The five-level model: a new approach

body-composition
research12
Zi-ifian

Wang,

Richard

ABSTRACT
man

Jr. and

Body-composition

biology

position

N Pierson

that

levels

has
and

three

research

areas:

organizational

B Heyms/leld

is a branch

interconnecting

their

Steven

rules,

of hu-

body-com-

each

level

biochemical
and
model
is consistent
provides

steady

a specified

or different
for

creating

new

KEY

state
Finally,

explicit

are distinct,

quantitative

the five-level

model

J C/in

Body

provides

and
Nutr

composition,

body

a matrix
reveals

suggests

subjects
0.732]

gaps

assessment.

state

not

only

levels

between

The

Another

of human

search.
within

Nearly
many

science

are touched

every
medical

Information
rapidly

emerging
been

is now

with
the

niques

involved.

to

The

biological
growth,
disease

no

methodology

are often

published.

category

includes

biological

most

body-composition

categories
information,

has
such

as

which
are
ofthe
tech-

.1,71

i C/ui Nuir

information
be satisfactorily
1992:56:

19-28.

in USA.

body

or different

are

mass,

and

The

and

we could

mass
of clear

a subtle

no clear

approach

multicompartment

in extensive

reviews

observations

but

in published
bodyofoverlap
or omis-

find

building

Are

body
lack

has

In fact,

con-

example:
lean

components

sion

these

different

frequently
For

compartments?

for body-composition

components

by neuexist

between

terminology.

fat-free

models

quan-

to
body-

of previous

literature.

is the hypothesis

that

a third

central
category
of body-composition
research
exists that until
now has not been
adequately
formulated:
the levels
of body
composition

and

their

a comprehensive
of five distinct
level has clearly
five levels

system:

and

rules.

ofhuman

body

levels
of increasing
defined
components
are I. atomic:

V. whole

following
and

organizational

model

section

its associated

tures
or organizational
scribed.
Important

(Fig

presents

composition

models

ofthe

paper,

and

the widely

and

fined

concept

ofa

steady

III, cellular:

a detailed

each
Bwt.

IV. tissue-

next

of each

section

the

fea-

model
as a whole
are deto development
of bodyare presented

appreciated
ofbody

description

In the

of the
related

equations
state

presents
consisting

I).

components.
rules
concepts

report

complexity
in which
that comprise
total

II, molecular:

body

This

composition

but

in this
never

composition

portion

formally

de-

is introduced.

lactation,
I

would

appear
a recent

emerging
from
body-composition
included
into the technical
Printed

but

investigators

about

mass,

from

body

some

information

study ( 1 ) led us to appreciate

a serious
limitation
of the field as
it is now organized.
We recognized
that not all of the rapidly
accumulating
research
could

components

is that

ofcomponents.

that

the relationships
among
Another
example
is prochemical
compartments

many errors are evident

and models
because

The
sys-

indicates

serious
consequence:
composition
equations

level

continually

development,
pregnancy.
influence
body composition.
and

Most

or biological.
and

Although

body-composition

the technical

encompass

classic

and neutron-activation
analysis.
principle
or other characteristics

on the study ofhow

aging. exercise,
and
Although

biology.

components

(TBW)/fat-free

as well.

questions
same

mathematical

different

water

formulation

individual

body

(LBM)

The

is accumulating

methods.

groupings

re-

composition.

as technical

the many

y and

clinical

selected
areas
of exercise

ofhuman

categorized

for

informal

nutrition,
components
of body

100

>

and

composition

body-composition

dilution
techniques
based on a physical

science

knowledge

includes

classification
proposed.

study

body

our

category
new

tematic

to

is extending

technical

spans

of basic

on by the

information

The

composition

area

aspect
of clinical
specialties,
and

related

and

ofthis

body

to be an active

body

are many

from elements
estimated
in vivo
( 1 ). This suggests that relationships

problem

fronted

Growing

study

total

composition

composition

continues

[eg,

(2). This

of body

defining

Introduction

there
between

and body weight

(Bwt)
tron-activation
analysis

definitions

1992:56:19-28.

For example,
the relations

titative
associations
exist that describe
compartments
that are in equilibrium.
vided by the reconstruction
of human

lipid-free

important

nutritional

mass

exist

at the same

equations,

composition,

.1,n

ofa

associations

compartments

body

areas.

the concept

between

body-composition

WORDS

steady

define

in which

interval

ofhuman

research

compartments

to clearly

time

levels.

in the study

compoat pres-

physiological
connections
exist such that the
and functions
as a whole.
The model
also

the opportunity

composition
over

its multiple

describe

in healthy

complexity
are proposed:
I, atomic:
IV, tissue-system:
and V. whole body.

and

categories.
that

1992 American

and
Society

From

the Obesity

Research

Center.

St Lukes-Roosevelt

Columbia
University.
College of Physicians
and Surgeons.
NY.
2 Address
reprint requests
to Z-M Wang, Weight Control
West I 14th Street, New York, NY 10025.
Received
September
17, 1991.
Accepted
for publication
December
12. 1991.
for Clinical

Nutrition

Hospital,
New
Unit.

York,
4I1

19

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

Although

ofincreasing
III, cellular;

biological
models

measurement

techniques,
and biological
factors
that influence
body
sition.
In the first area, which is inadequately
formulated
ent, five levels
II. molecular:

to organizing

20

WANG

ET

AL

TABLE
1
Body composition
Man

on the atomic

level (I) for the 70-kg

Amount

Percent

Element

Reference

ofbody

kg

Le1I
(Atoalc)

FIG 1. The five levels of human

body
extracellular
fluid and solids, respectively.

composition.

ECF and

43
16
7
1.8
1.0
0.58
0. 14
0. 14
0.1
0.095
0.019

61

Total

69.874

99.537

Information

fundamental

building

Ofthe

blocks

gen,
Bwt,

nitrogen,
and one

mass

in the

elements

calcium,
element,
up

equation

human

body

are found

Man

account
> 60%

1) (2).

(Table

The

are atoms

ponents

for > 98% of

of total body
44

as defined

in the

atomic

level

of body

percent

mass

of Bwt
analysis

ofall

(1)
present

in amounts

(1).
is traditionally
from
content

analysis

analysis

(1

98%

can

be

techniques.

(3); nitrogen

3): and

than

carbon

of Bwt

estimated
The

carried

out

in

analysis

P110/cell/ar

(II)

The

1 1 principal

from

water

possible
in living
search

>

The

(A):

in detail.
The most

is water,

major

lipid

(G) (Table
categories.

components

(L);

protein

in present

(Pro):

atomic
and

by prompt-y
by inelastic

can

now

in

vivo,

level
is the

neutron-activation

neutron

scattering

be reconstructed
largely
is the

starting

elements

100 000
molecules

by

from

chemical

comprises

is to consider

point

Protein.
ally

The

includes

term

protein

almost

compound

60%

of Bwt

in the human
in the

in body-composition

all compounds

acid.

compounds

. with

59N26O32S07

and

density

of 1.34

Reference

research

containing

G/icogen.

