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composition
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BMD-0176-06.10-EN-US
Fat matters...
Looking beyond the bathroom scale
Accurate measurement of body composition provides valuable
information for assessing, monitoring and treating a variety of
diseases and disorders.
Most people are used to stepping on a scale before every visit to a
doctor's examining room. But monitoring patients' weight – while helpful –
is at best a crude and imprecise way to assess their health. Today's body
composition measurement tools provide far more complete and precise
information that can help support diagnoses and guide treatment. They
can even help athletes make decisions on the training regimens they use
to achieve better performance.
where matters more.
Clinical obesity
Obesity is associated with a large number of debilitating
and life threatening disorders. Although BMI provides a
simple, convenient measurement of obesity, a more
important aspect of obesity is the regional distribution
of excess body fat. Mortality and morbidity vary with the
distribution of body fat, with the highest risk linked to
excessive abdominal fat (‘central obesity’).1
Obesity has reached epidemic proportions,
with more than 1 billion overweight adults
worldwide - including at least 300 million
that are clinically obese. Half of these people
in North America and Western Europe die
from obesity-related diseases every year.2
Approximately 155 million children are also
overweight, with about 22 million of these
children under the age of 5.3

Body composition measurement with dual-energy X-ray absorptiometry

(DXA) can look beyond weight and the traditional body mass index (BMI)
to determine body fat distribution – an important risk factor in a variety
of serious diseases. More broadly speaking, information from DXA exams
can prove valuable in conditions, such as:

• Obesity • Wasting syndrome

• Anorexia nervosa (caused by HIV/Aids)
• Cystic fibrosis • Chronic renal failure

In all these cases, body composition measurement contributes to a

thorough patient evaluation and helps physicians monitor the effects
of therapy, diet or exercise.

Body composition scans with DXA provide precise and accurate data on
bone and tissue composition, including bone mineral density (BMD), lean
tissue mass, and fat tissue mass. They provide both total body data and
regional results (trunk, arms, legs, pelvis and android/gynoid regions).
The measurements are fast and non invasive.
Important clues for managing eating disorders
Assessment of body composition is important in evaluating
and managing severe eating disorders such as anorexia.
It is well known that women with anorexia nervosa more
easily develop osteoporosis.4
Patients with anorexia lose a substantial amount of lean
tissue, accounting for from 15% to 45% of the loss of
total body mass. Much of this loss in lean tissue is muscle.
Physicians treating anorexia use body composition with DXA to:
a) evaluate disease severity by setting target values
of lean and fat
b) monitor changes in both lean and fat compartments,
and c) measure the effectiveness of nutritional
interventions.5
As one study found, “A key advantage of DXA is that
changes in bone mineral density, fat and lean mass can
be monitored. Weight scale measures general weight
change, but without specific differentiation of changes in
fat and lean mass for the total body or in various regions
of interest.”6
Nutritional therapies must not only increase fat tissue,
but must also re-establish the normal relationship of fat
to lean tissue. Young women with eating disorders have
an increased risk for osteopenia, and osteoporotic
fractures later in life.6
Studies show that change in whole body lean-tissue
mass correlates strongly with change in body weight
after hemodialysis. Renal failure also affects the skeletal
constitution: Patients with renal dysfunctions are at
significantly higher risk of primary and secondary
osteoporosis.7
AIDS/HIV
Wasting syndrome, defined as weight less than
90% of ideal body weight, is a devastating
disease and a consequence of HIV infections.9
Accurate determination of body composition
with DXA has value in assessing the extent of
gender-specific muscle wasting and fat loss.
The information can be used to monitor the
effects of pharmacological and nutritional
programs aimed at preventing or treating
wasting syndrome of AIDS/HIV.8
User-adjustable %fat threshold: To visualize high %fat regions. Bone image Color % fat mapping
Helping athletes make decisions on training regimens
The value of body composition measurement is not limited to treating Importance of Regional Analysis
illnesses – it can help some of the healthiest. Most athletes benefit from “This year, National Football
a lean body composition (low body fat percentage). In general, body fat Body composition provides important total body as well as regional League rosters list 411 players
beyond the amount needed for good health reduces efficiency. Athletes information for sports medicine applications.7,10,11 weighing in at over 300 pounds…
can achieve the body composition they desire through training and a Women who participated in an exercise program demonstrated a striking Size, of course, is a desirable
proper diet. difference in tissue response in the arms and legs. Total body fat showed attribute in football… But mass
Experts say the key is to track how much the expected beneficial loss with exercise, along with an increase in lean without accompanying muscle
body fat athletes lose instead of relying on tissue. Regional analysis, however, showed that arms lost considerable is dead weight.”
GE Healthcare fat, but no lean tissue, while legs increased lean with no increase in fat
the bathroom scale. Height/weight tables PO Box 7550 – Wall Street Journal, October 5, 2005
based on BMI do not distinguish muscle Madison, WI 53707-7550 tissue. Women who exercised regularly also did not show an increase in
from fat and so are not useful for high- Patient: #### Facility ID: central adiposity with age that is frequently found in sedentary women.12
Birth Date: XX.XX.XXXX 40.2 years Referring Physician:
Height / Weight: 74.0 in./1.88 m 219.3 lbs./99.5 kg Measured: XX.XX.XXXX 14.13.59 (10.20)
performing athletics. A recent study in the Sex / Ethnic: Male White Analyzed: XX.XX.XXXX 14.14.52 (10.20)
This important finding would have been missed without regional analysis
Total Body Tissue Quantitation Composition Reference: Total Composition Trend: Total
United States by Oates et al. suggest that Tissue (%Fat) Centile Fat (g) Fat Free (g) [Cyan]
of body composition. Moreover, profound changes in body composition in
40%
84800
“DXA values may be more fundamental 35%
30%
90
50 17000 84600 athletes may be an indication of serious health concerns, including eating
25% 10
and less affected by anthropometric 20%
15%
2 16000
84400
84200 disorders, amenorrhea, and osteopenia or osteoporosis.13
10%
variables, or at least more precisely 5% 15000 84000
0% 83800

