oe cor Le Dot eu Sor our 2 eee sn % ws iyi sys Ms mn Waly » passnag nonssanuy afi, “png sishpouy soavpn sjossnag Tyson, 2adsranssy]-asorlpy pur jysiaay hpog fo maria » sp hpog. uoumy ympy ays ua saysasy onssip sso1'y Foe,MED Human Body Composition ta no Ist wa 206 wa e508 Shae! a ws 305 RORRSE SE 338 S292 93 z é eggs g TOTAL, 469,470 J.P. Clarys, A.D. Martin, D. 7. Drinkwater ble the weight loss was assumed to be evaporative loss from the |: areas of moist tissues exposed during dissection. The measured tissue weights have, therefore, been augmented by an amount equal to the total evaporative loss multiplied by the ratio of the tissue weight to the total body weight. The Adipose-tissue-free weight concept As shown in Table 4, the subjects tended to obesity, The mean adipose tissue weight of the females at 40.5% of body weight, being considerably greater than that of the males at 28.1%. Comparison between different groups can be facilitated by using the concept of adipose-tissue-free weight (ATFW), which comprises the weight of the whole body less the weight of all dissectable adipose tissue. When we applied this normalising device to our sample (Table 4), the sex differences in relative composition of muscle and bone are substantially reduced: muscle accounting for 52.0% of ATFW for males and 48.1% for females; bone accounting for 19.9% of ATFW and 21,3%, respectively. It can be seen that the mean skin, muscle and bone proportions of the ATFW from the Brussels data (8.5%, 50.0%, 20.6%) are very similar to the means for the 19th century data (7.5%, 49.2%, 21.3%), while the 20th century figures (8.6%, 44.4%, 18.4%) are considerably lower in muscle weight and correspondingly higher in the residual component (Table 4). This discrepancy may well be due to the nutritional state of some subjects at death During chronic illness the emaciative loss of body weight is not pro- portionally distributed, adipose tissue being most labile, followed by muscle and finally bone. Thus, cause of death is an important considera- tion, physical trauma providing the most representative data. Since some of the 19th century data were obtained from executed cr data may be most representative of the living composition While trauma victims were rare in the Brussels study, none of the subjects was emaciated or noticeably abnormal, though some were obese. However, several of this century's earlier dissections were on abnormal subjects, as in the case of Moore et al. (1968), whose emaciated subject's weight at death was some 16 kg below her normal living weight. Even this value is misleading due to a further tissue loss hidden by edematous weight gain. For this reason this subject was not included in any of our calculations. What are the effects of the embalming fluid? If the embalming fluid were distributed homogeneously throughout all tissues it would have had nals, theseHuman Body Composition 471 no effect on the tissue masses expressed as percentages of body weight or ATEW. However, our observations were that adipose tissue, muscle and undifferentiated tissues retained more of the embalming fluid than skin or bone. This was seen by the greater amount of fluid draining from these embalmed tissues as compared to the unembalmed ones. The retention of embalming fluid would therefore tend to inflate the relative weights of adipose, muscle and undifferentiated tissues as compared to bone and skin, Hence we are less certain of the relative weights of these tissues in the embalmed cadavers Implications for the 2-component model Using densitometry to estimate the fat weight and fat-free weight (FFW) of the 2-component model requires the assumption of a constant density for the FFW. This in turn requires (1) that the composition of the FEW be fixed, that is, proportions of fat-free muscle, fat-free adipose tissue, fat-free bone and other tissues, do not change from one person to another, and (2} that the densities of these tissues also be constant. Though the Brussels study did not include whole-body fat determina- tion, the data can shed some light on the validity of these assumptions. Ev ion varied considerably The range for bone weight was 16.3% to 25.7% and for muscle was 41.9% to 59.4% While the ATFW is not the same as the FFW it seems certain that compositional changes in the former would be reflected in the latter. Combining this with the known variations in bone density could indicate a greater range of variation in the density of the FFW than has hitherto been assumed (Bakker and Struikenkamp, 1977; Lohman, 1981) n for our narrow sample the ATFW composi CONCLUSION No satisfactory methods exist for the in vivo estimation of muscle, bone and adipose tissue weights in humans. This is due in large part to the very small amount of direct data available. We have extended from 9 to 34 the number of adult subjects for whom the weights of