The

cogen.

which

cipal

distribution

1% and

nitrogen,

molecular

storage

form

in the

cytoplasm

is in skeletal

muscle

of their

usuranging

The most
protein
is

weight

of 2257.4

at 37 #{176}C
(1, 5).

primary

is found

2.2%

an average

g/cm3

respective

on the molecular

of carbohydrate
of most
and

wet

liver,

weights

is gly-

cells.

The

which

prim-

contain

in the

form

of

five

into

levels

Component

Amount
1cv

we

molecules

found
in the
and molecular
It is neither

human
weight

useful

nor

compounds
individually
in body-composition
rein categories

level (II) for the 70-kg

Reference

(4).

elements

of body-corn-

for the

incorporated

all ofthese
chemical
The alternative
used
chemical

(M):

(2).

neutron-activation

foundation

chemical
compounds
range in complexity

to deoxyribonucleic

to measure
humans.

are

use

mineral

2). Because
some confusion
exists
in
we now review
the five chemical
corn-

abundant

which

TABLE 2
Body composition
Man*

propose.

that form
body. These

species.

selected
tissues and organs.
of most
major
elements

be measured
directly
in vivo: potassium
by whole-body
sodium,
chlorine,
and calcium
by delayed--y
neutron-

activation

position

elements

of humans

cadavers
or in biopsy specimens
In addition,
the whole-body
can now
counting:

body
Man

CH

R is the residual

Elemental

that

2 (modified).

from simple
amino
acids to complex
nucleoproteins.
widely
used
representative
stoichiometry
for

is

+S+K+Na+Cl+Mg+R

0.2%

Water.

2% of Bwt.

<

Bwt=O+C+H+N+Ca+P

More

on reference

or aqueous

and glycogen
these different

organs
hydro-

remaining

molecular

are water,

in the human

in the various
tissues
and
Six elements
(oxygen,
carbon,

for Bwt,

composition

50

and phosphorus)
oxygen,
constitutes

Reference

make

ofthe

106 elements,

body and their distributions

are well documented
(2).

<

based

of closely

Water
Extracellular
Intracellular
Lipid
Nonessential
Essential
Protein
Mineral

(fat)

Total
*

Glycogen.

Information

normally
based

of body

26
34

12
1.5
10.6
3.7

17
2.1
15
5.3

69.8

99.4

2.

weight

18
24

400 g. is not included

on reference

Percent

in the Reference

Man.

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

related

or elements.

where

10
2.6
1.4
0.83
0.20
0.20
0.14
0.14
0.027

ECS,

(I)

The

23

model

Atomic
The

Oxygen
Carbon
Hydrogen
Nitrogen
Calcium
Phosphorus
Sulfer
Potassium
Sodium
Chlorine
Magnesium

Five-level

weight

FIVE-LEVEL
( I. 2). The

glycogen
with

an average

.tIiThl(ll.

The

compounds

term

sodium.

oxygen.

phosphorus.

period

to

mineral

ofa

#{176}C,
and

500

>

mineral

some

carbonate

during

the

two

subcategories:

the

largest

86%

(2). Other

rime.

are primarily
level,
fat

speaking

they

definition
are insoluble

cluding

triglycerides

simple

lipid,

essential

contains

lipid,

physiologically

(Le)

and

nonessential

(Ln)

as forming

of triglyceride,

storage

depot

ofmobilizable

is essential

and

Although

90%

and

and

it is difficult

(6. 7). An approximate

selection

ofthe

temperature,
vents such
extract

5)

lipids,
lipids.

by using

chloroform.

binary

10%

fatty

and

About

FFM

weights

acid

other

stoichiometry

two

lipids,

solvent

factors.

but

Reference

Man

(2).

are structurally

The

stoichiometry

be found

in a review

ofprevious

and

oftotal

included
of

equations

can

<

I%

also

be

Bwt

(3)

is the

sum

of L + Pro

+ M

body

mass

(4)

even

and

optimum

be expressed

conditions.

as the
for

total

Thus

combined
body

weight

nonessential

fat + FFM

Ln

+ FFM

(5)

is fat-free

ponents:
amount

term

to fat-free

body

mass

mass,

which

represents

the combined

+ M + G + R.
body

mass

suggested

is LBM.

included

The

have

used

some

the same

the

debate

or different

and

FFM

henceforth

the

following
In equation

terms
still

LBM
prevails

and

FFM

about

compartments.

def-

five corn-

an unspecified
most investi-

interchangeably.

whether

Our

be considered

early

at least

water,
protein.
mineral.
glycogen,
and
of essential
lipid (9. 10). More
recently,

though

lipid-free
essential

body

or not

suggestion

synonymous

althese

is that
on the

are
LBM

basis

of

reasoning.
4 we clearly

body mass. The

and nonessential

define

two

fractions

lipid fraction
consists
or fat. Accordingly,

ofBwt,
oftwo

lipid

and

portions.

are

in vitro
time

used
used

and

(6). Solalone
to
can

such

be exas 45%

(8).
with

accepted

diet.

anatomic

representative

is C51H98O6,

studies.

can

material
with

fat or triglyceride.

heptane

lipid

solvents

mass is the
homogenate

by careful

essential.

a density

lipid-free
body
of a whole-body

and

solvents

them

varies

humans

of 806

lipid

mixtures

the generally

in adult

weight

37#{176}C
(2).

45%

oftriglyceride

largely
and

the extraction

or ternary

as

body

the neutral

and

such
functions

be accomplished

primarily

groups:

lipids.

in organic

are

methanol,
profile

found

molecular

mainly

In

10% oftotal

separate
can

A + dry

equation

of Le + A + Pro
of lean

gators

can

insulation

lipids

analyzed,

which

(6. 7). A

composition.

and particularly
the type of solvent
as petroleum
or ethyl ether are usually

nonessential

The

thermal

to clearly

related

L + lipid-free

mass

Bwt

inition

ester-

which

important

solubilities

oftissue

lipid
lipid,

Essential

in the

separation

type

remaining

tracted

their

acids

triglyceride

nonessential

nonessential

different.

and

The

is nonessential

essential

physiologically

(2).

provide
fuel.

not

in quantities

then

where

(eg. phos-

acids:

into

serve

cell membranes.

form

to this

organic
body

by

fatty

of body

phospholipids,

three

occur

(in-

is fat (2).

be classified

and

level,

compounds

that

of A + Pro + M + G + R.
As fat accounts
almost
entirely

50 dif-

with

fat and

models
lipid

chemical
and

4 (Fig 2, right).
after extraction

lipid-free

such

lipids

lipids

of total

terms

also

in the

similar

a subcategory

body

(2)

Dry Bwt consists

ofthe
anhydrous
chemical
2, left), and equation
2 can therefore
be re-

Bwt according

appropriate

that

are divided

three

can

sphingomyelin

erage

these

4) fatty

fat is synonymous

oftotal

of

as

In equation
remaining

traditional

1) simple

term

in constructing

90%

Lipids

site.

