The BOD POD, a new air-displacement plethysmograph for measuring human body composition, utilizes the inverse relationship between pressure and volume (Boyle’s law) to measure body volume directly. The quantity of air in the lungs during tidal breathing, the average thoracic gas volume (Vtg), is also measured by the BOD POD by using a standard plethysmographic technique. Alternatively, the BOD POD provides the use of a predicted Vtg (Vtgpred). The validity of using Vtgpred in place of measured Vtg (Vtgmeas) to determine the percentage of body fat (%BF) was evaluated in 50 subjects (36 women, 14 men; ages 18–56 yr). There was no significant difference between Vtgmeas and Vtgpred (mean difference ± SE, 53.5 ± 63.3 ml) nor in %BF by using Vtgmeas vs. Vtgpred (0.2 ± 0.2 %BF). On an individual basis, %BF measured by using Vtgmeas vs. Vtgpred differed within ±2.0% BF for 82% of the subjects; maximum differences were −2.9 to +3.0% BF. For comparison, data from 24 subjects who had undergone hydrostatic weighing were evaluated for the validity of using predicted vs. measured residual lung volume (Vr pred vs. Vr meas, respectively). Differences between Vr meas and Vr pred and in %BF calculated by using Vr meas vs. Vr pred were significant (187 ± 46 ml and 1.4 ± 0.3% BF, respectively;P < 0.001). On an individual basis, %BF determined by using Vr meas vs. Vr preddiffered within ±2.0% BF for 46% of the subjects; maximum differences were −2.9 to +3.8% BF. With respect to %BF measured by air displacement, our findings support the use of Vtgpred for group mean comparisons and for purposes such as screening in young to middle-aged individuals. This contrasts with the use of Vr pred in hydrostatic weighing, which leads to significant errors in the estimation of %BF. Furthermore, although the use of Vtgpred has some application, determining Vtgmeas is relatively simple in most cases. Therefore, we recommend that the use of Vtgmeas remain as standard experimental and clinical practice.
- fractional lung volumes
- hydrostatic weighing
- body volume
a new air-displacement plethysmograph (BOD POD body composition system; Life Measurement Instruments, Concord, CA) for measurement of body composition has recently been described (6). This system utilizes the inverse relationship between pressure (P) and volume (V) (Boyle’s law: P1V1= P2V2) to determine body volume (Vb). Once Vb is determined, the principles of densitometry are used to determine body composition from body density (Db = mass/volume) (2, 4). A previous study in our laboratory indicated that body composition estimates by the BOD POD are not significantly different from those determined by hydrostatic weighing (HW) (16). Thus a chief advantage of the BOD POD is that it represents a densitometric method that is based on air displacement rather than on water immersion; therefore, it is simpler and more rapid than HW and potentially has wider clinical application.
Measurement of Db by HW typically requires determination of residual lung volume (Vr) to correct for air remaining in the lungs after maximal exhalation (13). Any air remaining in the body (e.g., in the lungs or gastrointestinal tract) will have the effect of increasing buoyancy, leading to an overestimate of Vb, an underestimate of Db, and thus an overestimate of the percentage of body fat (%BF). Although Vr can be measured accurately by numerous techniques, such as O2dilution, N2 washout, and He dilution, several investigators have examined whether Vr can be predicted without compromising the accuracy of body composition measurements by HW (8,11, 14, 17, 22). Whereas group means can sometimes be predicted with accuracy (17, 22), Vr is usually systematically over- or underestimated, and resulting errors have been observed of up to ∼4.0% BF in normal, healthy subjects (8, 11, 14,17). In addition, individual errors in the calculation of %BF resulting from the use of predicted Vr(Vr pred) can be unacceptably high (22).
Similarly, measurement of Db by air displacement requires determination of the quantity of air in the lungs during normal tidal breathing, or the average thoracic gas volume (Vtg). As described by Dempster and Aitkens (6), Vb determined by Boyle’s law is underestimated by 40% of the Vtg because the air in the lungs, because of its isothermal nature, is 40% more compressible than the surrounding air (adiabatic conditions). Failure to correct for this phenomenon will result in an overestimate of Db and, consequently, an underestimate of %BF. Thus an ancillary measurement of Vtg by the BOD POD is incorporated into the testing procedure (15). Alternatively, the BOD POD also offers the use of a predicted Vtg (Vtgpred). In certain situations, such as when screening a large number of subjects or repeatedly testing the same subject to evaluate changes in body composition, the use of Vtgpredwould be time saving if it offered a reasonable estimate of Vtg.