skin, adipose tissue, muscle and bone are reliably known. While the mean percentage composition of the ATFW shows reasonable agreement over all groups, the individual variation is large. This casts some doubt on the common densitometric assumption of the constancy of density of the FFW. In using these data, however, the characteristics of our sample must be kept in mind, namely that they are old, Belgian and for the most part did not472 J.P. Clarys, A. D. Martin, D. T. Drinkwater die from immediate physical trauma. Therefore generalizing from these data to a living younger population should be done with some caution. ACKNOWLEDGEMENTS The authors would like to thank Prof. Dr. W. D. Ross University, for the inspiration to carry out this project They also wish to express their gratitude to the dissection team: E. van Humbeck, C. De- moortel, R. Stein, F. van Bont, T. Signorelli, P. de Ridder, M. Pauwels, G. van der Veken, L. Hens, V. van Velthoven and H. Verbruggen for their physical and technical contribution to the project. The authors are indebted to Prof. Dr. Roels (Instituut voor Mor- fologie), Prof. Dr. Leduc (Dept. Motorische Revalidatie en Ki- nesitherapie), Prof. Dr. Massart (Dept. Analytische Scheikunde en Bro- matologie), Prof. Dr. de Meuter (Dept. Medische Microbiologie) who kindly lent members of their staff; to Prof, Dr. R Potvlieghe, Dr. E Desmedt, J. van Drogenbroek (Radiology Dept. A.Z.-V.U.B.), to A. Berghmans for his technical assistance and to Prof, Dr. Mulnard and E Godefroid (Instituut d’Anatomie U.L.B.) for providing part of the cadaver population. A very special note of thanks is extended to N. Arras for her devotion to the project and for her many technical, secretarial, and organizational skills. Grants were received from the Vrije Universiteit Brussel and from the Belgian Ministry of National Education, Dept. of International Cultural Relations. non Fraser Received: 15 April 1983; revision received: 10 November 1983. REFERENC es Baxgen, HK. ANDR.S. StHUIKENKAM 1977 Biological variability and lean body mass estimates, an Biol, 53: 181-225, Brunke. AOR. BOG. Feex asp W. € men. JA.M.A. LI8: 495-498, Beuxne. AOR. 1963) Closing con Bischorr, F 1863 Einige Gewichts and Trockenbestimmungen der Organe des men- sch lichen Kérpers. Zeitsch. fa rationelle Medizin Chausen, CE. J.T. MeCoxviine aNp JW. YOUNG 1969 Weight volume and center n body, AMRL-TR-69-70, Wright-Patterson Air Force Wetas 1942 The specific gravity of healthy ent to conference on body composition. Annals N.Y of mass of segments of the hu Base. Ohio.Haman Body Composition 473, Deavsren, W. T. 1955 Space requirements of the seated operator. Geometrical ki- nematic and immechanical aspects of the body with special reference to the limbs. WADG Technical report 53-159, Wright-Patterson Air Force Base, Ohio. Densy 1863. Lehrbuch der systematischcn Anatomie, p. 516, cited by Vierordt, 1906. Fonnes. RM. A.B. Coorrn axp H. H. Mires. 1953 The composition of the adult human body as determined by chemical analysis. J. Biol. Chem. 203: 359-366. Fouues, RM. He HL Miron. axp AR. Coores 1956 Further studies on the gross composition and mineral clements of the adult human body. J. Biol, Chem. 223: 969.975, Grant, |. CB. 1967 Grant's Dissector, 6th edition. Williams and Wilkins, Bal Keys, A. ap J, Brozex 1953 Body fat in adult man. Physiol. Rev. 33: 245-325. 1G VON, G. 1874 Gewichtshestimmungen der Organe des menschlichen Kérpers, Archiv, fiir Anat., Physiol. umd Wissensch, Medizin 96-117. Lousas,T.G. 1981 Skinfolds and body density and their relationship to body fatness: a : 181-235 Marincka, J. 1921. The testing of physical efficiency. Am. J. Phys. Anthe. 4: 223-230, Mircunit, H. HL. T. 8. Hayunton. FR. Stecceans aND H.W. Bean 1943 The chemical composition of the adult human body and its bearing on the biochemistry of growth, J. Biol. Chem. 158: 625-637 Moore. F.D.. J. Listen, C. M. Boypes, M. Re Batt. Nv SULLIVAN AND F. J Daciier 1968 The skeleton as a feature of body composition. Human Biol. 40: 136-158, Scuwasy, M. 1843) Mesures des organey inteenes du corps humain. Memoires de lAcademie Royale des Seiences et Belle-Lettres de Bruxelles. 16: Theis, FW. 1884 Gewichtsbestinmungen zur Entwicklung des Muskelsystems und des Skelettey beim Menschen, Nova Acta der Ksl. Leop.-Carol.-Deutschen Akademie der Naturforscher 46(3): 170. Toop. T. W. anp A. Lixpat.y 1928. Thickness of the subcutancous tissue in the living and the dead. Amer. J. Anat, 412: 153-169 Virnonnr, H. 1890 Der Massenwachsthum der Korperorgane des Menschen. Archiv fir Anat, und Physiol. Anat. Abth. Suppl. Bd. Virnoxpt. H. 1906 Anatoi ellen, Jena: G. Fisher VoukMass. AoW. 1573. From Vierordt, H. (1590) Winpowso, E. MLR AL McCaxce axp C. M. Senay 1951 The chemical composi- tion of the human body. Clin, Sei. 10: 113-125. review. Hum, Biol che, physiologische umd physikalische Daten and Tab-