Bwt (1).
the molecular

Bwt

terms

solvents

2) compound

the

level

+ G + R.

strictly

(6, 7). About

and

3) steroids:

is to confuse

to errors
adult.

The

the

The

subcategories:

fat is clearly

error

residual
categories

chlo-

compounds

in organic

triglyceride,

The

therefore

common

such

oftotal
On

A similar

to glycerol.

lead

five main

Bwt

on the

though

ofchemical

waxes):

R represents

in the

(6).

The

the

and

where

Dry

and

because

chloroform

sphingolipids):

molecular

Reference

components
even

in humans,
five

the

into

calcium

in the

by

L+A+Pro+M+G+R

Bwt=

written

as defined

mineral.

soluble

and

into

and

terpenes

very

benzene,

chemists

pholipids

and

body

compartments.

to a group

are recognized

organic

and

to different
refers

ether,

most

Bwt

is

mineral.

sodium.

interchangeably.

in water

lipids

phosphorus

for

defined
as follows.
components
(Fig

hydroxyapatite

as potassium,

confusing

refer

divided

of total

lipid

is the

water

Osseous

in extraosseous

used

from

bound

is usually

chemical

oflipid

as diethyl

body

of

in weight

dioxide

of tightly

the five principal

are

portion

lower

of carbon

99%

>

such

found

for a prolonged

is calcium

contains

of total

heated

extraosseous.

which

21

of 0.900
in humans

with

an avg/cm3

could

at
not

FIG 2. Body-composition
model on the molecular
level (II). FFM.
fat-free body mass: LFM. lipid-free
body mass: and Le and L. essential
and nonessential
lipids. respectively.

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

molecular
lipid

ferent

and

elements,

Among

and

Mineral

of

Ca(OH)2).

and

( 1 . 2).

(eg.
to mm-

nonvolatile

loss

release

osseous

Man

Lipid.

period

elements
similar

is slightly

the

equation
composition

(eg.

a term

of the
ash

of the

and

component

([Ca3(PO4)2]3
(TBCa)

because

groups

heating

sample

body

The

both

elements

nonmetal

Ash,

consists

Total

mass

and

MODEL

of inorganic

of metal

chlorine).

biological

is (C6H10O5).

a category

abundance

potassium)
and

COMPOSITION

at 37 #{176}C
( 1, 2).

g/cm3
describes

an

compounds.

than

ifled

mineral

and

is the residue

of glycogen

of 1 .52

containing

calcium.
eral.

stoichiometry

density

BODY

22

WANG
Body

in which

both

lipid-free

body

weight

LBM

and

FFM

mass

and

the remaining

or fat. All ofthe

each

other

Ln + LBM

terms

when

shown
in Table
3.
At present
the main
components
TBW can
lution

techniques

measurements
protein

model

can

level

guidelines

must

is in protein
example,

FFM

for the

level

connects

areas,

notably

of body

higher

the

study

body

whole-body

level,

densities

that

of body

is the

follow.

Also,

composition

that

trients,
at

(1).
by asand

human

can

be divided

into

space

nated

functions

study

of human

level

is therefore

search.
The
on the

human
cellular

solids.

Each

and

interactions

physiology
an

between
in health

important

cells
and

Reference

include
Both

area

corn-

The

three

ofthese

oxygen

apatite

( 1 ).

sodium
re-

From

is now

described

Cells.

The

cells possess
growth,
and

composition,
specific

metabolism,
functions,

contraction.
can be defined:

TABLE
Different

such

Based

and

properties
elemental

distribution.

as support,

on these

connective,

many
shape,

the
can

in additional

electrical

differences,
epithelial,

four
nervous,

are adapted

conduction,
categories
and

muscular

intravas-

extravascular

for

5%

solids

collagen,
fibers
are

Reference

in bone

are the
are

the

is dis-

in the
and

space.
20%

of Bwt

are also

reticular,

formed

from

solids

represent

main

elastic

the

elements

elastin.
ofthe

are
citrate,

terms

on the molecular

inorganic

calcium
also

present

in ex-

magnesium,

and

previous

discussion,

be accurately
Bwt

CM

CM

muscle

the

cellular

described
+ ECF

level

of body

+ ECS

cells

+ epithelial

(7)

+ connective
cells

ECF

plasma

+ 1SF

ECS

organic

ECS

Bodyweight
Dry body weight
Lipid-free
body mass
Fat-free body mass
Lean body mass
*

Ln, nonessential

lipid or fat; and

x
x

X
X
x
x

Le, essential

lipid.

corn-

by the equations

+ nervous

cells
cells

(8)
(9)

+ inorganic

(10)

ECS

to
where

and
of cells

CM

is cell

cellular
solids.
most
components

(13).

mass,

and

ECF

is extracellular

1SF is interstitial
in equations
7-10

fluid,

ECS

Water
X
x
x
x

Protein
X
x
x
x
x

Mineral
X
x
x
x
x

is extra-

fluid.
However.
because
cannot
be measured
in

Lipi ds*

Le

ex-

hydroxy-

level (II)

Ln

dry

phosphorus,

ofthe

components

pro-

protein
65%

into

bicarbonate,

(13).

ofcollagen

Calcium.