Therefore, the purpose of this analysis was threefold. We sought to1) compare measured Vtg (Vtgmeas) and Vtgpred(Vtgmeas vs. Vtgpred);2) determine the effect of using Vtgpred on the estimation of %BF; and 3) compare and contrast the use of Vtgpred with air displacement with the use of Vr pred in conjunction with HW.
MATERIALS AND METHODS
Body composition data were studied from the 50 subjects who had most recently been tested in our laboratory by air displacement with Vtgmeas. Subjects were healthy and not on medication known to affect lung volumes. One subject smoked cigarettes but had lung volume measurements that were well within the range of those for the remaining subjects. The methods used are described in detail elsewhere (6, 16). Briefly, after voiding the bladder, each subject was weighed to the nearest gram while wearing a swimsuit. Height was measured to the nearest centimeter. The BOD POD was calibrated according to the manufacturer’s instructions, and raw body volume (Vbraw) was determined. Finally, Vtg was measured in the BOD POD by using a technique, common to standard pulmonary plethysmography, called the “panting maneuver” (7). While wearing a noseclip, the subject breathed through a tube; after two to three normal breaths, the airway was occluded for 3 s at midexhalation. During this time, the subject was instructed to gently puff against the occlusion by alternately contracting and relaxing the diaphragm. This technique is analogous to the gentle repeated exhalations one might use to fog one’s glasses before cleaning them.
The airway pressure was measured, and Boyle’s law was utilized to determine Vtg. Vb was calculated by using the formula Equation 1where SAA is the surface area artifact, a term used to correct for the underestimation of Vb by Boyle’s law because of the isothermal air conditions at the skin’s surface (6). Db was then calculated as mass/Vb. Substituting for Vb, the equation for Db determined by the BOD POD (DbBP) becomes Equation 2where M is body mass. %BF was then derived from DbBP by using the Siri formula (20). All measurements conducted with the BOD POD used software versions 1.50 and 1.53. These two versions did not differ with respect to the measurement or prediction of Vtg.
Twenty-four of the subjects who had been tested by air displacement had also undergone HW on the same day. The subjects were weighed underwater, according to standard procedures described in detail by McCrory et al. (16). Vr was measured on land by using the O2-dilution technique (21). Db from HW (DbHW )was calculated as Equation 3where Ma is body mass in air, Mw is body mass in water, and Dw is the temperature-corrected water density (4). %BF was calculated from DbHW by using the Siri formula (20).
Lung volume prediction.
Because Vtg is measured at the midpoint of exhalation, Vtgpred was calculated as Equation 4where FRC is functional residual capacity, and Vt is the tidal volume estimated during normal breathing. FRC and Vr were predicted from age and height according to the following formulas developed by Crapo et al. (5) Equation 5 Equation 6 Equation 7where predicted FRC (FRCpred) and Vr pred are in liters, Ht is height in centimeters, and A is age in years. These prediction equations were developed from healthy subjects, ages 17–91 yr, by using single-breath He dilution to measure FRC and Vr. %BF measured by air displacement and by HW were recalculated by using Vtgpred and Vr pred, respectively.
Data were analyzed by using SAS-PC, version 6.04 (19). Group means were compared by either one-sample (paired) or two-samplet-tests where appropriate. Associations between variables were assessed by calculating Pearson correlation coefficients. To determine how well predicted variables reflected measured variables, the measured variable was regressed on the predicted variable with the use of linear-regression analysis. The residuals from this regression were then plotted against the predicted variable and tested for skewness, curvilinearity, and heteroskedasticity. All tests were two-tailed, and the level of significance was set at P = 0.05.
