Impact of body-composition methodology on the composition of weight loss and weight gain

We intended to (i) to compare the composition of weight loss and weight gain using densitometry, deuterium dilution (D₂O), dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI) and the four-compartment (4C) model and (ii) to compare regional changes in fat mass (FM), fat-free mass (FFM) and skeletal muscle as assessed by DXA and MRI.

Eighty-three study participants aged between 21 and 58 years with a body mass index range of 20.2-46.8 kg/m(2) had been assessed at two different occasions with a mean follow-up between 23.5 and 43.5 months. Body-weight changes within < 3% were considered as weight stable, a gain or a loss of >3% of initial weight was considered as a significant weight change.

There was a considerable bias between the body-composition data obtained by the individual methods. When compared with the 4C model, mean bias of D₂O and densitometry was explained by the erroneous assumption of a constant hydration of FFM, thus, changes in FM were underestimated by D₂O but overestimated by densitometry. Because hydration does not normalize after weight loss, all two-component models have a systematic error in weight-reduced subjects. The bias between 4C model and DXA was mainly explained by FM% at baseline, whereas FFM hydration contributed to additional 5%. As to the regional changes in body composition, DXA data had a considerable bias and, thus, cannot replace MRI.

To assess changes in body composition associated with weight changes, only the 4C model and MRI can be used with confidence.