(2).

incorporated

inorganic

and

are composed

Man

including

a nonmetab-

body that consists

of organic
and
The organic
extracellular
solids

extracellular

that

by volume,

3
body-composition

to

(1. 2).

in common,
and molecular

Cells

of nu-

is referred

respectively.

in the

Other

in

Extracellular

fibers

the characteristics
of life including
reproduction.
Although
the l018 cells

of the adult
human
body share
there are great variations
in size,

(2),

reticular

solids.

detail.
metabolism,

products
water

account

of fiber:

and

solids

tracellular

cellular

types

inorganic

is composed
of three
main
compartments
cells, extracellular
fluid, and extracellular
compartments

and

surrounding
transfer

plasma

fluid

fluid

elastic

matrix

position
body
level:

Cells

fluid

fluid

end

is 94%

interstitial
Man

collagen

tracellular

to the

of body-composition

cardiac.
of human

weight.

gas exchange,

compartments:

solids.

whereas

and

of these cornThe coordi-

disease.

and

in the

for

olizing
portion
of the human
inorganic
chemical
compounds.

research

are central

ofbody

nonmetabolizing

which

main

interstitial

Extrace/lular

conceptual

different

and

the intracellular

of metabolic

fluid,

and

tein

body

and

of specialized

fluid.

two

Plasma

The
the

The

excretion

into

cular

body

biochemistry.

at the molecular
level, it is the assembly
into cells that creates
the living organism.

the osteoclasts

smooth.
foundation

fraction

components,

a medium

Extracellular

bone
Although

fluid.

extracellular

tributed

(III)

ponents
ponents

cells.

representations

for a large

solid

provides
and

as the

the molecular

to other

and

E.vtracel/u/ar

ex-

of0.900

Bone

are

solids.

all of body
from

cells

account

offluid

cells

is nitrogen

and

consist

nitrogen

that

composition

levels

movement

For

fat is stored.

blood

Muscle
cells include
striated
skeletal,
The striated
skeletal
muscle
cells are the

by using

be calculated

respective

cells.

cell in which

three groups:
loose, dense.
and speor fat cells, are a type of loose con-

Glycogen
x
x
x
x
x

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

10).
level

total

of protein

at the

have

connective

as

remaining

levels.

assumptions:
16%

with

be estimated

four

other

fat can

and

mineral.
isotope-di-

The

of the

that

body

can
(12).

from

is a dimension
fat and

1.100 g/cm3 (9,

The molecular
foundation

and
total

which

mineral

indirectly

two

nective
osteoblasts.

for estimating

be estimated

be determined

Another

that

in one

Connective
cells include
cialized
( 1 3). Adipocytes.

plus

and

and

AL

lipid

are consistent

available

osseous

by making

nitrogen

Cellular

level

absorptiometry

included

atomic

suming

lipid

is nonessential

to these

techniques

( 10. 1 1), and

ofthe

density,

direct

dual-photon

components

the

molecular
according

(6)

ofessential

Bwt

on the molecular
level are for water
be measured
by several
well-established

by whole-body

ample,

are the sum

ofthe

defined

fat + FFM

ET

FIVE-LEVEL
vivo

at present.

alternative

the following

for

Bwt

Bwt
where

BCM

mass

that

porting
cells

fat cells

cell

according

does

cells

must

share

therefore
The

overlap
fluid

as shown

ICW

are

Reference

at this
3. According
and

inorganic

in equation

and

solids

fluid

can be quantified
no direct
methods
compartments
from
TBCa

[BCM

Because

solids.

(in kg)

the cellular

lower

difficulty

and

ofthe

fat

to

ECW

and

Re and

Ri

solids.
total body

three

FIG 4. Relationship
between total body
ECF. extracellular
fluid: ECS, extracellular

at the
its plasma

cell

portion

of

cellular
level.
subcompartment

methods

levels
and

intact

in the
has

been

with

example

ofevaluating

level

is the

those

of the

in quantifying

at the

of human

directed

solids estimated
analysis
(ECS

X TBK
first

level

of BCM

(in mmol)]
at which

body

at this
some

animate
higher

ofthe

features
levels.

composition.

level,

perhaps

and inorganic

solids.

(I J )

Tissue-System

the

cellular

level

extracellular
fluid.
ponents
are further
the

fourth

the

human

body

and extracellular
organized
into

appearance.

function.

and

is composed

of cells.

solids.
These
three
corntissues.
organs.
and systems-

level of body composition.

Generally.
tissues
contain

iissl1Ls.

cells

embryonic

that

origin.

are

similar

All ofthe

in

diverse

tissues ofthe
body can be grouped
into four categories:
muscular.
connective.
epithelial.
and nervous
( 13).
Bwt at the tissue
level ofhody
composition
is defined
as

( 1 1)

character-

Bwt

muscular

tissue

appear.
it occupies
a central
position
features
of body
composition
at

humans
study

some

is the calculation

0.00833

the

methods
( 10). In contrast.
for estimating
either
cell

Indirect

mineral
solids.

compo-

inorganic

inorganic

ECS

and
related

model.

mineral,
the

directly
by dilution
are yet available

istics ofthe
living organism
in connecting
the inanimate

research

and

compartments
fluid and

1 77) ( 10). Another

TBK

portance

be

are available,
such as extracellular
measured
by neutron-activation

TBCa/0.

organs.

(2).

also

Inorganic

( I 1).
and

At

or extracellular

from

4). Each

ResIdual

Body
Mineral

to

solids.

Of the three primary

volume
of extracellular

mass

Man

water.

to total

residual,

(TBK)
BCM

and intracellular
level is between

(Fig

7 contribute

extracellular

extracellular

the

intracellular

ECI

of tissues.

Despite

its imvery

because

little
of the

compartments.

+ connective
+ epithelial

Three

specific

tissues

position

research:

comprise
Bone

75
ofBwt
is a specialized

of bone

cells

tissue

+ nervous

are particularly

hone.

adipose.

and

by a matrix

stance.
The distinguishing
substance
is calcified
and
(2).
The calcified
ground
([Ca3(P04)2]3Ca(OH),)

important

(/2)

in body-cornwhich

Man

(2).
tissue

of fibers

and

together

that

consists

ground

sub-

feature
of bone
is that the ground
accounts
for 65
ofdry
bone weight
substance
is mainly
hydroxyapatite
and

a small

is another

of fat cells (adipocvtes)

broblasts.
and capillaries.

tissue

muscular,

in the Reference
form of connective

surrounded

bonate
(14).
Adipose
tissue

tissue

type

amount

of

of connective

with collagenous
Adipose
tissue

calcium

tissue

and
can

car-

made

up

elastic
fibers.
fibe divided
into

four types according

to its distribution:
subcutaneous.
visceral
(ie. loosely
surrounds
organs
and viscera).
interstitial
(ie. intimately
interspersed
among
the cells oforgans).
and yellow
marrow (2). Muscle
tissue can be subdivided
into striated
skeletal,
smooth.
Oq.aiis.
to form
vessels.
FIG 3. Relationship
between
body fluids. ECF. extracellular
ECW. extracellular
water: ICF. intracellular
fluid: ICW. intracellular
ter: R, and R, . extracellular
and intracellular
residual:
and TBW.
body water.

fluid:
watotal

Siste,ns.

and

cardiac

The
large

tissues

organs
functional

Several

(2).

consist

organs

oftwo

units
whose

such

or more
as skin,

functions

tissues
kidney,

combined
and

are interrelated

blood
con-

stitute
an organ
system.
For example.
the digestive
system
composed
of many
organs.
including
the esophagus.
stomach,
intestine.
liver. and pancreas.
Each organ.
such as the stomach.

