The five-level model: a new approach body-composition research12

Zi-ifian ABSTRACT
man position biology levels that and

to organizing

Wang,

Richard

N Pierson

Jr. and research

Steven

B Heyms/leld
of hubiological models in healthy mass
=

Body-composition
has three their organizational

is a branch areas:

categories. that 0.732] describe subjects

For example, the relations [eg, total body formulation

there between water

are many different that

mathematical components body quansome

interconnecting

body-commeasurement compoat pres-

rules,

(TBW)/fat-free

techniques, and biological factors that influence body sition. In the first area, which is inadequately formulated ent, five levels II. molecular: Although each ofincreasing III, cellular; level and

(2). This

indicates

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

titative associations exist that describe compartments that are in equilibrium. vided by the reconstruction of human and body weight (Bwt) tron-activation analysis not levels fronted lipid-free (LBM) definitions the only Another with body same between problem questions mass, of body composition is that about fat-free

the relationships among Another example is prochemical compartments by neuexist different conAre mass of clear but

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biochemical and model is consistent provides composition over for new a specified levels. explicit ofhuman areas. creating research or different steady

physiological connections exist such that the and functions as a whole. The model also to clearly in which between the five-level composition, interval define quantitative compartments model and Nutr provides suggests equations, 1992:56:19-28. nutritional assessment. the concept associations ofa body exist a matrix reveals gaps important state Finally, body
.1,n

from elements estimated in vivo ( 1 ). This suggests that relationships components as well. investigators terminology. body mass, components and compartments? are For The has frequently example: lean body lack but between

individual

the opportunity time

at the same

body-composition

or different

in the study

for body-composition

a subtle

J C/in

serious consequence: composition equations sion ofcomponents. components models from these defining composition Growing

many errors are evident and models because In fact, and we could building find

in published bodyofoverlap or omisno clear of previous approach bodyliterature. that a third to

KEY
steady

WORDS
state

Body

composition,

multicompartment reviews is the hypothesis

in extensive observations

Introduction
The continues search. within science rapidly ofthis The emerging tematic been study Nearly many of human every medical related is extending is now category new body area composition of basic spans science nutrition, components of body ofhuman as technical classic and Although methodology published. such methods. are often and
>

100 clinical

y and re-

central category of body-composition research exists that until now has not been adequately formulated: the levels of body composition a comprehensive of five distinct level has clearly The five levels and and The level following system: and their model organizational ofhuman rules. body This report presents consisting each Bwt. composition

to be an active

aspect of clinical specialties, and on by the to our includes for body study

selected areas of exercise is accumulating biology. Most or biological. continually no syshas as

are touched and

composition.

levels of increasing defined components are I. atomic: body

complexity in which that comprise total III, cellular: description next section

Information information technical

composition

II, molecular:

IV. tissueof each the fea-

knowledge categorized the many

V. whole section

(Fig

I).
a detailed In the

presents components.

its associated

body-composition informal groupings

classification proposed.

body-composition

tures or organizational scribed. Important composition ofthe fined paper, concept models and ofa

rules concepts and steady the widely state

of the related appreciated ofbody

model as a whole are deto development of bodyare presented but composition never in this portion deformally is introduced.

equations

dilution techniques based on a physical niques involved. on the study ofhow aging. exercise, and Although to encompass most

and neutron-activation analysis. principle or other characteristics The biological growth, disease and category includes development, pregnancy. influence body composition. biological categories information,

which are ofthe techinformation lactation,

From

the Obesity

Research

Center.

St Lukes-Roosevelt

Hospital, New Unit. York, 4I1

the technical

would

appear a recent

body-composition

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
.1,71

information be satisfactorily 1992:56: 19-28.

emerging from body-composition included into the technical Printed in USA. 1992 American

and Society

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

i C/ui Nuir

19

20

WANG

ET

AL

TABLE 1 Body composition Man Element

on the atomic

level (I) for the 70-kg

Reference

Amount
kg

Percent

ofbody
%

weight

Le1I
(Atoalc)

Oxygen Carbon Hydrogen Nitrogen Calcium Phosphorus Sulfer Potassium Sodium Chlorine Magnesium composition. ECF and ECS, Total
*

43 16 7 1.8 1.0 0.58 0. 14 0. 14 0.1 0.095 0.019 69.874

61
23

10 2.6 1.4 0.83 0.20 0.20 0.14 0.14 0.027 99.537 2 (modified).

FIG 1. The five levels of human body extracellular fluid and solids, respectively.

Information

based

on reference

Five-level
Atomic The (I)

model
related building blocks ofthe 50 human are found body are atoms organs hydromolecular species. (A): (G) (Table categories. abundant comprises protein The lipid major (L); components protein (Pro): in present mineral use (M):

fundamental Ofthe

are water,

or aqueous

or elements.

