Improved 4-compartment body-composition model for a clinically accessible measure of total body protein

Am J Clin Nutr. 2013 Mar;97(3):497-504. doi: 10.3945/ajcn.112.048074. Epub 2013 Jan 30.


Background: Muscle wasting is a consequence of many primary conditions including sarcopenia, cachexia, osteoporosis, HIV/AIDS, and chronic kidney disease. Unfortunately, there is not a clinically accessible method to measure total body protein, which is the functional mass of muscle.

Objective: We sought to derive a simple method to measure total body protein by using dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA).

Design: We retrospectively analyzed a clinical convenience sample of individuals with numerous metabolic conditions from the Monash Medical Centre, Melbourne, Australia, who had a concurrent protein measure by using neutron activation analysis-derived protein (NAA-TBPro), water measure by using BIA, and whole-body DXA scan. The study was split into calibration and validation data sets by using simple random sampling stratified by sex, BMI category, and age decade. We generated a protein estimate direct-calibration protein (DC-TBPro) derived from BIA water, bone mass, and body volume. We compared NAA-TBPro with DC-TBPro and 2 protein estimates from the literature, one that used the DC-TBPro equation with fixed coefficients [4-compartment Lohman method for analysis of total body protein (4CL-TBPro)] and another that used fat-free mass, age, and sex [Wang equation-derived protein (W-TBPro)].

Results: A total of 187 participants [119 women; mean (±SD) age: 37.0 ± 15.4 y; mean (±SD) BMI (in kg/m(2)) 24.5 ± 7.7] were included. When plotted against NAA-TBPro, DC-TBPro had the highest correlation [coefficient of determination (R(2)) = 0.87], lowest root mean squared error (RMSE; 0.87 kg), and fewest outliers compared with 4CL-TBPro (R(2) = 0.75; RMSE = 1.22 kg) and W-TBPro (R(2) = 0.80; RMSE = 1.10 kg).

Conclusions: A simple method to measure total body protein by using a DXA system and BIA unit was developed and compared with NAA as proof of principle. With additional validation, this method could provide a clinically useful way to monitor muscle-wasting conditions.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Absorptiometry, Photon / methods
  • Adult
  • Australia
  • Body Composition*
  • Body Mass Index
  • Body Water / chemistry
  • Bone Density
  • Calibration
  • Electric Impedance
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Biological*
  • Neutron Activation Analysis / methods
  • Proteins / analysis*
  • Retrospective Studies
  • Young Adult


  • Proteins