is

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

and

nents

can

Inorganic

Total

in fat
85%

of adipoctes

to this

nonaqueous
residual
extracellular
Another
relation
at the cellular

mineral

level

Residual

energy-

occupies

potassium

1 kg in the

Cell

to its sup-

1 1 in that
portion

in Figure

extracellular

body

Inorganic

cell

no present
method
can directly
used term and is assumed
to be

nonfat

compartments

TBW

of total

the protoplasm

fat, which

in equation
the

by

( Ii)

in relation

includes

or total

be noted

in common

+ ECS

is a portion

body

the stored

by exchangeable

A deviation

13CM

BCM

include

23

MODEL

as a practical

et al ( 1 1) is the working.

cell weight.
Although
BCM.
it is a widely

represented

+ ECF

human

Hence,

not

COMPOSITION

level

mass.

ofthe

structure.
hut

is suggested

+ BCM

to Moore

portion

90
offat
measure

are

at the cellular

is body

metabolizing

equation

BODY

WANG

24
contains
and

several

kinds

nervous)

and

extracellular
are

nine

system

Bwt

main

level

systems

in the

of body

Although
level, most

in vivo

+ respiratory

at present.

The

tissue

the

ofhuman

at the tissue

and

system

ologists

focus

systems

(13)

is suggested

as

is computerized
volume

and

including

oftheir

(Table

interfaces

with

histology
and

interest

and

direct

techniques
ofskeletal

excretion

or from
analysis

i/i Ito/c body

TBK

(16,

for

visceral

are also

available

at the

be used to estimate
level. An example
directly

tissue

at this
24-h

level.

urinary

content

(15).
such

as

creatinine

and

some

however,

distinguishes

whole-body

humans

by neutron-acti-

similar
and
with

from

body

level

of body
and

all other

indicator

char-

primates.

concerns

ofgeneral

body

There
(18).

body

are

size and

elbow-wrist

length.
Body

3) Body breadths:
the

mass,

and

frame

wrist, elbow,
ankle,
4 ) Circumferences:

of body
mass.

density,
and

are upper

energy
arm,

pose
have

and

size.

are a measure

The

sites

most

knee, and biiliac.

The circumferences

FFM,

adipose

stores.
waist

breadths

The

(abdominal),

tissue
most

are

mass,
widely

and

ofbody
widely
useful

total
used

thigh.

body

Skinfolds

skin
(medial),

tissue.
Numerous
been developed
that

FFM.
7) Body

and

area

(BSA):
used

abdominal

are

the

The

The

The

total

to estimate

total

body

most

cornmethod
adi-

BSA

is an

basal

metabolic

volume

in screening
Bwt

of

Triceps.

for the prediction

of body
use of skinfold
thicknesses.

for growth

equation

that

fat

exterior
rate

is an important

and is used to calculate

body
simplest
and most important

Bwt is used

layer

locations.

thickness
provides
a simple
the distribution
of subcutaneous

is often

volume:

a double

anatomic

equations
that make

surface

represent

at specific

sites. Skinfold
fatness
and

characteristic

Bwt

head

weight

+ neck

extremity

weights

9)

Body

mass

form indices
of the indices

rate,

defines

in-

density.
morphologic
obesity.

the

and

whole-body

weight

+ trunk

+ upper

weight

extremity

weights

(15)

m2), which
such
with

is often

are

indicators
protein

circumferences

Bwt

and

stature

can

used

more

in obesity
complex

studies
and

Body

density:

from

Bwt and

body
as

fat and

The

volume,
FFM

where

Db.

DF, and

body,

fat,

and

density

is widely

(9,

1/Db

as a measure

tissue-system,

of fatness
indices,

correlate

better

human

body,

derived

at the

estimate

total

molecular

level

(16)

+ fFFM/DM

are the densities

body,

to
known
in kg!

often

to indirectly

is defined

fFat/DF

DFFM

fat-free

of the
used

10) and

fractions
of Bwt as fat and
tions for total body density
the cellular,
written.

be combined

population-specific

as the Fels index

(Bwt2/stature33),
total body fat ( 18).

shape,
used

index:

that correlate
with total body fat. The best
is body mass index
(body
weight/stature2.

( 19). However,

10)

length.

skeletal

calf

monly
used
of estimating

+ lower

2) Segment
lengths:
Many
segment
lengths
are used in the
study ofbody
composition,
the most common
ofwhich
are lower
extremity
length,
thigh length,
calflength,
shoulder-elbow
length,
and

2 (modified).

In

processes
also on the

physical
characteristics.
at the whole-body
level

is a major

levels.

its complex

composition

11
7.1
1.4
2.1
7.1
7.9
3.7
2.6
2
1.7
1.4

compo-

tissue-system

genetic,
and pathological
at the first four levels but

size, shape,
and exterior
10 suggested
dimensions
This

have

level,

addition,
many
biological,
have an impact
not only
human
body as a whole.

I) Stature:

primates
cellular,

whole-body
that

and

subscapular,

indicators.

molecular,

40

on reference

thicknesses:

tissue

undernutrition.
level is

humans

weight

7.5
5
1
I .5
5
5.5
2.6
1.8
I .4
1.2
I

dicator
of body size
8) Bwt: One ofthe

(I)

It is at the

adipose

6) Body

determine

adipose

from

nitrogen

of body

28

based

5) Skinfold

physi-

composition

can

Information

organ

exercise

17).

at the atomic,

acteristics

which

mass

Percent

several

is available
at this level,
or tissue biopsies.
There

and

and

Amount

Skeletal muscle
Adipose tissue
Subcutaneous
Visceral
Interstitial
Yellow marrow
Bone
Blood
Skin
Liver
Central nervous system
Gastrointestinaltract
Lung

4) (2).

at the

and

methods
that can
at the tissue-system

muscle

or organ

histochem-

physiology

in body

axial tomography,

indirect

skeletal

R accounts

Man

nutritionists,

of subcutaneous

estimation

The

and

(14)

+ R

level.

are only a few in vivo

the major
compartments

Both

+ blood

for 85%

Although
a great deal of information
most of it comes
from cadaver
studies

sitions

+ urinary

Reference

anatomy

Physicians,

much

+ viscera

is complex

and

Tissue

tissues

as

muscle

in the

biology,
level

level.

tissue-system

vation

Bwt

on the tissue-system
leve I (IV) for principal
70-kg Reference
Man*

respectively,

(in g/cm3)
and

ofthe

FFM, respectively
(20). Similar
based on individual
components
and

whole-body

total

f represents

levels

can

the
equaat
also

be

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

level

TABLE 4
Body composition
and organs ofthe

&v

equation

account

1 5% of Bwt

istry

Some

and

hence

be defined

+ reproductive

+ skeletal

tissue-system

branches

the

body.

can

following

five components

remaining
The

human

+ digestive

+ bone

the

cells

alternative
adipose

where

epithelial.

many

Bwt can be expressed

accurately
on the tissue-system
components
in equations
12 and 13 cannot
be mea-

a practical
=

of

AL

+ nervous

+ endocrine

Bwt

up

composition

+ skin

+ circulatory

sured

connective.

is made

musculoskeletal

(muscular.

tissue

material.