determined than the values for the other 20 30 40 50 60 70 80

Age (years)
90 100 38 39 40
Age (years)
41 42

techniques”.9 Trend: Total

1 2,3 1 1 1
Measured Age Tissue Centile Total Mass Region Tissue Fat Lean BMC Fat Free
Date (years) (%Fat) (kg) (%Fat) (g) (g) (g) (g) (g)

For highly trained athletes, even a small XX.XX.XXXX 40.2 15.4 11 99.5 14.8 95,503 14,677 80,826 3,964 84,790
XX.XX.XXXX 40.0 15.9 13 99.8 15.3 95,839 15,237 80,602 3,998 84,600
change in body composition can XX.XX.XXXX 39.8 18.0 26 101.4 17.3 97,358 17,541 79,817 4,077 83,894

significantly affect performance. Body

composition monitoring provides valuable
information that athletes and their trainers Trend: Fat Distribution
Measured Age Android Gynoid A/G Total Body
1

Date (years) (%Fat) (%Fat) Ratio (%Fat)

can use to adjust diet and training XX.XX.XXXX 40.2 17.7 16.8 1.06 15.4
XX.XX.XXXX 40.0 18.1 18.4 0.98 15.9
regimens. Body composition measurement XX.XX.XXXX 39.8 20.8 20.3 1.03 18.0

helps establish a starting point and a

target, helping any athlete to pursue a COMMENTS:

specific goal.