Physical characteristics of the subjects are shown in Table 1. On average, the men weighed more and were taller than the women (P < 0.01). Because of the height difference, the men had a larger Vtgmeas, Vtgpred, and Vr meas than did the women (P < 0.01). The gender difference in Vr predapproached but did not reach statistical significance (P = 0.06). Vtgpred was not significantly different from Vtgmeas for either gender; Vr pred was significantly higher than Vr meas in the women but not in the men (P < 0.03).
Mean values for the predicted and measured lung volumes and for %BF calculated by using predicted and measured lung volumes are shown in Table 2. There was no significant difference between Vtgpred and Vtgmeas, nor in %BF measured by air displacement calculated by using Vtgpred vs. Vtgmeas. In contrast, Vr was overpredicted by 187 ml or 14% (P = 0.0004). This had the effect of significantly underestimating %BF by HW when calculated by using Vr pred(P = 0.0004). Results from the linear regression analyses of measured on predicted variables are also shown in Table 2. R 2values for Vtg and Vr were 0.63 and 0.52, indicating moderate agreement between predicted and measured lung volumes. Whereas the standard error of the estimate (SEE) for Vr was less than one-half that for Vtg (0.22 vs. 0.44 liters), they are similar when expressed as a percentage of the mean corresponding predicted lung volume (±0.14 and ±0.12%, respectively).R 2 values for regressions of %BF calculated by using the measured lung volume vs. that calculated using the predicted lung volume were high for both methods (0.98 and 0.96 for air displacement and HW, respectively), and corresponding SEEs were ±1.36 and ± 1.67% BF, respectively.
Figure 1,A andB, illustrates the residuals from the linear regressions of Vtgmeas on Vtgpred and of Vr meas on Vr pred, respectively, plotted against the corresponding predicted lung volume. For both Vtg and Vr, there appear to be an approximately equal number of positive and negative residuals, indicating that the prediction errors are fairly evenly distributed around zero; i.e., there is little skewness. Tests for curvilinearity and heteroskedasticity were not significant.
Residuals from the linear regressions of %BF calculated by using measured lung volume on that calculated by using predicted lung volume are shown in relation to %BF calculated by using the predicted lung volume in Fig. 2,A andB. For both air displacement and HW, there appears to be a similar range of prediction errors (within ±2.0 to ±3.0% BF), with the exception of one data point for HW with a residual of nearly −4.0% BF.
For individual subjects, calculating differences in %BF by using measured and predicted lung volumes yielded the following results. For air displacement, estimates of %BF by using Vtgpred were within ±1% BF calculated by using Vtgmeas for 58% of subjects and ±2% BF calculated by using Vtgmeas for 82% of subjects. However, for HW, estimates of %BF by using Vr pred were within ±1% BF calculated by using Vr meas for 25% of subjects and ±2% BF by using Vr meas for 46% of subjects.
The error in estimation of %BF by using predicted lung volume in relation to the difference between predicted and measured lung volumes is illustrated in Fig. 3. When Vtg is underpredicted, %BF is underestimated; when Vtg is overpredicted, %BF is overestimated. In contrast, when Vr is underpredicted, %BF is overestimated; when Vr is overpredicted, %BF is underestimated. Thus a given error in lung volume prediction by air displacement and HW affects the calculation of %BF in opposite directions, a function of Eqs.2 and 3 (seematerials and methods). In addition, it can be seen from Fig. 3 that a given error in the prediction of Vtg will have less than one-half the effect on measurement of %BF by air displacement than will the same error in the prediction of Vr on measurement of %BF by HW; this is also a function of Eqs. 2 and 3 .
The principal findings of this study show that, on average, Vtgpred did not differ significantly from Vtgmeas, and there was no difference in body composition estimates measured by air displacement by using Vtgpredrather than Vtgmeas. In contrast, Vr was systematically overpredicted, leading to a group mean underestimate of 1.4% BF from HW. Further analysis revealed that, although the outer ranges of individual estimates of %BF by using the predicted vs. measured lung volume for air displacement and HW were similar (±3–4% BF), for air displacement the majority of subjects (82%) fell within ±2% BF of that when using Vtgmeas, but for HW, only about one-half of the subjects (46%) fell within ±2% BF of that when using Vr meas. Finally, it is notable that a given absolute error in Vtgpred will lead to an error in the estimation of %BF that is less than one-half that of using Vr pred. This is attributable to the fact that only 40% of the Vtg enters into the calculation of Vb by air displacement (Eq.2 ), whereas 100% of the Vr enters into the calculation of %BF by HW (Eq. 3 ).