There
at the

oftissue

each

ET

FIVE-LEVEL
TABLE 5
Some related

but distinct

components

on different

BODY

COMPOSITION

25

MODEL

levels
Tissue-syste

Atomic

level

Molecular

Total hod calcium

and phosphorus

Mineral

Total

Lipid

body

carbon

level

Cellular
Extracellular

and fat

It is clear

related

any

relation

of the
body

four

level.

composition

levels

Most

using

indicators

the

are

large-scale

studies

Features

of the

whole-body
level

on the

levels.

level

whole-

other

well

cells

direction

presence

for

work.

model

of the

features

of the

Distinctions

and

are distinct

aspect
and

with

five-level

have

one

from

unique

properties

level,

differences

the inorganic

there
between

ofthe
and

of living
the

5)
from

all other

levels,

linkages

appear
ofliving
olism.

distinct
five-level

organisms

such

enzymatic

appearance

exist

that

model.
level

many

the
the

level

below

for

each

on only
failing

An

and

connections
feature

relationships

different
It was not

levels.
unusual

to be confused

with

ferent
levels.
components

between

different

model

mineral,
extracellular
related
compartments

and

distinct

phosphorus

2)

mor-

of the

is that

ofthe

five
in

cells

that

characteristics
energy

whole-body
some ofthe

and

Mineral

and

extracellular

solids

3)

fibers, and
Extracellular

cell
levels.
char-

their connections
can reveal
information
and suggest
a

solids

components

RNA,

4)

bone

tissue

cartilage,
periarticular
low marrow.

tissue

on dif-

confused
TBCa
and

bone

ofTBCa

is some

and

phosphorus

phospholipid).

On

phosphorus,

mineral

Most

hydrogen,

oftotal
still

mag-

body

is a small

the

mineral
amount

fluid. On the other

hand,
form
of inorganic
material.

organic

skeleton:
although

were

and

there

solids

fibers.
and bone

contains

components

ifthey

oxygen,

solids:

are in the form

Bone tissue and

of the skeleton

same

and

carbon,

such

tissue:
ofbone

still is a small amount

ofextracellular
in skeletal
muscle).
On the other hand,
solids.

for related

there

and extracellular
mineral
in the
contain

cornof the
and

at the

sets of commonly
5. In the first set,

although

elastic
solids

major
in one
properties

from each other:

and mineral:
Most

extracellular
solids

in cells
to the

other

although

(eg,

that

components

be included
has unique

to calcium

other
elements
and sodium).

changes

solids,
bone tissue,
and skelbut belong
to different
levels

(eg, DNA,

in addition

of mineral
in addition
ticular

in mineral

lipid

hand,

extracellular

metabofthe

exist

in protein

differences
phosphorus,

and

and

Bwt.

can

of three
in Table

were

level)

every

particularly

phosphorus.
eton,
are
have

is that

studies

other,

An example
is presented

studies

level). Very few studies

the other levels of body
increasing

in earlier

areas
at one

connections

the coordinated

with

each

the
obesity

with

ofthe

compo-

(at the whole-body

molecular
influences

sethe

in these

a few components

previous

changes

all five levels

important

it is known

on body

to appreciate

most

importantly

jority
and

effects
composition

example,

or more

Distinctions

muscle

example.

ofbody

composition

is in extracellular

it.

ofdistinct
levels
body-composition

thereby

For

throughout

For

important

focusing

to anthropometric

contains
nesium,

of tissues,
functions.

recognizable

characteristics

acteristics

is different

ofdistinct

transport,

These

at the tissue-system
and
is thus unique
but maintains

of the

from
have

is differentiated

An example

as membrane

processes.

body

are clearly

have

and

1) Calcium

body

are still maintained

Each higher
level
Recognition
gaps in present

of complex

presence

properties
present

first on the cellular

and

or any
the in-

protein.

ofthe
appearance
structures
and

ofthe

all have

(at the
obesity

be con-

elements
body and

human

efforts.

most studies

levels.

Skeletal

factors
including
growth,
development,
nutritional
status,
exercise
level,
and

alterations
in fat mass
have investigated
how

and

to each other varies.

body is differentiated

the human

because

are also

ofthe

the

tissue

research

in scope,

levels

limited

other

because
complex

level,

primates

features.
these

the context

not

human
body is distinct
appearance
ofcells
that

level,

world
having

On the whole-body

phological
Although

should

themselves

organisms.

tissue-system

from the lower animal

organs.
and systems

future

yet maintains

levels

are no special
the human

as lipid

level, the
because
ofthe

world

4) On

levels

the

that

because

such

3) On the cellular
nonliving

is that

the ratio ofelements

level, the human

world

compounds

characteristics

diflirent

model

organic
world. although
2) On the molecular
organic

bettieen

of the

muscle

ponent
has a clear definition
and
five levels. Each ofthese
components

as a whole.

another.

I) On the atomic
fundamental

model

connections

An essential
fused

model
provides
a structural
framework
for
body composition
that goes beyond
an mdior level. In this section
we describe
some

Skeletal

of disease

between

occur
The
five-level
studying
human
vidual
compartment

tissue

biological
race, sex,

limited

level

Skeleton

Adipose

However,

or two

four

suited

for

that many
nescence.

are

Organ

Bone

sition.

are simpler

at the

are often

This

components
at the

measurements

at this

or for field

the

measurements

at the

than

techniques

four

for estimating

by

muscle

on the whole-body
whole-body
level are

on the other

foundation

to perform

thus

in body

solids

level

cells

as collagen,

Most
tissue

of total

body

although

there

solids in other tissues

(eg,
in addition
to extracellular
and

extracellular

fluid.

Bone tissue constitutes

the latter
also includes
adhering

re-

tojoints,

and

the maskeletal

red and

yel-

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

levels.

changes

in composition

is the

other

easier

major

will manifest
themselves
most differences
at the

to changes

latter

and

that

four levels
Conversely.