106 elements,

in the human

body and their distributions are well documented (2). gen, Bwt, mass elements The composition nitrogen, and one in the make equation is calcium, element, Reference up
<

in the various tissues and Six elements (oxygen, carbon, account > 60% The atomic

and glycogen these different ponents

2). Because some confusion exists in we now review the five chemical cornchemical 60% compound of Bwt in the human in the Reference usuranging

and phosphorus) oxygen, constitutes Man (Table 2% of Bwt. as defined in the

for > 98% of of total body remaining level 44

Water.
body Man ally
(2).

in detail. The most which term

is water, The

1) (2).

Protein. of body includes

in body-composition containing

research nitrogen,

for Bwt,

almost

all compounds

Bwt=O+C+H+N+Ca+P +S+K+Na+Cl+Mg+R where

<

from simple amino acids to complex nucleoproteins. The most widely used representative stoichiometry for protein is CH 59N26O32S07 . with an average molecular weight of 2257.4

(1)
present in amounts carried out in

and

density

of 1.34

g/cm3

at 37 #{176}C (1, 5). of carbohydrate of most cells. and wet liver, which in the weights The is glyprimof

R is the residual percent of Bwt analysis

mass (1).

ofall

elements is traditionally

G/icogen. cogen. which cipal distribution 1% and

The primary storage form is found in the cytoplasm is in skeletal of their muscle 2.2% respective

0.2%

contain form

Elemental

of humans

cadavers or in biopsy specimens In addition, the whole-body can now counting: activation analysis More that position propose.
P110/cell/ar

from content

selected tissues and organs. of most major elements TABLE 2 Body composition Man* (4). Component Amount
1cv

be measured directly in vivo: potassium by whole-body sodium, chlorine, and calcium by delayed--y neutronanalysis (3); nitrogen by prompt-y neutron-activation (1 , 3): and carbon by inelastic neutron scattering 98% be The analysis of Bwt atomic and can in is the now vivo, starting level be reconstructed largely is the point by foundation for the from elements estimated neutron-activation of body-cornfive levels we

on the molecular

level (II) for the 70-kg

Reference

than can

Percent

of body %

weight

techniques.

(II)
1 1 principal
>

The

elements

are

incorporated

into

molecules human weight nor reof closely

that form body. These from possible in living search water

100 000 molecules

chemical compounds range in complexity acid. chemical used compounds all ofthese

found in the and molecular It is neither compounds in categories in body-composition

Water Extracellular Intracellular Lipid Nonessential Essential Protein Mineral Total

*

18 24 (fat) 12 1.5 10.6 3.7 69.8

26 34 17 2.1 15 5.3 99.4 in the Reference Man.

to deoxyribonucleic The alternative

useful individually

to measure humans. is to consider

Glycogen.

normally based

400 g. is not included 2.

chemical

Information

on reference

FIVE-LEVEL glycogen with .tIiThl(ll. compounds calcium. oxygen. eral. period mineral than some during two the to ( I. 2). The density term and ofa The sodium. phosphorus. is the residue
>

BODY is (C6H10O5). of inorganic elements elements (eg. (eg. to mmportion in weight from water into mineral. dioxide bound divided of

COMPOSITION The equation composition

MODEL for is Bwt= Bwt as defined by the molecular level

21 of

stoichiometry of 1 .52 mineral an and potassium) chlorine). consists body of the the and of of total contains body such biological Total because and period osseous g/cm3 describes abundance

of glycogen a category of metal and Ash, sample of the ash loss release Mineral extraosseous. is calcium
>

an average

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

both

containing

L+A+Pro+M+G+R
residual chemical and three that compounds occur in quantities equations can not included of
<

(2)

nonmetal a term heated nonvolatile is slightly of carbon of tightly is usually

where in the oftotal On

R represents five main Bwt (1). the molecular

similar

categories level,

I% be

for a prolonged lower

500

#{176}C, and

related

also

compounds. mineral carbonate the heating component Ca(OH)2). 86% elements, mass groups

defined as follows. components (Fig written as

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

( 1 . 2).
which

subcategories: largest and (2). Other are primarily Among level, fat they oflipid ether, chemists triglycerides and (6). simple to glycerol. therefore error 90% can (Le) also and and to errors adult. Lipids lipid, are refer

Osseous of total body

Bwt Dry Bwt according to this

A + dry

Bwt is the sum of L + Pro

(3) + M

hydroxyapatite calcium Reference and chloon the the terms strictly traditional that such 50 difby (inin the sodium.

equation

([Ca3(PO4)2]3 (TBCa) Man rime.

99%

+ G + R. Bwt In equation remaining appropriate lipid-free

= L + lipid-free

phosphorus

as potassium, chemical confusing compartments. ofchemical soluble chloroform and

body

mass mass is the homogenate conditions. combined body

(4) material with Thus weight

found lipid used refers benzene, into and five

in extraosseous most

mineral. components because even though The compounds solvents are divided lipids acids: acids and lipids (6, 7). About these 4 (Fig 2, right). after extraction organic body mass solvents can lipid-free body of a whole-body and optimum as the for total be expressed

Lipid. molecular lipid speaking definition and

the five principal is the to different to a group and very and

interchangeably.

are insoluble as diethyl ferent organic cluding pholipids terpenes The ifled and lead the lipids

in water

in organic

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

nonessential

lipid,

then Bwt
=

are recognized

in humans, subcategories: waxes):

fat + FFM

Ln

+ FFM represents is LBM. the combined The early

(5)