In this study, Vr was overpredicted by 187 ml on average, and the overprediction of Vr occurred to a greater extent in women compared with men. In a variety of studies conducted in healthy subjects, Vr pred has been reported to be, on average, 1.23 liters less than Vr meas(11), 495 ml greater than Vr meas (8), and approximately equal to Vr meas (8,11, 17, 22). There appears to be no consistency as to whether Vr is over- or underpredicted in women vs. men. The lack of congruence among these studies with regard to the accuracy of Vr pred may be related to intersubject variability but also to the particular equation used to predict Vr. There are several prediction equations for Vr (e.g., Refs. 1, 3, 5, 9, 10,12, 18, 22), each developed by using different reference techniques (e.g., O2 dilution and He dilution). The agreement of Vr pred and Vr measlikely also depends on the method used to measure Vr. Forsyth et al. (8) reported that average Vr measrange in women was from 1.130 to 1.437 liters and in men was from 1.236 to 1.759 liters, depending on the method used to measure Vr. The equations by Crapo et al. (5) were used in the present study to predict Vr (Eqs.6 and 7 ) because the manufacturer of the BOD POD incorporates the estimate of FRC by those authors in their prediction of Vtg (Eq.5 ). To our knowledge, there are no published studies on the prediction of Vr by using the Crapo et al. (5) equations in conjunction with HW, so a direct comparison with other studies is not possible. In the present study, Vr was predicted by equations developed by using He dilution, yet Vr was measured by O2 dilution. These differing methods may be responsible to some degree for the differences between Vr pred and Vr meas.
Despite the lack of agreement among studies on the accuracy of Vr prediction, most investigators have found that erroneous estimates of %BF for individual subjects can arise when using Vr pred. Wilmore (22) reported that using Vr pred had no effect on the estimation of %BF for the group, but individual estimates deviated quite substantially from that calculated by using Vr meas, in some cases deviating by >4% BF. Similarly, Hackney and Deutsch (11) calculated that, on average, with a standardized man of 70 kg and 15% BF as the subject, calculating %BF by using the Vr predvalues obtained in their study resulted in average overestimates of 16.0% BF by using the Wilmore equation (22) and of 11.6% BF by using the Boren equation (3).
Keys and Brozek (13) have calculated that an error of ±100 ml in Vr results in an error of ±0.8% BF by HW for a person weighing 70 kg with 20% BF. Because only 40% of the Vtg is used in the calculation of Vb measured by air displacement, an error of ±100 ml in Vtg would result in an error of only ±0.3% BF (assuming Vbraw = 64.0 l, Vtg = 4.0 l, and SAA = −0.9 l). It would take an error of ∼10% in Vtg determination for a Vtg of 4.0 liters (±400 ml) to produce an error of ±0.8% BF by air displacement in the same 70-kg, 20%-BF person. We have observed that, on average, the between-day coefficient of variation of Vtgmeas is ±3.5% (n = 22; unpublished observations). For a Vtg of 4.0 liters, this represents an error of ±140 ml and a resulting error of about ±0.4% BF.
Our findings support the use of Vtgpred in conjunction with air-displacement plethysmography for group mean comparisons and for purposes such as screening in young to middle-aged individuals. This contrasts with the use of Vr pred in conjunction with HW, which leads to significant errors in the estimation of %BF. Furthermore, although the use of Vtgpred may be valuable in some circumstances, obtaining Vtgmeasis relatively simple in most cases. Therefore we recommend that the use of Vtgmeas remain a part of standard experimental and clinical practice. The results of this study do not necessarily apply to other groups, such as pediatric or elderly subjects, or to those with pulmonary dysfunction. Additional research is needed to determine the validity of Vtgpred in these groups.
We thank Janet Peerson of the Program in International Nutrition at UC Davis for statistical recommendations and our subjects for participating in this study.
Address for reprint requests: M. A. McCrory, Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts Univ., 711 Washington St., Boston, MA 02111-1524 (E-mail:).
- Copyright © 1998 the American Physiological Society