Tissue

Fat cells
Skeletal

other
level.

level

m level

26

WANG
Another

body
and

example

of related

carbon

(level

I). lipid

adipose

tissue

(level

confused
helps

with

each

but

and
IV)

other,

distinct

components

fat (level
(Table

is total

II), fat cells

5). These

a problem

that

(level

terms

the

ET

nitrogen

III),

are

often

five-level

The

third

and

but

related

muscle

tissue,

final

example

in the table

components

and

intact

skeletal

whole

skeletal

thus demonstrates
that differences
components
on each of the five
to develop
include

equations

for body

components

or omission

from

of some

is the

cells,

muscles.

and
levels.

dif-

volume,

level

state

are

these

components

according

The

model

The

concept

to avoid

hodi

A primary
the

that
overlap

composition

of a steady

size

aim

ofeach

is important

compartments

measured

directly.

not

only

and

in bio-

An

Body

it is this property

time

period

if Bwt

stable
level.

proportions
For example,

and

the

is maintained
of a steady

among
the different
on the molecular

mass

the

sibility
neous
eral

(kg)

Bwt

BSA

and

stature

(in

rn) is also

relatively

constant

such

0.007 184 x stature#{176}725 X body weight#{176}425(22).

There
are also relatively
constant
proportions
among

evant
components
is in a steady
state.

on different
For example,

TABLE 6
The relation

direct

between

levels
total

and indirect

when
body

the

rel-

body composition
protein/total
body

body-composition

measurable

and

chlorine,

and

calcium)

analysis

( 1).

Until

level

model

and

presents

limited
defines
the

comprehensive

measurements

organized

measured

the studies

neutron-

concept
from

of

of developing

recon-

multiple

fragmentary.

the equations

challenge

pos-

is the

by in vivo
the

were

body-composition

by the five-level

An example

composition

explicitly

the

components
and Bwt at
(carbon,
nitrogen,
sodium.

recently

ofbody
and

from

suggests

components.

activation
was

equations

component

and volume
by writing
simultasteady-state
relations
between
sev-

unknown

levels

measur-

compartments.

model

of the five major

chemical
level from six elements

whole

to establish

known

unknown

five-level

Bwt

of body

body-composition

potassium.

ponents

The
exploit

which

between

unmeasurable
one

these

model

within

in developing

cornadults.

to establish

five-level

matrix

estimating

of reconstructing
equations
that

structing

that

The

presently

been

unknown

in healthy

investigators

rules.

in-

not

the

stable

relations

component.

calculation
the molecular

0. 1383 X TBCa(g)
17. 1 ] (2 1 ). On the
relation
between
BSA (BSA,
in m2) and

[ie, TBK(g)
level the

and

involves

measurable

components
on the same
level the average
ratio of

enables

have

to measurable

is relatively

a logical

research

primarily

constant.
there are

is to estimate

numerous

that

relationships

or

is to estimate
are

alternative

steady-state

components

Present

of various

relatively
state is that

quantitative

able

total body water content

to FFM is relatively
constant
in healthy
subjects
(ie, total body water/FFM
=
0.732)
(2). On the atomic
level the correlation
between
TBK
and TBCa
is reproducible
for males
whole-body

all of

organized

comThe

five-

for Bwt at each

level

more

complex

and

equations.

model

Indirect
Direct
Atomic

Atomic

level

Molecular

= (0.456

TBP

TBO. TBC. TBH, TBN.

TBK. TBCa. TBNa.
TBP. TBCI. Nae. Ke

level

+ (0.555

Molecular

Pro = 6.25 X TBN

FFM = TBK/68.l

X TBCa)
x TBK)

mineral.

creatinine.

FFM

= TBW/O.732

FFM

24.1

level

0.00833

Tissue-system

TBK

SM

= TBCa/0.l77
= (0.9 X TBCI)/

Plasma

3-MH
Cellular

BCM

ECS
ECF

level

TBW,

Cellular

level

0.0196

TBK

0.0261

Whole-body

level
Bwt

X TBN

+
+

SM

X Cr

1 1 .8 X Cr

Bwt

+ 10.1

visceral

+ bone

adipose

+ blood

Whole-body

level

S. By,

TBK

circumference.

skinfold

A. water

creatinine
glycogen(kg):
ofchlorine

(kg):

(g):

CTG.

BCM.

body

corrected

Ke. exchangeable
(mmol/L):

+ ECF

tissue

+ skeletal

tissue
Bwt,

CM

= adipose

Bwt

of subcutaneous

and

+ ECS

level

Volume

L + A + Pro

20.7

volume

Tissue-system

+ M + G + R
Bwt

plasma

0 + C + H + N
Ca + P + K + Na
Cl + R

Cl

level

ECF.

level

Pro.

cell
thigh

X Bwt)

5)

+ (11.5

+ 77.8

Age)

mass
girth

potassium:
protein

(27.3

(kg):

(kg):

(21.9

BV.

(cm):

body

ECF.

L. lipid(kg):
R. residual

Fat%

Bwt

volume

S. stature

4.5)

X 100

Bwt.
fluid

M. Mineral(kg):
(kg):

X BV/

(L):

extracellular

(4.95

(cm):

body

ECF
+

weight

(kg):

(kg):

ECS.

extracellular

3-MH.

24-h

urine

SM.

skeletal

0.135

7.35

CCG.

CTG2
x FG2 +
x CCG2)

corrected
solids

(kg):

3-methylhistidine:

muscle

(kg):

= 5(0.0553

SM

X Bwt

TB.

total

medial
FFM.

calf
fat-free

Nae.

exchangeable

body

element

girth

Body

+ 0.0987

+ vi5Cers
+ R

= 0.007184

surface

X 50725

x BW#{176}425

0.0331
-

2445

(cm):

body

CM.

mass
sodium:

(kg):

muscle

and

cell

(kg):
plasma

TBW.

mass

FG.
total

(kg):

forearm

Cl.
body

plasma
water

Cr,

24-h

girth

(cm):

concentration
(kg).

urine
G.

Downloaded from ajcn.nutrition.org by guest on April 1, 2015

a specified

components
on different
levels
The important
implication

disciplines

research
there

relevance

that

affords

during

and

are well

ofclinical

composition

composition

scientific

although

body,

they

although

by establishing

also in body-composition
research.
The meaning
of a steady
state of body composition
can be defined
in the context
of the
five-level
model:
A steady-state
or dynamic
homeostasis
exists

classic

other,

of body-composition

relations

other

that

human

relations

compartment.

dividual

ponents.

state

and

( 1 1 ), and

relations.

COlfl/)OsitiOfl

reproducible

physiology,

each

quantitative

but

chemistry,

indicates

in the

from

to definable

Quantitative

components.

OfbOdI

composition

components
differ

components
Steady-state

of body

so many

0.00833

x Bwt (20).