1) simple
4) fatty three of total fat and of body is fat (2). into important fatty with lipid,

2) compound

(eg. phos5)

where weights inition ponents: amount gators though

FFM

is fat-free term

body

mass,
body suggested

which mass

sphingolipids): triglyceride, term

3) steroids:
contains fat is synonymous a subcategory the body terms lipid (Ln) The provide fuel. nonessential their solubilities separate can analyzed, to clearly About in the lipids models

of Le + A + Pro to fat-free mass of lean body

+ M + G + R. defincluded at least five corn-

A similar ester-

The

triglyceride lipid (6. 7). A which can In groups: such functions lipids, largely and body Man solvents even lipid (2). and are in vitro by careful time used used can such and (6). Solalone to be exas 45% a as

fat is clearly is to confuse in constructing oftotal

water, protein. mineral. glycogen, and of essential lipid (9. 10). More recently, have some used the terms still LBM prevails and about Our FFM debate whether suggestion

an unspecified most investialthese basis lipid are LBM of and or not on the ofBwt, oftwo

common

interchangeably. is that

composition. two lipids.

the same and the FFM

or different henceforth reasoning.

compartments. be considered define two

be classified nonessential phospholipids,

physiologically (2). serve thermal Essential

synonymous fractions

essential such

following In equation

sphingomyelin as forming form depot and

4 we clearly

cell membranes. of triglyceride, ofmobilizable 90%

nonessential 10% oftotal Reference in organic them be accomplished the extraction

in the
storage

insulation

lipid-free essential

body mass. The and nonessential

lipid fraction consists or fat. Accordingly,

portions.

is essential
Although physiologically similar selection temperature, vents such extract The tracted remaining and

is nonessential and

essential different.

are structurally

it is difficult type

(6. 7). An approximate ofthe

separation oftissue

and particularly the type of solvent as petroleum or ethyl ether are usually lipids, lipids. binary which mainly are the neutral primarily solvent essential. mixtures

nonessential by using

fat or triglyceride.

or ternary

chloroform. The fatty site. and stoichiometry

10% methanol, and 45% acid profile oftriglyceride factors. found but the generally humans in adult

heptane (8). varies with diet. accepted is C51H98O6,

anatomic with an avFIG 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.

other

representative g/cm3 at could not

erage molecular 37#{176}C (2). The be found

weight of 806 and stoichiometry oftotal ofprevious

a density of 0.900 lipid in humans

in a review

studies.

22 Body weight and and Ln + LBM FFM ofthe

=

WANG fat + FFM ofessential is nonessential are consistent guidelines and lipid (6) plus lipid with as

ET

AL three groups: loose, dense. and speor fat cells, are a type of loose conBone cells. the osteoclasts of specialized and cardiac. of human Cells and fluid surrounding transfer of nuto is referred and are representations smooth. foundation ofbody

Connective cells include cialized ( 1 3). Adipocytes. nective osteoblasts. connective cell in which and cells. blood

in which
lipid-free each shown other

both body

LBM mass terms

are the sum Bwt molecular

fat is stored. cells

the remaining according

or fat. All ofthe when in Table

level to these

defined 3. direct

Muscle cells include striated skeletal, The striated skeletal muscle cells are the movement consist solids. E.vtracel/u/ar cells trients, as the tributed cular Plasma in the that provides and excretion fluid, two and main fluid. The nonmetabolizing for and offluid account and solid for a large components, fraction

At present components TBW can lution by whole-body components measurements ample, the nitrogen Another density, suming protein atomic

the main

techniques

available

for estimating and mineral. isotope-diremaining

weight.

on the molecular level are for water be measured by several well-established ( 10. 1 1), and dual-photon osseous mineral (12). can absorptiometry be estimated of the other from 16% fat can at the respective composition that follow. composition total assumptions: of protein be calculated whole-body densities is the Also,

the intracellular fluid products water plasma in the for solids 5%

techniques

be estimated

The

a medium fluid. which

gas exchange, end

ofthe model must included in one can be determined two that and total FFM level example, by making body have of body levels of body

indirectly by using four levels. For exbody that nitrogen all of body (1). body by asand from level, of0.900 conceptual research at

of metabolic is 94% fluid account respectively.

extracellular into space and Reference

Extracellular

by volume, in the and 20% extravascular

is disintravasspace. of Bwt

is in protein which that

is nitrogen

compartments: fluid (2),

interstitial Man solids.

is a dimension fat and 10). level higher study the

interstitial

1.100 g/cm3 (9, The molecular foundation level areas, connects notably

Extrace/lular

Extracellular

are also

a nonmetab-

for the

the molecular

olizing portion of the human inorganic chemical compounds. include Both tein bone The three collagen whereas inorganic matrix oxygen types and elastic in the in bone solids that Other solids. (1. 2). the can previous discussion, of fiber: reticular fibers extracellular Reference are the are inorganic including are

body that consists of organic and The organic extracellular solids collagen, fibers formed solids Man main reticular, from represent
(2).

to other

and the protein 65% ofthe

elastic

(13). pro-

biochemistry.

are composed

ofcollagen ofthe phosphorus, inorganic

elastin. dry exin exand corn-

Cellular
Although ponents ponents nated study level search. The on the solids. detail.

