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

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-TB Pro)]. 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. Am J Clin Nutr 2013;97:497-504.