4.50]

skeletal

or density

in order

steady

there

relations
exist between
It is therefore
advisable

weight,

the same

distinctly

muscle

( 1 ): BCM(kg)/TBK(mmol)

[(4.95/Db)

The

model

6.25

fat(kg)

to resolve.

ferent

AL

FIVE-LEVEL
Re/atiomi
At

present.
into

body-composition

methods

technique-specific

tematic
fashion.
Direct measurement

!fitt/lOds.

as anthropometric,

niques

that

position.

can

Direct
model
the

methods

can

and

body

nitrogen

total

body

carbon

On the

by delayed-y

by inelastic

molecular

isotope-dilution

adipose

techniques
5) On

(26).
the whole-body

body

According

to this

in the study
methods

body

levels.

There

cellular,

analysis

rnents

that

partments

ample,

are

total

not

as

thick-

direct

methods

Moreover,

most

and

techniques

These

whole-

on the

by

estimate

mo-

the
by

direct

of body

some

direct

method

corn-

methods.

For

compartment

ex-

(2,

10),

fat

Bwt

molecular

0.786

and

x TBW

and

4) from

(20);

on

the

used

the

methods

at different

atomic

direct

X Bwt,

direct

levels,
where

methods

fat
BV

fat

the

The

body

it can

the direct
proportions
termined
Direct
outlined

be seen
methods,
between
in sample

that
but

known

that

very

indirect

methods

on

( I 0,
there

17, 22,

are only
levels,

limited.

This

methodology
for future

of the

the
25,

is one

atomic

could

and

27-29).

Conmethods

relevant

ofthe

be
have

a few direct

so the

and

can

methods

indirect

weak

areas

constitute

in

an

im-

research.

study

direct

Bwt

branch

the

term

this

of science

paper

composition

spans

used.

represents

composition.

not

composition

research

is widely

body

only
research.

and
The

builds

an

but

>

100 y, and

However,
what

five-level

is conducive

exactly
model

appropriate

or rules.

terconnecting
ponents
and

cellular,

tissue-system,

ing the

methods

studying

the

influences

components

(Fig

and

research
the proportions
associations

of measuring

and
various

by
in

for
define

bodyhuman

that studies
steady-state

includes

three

in-

of various
cornamong
the atomic,

whole-body
factors

what

presented

levels:

components

of biological

term

is meant

structure
to clearly

Body-composition

areas:
studying
their steady-state

the

it is unclear

body composition
as a branch
of human
biology
various
body compartments
and their quantitative

study-

in vivo;
on

various

and
levels

5).

Conclusion
The

five-level

is body

X BV

volume

on the whole-body

that

in

model

developing
relate

is intended
or expand

method

2.057

of body

composition

composition

serves

in

broader

grows

methodologies

to the study

ofhuman

to be a foundation
selected
definitions
this organizational
view

of body-composition

from

a need
and
body

to organize

both

physiological
composition.

the

concepts
The

model

on which future
studies
can refine
or equations.
The five-level
model
capacity
and
also stimulates
a
research

as a whole.

C]

level,
12.1

References

indirect
also

direct

tissue-system

of body

this

as

molecular

fat=4.95XBV-4.5OXBwt,andfat=0.7l5XBwtx stature2
(in m) (19, 20).
Thus

many

that most

indices

are

levels

(10),
on

3) from

TBW/0.732:

1 .286

level

method

whole-body

anthropometric

of in-

evaluating

presently

measurements

1 : 2) from

also

topic

molecular.

compart-

important

indirect
ofdirectly

All ofthe

mea-

steady-state
relationunknown
components.

number

methods

the

shows
and

are

rapidly

the

liters

methods

relations

unknown

combining

fat is a major

on direct

such

skinfold

many

At present,

body

in vivo.
based

the table

Definition

imaging

levels.

only

no practical

TBK(mmol)/68.

level

research.

by com-

indices
and

a few direct

expand

be evaluated.

and

1) from

on

effects

6. The table demonstrates

and

respectively

body-composition

follows:

I Biological

ofbody-composition

that

from
levels.

versely,

vol-

and

developed

whole-body
on the cellular

resonance

on the atomic

composition

be assessed

fat compartment

mineral

determined

composition.

methods.

can

are

been

(18).

tissue-system

can

there

indirect

of subcutaneous

anthropometric

body

greatly

although

terest.

measured

by

(and plasma
isotope-dilution

by magnetic

there

are only

methods

directly

(24).

volumes

surernent
techniques
with the established
ship between
the directly
measurable
and
Indirect

and

estimated

osseous

fluid
several

are concentrated

of body

and

be directly

directly

and

presented
principal

(4).

be directly

circumferences,

neasuremnent

components

the

level,

ofhurnan

direct

Indirect

can

stature,

ofthe

scattering
(10),

and

be estimated

can

lecular,

areas

in Table
elements

amples
of the

portant

tomography

volume,

(23):

absorptiometry

level,

tissue

axial

used

rules

FIG 5. The three

(3):

activation

activation

can

level, extracellular
determined
by

(25).
the tissue-system

visceral

TBW

techniques

puterized

nesses

and

methods

are

not

only

are dependent

on the

and

components

unknown

based

on

steady-state
as de-

populations.

and indirect
body-composition
according
to the five-level
model

methodology
as shown

can be
by the ex-

Heymsfield
SB, Waki M, Kehayias
J. et al. Chemical
and elemental
analysis ofhumans
in vivo using improved
body composition
models.
Am J Physiol 199l:26l:E190-8.
2. Snyder WS. Cook Mi. Nasset ES, Karhausen
LR. Howells
OP.
Tipton
lH. Report of the task group on Reference
Man. Oxford:
Pergamon
Press, 1984.
I.

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techniques
4 ) On

neutron

by dual-photon

the cellular
can be directly

Bwt,

IV,

com-

to the five-

neutron

neutron

level,

3) On

and

according

I, II, III,

L Methodology

tech-

of body

Composition

composition

methods,

radioisotopic

be organized

by prompt--)

be quantified

ume)

and
components

on Levels
Body

to the five-level
in a more
sysdirect

of Body

Components

TBK can be directly

determined
by
( 12): total body sodium.
chlorine.

calcium

total

can

catemeth-

are some

biochemical,
to estimate

primarily
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According
be organized

There

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atomic
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#{176}K
counting

phosphorus,

several

such

Study

as follows:

1) On
whole-body

2)

are

groupings

27

MODEL

The

ods and neutron-activation

analysis.
model,
however,
the methods
can

level

COMPOSITION

to 1flCt/lOdOl()tl

gorized

such

BODY

28

WANG

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sodium,

4.

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6.
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8.

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1 1.

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ET