Sex differences in the composition of weight gain and loss in overweight and obese adults.

Sex differences in the ratio of fat mass (FM):fat-free mass (FFM) during weight change should differentially affect the extent of weight change during energy imbalance in men and women. In the present study, we determined FM and FFM contents by dual-energy X-ray absorptiometry and calculated the P-ratios (protein energy/total energy) of excess weight and weight loss during a randomised controlled trial of four commercial weight loss regimens. Overweight and obese women (n 210) and men (n 77) were studied at baseline and at 2 and 6 months during weight loss on four dietary regimens: Dr Atkins' New Diet Revolution; The Slim-Fast Plan; Weight-Watchers programme; Rosemary Conley's Diet and Fitness Plan. At baseline, the percentage of FFM (%FFM) and P-ratios of excess weight were 40 % and 0·071 for men and 27 % and 0·039 for women. At 2 months, men had lost twice as much weight as women and three times more FFM than women, indicating higher FFM content and P-ratios of weight loss for men, 0·052, than for women, 0·029, with no dietary effects. Between 2 and 6 months, the rate at which weight was lost decreased and the %FFM of weight loss decreased to similar low levels in men (7 %) and women (5 %): i.e. P-ratios of 0·009 and 0·006, respectively, with no dietary effects. Thus, for men compared with women, there were greater FFM content and P-ratios of weight change, which could partly, but not completely, explain their greater weight loss at 2 months. However, protein-conserving adaptations occur with increasing weight loss and over time, more extensively in men, eventually eliminating any sex difference in the composition of weight loss.

Errors in dual-energy X-ray scanning of the hip because of nonuniform fat distribution.

The variable proportion of fat in overlying soft tissue is a potential source of error in dual-energy X-ray absorptiometry (DXA) measurements of bone mineral. The effect on spine scanning has previously been assessed from cadaver studies and from computed tomography (CT) scans of soft tissue distribution. We have now applied the latter technique to DXA hip scanning. The CT scans performed for clinical purposes were used to derive mean adipose tissue thicknesses over bone and background areas for total hip and femoral neck. The former was always lower. More importantly, the fat thickness differences varied among subjects. Errors because of bone marrow fat were deduced from CT measurements of marrow thickness and assumed fat proportions of marrow. The effect of these differences on measured bone mineral density was deduced from phantom measurements of the bone equivalence of fat. Uncertainties of around 0.06g/cm(2) are similar to those previously reported for spine scanning and the results from cadaver measurements. They should be considered in assessing the diagnostic accuracy of DXA scanning.

Dual-energy x-ray absorptiometry measurements of total-body bone mineral during weight change.

Bone mineral measurements were made using dual-energy X-ray absorptiometry during a multicenter diet trial. There were five centers, two using Hologic QDR4500 fan-beam scanners, two using Lunar Prodigy fan-beam scanners,and one using a pencil-beam Lunar DPX. Measurements were made at 0, 2.5, and 6 mo. The mean weight loss was 7.9 kg, but there was a wide range. With the Lunar instruments, the total-body bone mineral density reduced with weight loss, but with the Hologic scanners, it appeared to increase. This anomaly is similar to that observed previously with a Hologic QDR1000 pencil-beam scanner. It was shown that changes of fat distribution can lead to alterations in bone measurement without any real change in the skeleton. With all of the scanners, there was a strong correlation between the change in the bone mineral content and bone area, with some values of the latter being quite implausible. There was an associated worsening of long-term precision compared with that derived from short-term duplicated scans, more marked with the Lunar scanners. It is concluded that measurement artifacts preclude the valid assessment of total-body bone mineral during weight change.

Estimation of thigh muscle and adipose tissue volume using magnetic resonance imaging and anthropometry.

Thigh muscle volume is a useful determinant of functional fitness. However, anthropometric prediction of muscle content is influenced by the variability of adipose tissue accumulation. The aims of this study were to predict thigh muscle and adipose tissue volumes from anthropometry and to assess the validity of the method by examining the various components of the measurements and the assumptions involved. The 19 participants (9 men, 10 women; age 23-49 years) varied in adiposity. They all underwent magnetic resonance imaging (MRI) of the upper leg and the eight men and two women with the lowest adiposity underwent detailed anthropometry involving girths and skinfolds. Using MRI as the reference method, muscle volume was predictedfrom anthropometry using a circular concentric model, and the assumptions inherent in the method were tested further using the MRI data alone. Muscle volume was best predicted by anthropometry in the 10 leanest participants using a five-slice truncated cone model that overestimated the mean MRI value by 30% (R2 = 0.95; standard error of estimate = 288 cm3; P < 0.001). A single skinfold plus girth measurement at the mid-thigh almost matched its predictive ability, but with an increased bias. Measurements of leg circumference by means of the two techniques agreed well. The assumption of a circular cross-section was valid. In contrast, the agreement between skinfold thickness measured by caliper and superficial adipose tissue thickness by MRI was poor, contributing to the scatter of fat and lean area comparisons. An anterior skinfold thickness measurement underestimated the area of superficial adipose tissue at that level, particularly at the most proximal and distal sites. Although these limitations increase the uncertainties of muscle volume determination by anthropometry, they do not prevent its valid prediction in leaner individuals. The prediction of superficial adipose tissue was poorer.