Image not for diagnosis 1 -Statistically 68% of repeat scans fall within 1SD (± 0.4 % Fat, ± 150 g Tissue Mass, ±
280 g Fat Mass, ± 310 g Lean Mass for Total Body Total)
Printed: 10.02.2006 14.27.35 (11.00)100:0.19:153.85:15.6 0.00:-1.00 2.40x3.04
2 -USA Total Body Composition Reference Population (v107)
13.5:%Fat=15.4%
0.00:0.00 0.00:0.00 3 -Composition Matched for Age
Filename: XXXXXXXXXX.meb
Scan Mode: Standard 3.0 µGy

Lunar iDXA
ME+999999

Monitoring athletes' body composition is easier now than ever: Trending capability allows direct
comparison of total and regional tissue. Body composition monitoring also assesses bone health,
which is crucial for overall health assessment.
DXA body composition Business Name

measurement Street Address

City, State Zip
Phone: ### ###-#### Fax: ### ###-#### Web: http://#########.com

Body Composition/BMD Report: (Day, Month, Year)

More powerful than ever (Patient Name)

##.#
Physicians today use DXA for body composition because it accurately shows
####### ##/##/#### ##/##/####
exactly where fat is distributed throughout the body. Lunar DXA systems directly
measure and calculate total fat, lean and bone tissue, instead of estimating
body composition.
Lean mass includes all parts of the body [organs,
DXA systems must perform at the highest precision possible. In fact, experts muscle, and fluids] but excludes body fat.
agree that in monitoring patients over time, it is crucial to get consistent results.
The higher the Tissue %Lean, the more muscular
Lunar DXA systems are backed by numerous studies that demonstrate high
the body.
accuracy and precision in total body measurement.14

The precision of Lunar DXA systems is enabled by TruView image reconstruction

technology, which eliminates the magnification and distortion inherent in Total Body: Total
traditional wide-angle fan-beam technology. TruView assesses the size of the Tissue (%Fat) Centile
50 %
anatomy accurately without making assumptions, providing true area and
45 %
body composition measurements. 40 %
90
35 %
When measuring total body composition it is critical to take the entire body 30 %
50
into account: bone, fat, and lean tissue. Lunar DXA systems calibrate across 25 %
20 %
a full range of values, rather than calibrating to an average patient. 15 %
10
10 % 2
20 30 40 50 60 70 80 90 100
Age (years)

Total Body: Total

BMD (g/cm2) YA T-Score
##/##/####
1.383 3

1.282 2

1.181 1

1.080 0

0.979 -1

0.878 -2

0.777 -3

0.676 -4

0.575 -5
20 30 40 50 60 70 80 90 100
Age (years)