(III)
the human body can be divided into different cornand

Calcium. into are citrate, calcium also

elements

at the molecular level, it is the assembly into cells that creates the living organism. functions of human is therefore human cellular Each The adult are great and an body level: ofthese interactions important between in health area and cells physiology disease.

of these cornThe coordito the cellular reThe

tracellular apatite tracellular sodium From position

incorporated components bicarbonate, the

hydroxy-

( 1 ).

present

are central

magnesium, level of body

of body-composition

cellular

be accurately Bwt CM
=

described + ECF cells + ECS

by the equations (7) cells cells (8) (9)

is composed of three main compartments cells, extracellular fluid, and extracellular compartments is now described in additional

CM muscle

+ connective cells + nervous

Cells.
metabolism, of the there

cells possess growth, and human variations metabolism, body

the characteristics of life including reproduction. Although the l018 cells share in size, and many shape, distribution. properties elemental Cells in common, and molecular to where CM is cell and of cells (13). are adapted ECF ECS
=

+ epithelial plasma organic mass, ECF

+ 1SF ECS + inorganic ECS fluid, ECS

(10) is extra-

composition,

specific functions, contraction. Based can be defined:

such as support, electrical on these differences, four epithelial, nervous,

conduction, categories and muscular

is extracellular

connective,

cellular solids. most components

and

1SF is interstitial in equations 7-10

fluid. However. because cannot be measured in

TABLE Different

3 body-composition terms on the molecular

Lipi ds*

level (II)

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

Le X X x x

Water X x x x

Protein X x x x x

Mineral X x x x x

Glycogen x x x x x

x x

Ln, nonessential

lipid or fat; and

Le, essential

lipid.

FIVE-LEVEL vivo at present. for Bwt where mass BCM that the following Bwt
=

BODY as a practical

COMPOSITION

MODEL

23

equation level

is suggested

alternative

at the cellular fat cells cell ofthe Hence, include + BCM mass.

Inorganic
+ ECS of total ( Ii) cell

Cell
ECI

Residual
ResIdual

+ ECF

Inorganic

is body portion

13CM

is a portion in relation

according structure.

to Moore

et al ( 1 1) is the working. human BCM body includes the protoplasm occupies

energyto its supin fat 85% to directly to be ( I 1). and fat and related to Total Body Mineral Inorganic ECS

metabolizing

porting
cells hut

does

not

the stored

fat, which

90 offat cell weight. Although measure BCM. it is a widely represented A deviation cells The TBW ICW are share fluid therefore by exchangeable must overlap be noted the by in common compartments

no present method can used term and is assumed or total body portion Reference level can potassium 1 1 in that Man also BCM (2). be

(TBK)

in equation nonfat at this

of adipoctes

1 kg in the

as shown in Figure 3. According are extracellular and intracellular

to this model. water. and and intracellular level is between

ECW and Re and Ri solids. total body compocell of the

nonaqueous residual extracellular Another relation at the cellular and inorganic fluid solids. compartments fluid and solids 7 contribute residual, (Fig in equation extracellular

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

mineral solids.

and inorganic

solids.

mineral nents and

4). Each to total and the

ofthe inorganic

three inorganic

mineral,

portion

Tissue-System

(I J )
cellular level the human body is composed of cells.

extracellular

At at the its plasma cellular level. subcompartment

the

Of the three primary volume of extracellular can be quantified no direct methods mass or extracellular compartments from TBCa
=

extracellular fluid. ponents are further the fourth

iissl1Ls.

and extracellular organized into

solids. These three corntissues. organs. and systemscells origin. that are similar diverse in

directly by dilution are yet available solids. Indirect

methods ( 10). In contrast. for estimating either cell methods ofevaluating some solids estimated analysis (ECS of BCM ( 1 1) character(in mmol)] at which

level of body composition. Generally. tissues contain function. and embryonic

appearance.

All ofthe

are available, such as extracellular measured by neutron-activation 1 77) ( 10). Another [BCM (in kg)
=

TBCa/0. TBK Because

example 0.00833 is the first

is the calculation X TBK level

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 Bwt
=

from

the cellular

level

muscular

tissue

+ connective + epithelial tissue

tissue + nervous important muscular, tissue in body-cornwhich together consists sub(/2)

istics ofthe living organism in connecting the inanimate the lower and has levels intact been in the with study those organs. portance research difficulty humans directed

appear. it occupies a central position features of body composition at of the at the at this animate higher body level, ofthe features levels. composition. perhaps compartments. Despite very because of tissues. its imlittle of the Three position comprise Bone of bone specific research: tissues

are particularly adipose. and in the Reference form of connective by a matrix

hone.

of human some

75 ofBwt is a specialized cells surrounded

Man (2). tissue that and ground

in quantifying

of fibers

stance. The distinguishing substance is calcified and (2). The calcified ground ([Ca3(P04)2]3Ca(OH),) bonate (14). Adipose tissue

feature of bone is that the ground accounts for 65 ofdry bone weight substance is mainly hydroxyapatite and a small type amount of calcium made carup

is another

of connective and can

tissue

of fat cells (adipocvtes) broblasts. and capillaries. four types according (ie. loosely surrounds mately interspersed row (2). 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.

with collagenous Adipose tissue

elastic fibers. fibe divided into

to its distribution: subcutaneous. visceral organs and viscera). interstitial (ie. intiamong the cells oforgans). and yellow marcan tissues consist units whose be subdivided (2). oftwo such or more as skin, tissues kidney, combined and blood consystem stomach, is into striated skeletal,

Muscle and large The

tissue organs functional

smooth.

cardiac

Several

organs

functions

are interrelated

stitute an composed intestine.

organ system. For example. of many organs. including liver. and pancreas. Each

the digestive the esophagus. such

organ.

as the stomach.

24 contains several kinds oftissue and nervous) and each tissue extracellular There at the Bwt
=

WANG (muscular. is made in the connective. up of many human can body. be defined epithelial. cells and hence as Bwt

ET

AL

material. are nine level main systems of body composition + nervous + digestive + reproductive + urinary systems (13)

TABLE 4 Body composition and organs ofthe Tissue or organ

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

tissues

Percent

of body % 40 11 7.1 1.4 2.1 7.1 7.9 3.7 2.6 2 1.7 1.4

weight

system

musculoskeletal + circulatory

+ skin + respiratory + endocrine

Although level, most sured a practical Bwt

=

Bwt can be expressed accurately on the tissue-system components in equations 12 and 1 3 cannot be meaat present. The following equation is suggested as alternative

in vivo

adipose

tissue

+ skeletal + bone

muscle + viscera for 85% Reference and and histology physiology and + blood and Man interfaces and + R R accounts (Table with at the exercise

(14)
for 4) (2). several organ physiat the

where the The branches istry and ologists

the remaining

five components 1 5% of Bwt level biology, level and oftheir Physicians,

account in the is complex including anatomy interest

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

28 7.5 5 1 I .5 5 5.5 2.6 1.8 I .4 1.2 I on reference 2 (modified).

Information

based

tissue-system ofhuman level. much level. at the tissue

histochem-

system focus

nutritionists, in body

5) Skinfold
adipose subscapular, monly used of estimating pose have tissue

thicknesses: and calf skin (medial),

Skinfolds at specific and

represent anatomic are

a double locations. the most

layer Triceps. corn-

of

composition

tissue-system

abdominal

Although a great deal of information most of it comes from cadaver studies are only a few in vivo the major compartments direct

is available at this level, or tissue biopsies. There

be used to estimate level. An example directly adipose at this 24-h content urinary determine tissue level. (15). such as

sites. Skinfold fatness and

thickness provides a simple the distribution of subcutaneous

method adifat

methods that can at the tissue-system which and are also mass nitrogen visceral available from can

tissue. Numerous been developed surface that volume:

equations that make area is often The (BSA): used total

for the prediction of body use of skinfold thicknesses. The total BSA basal is an metabolic exterior to estimate body volume

is computerized
the Some excretion vation volume indirect

axial tomography,
of subcutaneous techniques

6) Body
characteristic and FFM. 7) Body

rate in-

estimation

ofskeletal or from analysis (I) and (16,

muscle TBK 17). and

creatinine

is an important density. morphologic obesity. whole-body

by neutron-acti-

dicator of body size 8) Bwt: One ofthe indicators. undernutrition. level is The

and is used to calculate body simplest and most important in screening Bwt equation for growth that defines rate, the

Bwt is used

and

i/i Ito/c body Both sitions acteristics

humans

some molecular,

primates cellular, however, humans

have and

similar with

body

compolevels. charIn 9) Body mass index: Bwt and stature can be combined to known in kg! indices, correlate body, estimate molecular better derived total level form indices of the indices m2), which such with 10) from body as that correlate with total body fat. The best is body mass index (body weight/stature2. is often used in obesity complex and studies as a measure often human at the more population-specific Bwt
=

at the atomic, whole-body that

tissue-system its complex primates. all other

head

weight extremity

+ neck weights

weight + upper

+ trunk

weight weights (15)

It is at the

level,

+ lower

extremity

distinguishes

from

addition, many biological, have an impact not only human body as a whole. The whole-body level size, shape, and exterior 10 suggested dimensions

genetic, and pathological at the first four levels but of body and composition

processes also on the body are

concerns There (18).

of fatness

physical characteristics. at the whole-body level indicator ofgeneral

( 19). However,

I) Stature:
skeletal length.