Client: ############ Client ID: #######

Direct-digital performance
The array detector of Lunar fan beam DXA technology
directly converts X-rays into a digital signal. Lunar DXA
makes use of a narrow 4.5 degree angled fan type beam
kept parallel to the longitudinal axis of the patient, which
scans in a transverse pattern across the body of each
patient. The mode of operation is such that these fan
beams pass and overlap slightly with each other by a slight
margin to ensure that no anatomical part is left unscanned.
However, due to the overlapping, multiple images are
created in return. These overlapping images when acquired
and slid over each other for a match provided the actual
distance of the sample object from the detector. By sliding
these overlapping images together for a match (multiple
view image reconstruction), the true distance of the object
from the detector can be determined, thus reducing
magnification effects on the determination of BMC, bone
area, and soft tissue. The amount of absorbed energy from
the X-ray source is directly proportional to BMC and BMD,
which is measured with a precision of 1%.
Indications for use:
The GE Lunar Body Composition Software option (body
composition) used on GE Lunar DEXA bone densitometer
measures the regional and whole body bone mineral
density (BMD), lean and fat tissue mass and calculates
derivative values of bone mineral content (BMC), area,
soft tissue mass, regional soft tissue mass, total soft tissue
mass, fat free mass, regional/total soft tissue mass ratio,
% fat, region % fat, total body % fat, Android % fat,
Gynoid % fat, Android/Gynoid ratio (A/G ratio) and Body
Mass Index (BMI). The values can be displayed in user-
defined statistical formats and trends with color image
mapping, and compared to reference populations at
the sole discretion of the health care professional.These
body composition values are useful to health care
professionals in their management of diseases/conditions
where the disease/condition itself, or its treatment,
can affect the relative amounts of patient fat and lean
tissue. The GE Lunar Body Composition Software option
does not diagnose disease, or recommend treatment
regimens, or quantify treatment effectiveness. Only the
health care professional can make these judgments.
Some of the diseases/conditions for which body
composition values are useful include chronic renal
failure, anorexia nervosa, obesity, AIDS/HIV and cystic
fibrosis. DEXA body composition is a useful alternative
to hydrostatic weighing and skin fold measurements.
Direct-digital detector
MultiView image reconstruction (Truview)
References:
1. Chotai NP, Patel BG, Shah NN (2006) Obesity: A global
health concern. Pharma Times 38(No 12):31-33.
2. World Health Organization (WHO) World Health
Report (2002):8
3. T. Lobstein, L. Baur, R. Uauy for the IASO International
Obesity TaskForce Obesity in Children and Young
People: a crisis in public health (2004)
4. Kooh SW, Noriega E, Leslie K, Muller C, Harrison JE
(1996) Bone mass and soft tissue composition in
adolescents with anorexia nervosa. Bone 19:181-188.
5. Joyce JM, Warren DL, Humphries LL, Smith AJ,
Coon JS (1990) Osteoporosis in women with eating
disorders: comparison of physical parameters,
exercise, and menstrual status with SPA and DPA
evaluation. J Nucl Med 31:325-331.
6. Soyka LA, Grinspoon S, Levitsky LL, Hergog DB,
Klibanski A (1999) The effects of anorexia nervosa
on bone metabolism in female adolescents. J Clin
Endocrinol Metab 84: 4489-4496.
7. Fiori CE, Dieli M, Vintaloro G, Gibilaro M, Giacone G,
Cottini E (1996) Body composition and bone mineral
density in competitive athletes in different sports.
Int J Tiss Reac 18:121-124.
8. Grinspoon S, Corcoran C, Askair H, Schoenfeld D,
Wolf L, Burrows B, Walsh M, Hayden D, Parlman K,
Anderson E, Bagoz N, Klibanski A (1998) Effects of
androgen administration in men with the AIDS
wasting syndrome. Ann Intern Med 129:18-26.
Advanced DXA technology
Consider these advances in DXA, available from GE Healthcare, Lunar:
Lunar iDXA®
Lunar's latest and most advanced leadership bone
densitometer produces high-precision results and
crisp images, enabled by the patented high-definition
direct-digital technology.
Prodigy®
Prodigy’s direct-digital technology eliminates the
magnification effects of traditional wide-angle fan-
9. MK. Oates, S Puhl, WK Wacker Total Body %Fat - beam densitometers. With more than 5,000 systems
Comparison of DXA With Other Body Composition
Methods Abstract Published J Bone Miner Res 2006;
installed worldwide, Prodigy is one of the most trusted
21(Suppl 1):S117 ASBMR Annual Meeting, fan beam densitometers available.
Philadelphia, PA, September 2006
10. Taaffe DR, Pruitt L, Pyka G, Guido D, Marcus R (1996)
Comparative effects of high and low-intensity
resistance training on thigh muscle strength, fiber
area, and tissue composition in elderly women.
Clin Physiol 16:381-392.
11. Nindl BC, Friedl KE, Marchitelli LJ, Shippee RL, Thomas
CD, Patton JF (1996) Regional fat placement in
physically fit males and changes with weight loss.
Med Sci Sports Exer 28:786-793.
12. Van Pelt RE, Davy KP, Stevenson ET, Wilson TM, Jones
PP, Desouza CA, Seals DR (1998) Smaller differences
in total and regional adiposity with age in women
who regularly perform endurance exercise. Am J
Physiol 275:E626-E634.
13. Nichols DL, Sanborn CF, Bonnick SL, Gench B,
DiMarco N (1995) Relationship of regional body
composition to bone mineral density in college
females. Med Sci Sports Exer 27:178-182.
14. Lunar publication BMD-0172-05.06.-EN-US 21. KG
Faulkner, Accuracy and Precision of the Lunar iDXA, a
New Fan-Beam Densitometer, presented at ECTS 2006.