This

is a major

body

size and

as the Fels index (Bwt2/stature33), total body fat ( 18). Body Bwt and fat and density: volume, FFM (9, The density of the used is defined is widely 10) and

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 elbow-wrist mass,

to indirectly

3) Body breadths:
skeletal the

length. Body frame

breadths size. The

are a measure sites most are used

ofbody widely useful body

shape, used are where body, Db. fat, and

1/Db DF, and

fFat/DF

+ fFFM/DM (in g/cm3) and ofthe

(16)
total the equaat also be

and

DFFM

are the densities body, respectively,

wrist, elbow, ankle, 4 ) Circumferences: density, and energy arm, FFM, stores. waist

knee, and biiliac. The circumferences adipose The (abdominal), tissue most and mass, widely thigh.

fat-free

f represents

indicators protein

of body mass. are upper

total

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

FFM, respectively (20). Similar based on individual components and whole-body levels can

circumferences

FIVE-LEVEL TABLE 5 Some related

BODY

COMPOSITION

MODEL

25

but distinct

components

on different

levels Tissue-syste m level Organ Skeleton level

Atomic

level

Molecular Mineral

level

Cellular Extracellular

level solids Bone

Tissue

level

Total hod calcium and phosphorus Total body carbon

Lipid

and fat

Fat cells Skeletal muscle cells

Adipose Skeletal

tissue muscle tissue Skeletal muscle

It is clear other level. related latter of the body and levels. large-scale four

that levels

any will

major

changes differences

in body at the for estimating

composition on the four the level at the well whole-body

on the whole-body level levels. are This wholefour for

direction that many nescence. presence

for race,

future sex,

research factors nutritional all have

efforts. including status, important ofbody on only failing most changes

For

example. exercise

it is known seand the areas at one were and compolevel,

manifest

themselves

biological of disease

growth, effects composition

development, on body

Conversely. to changes relation other level. easier thus is the four Most the studies

most

in composition foundation by than using at the are at this work. levels indicators techniques

on the other measurements whole-body level are often measurements

components at the other suited are simpler

sition.
are or two between limited

However,
levels levels. and

most studies
focusing thereby example, (at the obesity importantly

in these the

limited

in scope, For

a few components obesity studies

to appreciate previous

connections level)

to perform

to anthropometric

(at the whole-body

or for field

alterations in fat mass have investigated how composition occur throughout and or more

molecular influences with between

level). Very few studies the other levels of body changes Bwt. components every major in one properties at the cornof the and same that increasing different is that

Features

of the

model
model provides a structural framework for body composition that goes beyond an mdior level. In this section we describe some five-level model bettieen model properties as a whole. diflirent is that that the levels levels should themselves not be conor any the in-

the coordinated

all five levels connections feature ofthe

The five-level studying human vidual compartment of the features and

Distinctions An important

model can other studies

of the

ponent has a clear definition and five levels. Each ofthese components yet maintains and different It was not relationships levels. unusual with with

be included has unique components for related ifthey

Distinctions An essential are distinct fused with

connections aspect of the unique level,

and one

have another.

in earlier each other,

components were on difconfused TBCa and

to be confused there between are no special the human elements body and ferent levels. components phosphorus. eton, are and the the have

particularly

I) On the atomic
fundamental differences organic world. although 2) On the molecular from organic nonliving characteristics the inorganic compounds world the

An example is presented

of three in Table

sets of commonly 5. In the first set,

the ratio ofelements level, the human because as lipid ofthe and such

to each other varies. body is differentiated appearance of complex from have

mineral, extracellular related compartments distinct and differences phosphorus,

solids, bone tissue, and skelbut belong to different levels ofTBCa and

world

protein.

1) Calcium
phosphorus in protein other hand, contains nesium, 2)

from each other: and mineral: Most

3) On the cellular

level, the because ofthe organisms.

human body is distinct appearance ofcells that the human body

exist in mineral although and lipid (eg, DNA, RNA, in addition to calcium (eg, carbon, solids: other elements and sodium).

there is some phosphorus and phospholipid). On the and phosphorus, hydrogen, body mineral magmineral amount oxygen, Most still oftotal

of living tissue-system

4) On

level, because complex

is different of tissues, functions.

from the lower animal organs. and systems 5) On the whole-body from all other primates phological Although levels, features. these

world having

ofthe appearance structures and

Mineral

and in cells to the solids and solids

extracellular solids although

level, because

the human body ofthe presence exist for

is differentiated ofdistinct moreach of the five in

is in extracellular of mineral in addition extracellular ticular fibers,

there

is a small

and extracellular mineral in the contain elastic solids organic fibers. and bone

fluid. On the other hand, form of inorganic material. solids tissue: ofbone solids such Most tissue as collagen, of total although tissues fluid. the red and mayelskeletal rebody there (eg,

distinct

properties present that

linkages

are also

are clearly

recognizable

the context ofthe five-level appear first on the cellular ofliving olism. are still Each acteristics organisms and higher enzymatic level of the is thus level maintained such at the below

model. An example is that cells that level have many ofthe characteristics as membrane These but it. and their connections can reveal information and suggest a tissue-system transport, characteristics and maintains whole-body some ofthe energy metabofthe cell levels. char-

3) Extracellular
extracellular still is a small in skeletal solids. bone Bone of the amount tissue tissue skeleton

are in the form ofextracellular On the other contains and skeleton: although tissue bone

in other extracellular constitutes also includes and

processes. unique

muscle).

hand, cells Bone the

in addition and tissue latter tojoints,

to extracellular

4)
jority

Recognition gaps in present

ofdistinct levels body-composition

cartilage, periarticular low marrow.

adhering

26 Another body and helps The ferent muscle confused carbon adipose with to resolve. third but tissue, and related and final example intact whole in the table skeletal skeletal and levels. weight, level is the muscle muscles. distinctly cells, The example (level tissue each of related I). lipid (level other, and IV) but (Table distinct components II), fat cells terms five-level the are

WANG is total (level III), often model difskeletal model

ET

AL
=

nitrogen fat(kg) The there these

=

6.25

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

0.00833 that body, are well

( 1 1 ), and although and all of organized

fat (level that

5). These

[(4.95/Db) steady state are so many to definable hodi aim components

4.50] x Bwt (20). of body composition indicates components differ from each quantitative in the other, human they

a problem

according Quantitative A primary the size

relations.

components

COlfl/)OsitiOfl

relations
research there are that relevance is to estimate numerous have the in healthy to establish model which known not unknown cornadults. these of body to establish measurequations from the posa suggests inbeen

thus demonstrates that differences components on each of the five to develop include or omission Steady-state The chemistry, concept equations components of some OfbOdI for body from components. composition state other the same

relations exist between It is therefore advisable volume, in order or density to avoid that overlap

of body-composition although ofclinical An alternative

ofeach directly. Body

compartment.

dividual measured components ponents.

compartments by establishing composition that relations affords and

is to estimate stable five-level within between body-composition one unknown model

relationships is relatively enables rules. investigators The matrix relations

to measurable

of a steady and

is important classic scientific

not

only disciplines

in biobut

and

it is this property

physiology,

reproducible composition the able quantitative components Present primarily measurable sibility neous eral

or

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 during a specified time period if Bwt and the mass of various constant. there are components on different levels The important implication stable level. proportions For example, is maintained of a steady relatively state is that

a logical presently

steady-state

unmeasurable

compartments. component

research involves component.

in developing estimating The Bwt exploit unknown

five-level

among the different on the molecular

components on the same level the average ratio of

of reconstructing equations that measurable and

and volume by writing simultasteady-state relations between sevcomponents. An example is the components and Bwt at (carbon, nitrogen, sodium. by in vivo the concept from fragmentary. more multiple The complex neutronof reconcomfivelevel and

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
Bwt

calculation the molecular potassium. activation structing ponents level and model presents was

of the five major chemical level from six elements chlorine, analysis and calcium) Until

[ie, TBK(g) level the and stature

0. 1 383 X TBCa(g) 17. 1 ] (2 1 ). On the relation between BSA (BSA, in m2) and (in rn) is also relatively constant such the that rel-

measured recently composition were

( 1).
and challenge

(kg)
=

whole

levels

ofbody

BSA

0.007 184 x stature#{176}725 X body weight#{176}425(22). There are also relatively constant proportions among on different For example, levels total when body

limited defines the

the studies

explicitly

the equations of developing equations.

for Bwt at each

evant components is in a steady state.

body composition protein/total body

comprehensive

body-composition

TABLE 6 The relation

between

direct

and indirect

body-composition

measurements

organized

by the five-level Indirect

model

Direct
Atomic level TBP

Atomic

level X TBCa) x TBK)

Molecular

level BCM

Cellular
=

level
X

Tissue-system

level X

Whole-body Bwt + +

level

= (0.456

TBO. TBC. TBH, TBN. TBK. TBCa. TBNa. TBP. TBCI. Nae. Ke
Molecular TBW, Cellular level mineral. level plasma volume level of subcutaneous visceral level adipose creatinine.

+ (0.555

Pro = 6.25 X TBN FFM = TBK/68.l

0.00833

TBK

SM
-

0.0196

TBK

ECS
ECF

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

Cl SM

0.0261

X TBN

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

Plasma FFM FFM +

= TBW/O.732
=

1 1 .8 X Cr

Bwt

L + A + Pro

24.1

X Cr

+ 10.1

+ M + G + R Bwt Bwt

3-MH ECF.
Volume and tissue Whole-body Bwt, skinfold TBK
=

20.7
=

CM

+ ECF

+ ECS

Tissue-system

= adipose
+ skeletal + bone + blood + R

tissue
muscle

+ vi5Cers

(27.3 X

X Bwt)

Fat% Bwt

= -

(4.95
4.5)

X BV/ X 100

ECF +

0.135

X Bwt

SM X

= 5(0.0553
CTG2 x FG2 + x CCG2)
girth body (kg): and + 0.0987 0.0331
-

Body

surface

= 0.007184
x BW#{176}425

S. By,

circumference.

+ (11.5

5)

(21.9

7.35

X 50725

Age)

+ 77.8

2445 CM. (kg): plasma total cell mass (kg): Cr, girth (kg). 24-h (cm): urine G.

A. water (g):

(kg): CTG.

BCM.

body

cell thigh

mass girth (kg):

(kg): (cm):

BV.

body

volume extracellular

(L):

Bwt. fluid

body (kg):

weight ECS. 24-h

(kg):

CCG.

corrected solids (kg): total

medial FFM. Nae. body

calf fat-free

(cm): mass sodium:

creatinine glycogen(kg): ofchlorine

corrected Pro.

ECF. (kg):

extracellular urine muscle (kg):

FG. Cl.

forearm plasma water body

Ke. exchangeable (mmol/L):

potassium: protein

L. lipid(kg): R. residual

M. Mineral(kg): S. stature (cm):

3-MH. SM.

3-methylhistidine: TB.

exchangeable element

concentration

skeletal

TBW.

FIVE-LEVEL Re/atiomi At gorized to 1flCt/lOdOl()tl body-composition technique-specific methods groupings are such primarily as dilution

BODY

COMPOSITION

MODEL

27

The
catemeth-

Study

of Body
on Levels

Composition
IV, and V

present. into

Components

I, II, III, rules

ods and neutron-activation analysis. model, however, the methods can tematic fashion. Direct measurement such niques position. level model the as anthropometric, that can be used methods Direct !fitt/lOds.

According be organized are some and components

to the five-level in a more sysdirect methods, techcomto the five-

Body

composition

There

biochemical, to estimate can be organized

radioisotopic of body according

L Methodology
FIG 5. The three

_
j
areas

I Biological

I
effects
research.

ofbody-composition

as follows: atomic level, #{176}K counting and nitrogen carbon molecular calcium TBK can be directly determined by ( 12): total body sodium. chlorine. by delayed-y neutron neutron TBW can (10), neutron scattering be directly and fluid several volumes activation (23): (4). estimated mineral vol(24). (and plasma isotope-dilution of subcutaneous by comimaging such thickmethods most wholemoand as resonance indices and not many skinfold direct Moreover, on the by osseous (3): and activation amples of the directly been versely, methods portant level, can and level, directly analysis there body the be directly by magnetic anthropometric (18). are composition. techniques estimate determined whole-body on the cellular are topic body-composition presented principal measured developed levels. the table also and in Table elements and from shows very that the that limited. research.

1) On whole-body
phosphorus, total total 2) several can ume) body body

6. The table demonstrates

and many direct there This and anthropometric of the methods indirect on the 25, indices

that most
can be have and Conmethods indirect areas an in immethods atomic 27-29).

by prompt--) by inelastic level,

On the

respectively tissue-system methodology

( I 0,
levels,

17, 22, so the

isotope-dilution the cellular can be directly

techniques by dual-photon

are only is one could

a few direct relevant weak constitute ofthe

be quantified

absorptiometry

3) On

level, extracellular determined by

techniques 4 ) On and visceral puterized techniques 5) On Bwt,

nesses

(25). the tissue-system adipose axial (26). the whole-body volume, to this methods There and of body stature, be estimated ofhurnan are only tissue tomography

for future

Definition
The study

of body
of body of science body not only research.

composition
composition is widely represents The an builds but used.

research
spans and
>

100 y, and it is unclear exactly model structure

the

term what by in body-

body
can

circumferences,

body
this the this

composition branch term paper

However, what five-level

is meant presented for define human

According used ofthe body lecular, direct levels.

composition.

in the study

appropriate

are concentrated a few direct tissue-system

on the atomic levels. These by

composition

is conducive

to clearly

cellular,

body composition as a branch of human biology various body compartments and their quantitative relations or rules. Body-composition research the proportions associations and various includes terconnecting ponents and molecular. ing the studying and methods the areas: studying their steady-state cellular, tissue-system, of measuring influences (Fig 5). of biological

that studies steady-state three in-

Indirect
components

neasuremnent

methods.
composition

unknown direct mea-

combining

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

steady-state relationunknown components. of body important methods. compartment evaluating used methods levels fat For compartcornexthe are as
Bwt

of various cornamong the atomic, levels: on various studyand levels in vivo;

whole-body components factors

methods that can

can

greatly be evaluated. be assessed total

expand only

the by

number some indirect ofdirectly presently

At present, fat is a major methods All ofthe measurements on the direct atomic

components

ample, terest. indirect follows:

although there and are based direct 10), fat

body

of in-

no practical in vivo. on direct method Bwt and

-

Conclusion
The rapidly that five-level developing relate model grows ofhuman from a need and body to organize physiological composition. The both concepts model the

fat compartment

at different level on fat BV (10), the direct

=

methodologies

1) from
-

to the study

TBK(mmol)/68. (2, the 0.786 (20);

=

1 : 2) from
-

method levels, where

molecular method X BV in level, 12.1 volume

level on
-

TBW/0.732:
X Bwt,

3) from

is intended or expand
serves in

molecular

whole-body direct methods

2.057

to be a foundation selected definitions this organizational view of body-composition

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

x TBW
and

1 .286

is body

broader

C]

liters

4) from

on the whole-body

fat=4.95XBV-4.5OXBwt,andfat=0.7l5XBwtx stature2 (in m) (19, 20). Thus it can be seen methods, between in sample that but indirect also and methods are dependent unknown are not only based the direct proportions termined Direct outlined on the components methodology as shown steady-state

References
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